As an RDH with more than 30 years of experience, I strongly oppose allowing dental assistants without the formal education and clinical training required of registered dental hygienists to perform procedures such as scaling. 

This is not simply about job titles or who is allowed to perform a procedure. It is about patient safety, education, clinical judgment, and the standard of care patients deserve. 

The dentists advocating for expanded assistant duties are often the same practice that struggle to empty hygienist because they do not provide the equipment, supplies, working conditions, or compensation necessary to attract and retain qualified dental hygienists. Lowering the educational and licensing standards should not the the solution to that problem.

Patients may not immediately recognize inadequate periodontal care. Calculus can be left behind or simply polished over, while the underlying disease process continues. The consequences may not become obvious until years later, when patients experience periodontal breakdown, bone loss, mobility, and potentially tooth loss. By then, the damage has already been done.

I have personally seen patients after spending years in practices where adequate calculus removal had not bee performed. Pediatric practices are an area of concern as they employ assistants rather than hygienists. I have seen pediatric patients with heavy, tenacious veneer calculus that had essentially been polished over. Removing that calculus revealed significant areas of decalcification that had be hidden underneath. More importantly, children can become frightened or traumatized by an experience that could have been prevented through appropriate  preventive care and early intervention. Preventative dentistry requires education, assessment, instrumentation skills, knowledge of periodontal disease, and the ability to recognize conditions that require further evaluation. 

Let's be honest about the economics: If practices are allowed to substitute less educated personnel for licensed hygienist, are patients actually going to see their fees reduced? Will the savings be be passed on to the patients-or will patients simply pay the same fee for a service delivered with less education and training? And will assistants receive the compensation that reflects the additional responsibilities being placed on them? We should be asking whether we are improving the access to quality dental care or simply lowering the stand of care to make dental practices more profitable. A dental assistant is not a dental hygienist. Their education, scope of practice, clinical training, and professional responsibilities are different for a reason. Patients deserve better than having those distinctions erased for the sake of convenience or cost savings. 

If we continue down this road, where does it end:

Will nurses be performing surgeries because hospitals can't-or don't want to-pay surgeons?

There is a reason healthcare professions have education, training, licensing and defined scopes of practice. Those standards exist to protect the patient.