Dear Board of Dentistry: Please consider the possibility of training Dental Assistants to be allowed to scale and polish periodontal Type I patients under direct supervision of the dentist. This only makes sense. Since these dental assiatnts often scale cements from crown margins (and set cements are much more tenacious than calculus) they already are doing a similar, but more difficult, procedure.  Please note that I am not trying to replace dental hygienists. They are a very valuable member of the dental team. However, their talents are wasted scaling minimal amounts of tarter from patients with good periodontal status and generally healthy gums. Hygienists should use their talents to treat the more difficult periodontal patients. Personally in my office, I have a good number of young (teenage and young adult) patients who are healthy periodontaly and have very little tarter to clean from their teeth routinely. This accounts for maybe 20% of my patients. The dentist always has to do the diagnosis (even when a hygienist does the treatment) and is therefore the one responsible for directing the patient to the appropriate team member to accomplish the desired task. The dentists is always RESPONSIBLE for any treatment perfromed in the office and that should always be the case. If access to care is a concern then financial cost is a definite barrier to access. Allowing a lower paid, but competent, employee to perform these tasks can lower the costs of dental care. At a minimum it would lower the future rise in costs which still reduces the costs to the patients.

Please know that I am not in favor of anything that lowers the standard of care for treatmant our patients receive in our offices. But I know this would work well in my office. Please give it serious consideration. Our patients deserve the very best. Our dentists must make these decisions and stand behind them. I could even live with a compromise of  all new patients being required to see a registered dental hygienist, or dentist,  on their initial cleaning and periodontal evaluation. But still, the diagnosis is done by the dentist and the dentist decides where the patient should go for the appropriate treatment. This would allow for many good things to happen. Cost of care would be lowered, dental hygienists can concentrate on patients who actually need their talents and services, dental assistants would have the ability to increase their value to the practice and earn higher wages, more patients could be seen in the dental office thereby increasing access to dental care, the dentist will always remain responsible for appropriate care to be delivered in his/her office, and quality of care to the citizens of Virginia will not be compromised.

Also, please note that the idea of supragingival scaling versus subgingival scaling is impossible to monitor or address. But definitions of Periodontal Type I, II, III, and IV patients are very specific and can be catagorized very easily. So on a Perio Type I patient, if they have probing dephs of 3mm or less and the calculus is actually 1 mm subgingival, it is not difficultr to access and scale that area. The whole idea if defining scaling to supra and sub gingival calculus is academic because we all know that the base of supragingival cuculus is often just below the gingival margin making that portion subgingival. So Please stay away from those types of definitions, They simply do not address the real world. Instead, limit the "scaling technitian" to treating Type I periodontal patients only, and only under the direct supervision of teh dentist.

Thank you for considering these suggestions. I appreciate your service to the dentists and patients of Virginia.

Bruce R. Hutchison, DDS

Centreville, VA 20121