I agree with Dr. Hogan and others, that to maintain the quality of dentistry we are expected to provide, it should only be provided by properly trained individuals.  There is much more involved in a 4 - year hygiene program than just learning to scrape teeth.  As a former member of the military, I was forced to consider training dental assistants in scaling and prophylaxis.  I consistenly refused, which was ultimately detrimental to my career.  If this really improved access to care, or actually produced a new level of provider that would provide a genuinely valuable service, I would support it.  All this will do is allow a greater dilution of quality care that I already see in practice.  Many individuals will use the "letter of the law" to provide much greater volume of reduced quality hygiene care, to increase practice profit.  This profit will not be passed on to the consumer, it will only move our focus in the profession to a "Wal-Mart" approach, where a serious reduction in quality is justified by reduced costs.  Again, the consumer will likely never see any reduction in fees, but more dentists will see an improvement in their "bottom line".  Bad dentistry is never an adequate substitute for no dentistry.  If dentists and hygienists in the Indian Health Service were paid enough, there would be no shortages.  Access to Care must be addressed, but as a community we can insist on quality dentistry, adequate reimbursement for services, and increased funding for accredited training programs.  Attacks on quality, integrity, education, and standards must always be rejected.  It is our duty and privilege as professionals allowed to treat the public.