I believe that allowing dental assistants to perform dental scaling in Virginia raises important ethical concerns about patient safety, quality of care, and professional responsibility. Although expanding the duties of dental assistants may appear to improve efficiency and address staffing shortages, I believe scaling should remain primarily within the scope of dental hygienists who receive specialized education and clinical training in periodontal assessment, instrumentation, prevention, and patient education.

Dental hygiene is more than simply removing plaque and calculus. Scaling is performed within a larger process of evaluating a patient's oral health, recognizing signs of periodontal disease, assessing tissue conditions, providing individualized oral hygiene instruction, and identifying problems that may require referral to a dentist or periodontist. Dental hygienists receive focused education and clinical experience in these areas.

My concern with dental assistant scaling is therefore not that assistants are incapable of learning an instrumentation technique. Rather, it is that scaling should not be viewed as an isolated mechanical procedure. If a provider is primarily trained as an assistant, there is a potential risk that the procedure could become focused on removing deposits without the comprehensive periodontal assessment and preventive care that accompany professional dental hygiene practice. This could contribute to missed signs of disease or delayed referral.