To preface- I’ve been a hygienist for over 20 years. I know this legislation is just about supragingival scaling, but it’s more than that. The hygienist is a second set of skilled, trained eyes for the dentist. So the patient, if they just see the assistant and dentist, is not having another set of eyes that performs oral cancer screenings, medical history assessment, periodontal screening etc. Assistants are not allowed to do any of those.

Ultimately it is the patient that will suffer. Many times I have pointed out something that the doctor has missed. We are supposed to be a team that works together, two sets of eyes are better than one. Not to mention we have the proper training and schooling to assess these, this cannot be something learned on the job. 

As far as the Supra scaling goes. An assistant can be taught, but if it’s on the job and they are certified by the same dentist, there are not formal regulations governing what training is done. How will the flow of the appointment even work? Will the dr come in do the assessments (medical history, periodontal screening, exam) let the assistant scale and polish; then the dr come back in to scale subgingivally? Or will they do that with the assessment first? It takes TIME to scale under the gumline and do those assessments. That takes away from doctors production time, so it makes no sense. I can see this leading to neglect. The doctor does a cursory probing, goes through quickly with the cavitron, then lets the assistant go back. I’ve seen this happen so many times and when the hygienist sees them later there is so much subgingival buildup left behind that should’ve been removed at the previous appointment. Also oral hygiene instruction- I have heard even the most experienced assistant give misinformation. You don’t know what you don’t know. During the appt we can discuss how medications impact the mouth and overall health, give custom tailored instructions for care (especially periodontal patients) that the assistant has not had the same training to do. We also can do a deep dive with homecare, nutritional habits etc that assistants do not have the same level of training we received in school to do. 
So sure, they can perform the skill of scaling Supragingivally- but everything else that is done in a hygiene appointment- is the dentist going to do that in the 10 minutes they are with the patient? 

I think we do need to combine powers and tackle the big fish in the pond- insurance companies, their low reimbursement rates and how they hold so many offices basically hostage. I see the business side- so many insurances pay less than the cost of a haircut for a prophy. Yet CEOs line their pockets. Something is majorly afoul here. It’s a BIG problem to take on- but it needs to be done. Not just in dentistry but all across healthcare. Why does a CEO need to make millions of dollars yet we struggle to get a claim approved for a textbook scaling and root planing. 

Also, it saddens me to see some of the comments that dentists have put in this commentary. Sure some of them may have been “burned” so to speak, but so have hygienists. It’s really telling to see how awful and bitter some of commentary is. I’m sure there’s fault on both sides, but many offices are a toxic work environment and dentists refuse to address that as well.