Chapter 01: Ethics and Professionalism
Beemsterboer: Ethics and Law in Dental Hygiene, 3rd Edition

MULTIPLE CHOICE

	1.	When was the inception of the profession of dental hygiene?
a.	In ancient Greece	
b.	In the early 1800s	
c.	In the early 1900s	
d.	In 1979	

ANS:	C
The scope of practice of a dental hygienist was first established by law in Connecticut in 1915. Alfred C. Fones taught his dental assistant, Irene Newman, to treat patients and to teach them to maintain their mouths in a clean state. In 1913, Fones established the first school for dental hygienists in Bridgeport, Connecticut. The first oath written for dental hygienists called upon Apollo and Hygeia, who were the Greek god and goddess of health, respectively. A modernized version of the first oath was adopted by the Board of Trustees of the American Dental Hygienists’ Association (ADHA) in 1979.

DIF:	Recall	REF:	p. 3	OBJ:	1	
TOP:	7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent

	2.	Which member of the dental team is the primary oral preventive therapist?
a.	Dentist	
b.	Dental hygienist	
c.	Dental assistant	
d.	Receptionist	

ANS:	B
The dental hygienist is the oral preventive therapist in the dental office. The dentists who pioneered this special field of endeavor had a vision of the day when dental disease could be prevented by following a system of treatment and cleanliness. The dentist is primarily concerned with restorative treatment, although he or she also shares in preventing oral disease. The dental assistant assists the dentist and may assist the dental hygienist as well. The receptionist greets patients and may help with the business and financial aspects of the practice.

DIF:	Recall	REF:	p. 4	OBJ:	1	
TOP:	7.0 Professional Responsibility | 7.4 General

	3.	The dental hygiene oath is revised by action of which of the following professional organizations?
a.	The American Dental Association (ADA)	
b.	The American Dental Hygienists’ Association (ADHA)	
c.	The Occupational Safety and Health Administration (OSHA)	
d.	The Organization for Safety, Asepsis, and Prevention (OSAP)	
e.	The Food and Drug Administration (FDA)	

ANS:	B
The first dental hygiene oath was adopted by the Board of Trustees of the American Dental Hygienists’ Association (ADHA) in 1979 and is still in use today. The oath may be seen at the following website (www.adha.org/aboutadha/dhoath.htm). The American Dental Association has an oath for dentists. A copy of each oath may be found in the textbook.

DIF:	Recall	REF:	p. 3	OBJ:	1	
TOP:	7.0 Professional Responsibility | 7.4 General

	4.	Society recognizes that health care providers are held to a higher standard than legislative mandate. These higher standards are expressed in professional codes of ethics and are enforced by the legal system.
a.	Both statements are true.	
b.	Both statements are false.	
c.	The first statement is true, the second statement is false.	
d.	The first statement is false, the second statement is true.	

ANS:	C
Health care providers are held to a higher standard than can be expressed exclusively by legislative mandate. While it is true that these higher standards are expressed in professional codes of ethics, they are enforced by those within the profession rather than by the legal system. Important components of this enforcement include self-regulation and submission to peer review.

DIF:	Comprehension		REF:	p. 4	OBJ:	1
TOP:	7.0 Professional Responsibility | 7.4 General

	5.	Success is measured by financial gain in the corporate world; however, for the health care professional the patient’s welfare is placed above profit.
a.	Both the statement and reason are correct and related.	
b.	Both the statement and reason are correct but NOT related.	
c.	The statement is correct, but the reason is NOT.	
d.	The statement is NOT correct, but the reason is correct.	
e.	NEITHER the statement NOR the reason is correct.	

ANS:	A
Because the welfare of the patient is more important than profit, society has granted the health care professional a certain status that carries prestige, power, and the right to apply special knowledge and skills.

DIF:	Comprehension		REF:	p. 4	OBJ:	2
TOP:	7.0 Professional Responsibility | 7.4 General

	6.	Which of the following is regarded as the most important aspect of the delivery of health care services?
a.	Technical skill	
b.	Appropriate knowledge	
c.	Critical judgment	
d.	Caring	

ANS:	D
Although all of the choices are important, caring is regarded as the most important. Patients perceive this essence of caring and respond to it. Trust is the critical foundation for the relationship between the person seeking services and the health care provider. The caring that the patient seeks also gives the provider the greatest opportunity for professional service and satisfaction.

DIF:	Recall	REF:	p. 4	OBJ:	2	
TOP:	7.0 Professional Responsibility | 7.4 General

	7.	The publication “Medical Professionalism in the New Millennium: A Physician Charter” set out three fundamental principles, including patient welfare, patient autonomy, and the principle of social justice, because it is thought this will reinvigorate the value of professionalism.
a.	Both the statement and reason are correct and related.	
b.	Both the statement and reason are correct but NOT related.	
c.	The statement is correct, but the reason is NOT.	
d.	The statement is NOT correct, but the reason is correct.	
e.	NEITHER the statement NOR the reason is correct.	

ANS:	A
The Physician Charter sets out three fundamental principles that are not new but reinforce the foundation of the medical profession as one of service to others. The ethical principles of the primacy of patient welfare (beneficence and nonmaleficence) and patient autonomy are listed first; the principle of social justice is the third main tenet. The desired goal was to reinvigorate the value of professionalism that includes social responsibility, the ethic of care, and access to that care, for all members of society.

DIF:	Comprehension		REF:	p. 5	OBJ:	3
TOP:	7.0 Professional Responsibility | 7.4 General

	8.	Each of the following is a requirement for licensure of a dental hygienist in the United States EXCEPT one. Which one is the EXCEPTION?
a.	Completion of a higher education accredited program	
b.	Graduation from a college or university	
c.	Passed a written national board examination	
d.	Passed a clinical national board examination	

ANS:	D
There is no clinical national board examination. The dental hygiene candidate for licensure must pass a state or regional clinical examination. Examples of regional boards include the Council of Interstate Testing Agencies (CITA), the Central Regional Dental Testing Services, Inc. (CRDTS), the Commission on Dental Competency Assessments (CDCA), the Southern Regional Testing Agency, Inc. (SRTA), and the Western Regional Examining Board (WERB).

DIF:	Comprehension		REF:	p. 5	OBJ:	3
TOP:	7.0 Professional Responsibility | 7.4 General

	9.	Which of the following characteristics is used to separate the professional from the layperson?
a.	Competency	
b.	Quality performance	
c.	A specialized body of knowledge and skill of value to society	
d.	A code of ethics	

ANS:	C
To be considered a profession, a specific field or area of study traditionally must have several characteristics. These include a specialized body of knowledge and skill of value to society, an intensive academic course of study, set standards of practice determined and regulated by the group, external recognition by society, a code of ethics, an organized association, and a service ethic. What separates the professional from the layperson is specialized knowledge, which is exclusive to the professional group.

DIF:	Recall	REF:	p. 5	OBJ:	3	
TOP:	7.0 Professional Responsibility | 7.4 General

	10.	Each of the following is considered to be a true profession EXCEPT one. Which one is the EXCEPTION?
a.	Law	
b.	Medicine	
c.	Dentistry	
d.	Culinary chef	
e.	Ministry	

ANS:	D
Because being a professional is desirable, many careers and occupations aspire to this level. Real estate agents, auto mechanics, and culinary chefs all use the term professional to indicate a desired level of competency and quality performance. However, the true professions are still considered to be medicine, dentistry, ministry, and law because they possess all the characteristics previously listed, including a specialized body of knowledge and skill of value to society, an intensive academic course of study, set standards of practice determined and regulated by the group, external recognition by society, a code of ethics, an organized association, and a service ethic.

DIF:	Recall	REF:	p. 6	OBJ:	3	
TOP:	7.0 Professional Responsibility | 7.4 General

	11.	Professionalism is demonstrated through a foundation of clinical competence, communication skills, and ethical and legal understanding. Upon this foundation is built the aspiration to and wise application of the principles of professionalism.
a.	Both statements are true.	
b.	Both statements are false.	
c.	The first statement is true, the second statement is false.	
d.	The first statement is false, the second statement is true.	

ANS:	A
The principles of professionalism are excellence, humanism, accountability, and altruism. Highlights of the Standards for Clinical Dental Hygiene Practice include assessment, dental hygiene diagnosis, planning, implementation, evaluation, and documentation. Professional traits of the dental hygienist include honesty and integrity, caring and compassion, reliability and responsibility, maturity and self-analysis, loyalty, interpersonal communication, respect for others, and respect for self.

DIF:	Recall	REF:	p. 6	OBJ:	3	
TOP:	7.0 Professional Responsibility | 7.4 General

	12.	Which of the following models or professionalism presents dentistry as an all-knowing profession?
a.	Commercial	
b.	Guild	
c.	Interactive	

ANS:	B
It is called the guild model because it resembles the medieval guild of old in which those who were members of the group controlled knowledge, skill, and competency. In this model the patient has dental needs and the dentist provides care to meet the needs of that patient, who is uninformed and passive in the process. The commercial model describes a relationship in which dentistry is a commodity, a simple selling and buying of services. In the interactive model, the patient and dentist are equals and have roles of equal moral status in the process of the delivery of dental care.

DIF:	Recall	REF:	p. 6	OBJ:	3	
TOP:	7.0 Professional Responsibility | 7.4 General

	13.	Which of the practice models described by Ozar is considered most desirable?
a.	Guild	
b.	Interactive	
c.	Commercial	

ANS:	B
According to the interactive model, patients determine their own needs and health care choices on the basis of their personal values and priorities but seek the care of the dentist because of his or her knowledge and skill. This model is preferable because it presents the patient and provider as partners who make different contributions to the partnership. This equal moral status creates an obligation for equal respect as partners working together toward attaining and maintaining oral health.

DIF:	Comprehension		REF:	p. 6	OBJ:	3
TOP:	7.0 Professional Responsibility | 7.4 General

	14.	Which of the following is an example of interprofessional education (IPE) in an academic health center involving two different health education organizations?
a.	Nursing students learn about nursing bottle caries along with dental hygiene students.	
b.	Dental students learn about preventive fluoride along with dental hygiene students.	
c.	Dental students learn about dental restorative procedures along with dental hygiene students.	
d.	Dental hygiene students learn about dental preventive procedures along with dental assisting students.	

ANS:	A
The term IPE refers to occasions when students from two or more health professions learn together during all or part of their professional training with the objective of cultivating collaborative practice to improve the quality of patient care at the individual and population level. The Interprofessional Education Collaborative (IPEC) includes six major health education organizations: the American Association of Colleges of Nursing, American Association of Colleges of Osteopathic Medicine, American Association of Colleges of Pharmacy, American Dental Education Association, Association of American Medical Colleges, and Association of Schools of Public Health.

DIF:	Comprehension		REF:	p. 7	OBJ:	4
TOP:	7.0 Professional Responsibility | 7.3 Patient and Professional Communication

	15.	Which of the following organizations is recognized by the United States Department of Education to accredit programs for dental hygiene in the United States?
a.	The college or university with the dental hygiene program	
b.	The American Dental Hygiene Association (ADHA)	
c.	The State Board of Dentistry for the respective state	
d.	The Commission on Dental Accreditation (CODA)	

ANS:	D
The Commission on Dental Accreditation (CODA) is the specialized accrediting agency recognized by the United States Department of Education to accredit programs that provide basic preparation for licensure in dentistry, dental hygiene, and all related dental disciplines. The commission consists of 30 members and includes a representative of the ADHA. All accredited programs participate in an accreditation review every 7 years. The program prepares a self-analysis and self-study report with information about program resources, curriculum, policies, and standards. This report is submitted to the CODA in preparation for an on-site review by CODA team members. The members of the commission interview administrators, faculty, staff, and students to verify the information contained in the self-study. Next, the CODA team members create a site visit report for both the institution and the Commission. The Commission reviews the report and makes a decision to offer accreditation status without a reporting requirement or accreditation status with a reporting requirement. Programs must demonstrate compliance with Commission recommendations or risk loss of accreditation.

DIF:	Recall	REF:	p. 9	OBJ:	5	
TOP:	7.0 Professional Responsibility | 7.4 General

	16.	How often must a dental hygiene program undergo a formal, on-site review by the accrediting body?
a.	Every 10 years	
b.	Every 7 years	
c.	Every 3 years	
d.	Only once, when the program is first created	

ANS:	B
A formal, on-site review is conducted every 7 years by the Commission on Dental Accreditation of the American Dental Association. All accredited dental programs have accreditation every 7 years, except for oral and maxillofacial surgery programs. These programs are reviewed every 5 years.

DIF:	Recall	REF:	p. 9	OBJ:	5	
TOP:	7.0 Professional Responsibility | 7.4 General

	17.	Which of the following is the correct sequence for the stages of mastery learning according to the competency continuum?
a.	Novice, proficient, competent	
b.	Master, competent, novice	
c.	Novice, competent, proficient	
d.	Proficient, novice, competent	
e.	Competent, novice, master	

ANS:	C
Educational theory categorizes the process of skill performance into five stages of mastery learning, also termed the competency continuum. The five stages are novice, beginner, competent, proficient, and master. The student is a novice or advanced beginner when he or she begins preclinical activities and progresses to caring for clinical patients under the supervision of faculty. The student will have achieved competency at or before graduation, meaning that he or she has the ability to perform clinical skills without faculty supervision. After graduation, the dental hygienist works toward proficiency and continues working throughout his or her professional life, toward becoming an expert.

DIF:	Recall	REF:	p. 9	OBJ:	6	
TOP:	7.0 Professional Responsibility | 7.4 General

	18.	Each of the following is one of the American Dental Hygiene Association (ADHA) standards for clinical dental hygiene practice EXCEPT one. Which one is the EXCEPTION?
a.	Implementation	
b.	Documentation	
c.	Recapitulation	
d.	Assessment	
e.	Dental hygiene diagnosis	

ANS:	C
The six ADHA standards of practice are assessment, dental hygiene diagnosis, planning, implementation, evaluation, and documentation. Implementation is the delivery of dental hygiene services to the patient. Modification of care often occurs to minimize risk, thus optimizing the outcome of the care plan. Documentation is the accurate recording of collected data, treatment planned and provided during patient care, is entered to create a permanent document. Assessment is the systematic collection, analysis, and documentation of oral and general health status and patient needs. It is comprised of patient history collection, performing a clinical evaluation, and measuring risk assessment. Dental hygiene diagnosis is the identification of an existing or potential oral health problem that the hygienist is educationally qualified and licensed to treat. Establishing, reviewing, revising, and publishing these standards are professional responsibilities that the ADHA assumes for its members to ensure that professional practice is based on the best and most scientifically accurate evidence and practice approaches.

DIF:	Recall	REF:	p. 9	OBJ:	6	
TOP:	7.0 Professional Responsibility | 7.4 General

	19.	Which of the following terms is used to describe that core of health care that places the needs of the patient or client ahead of those of the provider?
a.	Autonomy	
b.	Justice	
c.	Beneficence	
d.	Nonmaleficence	
e.	Veracity	

ANS:	C
The professional traits of a successful dental hygienist are found in the basics of professionalism. All of the traits are rooted in beneficence: the core of health care that places the needs of the patient or client ahead of those of the provider. Autonomy is self-determination and the ability to be self-governing and self-directing. The principle of justice is concerned with providing individuals or groups with what is owed, due, or deserved. Nonmaleficence declares that a health care provider’s first obligation to the patient is to do no harm. Veracity is defined as being honest and telling the truth.

DIF:	Recall	REF:	p. 10	OBJ:	7	
TOP:	7.0 Professional Responsibility | 7.4 General

	20.	An individual who demonstrates certain attributes, traits, and behaviors that embrace the best qualities of care and service is known as a
a.	professional.	
b.	technician.	
c.	vendor.	
d.	supplier.	

ANS:	A
From the perspective of the general population, the term professional has evolved to mean an individual who demonstrates certain attributes, traits, and behaviors that embrace the best qualities of care and service. According to the Merriam-Webster dictionary, a technician is a person with a job related to the practical use of machines or science in industry or medicine, a vendor is a person who sells things, especially on the street, and a supplier is a person or entity that is a source for goods or services.

DIF:	Recall	REF:	p. 10	OBJ:	7	
TOP:	7.0 Professional Responsibility | 7.4 General

	21.	According to the ethicist Laurence McCullough the two virtues required in a professional person are
a.	honesty and integrity.	
b.	self-effacement and self-sacrifice.	
c.	caring and compassion.	
d.	maturity and self-analysis.	

ANS:	B
Laurence McCullough has stated that there are two virtues required in a professional person. The first is self-effacement, which means putting aside all notions of self as better educated, socially superior, or more economically well off and focusing on the needs of the patient. The second is self-sacrifice, or putting aside or giving up one’s own interests and concerns. Honesty and integrity, caring and compassion, and maturity and self-analysis are professional traits of the dental hygienist; however, they are not the two virtues mentioned by Laurence McCullough.

DIF:	Recall	REF:	p. 10	OBJ:	7	
TOP:	7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent

	22.	Which of the following professional traits of the dental hygienist ensures that the patient should be confident that information given in written and verbal form is held in confidence and handled appropriately?
a.	Caring and compassion	
b.	Reliability and responsibility	
c.	Maturity and self-analysis	
d.	Honesty and integrity	

ANS:	D
While it is true that all of the choices are professional traits, a relationship of trust is essential to providing care when personal health information is shared. Patients and colleagues must be able to depend on the words and actions of individuals who treat and work with them. Professional integrity is a commitment to upholding the code of ethics and the standards of care.

DIF:	Recall	REF:	p. 11	OBJ:	7	
TOP:	7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent

	23.	Which of the following terms means demonstrating the empathy necessary to comfort and guide the patient in the health promotion process?
a.	Caring	
b.	Reliability	
c.	Tolerance	
d.	Loyalty	
e.	Honesty	

ANS:	A
The ability to care for and be compassionate to each and every patient is a critical trait expected of all individuals who seek a career in a health care profession. Persons who are compassionate are merciful to all patients, including those who are unlike themselves or who are possibly difficult to understand and treat.

DIF:	Recall	REF:	p. 11	OBJ:	7	
TOP:	7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent

	24.	Most states have a legal requirement for continuing education for those who hold a dental hygiene or dental license because mandated continuing education helps ensure optimal health services to the public.
a.	Both that statement and reason are correct and related.	
b.	Both the statement and reason are correct but NOT related.	
c.	The statement is correct, but the reason is NOT.	
d.	The statement is NOT correct, but the reason is correct.	
e.	NEITHER the statement NOR the reason is correct.	

ANS:	A
The goal of mandated continuing education is to ensure optimal health services to the public by fostering continued competence. It is critical for a practitioner to be aware of the continuing education requirements for the state in which he or she practices because they vary from state to state. Information about state requirements may be found on the American Dental Hygiene Association website or on individual state dental board websites.

DIF:	Comprehension		REF:	p. 12	OBJ:	7
TOP:	7.0 Professional Responsibility | 7.2 Regulatory Compliance	

	25.	The trait in which the dental hygienist assesses his or her skills and takes responsibility for changing and improving those skills when necessary is called
a.	integrity.	
b.	self-analysis.	
c.	loyalty.	
d.	reliability.	
e.	interpersonal communication.	

ANS:	B
Self-analysis is assessment of skills and taking responsibility for changing and improving them when necessary. Professional integrity is a commitment to upholding the code of ethics and the standards of care. Loyalty is protecting and promoting the interests of a person, group, or organization. Reliability is meeting the obligations of time and duty, keeping appointments and meeting established schedules. The foundation of trust lies in communication and the ability of the patient to speak and be heard.

DIF:	Recall	REF:	p. 11	OBJ:	7	
TOP:	7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent

	26.	Loyalty is defined as
a.	to treat all patients without discrimination.	
b.	to work toward the goals of attaining and maintaining oral health for each patient.	
c.	protecting and promoting the interests of a person, group, or organization.	
d.	a commitment to upholding the code of ethics and the standards of care.	

ANS:	C
Any relationship between a health care provider and a patient is a special affiliation; all professional decisions must be unencumbered by conflicting personal interests. To treat all patients without discrimination is an example of tolerance. A mature individual works efficiently and effectively toward the goals of attaining and maintaining oral health for each patient. Honesty and integrity are exemplified by a commitment to uphold the code of ethics and the standards of care.

DIF:	Comprehension		REF:	p. 11	OBJ:	7
TOP:	7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent

	27.	When a license to practice dental hygiene is granted, that person is responsible for knowing and upholding the laws established by the state dental practice act. If a portion of the code is changed subsequent to the date of licensure, that person is not responsible for practicing according to revisions in the law.
a.	Both statements are true.	
b.	Both statements are false.	
c.	The first statement is true, the second statement is false.	
d.	The first statement is false, the second statement is true.	

ANS:	C
The person must practice according to the current laws. Ignorance of a portion of the law or code is not an excuse for noncompliance by a dental hygienist or any other health care provider. The ADHA Code of Ethics for Standards of Professional Responsibility (To Ourselves as Professionals) states that a dental hygienist should “enhance professional competencies through continuous learning in order to practice according to high standards of care.” It also states (To Scientific Investigation) “Be knowledgeable concerning currently accepted preventive and therapeutic methods, products, and technology and their application to our practice.”

DIF:	Comprehension		REF:	p. 12	OBJ:	7
TOP:	7.0 Professional Responsibility | 7.2 Regulatory Compliance	

	28.	A license to practice as a dental hygienist is granted by
a.	The American Dental Association	
b.	The American Dental Hygienists’ Association	
c.	The State Board of Dentistry	
d.	The school of matriculation, meaning where the student graduated	

ANS:	C
Licenses are granted by the state. All state boards, as well as those in the Virgin Islands and Puerto Rico, grant a license to practice to the dental hygienist. The responsibility and power for legislative protection of the public rest with each individual state or territory. Licensure is designed to enforce practice codes, establish standards, and sanction incompetent practitioners.

DIF:	Comprehension		REF:	p. 12	OBJ:	7
TOP:	7.0 Professional Responsibility | 7.2 Regulatory Compliance	

	29.	Which of the following individuals is regarded as the father of dental hygiene?
a.	Dr. David T. Ozar	
b.	Dr. Laurence McCullough	
c.	Dr. A. C. Fones	
d.	Dr. Carl Rogers	

ANS:	C
Dr. Fones is regarded as the father of dental hygiene. The scope of practice of a dental hygienist was first established by law in Connecticut in 1915 at the urging of Dr. Fones. The Connecticut dental law served as a model for the states that later adopted similar legislation. Dr. Ozar is credited with developing the three models of professionalism. Dr. McCullough stated that two virtues are required in a professional person. Dr. Rogers was a famous humanistic psychologist.

DIF:	Recall	REF:	p. 12	OBJ:	7	
TOP:	7.0 Professional Responsibility | 7.4 General

	30.	Most legislative changes related to dental health care are driven by individuals in the dental or dental hygiene profession. For the most part the public remains unaware of the intricacies of the process.
a.	Both statements are true.	
b.	Both statements are false.	
c.	The first statement is true, the second statement is false.	
d.	The first statement is false, the second statement is true.	

ANS:	A
Some of the factors that influence legislative changes in a state include the need and demand for dental care, the distribution of dental health care providers, federal health legislation, and the goals of organized dental and dental hygiene association’s advocacy groups.

DIF:	Recall	REF:	p. 12	OBJ:	7	
TOP:	7.0 Professional Responsibility | 7.4 General

	31.	Which of the following is regarded as an expanded function for a dental hygienist rather than a traditional duty?
a.	Scaling and root planing	
b.	Patient education	
c.	Exposing dental radiographs	
d.	Administration of an injection	

ANS:	D
Examples of expanded functions include administration of injectable local anesthesia or placement of restorative material. Some states have implemented an additional practice level for dental hygienists. Individuals pursuing this level of practice must complete additional training in periodontal or restorative functions and be sanctioned to perform these skills by the particular state in which they practice.

DIF:	Recall	REF:	p. 13	OBJ:	7	
TOP:	7.0 Professional Responsibility | 7.2 Regulatory Compliance	

	32.	A dental hygienist can practice independently of a dentist in all states, because several states have adopted mechanisms to allow practice without the supervision of a dentist after gaining a special license or credential.
a.	Both that statement and reason are correct and related.	
b.	Both the statement and reason are correct but NOT related.	
c.	The statement is correct, but the reason is NOT.	
d.	The statement is NOT correct, but the reason is correct.	
e.	NEITHER the statement NOR the reason is correct.	

ANS:	D
It is true that several states have adopted mechanisms to allow a dental hygienist to practice without the supervision of a dentist after gaining a special license or credential. But states differ in which services are permitted and the level of supervision required, and only duties or functions allowed in a particular state may be performed, even if an individual is trained and licensed in another state when the dental practice act is more expansive.

DIF:	Comprehension		REF:	p. 13	OBJ:	7
TOP:	7.0 Professional Responsibility | 7.2 Regulatory Compliance