The vast majority of states do NOT allow an on-the-job trained (OJT) dental assistant to scale calculus. Legally, calculus removal using sharp hand instruments or ultrasonic scalers is strictly restricted to licensed dental hygienists or dentists. 

While a few states allow highly specific, credentialed Expanded Functions Dental Assistants (EFDAs) to perform scaling under direct supervision, an unlicensed OJT assistant, does not possess the clinical training to properly and safely operate these instruments. Allowing an assistant to do so can be detrimental to a patient's overall health. Expanding access to dental care should never mean lowering the clinical standard of care.

Risks to the Patient:

Performing dental scaling requires extensive clinical education to master tactile sensitivity, anatomical knowledge, and instrument adaptation. When an assistant performs these tasks, patients face significant risks which can include the following:

1. Damage with Sharp Hand Instruments:

• Gingival Lacerations due to improper adaptation of a sharp curette or sickle scaler can easily slice, puncture, or tear the delicate gingival tissues.

• Enamel and Root Gouging: Excessively hard or improperly angled hand strokes can permanently scratch, gouge, or remove protective tooth enamel and underlying root cementum. 

• Incomplete Calculus Removal (Burnishing): Untrained operators often shave off only the outer layer of tartar rather than fracturing it cleanly from the tooth. This leaves behind a smooth, "burnished" sheet of calculus that still harbors active bacteria, making it harder to detect and remove later. 

2. Damage with Ultrasonic Scalers

• Thermal Pulpal Damage: Ultrasonic tips vibrate at tens of thousands of cycles per second, generating extreme frictional heat. If the assistant fails to maintain constant motion, lacks adequate water coolant, or applies too much pressure, the heat can permanently kill the tooth's internal nerve (pulp). 

• Medical considerations: Ultrasonic instrumentation requires knowledge of a patient’s medical history and an understanding of situations in which particular equipment or techniques may require modification or avoidance.

• Pacemaker Malfunctions: Older magnetostrictive ultrasonic units can emit electromagnetic interference. An untrained assistant might inadvertently use one on a patient with an unshielded cardiac pacemaker, triggering dangerous cardiac arrhythmias. 

• Aerosolized Contamination: Ultrasonics create a massive cloud of airborne droplets containing saliva, blood, and pathogens. Aerosols produced during ultrasonic scaling procedures are always contaminated. Without proper isolation and techniques, this increases the risk of severe respiratory cross-contamination for everyone in the office. 

• Ultrasonic tip maintenance: Assistants do not have the training to know when an ultrasonic tip has reached its life span. Using tips that are worn or damaged can lead to tips breaking and risk aspiration by the patients. 

• Ultrasonic Maintenance: The ultrasonic is considered to be dental equipment, and requires proper maintenance. It requires water which means that the water must be monitored for bacterial growth. Improper water maintenance causes severe biofilm buildup, equipment clogs, and potential patient infection risks. 

3. Progression of Undiagnosed Periodontal Disease

• Undetected Periodontal disease: Perhaps the greatest concern is not simply what happens during instrumentation, but what may be missed when a procedure is performed without the appropriate clinical assessment.

• The "Superficial Clean" Trap: An assistant typically only cleans what they can see above the gumline (supragingival). If a patient has deep gum pockets from periodontal disease, removing only the surface tartar allows the aggressive, anaerobic bacteria deep beneath the gums to continue destroying the bone silently.

• Lack of Assessment: Unlike assistants, licensed hygienists and dentists spend years learning how to screen for oral cancer, evaluate airway health, track bone loss, and assess complex medical histories that impact health. 

The elderly population is growing and keeping more of their teeth. They need a clinician that is college educated and knowledgeable in areas such as medical emergencies, pharmacology, oral pathology, and nutrition. Removing visible calculus above the gumline does not constitute comprehensive periodontal care.

Better solutions

If Virginia is seeking innovative solutions to expand access to oral healthcare, there are safer and more effective approaches that strengthen—not dilute—the dental hygiene workforce

•  More efficient pathway for licensed dental hygienists from other states: Create a more efficient pathway for licensed dental hygienists from other states to obtain Virginia licensure. Experienced, licensed dental hygienists who have already met rigorous educational and competency standards in another state should have a streamlined pathway to Virginia licensure, while maintaining appropriate safeguards for patient protection.

• Expand opportunities for Virginia-licensed dental hygienists to practice with greater autonomy: Virginia should continue exploring models that allow licensed dental hygienists to provide preventive and periodontal services in appropriate settings outside of a traditional dental office, particularly in communities where access to dental care is limited. This could include schools, long-term care facilities, community settings, public health programs, mobile clinics, and other locations where patients face barriers to accessing traditional dental care.

The Bottom Line

The solution to Virginia’s dental workforce shortage should not be to replace educated, licensed clinicians with inadequately trained personnel.  Instead, Virginia should remove unnecessary barriers for qualified dental hygienists, expand opportunities for licensed hygienists to provide care, and invest in models that bring preventive and periodontal services directly to the people. Expanding access and protecting patients are not competing goals. We can—and should—do both.