Dear Members of the Virginia Board of Dentistry:
I am writing to respectfully urge the Virginia Board of Dentistry to reconsider its decision not to develop regulations or guidance regarding implementation of the new scaling assistant law.
As a dental hygienist for over 43 years, dental hygiene educator, for over 30 years, former dental hygiene program director at 3 universities and longtime advocate for high-quality dental hygiene education and patient care, I am particularly concerned about the educational and clinical implications of allowing dental assistants to perform supragingival scaling following a pathway that currently lacks sufficient definition and standardization.
My concerns with this legislation are many. However, for this board, my concern is what happens when a new clinical responsibility is created without clear, consistent standards for education, clinical training, competency assessment, supervision and documentation.
The statute requires a dental assistant to have a minimum of 1800 hours of dental assisting practice to begin training. The training is to complete 20 supervised full-mouth supragingival scaling procedures. However, several important questions remain unanswered.
What constitutes "appropriate clinical experience"?
The law establishes a minimum number of clinical hours, but does not define what those hours MUST encompass. Clinical experience as a dental assistant is not equivalent to experience performing periodontal assessment, instrumentation, infection control, patient assessment or clinical decision-making associated with scaling.
What constitutes adequate education and competency?
Supragingival scaling is a clinical procedure that requires more than simply learning how to manipulate a hand or ultrasonic instrument. It is only one part of scaling and implementation, as disease is mainly subgingival. Furthermore, competent performance requires knowledge of oral anatomy, periodontal structures, instrumentation, infection prevention and control, patient assessment, medical and dental history considerations, contraindications, tissue response, ergonomics, and recognition of conditions that require referral to a dentist or dental hygienist.
As an educator who has spent decades preparing dental hygienists for clinical practice, I believe these foundational competencies should not be assumed or left to individual interpretation.
The requirement for 20 supervised full-mouth procedures also requires clarification.
The statute does NOT define what constitutes a "full-mouth" scaling procedure, who may supervise these procedures, what supervision entails during training, how competency is evaluated, or how successful completion should be documented.
Twenty procedures alone should not be viewed as synonymous with competency. The quality and structure of those clinical experiences are critical. A standardized competency-based approach would provide substantially greater assurance than an individual is prepared to provide safe care.
Consistency in training IS IMPORTANT.
The law permits training through several different pathways, including training by a licensed dentist or dental hygienist using an education curriculum provided by a "statewide dental association", certain federal programs, or an existing dental assisting education program.
These pathways may provide very different educational experiences unless the Board establishes minimum standards for curriculum content, faculty qualifications, clinical instruction, competency assessment and documentation.
Existing dental assisting education programs are another area that deserve careful consideration. Current Board regulations establish educational requirements and competency-based expectations for dental assistant II programs only. If these programs are now being used as a pathway for preparation to perform supragingival scaling; the Board should clearly define what additional education and clinical competency requirements are necessary. This may also mean that a dental assistant must be of dental assistant II status.
Patient safety must remain the central consideration.
The Board's existing regulations recognize the importance of education, training, and competency when determining what clinical duties may be delegated. Current regulations specifically identify scaling as a duty delegated to dental hygienists and establish requirements concerning supervision and scope of practice.
The new law creates a specific statutory exception permitting "certified" dental assistants to perform supragingival scaling and coronal polishing under indirect supervision of a dentist. That makes it even more important that the Board provide a clear framework for how this new pathway is to be implemented.
I am also concerned about the potential for significant variation from one dental practice to another. Without Board guidance and oversight, one office may provide extensive didactic and hands-on education with meaningful competency evaluation, while another may interpret the statutory minimum much more narrowly. Patients should not receive different levels of protection simply because they receive care in different dental practices.
The statute itself provides a strong indication that Board rulemaking was contemplated. HB 970 states that "regulations promulgated by the Board of Dentistry pursuant to this act" shall be exempt from the Administrative Process Act. In my opinion, this language supports the position that the General Assembly anticipated a role for the Board in implementing the new law.
I respectfully ask the Board to begin a rulemaking process---or at minimum, develop formal guidance to address:
This is NOT a request for the Board to rewrite or expand the law enacted by the General Assembly. It is a request for the Board to use its regulatory expertise to ensure that the law can be properly implemented consistently, safely, and in a manner that protects the public.
Virginia has an opportunity to establish a thoughtful, competency-based framework before inconsistent practices become established. As someone who has devoted my career to dental hygiene education, faculty development and preparing clinicians to provide safe, evidence-based care, I believe this is a critical responsibility that should not be overlooked.
I respectfully request that the Board reconsider its position and initiate a rulemaking process to establish clear standards for implementation of the scaling assistant law.
Thank you for your consideration and for your continued commitment to protecting the health and safety of the citizens of Virginia.
Marion C. Manski, MS, RDH