Scaling by DA II or any assistant should not be allowed by the Board of Dentisry.  I have worked, even in a pediatric practice in South Carolina where DA can scale supragingivally. Where there is supra gingival calculus, their is subgingival calculus!  I saw kids suffer from being scaled and polished even at small ages sometimes. Some may slide through okay...but unless EVERY surface is explored, ( and the supervising dentist will not be doing this during an exam), substandard care is being given.

Monetary consideration should be the LAST consideration when dealing with patient health. In working with perio patients, they have often presented okay at one visit and become perio active  at another.  Each patient deserves a full probing and evaluation by a liscenced , trained dental hygienist.  Supervising dentists rarely have time or take time to do a very through  OHN and exam, let alone probe and supervise the subgingival perio condition.

I feel such a provision would be negligent considering that perio infection and inflammation has so many systemic effects.  In my experience, and I have been working since 1976, hygienist and everyone make mistakes, or miss something. But to charge a patient for a prophy and exam from an assisitant without the care of a liscenced hygienist who has spend the last hour exploring and assessing the condition of the whole patient, is negligent, substandard care in my opinion.

If the dentist himself does the whole prophy, that is another matter, but a liscensed trained professional is the standard of care. What if exudate is present in a pocket...what if other symptoms a"technician" could not discern or was not trained to discern were present. There is NO way to have a dentist directly supervise prophylaxis in any patient, child or otherwise, without harming some patients.

Please do not allow VA standards to deteriorate.

Sincerely,

Kim C. Hislop, RDH