Patients of any periodontal classification are prone to move into a different periodontal classification. I regard the main focus of my job as assessing and/or preventing periodontal disease. If the person cleaning a patient's teeth is not well educated enough to deal with any and ALL conditions that might be found, the patient could not be getting adequate treatment. Hygienists also review medical histories, and not doing this properly could lead to dangerous combinations of medicines being administered, as well as putting the patient's overall health in jeopardy.

I do not believe that every dentist is going to fully asses the patient first (a full mouth probe on each patient, every time) to ensure they are still a class one periodontal patient. It is in the best interest of the patient to be treated by someone who is LICENSED to treat ANY periodontal condition they present with.

What happens to the patient that presents with one 4-5 mm pocket? The assistant can't treat this; should the patient be charged for a separate scaling and root planing procedure? A LICENSED HYGIENIST would have been able to care for that one tooth within the appointment.

In regard to children's cleanings, I have seen MANY children transfer to our office from a pedodontist who uses assistants to polish teeth. They are often COVERED in calculus. There is a false perception that children do not often present with calculus, when in fact they DO! The most accident prone scaling occurs on small children. If you are not skilled you can easily slip and hurt yourself or the patient. An accident in the dental chair due to an unskilled person providing the scaling could result in severe physical or mental harm. We have enough children out there who are afraid of the dentist without giving them a reason to be!

I can only imagine the ramifications this would have with insurance companies. Why should they reimburse at the same rate for a lesser trained person to provide the care? What will it take to get them to reimburse once periodontal disease has started? Will we have difficulty getting them to pay for a cleaning on a class two patient? 

The patients who do not have access to care are NOT class one patients!!!!

I respectfully say ABSOLUTELY NOT  to assistants scaling. If they want to scale they should go to hygiene school and get the proper training!