Nitrous Oxide and Scope of Practice in Tennessee: What Dental Assistants and Hygienists Need to Know

Jan 27 / Dent ED Online
Nitrous oxide is a familiar tool in many dental offices. It helps patients relax, supports smoother appointments, and can make dental care more accessible for anxious patients. But in Tennessee, who can monitor nitrous oxide and who can administer it is very clearly defined by the Tennessee Board of Dentistry, and the rules are different for dental assistants and dental hygienists. 

This resource breaks down those differences, outlines the certification requirements for each role, and helps clarify what Tennessee Board rules mean for daily practice.

Monitoring vs Administration: Why the Difference Matters

Tennessee Board rules make an important distinction between monitoring nitrous oxide sedation and administering nitrous oxide.

Monitoring nitrous oxide refers to observing the patient’s response to sedation, remaining physically present with the patient, and ensuring safety throughout the procedure. Administration includes initiating and managing the flow of nitrous oxide and oxygen according to approved protocols.

This distinction is the foundation of Tennessee’s scope of practice rules. After completing the appropriate certification, dental assistants are limited to monitoring only, while dental hygienists may qualify to both monitor and administer nitrous oxide.

What Dental Assistants Are Allowed to Do in Tennessee

Under Rule 0460-04-.05, dental assistants in Tennessee may not administer nitrous oxide. Their role is limited to monitoring nitrous oxide sedation, and only after certification has been issued by the Board.

To be eligible for certification, a dental assistant must first be currently registered with the Tennessee Board of Dentistry. Registration is required before attending a nitrous oxide monitoring certification course.

Once a registered dental assistant successfully completes a Board-approved nitrous oxide monitoring certification course, and certification is issued by the Board, they may monitor nitrous oxide sedation under the direct supervision of a licensed Tennessee dentist.

There are several important limits built into this role:
  • The assistant may monitor only one patient at a time
  • The assistant must remain physically present with the patient at all times
  • The assistant may not initiate administration of nitrous oxide
  • The assistant may adjust the dosage or terminate nitrous oxide only at the specific direction of the supervising dentist or in cases of patient distress

Certification remains valid only while the dental assistant maintains current registration with the Board.

Nitrous Oxide Monitoring Course for Dental Assistants

Dent ED Online offers a Tennessee Board-approved nitrous oxide monitoring certification course designed specifically for registered dental assistants.

This course includes:
  • 5 continuing education hours
  • 100% online instruction
  • No hands-on component, as the Tennessee Board does not require clinical training for dental assistant monitoring certification

The course focuses on patient safety, monitoring responsibilities, and understanding the assistant’s role within Tennessee’s scope of practice.

What Dental Hygienists Are Allowed to Do in Tennessee

Dental hygienists in Tennessee have a broader scope related to nitrous oxide, and certification is required before monitoring or administering sedation.

Under Rule 0460-03-.06, licensed dental hygienists may become certified to administer and monitor nitrous oxide after completing a Board-approved certification course and receiving certification issued by the Tennessee Board of Dentistry. Dental hygienists who hold certification in administration and monitoring of nitrous oxide may administer nitrous oxide under the direct supervision of a licensed dentist.

Even with certification, there are clear limits:
  • A dental hygienist may not administer or monitor nitrous oxide for more than one patient at a time
  • The hygienist, or a nitrous oxide-certified RDA, must remain physically present with the patient at all times
  • Certification remains valid only while the hygienist maintains a current Tennessee dental hygiene license

Nitrous Oxide Monitoring and Administration Course for Dental Hygienists

Dent ED Online offers a Tennessee Board-approved nitrous oxide monitoring and administration certification course for licensed dental hygienists.

This course includes:
  • 14 continuing education hours total
  • 10 hours of online didactic instruction
  • 4 hours of in-person, hands-on clinical training

The hybrid format allows hygienists to build a strong knowledge foundation online and then apply those principles during supervised hands-on training, as required for administration certification in Tennessee.

Why Staying Within Scope Really Matters

Nitrous oxide is safe and effective when used correctly, but it comes with clear legal and professional responsibilities. Practicing outside of your authorized scope or without proper certification puts your registration or license at risk and can compromise patient safety.

Knowing exactly what you are allowed to do, and completing the correct certification for your role, helps protect you, your supervising dentist, and your patients. It also makes the dental team run more smoothly when everyone understands their responsibilities.

Supporting Tennessee Dental Teams Through Education

At Dent ED Online, our nitrous oxide courses are built specifically around Tennessee Board of Dentistry rules. We focus on clear, compliant education that helps dental assistants and dental hygienists meet certification requirements with confidence.

Whether you are a registered dental assistant pursuing nitrous oxide monitoring certification or a licensed dental hygienist ready to expand into administration and monitoring, Dent ED Online offers Board-approved courses designed for Tennessee dental professionals.

References

Tennessee Board of Dentistry. (n.d.). Tennessee Secretary of State Official Compilation of Rules and Regulations: Rules of the Tennessee Board of Dentistry. Tennessee Department of Health. Retrieved January 27, 2026, from https://publications.tnsosfiles.com/rules/0460/0460.htm