I do not support the use of DAII for scaling patients with Type I Perio.  First and formost the general public does not understand there is a difference between a supragingival (above the gum) scaling and a subgingival (below the gum) scaling.  I find so many patients that explain they have NEVER had such a thorough cleaning before until I explain what I am doing and my educational background.  I question the educational/clinical level DAII's will have prior to working on the public.  Most dentists do not spend a great deal of hands on time training assistants how to hold/angle a scaler, which teeth have uniquely shaped surfaces, or the inflammatory response of the gum tissues.  These skills take many hours to learn and perfect. 

Secondly, the quality of care is compromised.  This goes back to understanding what exactly was scaled.  The patient leaves the dental office thinking they had their teeth cleaned, but in fact only calculus and plaque above the gum is removed.  What about those few areas where calculus was left under the gum to develop into more serious periodontal issues?  How many dentists will probe every tooth to decide if a patient is a Type I or Type II-IV perio patient??  By the time a dentist does a complete assessment of the patient to classify a Type I a dental hygienist could be scaling proficiently.  I know from personal experience that this lack of quality care can develop into severe periodontal disease, and who will ultimately pay for this??  The patient pays for the "supervised neglect" from the standpoint of increased visits to correct what was missed.  We must realize no one is perfect in removing every last bit of calculus, but the dentist will not have time to check behind the DAII and scale all missed areas.  The dentist does not check behind most dental hygienists; he relies on our clinical and educational training usually lasting 2+ years.

Lastly, I feel the dentists will be the ones affected by this change.  Once a patient realizes they will pay the same amount for a prophy/cleaning whether a dental assistant or dental hygienist performed the service, the patient may choose an office where more skilled clinicians work.  My patients do know the difference between a thorough cleaning and a "brush over" when they walk out the door because I educate them, I check behind myself, I explain what is being done, and they appreciate this knowledge.  No one deserves substandard care no matter what their socio-economic, ethnic, or location background.