As a dental patient I am strongly opposed to dental assistants scaling (OPAs) with no CODA-accredited dental hygiene training. I am a former dental assistant and I believe dental assistants are NOT going to provide adequate preventive dental prophylaxis. I am a registered dental hygienist in the state of Virginia with an active license. In the real world application of this law, the assistants will have a provider (i.e. dentist) attempting to juggle a full day of treating existing patients (drilling, restoring teeth, extracting teeth) while somehow providing hours upon hours of one-on-one hands-on training. After the perfunctory training, it is questionable if there will be any time for meaningful oversight once the OPAs are left alone with indirect supervision.

This discordant and unregulated on-the-job training in only supragingival calculus removal will harm more patients than it will help. Over 90% of my patients in general dentistry have some subgingival calculus which if left behind can quickly trigger permanent periodontal bone loss. The general population will not know these OPAs are performing substandard care, and furthermore they will not be aware of their unchecked periodontal disease. Periodontal disease often occurs over years with only mild warning signs which many patients will initially dismiss.

The Virginia Dental Hygiene Association (VDHA) have offered numerous realistic solutions to increasing access to preventive patient care, and the OPA legislation is a significant step in the wrong direction. This law was made without any input from the representative bodies who speak for dental hygiene professionals. These professionals have spent years of their lives studying how to prevent tooth loss and oral disease. When it comes to health care, dental disease prevention should be paramount as subgingival bacterial deposits have been linked to many common systemic diseases (e.g. diabetes, heart disease, and dementia). 

While it may be futile for one passionate patient advocate to try to repeal this, I have hope that the practical application of this law will fall flat in the face of its advocates: Dentists with a desire to increase patient interactions without increasing quality of care and health outcomes; Those who wish to replace valuable professional skills with cheaper unskilled labor; Dental insurance companies with a long track record of placing profits above prevention and treatment;  Insurance companies that have refused to reimburse fair rates to dental business owners for decades, who now think OPAs are going to solve their budgetary stress (it won't).

There are no other states with equivalent laws that have shown a positive change in dental patient outcomes after implementing similar scaling assistant models. Virginians should not be the proverbial guinea pigs!

Sincerely,

Christina Tulloch, RDH, BSDH, BS Biology