In Kansas we have Supragingival Scalers.  In the offices I have worked in this position has not been monitored with direct supervision like it should be.  These individuals are seeing a variety of patients with varying perio concerns.  I think the ratio of Dentist to clinician should reviewed more closely prior to considering the need for this new position.  How can one dentist honestly monitor so many employees under direct supervision?  The honest answer is that it is not possible.  To provide top quality care it is necessary to have  a professional who has received the proper education.  I don't believe allowing assistants to scale above the gum line will do any more than create a greater opportunity for oversight  and negligence.  I believe if you were to ask patients as a whole they would state they prefer a licensed well educated professional to care for their oral cavity.   This has nothing to do with access to care.  Will these dentist's be sending these clinicians out into the public to provide care to those in need or will they be reducing their fees since these clinicians don't have the same amount of education.   In the offices I have worked in the fees have been the same whether an RDH or a Supragingival Scaler has provided service.  Sadly enough this is all about creating a staff member to replace an  RDH and save the DDS money.   How sad for those individuals in Virginia who truly need and deserve more.