In this era of growing periodontal awareness, I am greatly disturbed about the proposal to allow Dental Assistant IIs to perform scaling on select patients.  I find most of the posted comments from dentists reflect the illusion that the therapy provided would be on a par with that delivered by a duly registered hygienist.  It is hardly credible to say that the standard of care would be undiminished because the dentist is ultimately responsible.

I call your attention to a fundamental fact.  At present, and during the recent decades, the number one cause of malpractice-based litigation in dentistry is undiagnosed periodontal disease.  There are dentists in our area who still do not even own a periodontal probe much less use them.  While those dentists are certainly exposed to the liability, it is the patients who really suffer.  We run the risk of DAIIs polishing calculus and patients being misinformed about their true status.  The implications of this extend beyond the realm of dentistry.

In today's world where the other healing arts are starting to really grasp the significance and implication of periodontal disease for analysis of total health, it reflects poorly and sets bad precedent to allow technicians to provide direct care delivery for one of the fundamental percepts of modern dentistry.  We as dentists have already in large part delegated the peiodontal care responsibilty to the hygienists.  What is the message we send to thelager medical community and the public when we are willing to now delegate to a second lower level of provider.  Patients can hardly be expected to take our perio therapies and maintenance recommendations seriously.

Practically speaking, the bet benefits are to the dentists who would allow this -- which would save costs that would not be passed on to the patients.  The 21st century should be focused on raising the standards, not compromising them because it is fiscally expedient.  The time to consider the change is when the litigation picture changes away from periodontal disease. Moreover, if our patients deserve the best, why accept compromise.

As stewards of our profession, please reject the proposal.