Dear Board of Dentistry: Please consider the possibility of training Dental Assistants to be allowed to scale and polish periodontal Type I patients under direct supervision of the dentist. This only makes sense. Since these dental assiatnts often scale cements from crown margins (and set cements are much more tenacious than calculus) they already are doing a similar, but more difficult, procedure.  Please note that I am not trying to replace dental hygienists. They are a very valuable member of the dental team. However, their talents are wasted scaling minimal amounts of tarter from patients with good periodontal status and generally healthy gums. Hygienists should use their talents to treat the more difficult periodontal patients. Personally in my office, I have a good number of young (teenage and young adult) patients who are healthy periodontaly and have very little tarter to clean from their teeth routinely. This accounts for maybe 20% of my patients. The dentist always has to do the diagnosis (even when a hygienist does the treatment) and is therefore the one responsible for directing the patient to the appropriate team member to accomplish the desired task. The dentists is always RESPONSIBLE for any treatment perfromed in the office and that should always be the case. If access to care is a concern then financial cost is a definite barrier to access. Allowing a lower paid, but competent, employee to perform these tasks can lower the costs of dental care. At a minimum it would lower the future rise in costs which still reduces the costs to the patients.

Please know that I am not in favor of anything that lowers the standard of care for treatmant our patients receive in our offices. But I know this would work well in my office. Please give it serious consideration. Our patients deserve the very best. Our dentists must make these decisions and stand behind them. I could even live with a compromise of  all new patients being required to see a registered dental hygienist, or dentist,  on their initial cleaning and periodontal evaluation. But still, the diagnosis is done by the dentist and the dentist decides where the patient should go for the appropriate treatment. This would allow for many good things to happen. Cost of care would be lowered, dental hygienists can concentrate on patients who actually need their talents and services, dental assistants would have the ability to increase their value to the practice and earn higher wages, more patients could be seen in the dental office thereby increasing access to dental care, the dentist will always remain responsible for appropriate care to be delivered in his/her office, and quality of care to the citizens of Virginia will not be compromised.

Also, please note that the idea of supragingival scaling versus subgingival scaling is impossible to monitor or address. But definitions of Periodontal Type I, II, III, and IV patients are very specific and can be catagorized very easily. So on a Perio Type I patient, if they have probing dephs of 3mm or less and the calculus is actually 1 mm subgingival, it is not difficultr to access and scale that area. The whole idea if defining scaling to supra and sub gingival calculus is academic because we all know that the base of supragingival cuculus is often just below the gingival margin making that portion subgingival. So Please stay away from those types of definitions, They simply do not address the real world. Instead, limit the "scaling technitian" to treating Type I periodontal patients only, and only under the direct supervision of teh dentist.

Thank you for considering these suggestions. I appreciate your service to the dentists and patients of Virginia.

Bruce R. Hutchison, DDS

Centreville, VA 20121

Scaling should be included in the training for the dental II assisting requirements.  

I would like to voice my opposition to the proposed expansion of Assistant duties.

I note that, among other things, the proposal would have registered / certified Assistants (level 2) would be allowed to have "expanded" duties so that they could provide "reversible" care that is normally performed by dentists or hygienists.

I also note that the local dental associate supports this proposal, except for wanting to have scaling included among the procedures that such a level-2 Assistant will be allowed to perform.

I also note that the local area in which I practice is experiencing a shortage of hygienists, which is having various effects, including causing a sharp spike in the salaries of hygienists.

Despite this shortage, I believe that expanding the duties of registered Assistants will be harmful to the treatment of patients, since more and more dentists will have Assistants provide cleanings / scalings and other duties.  This will confuse patients, upset their expectations and ultimately reduce the care and education of patients as less and less hygienists will be providing those services.

Ultimately, the standard or care will decrease in Virginia as the level of training and education required to provide services currently provided by hygienists and dentists is reduced.  The dental offices that will gain from this will be those that are willing to employ lesser-trained Assistants to provide those services, while the losing offices will be those that try to maintain a staff of highly-trained (and highly compensated) hygienists, in addition to assistant and other staff.

For those who might argue that patients will ultimately decide what is right for them (hygienist versus Assistant level-2), I would say that patients are the least informed among the various parties involved, and they will come to believe that those services which are downgraded to Assistants-2 providing them is the norm and the standard of care.

I respecctfully propose permitting assistants who have passed the legal requirements to be allowed to perform scaling functions under the presence of a licensed dentist. This will legalize dentists and their assistants to perform a function for their patients that supply and demand have not kept pace with.

please include scaling in dental assisting II training

Dear Board of Dentistry Members,

Please consider allowing the Dental Assistant II level to do Type I periodontal scaling.  I agree with Dr. Bruce Hutcuinson's comments on an earlier posting.  We will not take away work form the hygienists.  The assistants at the proposed level can be trained to perform those duties as they now do with the Indian Health Service.  Allowing the assistants that are trained and credentialed to do these duties will free the hygienist and dentist to work more with periodontal maintenance patients.

Sincerely,

Richard L. Taliaferro, DDS

It is my feeling, especially in view of the fact there is a dental hygienist shortage, that scaling be incorporated into the assistant II training program.  This should pertain to type I periodontal patients and the standard of care would be maintained under the direct supervison and exam of the dentist.

Thank you for your attention,

David P Sibley DDS

Respectfully I am for including scaling being included in dental assisting II training. It completely makes sense for periodontal type I patients not to have to wait for a hygienist or dentist availability on a procedure that could be done with a direct supervision of the dentist by a well trained assistant. 

Dear Board of Dentistry Members,

Please consider allowing the Dental Assistant II level to do Type I periodontal scaling. It will not take away work form the hygienists.  The assistants at the proposed level can be trained to perform those duties as they now do with the Indian Health Service of the Federal Government.

Ladies & gentlemen,

Please consider including scaling in upcoming legislation by dental assistants.  Your job is to protect the public.  An overwhelming shortage of hygienists, with resulting supply & demand salaries, is harming the public by creating fees for such services that prevent many from being able to afford them.

It works!  Years ago while serving in the US Navy Dental Corps, we trained and proved clinicians other than hygienists, can perform such services under the direct supervision of  a dentist.

Please allow Scaling to be included in Dental Assisting II Training. A training program already exists with the Indian Health Services

I am requesting that Scaling be included in Dental Assisting II Training. Such a training program already exists with the Indian Health Services. Expanding this to all of Virginia would enhance patient care throughout the state as a wide spread shortage of hygienist exists throughout the state. This shortage has decreased access to care and increased costs as hygienists salaries have increased dramatically over the last number of years. Dental Assistants II can be trained to do scaling for all Virginian's as they have been for the Indian Health Services. This would enable the cost for providing these essential services to decrease or at least remain in check since a much lower paid employee would be providing these services to the patient. In my opinion, anything that can be done, that does not endanger the health of the patient, yet increases access to care at decreased costs should be enacted.

Dear Virginia Board of Dentistry,

I respectfully request that scaling be included in Dental Assisting II training.  This would really help dentists and hygienists to focus more on periodontal issues.  Therefore it will ensure efficiency in serving dental care for the public.

Thank you for your time,

Julie Tran, D.D.S.

Scaling needs to be included in dental aasisting II

Dear dental board members. Please consider the creation of a new dental assistant who will be trained to scale & polish class I dental patients to help with the shortage of dental hygienist in the state of Virginia. We need to train our assistants and hygienist to handle advanced procedures under direct supervision by the dentist to help the productivity and efficiency of our dentist. Thank you for your consideration of this matter.

I support the inclusion of Scaling in the Dental Assistant II training curriculum.  I feel that, with adequate training and supervision, this procedure can benefit the profession and the public by decreasing some costs of the delivery of care while improving access.    

It will not be bad idea to implement it,It will add more value to dental team and save doctor's time and pt. will get more time for his oral hygiene care.

Dears Sirs,

Please give consideration in your syllabus for Dental Assisting II training for the inclusion of instruction in the scaling of teeth. This would be a big help in the effort of the dental community to increase access to care for the citizens of Virginia. Thank you.

Please consider allowing individuals qualified by these regulations as dental assistants II to perform scaling on Type I periodontal patients. Dr. Hutchinson has provided a good summary of the issues as I see them, but I would like to add the following. My assistants see me do periodontal procedures nearly every day and see the level of care I expect. My hygienest never sees me work and does not know how fastidious I am and how exquisitely clean and smooth I expect teeth to be when I'm finished. As a result, I think it will be easier to motivate rigourous treatment of these simple cases with an assistant II than is possible with the hygienest.

I do not mean that hygienest are not capable for this same level of care. In fact, I'm quite sure that if did only periodontal treatment that the hygienests would produce better treatment than I would. But I'm still resharpening instruments ever 20 strokes like I was trained to do and I think an assistant would feel obligated to so the same onece they have seen me do more difficult cases.

Thanks for the oportunity to comment.

I am in favor of dental assistants being able to be trained to scale teeth.  This could expand the scope of services by making dental care less expensive, thereby allowing more people to prevent problems before they occur.  Perhaps scaling and root planing could be limited to dental hygienists, but routine scaling should be allowed to be administered by a properly trained dental assistant.

Aren't there enough hygenist?

Dental Assistants certainly could be credentialed to perform limited scaling to include general oral debridement with a cavitron or other gross scaling techniques. Such a skill level would be comparable to a military trained hygienist that does not require a state license. Prophy reimbursements from 3rd party payers DOES NOT justify any more than basic scaling objectives!

An "Oral Healthcare Specialist" would also be a very appropiate job title for a dental assistant or LPN trained to perform oral debridement services for patients in long term care facilities and rehab facilities. Such an individual would also need training in the requirements for a facility dental director that would satisfy long term care regulatory requirements. In addition to long term care facilities, assisted living facilities patients may also be appropiate for services rendered by an oral healthcare specialist.  Virginia has many citizens that require dental treatment outside of the traditional office, and those unmet needs need to be understood and addressed. Virginia must recognize the needs, take action, and not wait or rely on what some other state to set the example. 

Mark Turner, DDS

The time to make changes to the dental practice act allowing properly trained dental assistants to perform simple scaling of teeth is overdue and should have been allowed years ago. In my view it is shameful that the powers that be have restricted those dental hygienists who desired advanced training leading to the performance of more advanced periodontal procedures. Restricting these capable, well trained, intelligent individuals, to a career limited to the detestable act of scraping odious accretions from patients teeth is beyond me. Is it any wonder they demand high wages, and want to keep themselves in demand by limiting the number of available hygienists? How many denists would remain in the profession if all they were allowed to do was scale teeth? It is time to give these people a career track that has advancement and a promising future. It's time to give properly trained dental assistants the option to scale teeth and hygienists options to advance from scaling teeth to other useful periodontal procedures that are in the public interest. For too long dentistry has kept the public interest secondary to practioners, dentists and hygieists, vested interests. If we don't move forward the regulators will do it for us sooner or later. We give too much lip service to being proactive when in fact we act on self interest, turf battles, and demonstrate a penchant for reactivity. What direction is the profession going? R. S. Mayberry DDS,  MCV-VCU 1978

First off I would encourage all commentators to read the Statute 54.1-2729.01 Practice of dental assistants.  Paragraph B says a person who has met the educational and training requirements prescribed by the Board, who holds a certification from a credentialing organization recognized by the ADA, and has met any other qualifications for registration as prescribed in regulations promulgated by the Board may practice as a dental assistant II.

The Law says that the dental assistant II must hold a certification from a credentialing organization recognized by the ADA.  Right now, to my knowledge, the only such organization is DANB.  Please visit danb.org and click on Exams to see what the pre-requisites are to sit for the DANB Exam.  In short, you have to graduate from an ADA accredited program, or be a high school graduate AND a minimum of 3,500 hours work experience as a dental assistant accrued over a continuous period of not less than 24 months or more than 48 months. Then you have to pay $300.00 to sit for a 4-hour, 320 question test.  Now, the Board can set the educational and training requirements, BUT, by law the dental assistant II MUST be certified.

The only reason I mention all this is because there is a misconception with many dentist who think they can just take their dental assistant and send them to a weekend course and then they can scale teeth.  Not so.  Plus, a CDA will command 18.00 to 20.00 per hour (according to DANB).  If a dentist does have a dental assistant II scale and polish Type I perio patients, will he charge less?  Don't count on it.  And this will not increase access to care.  Those people who lack access to care are not Type I perio patients.  The only thing it WILL do is give third party payers a reason to lower re-imbursement for adult prophys.  Dental assistants should not be providing adult perio services. That is and should be the job of the RDH.  What we really need is more 2-year hygiene programs to get more hygienists into the marketplace.

November 4, 2008

Dear Regulatory Board of Dentistry:

Please  allow Scaling in Dental Assisting II Training.

I know you are aware of the training program that already exists with the Indian Health Service.

Thank you for your thoughtful consideration.

Richard R. Zechini, D.D.S.

I support regulations, as supporteded by the Virginia Dental Association, to allow expanded prophylaxis duties for Dental Assistants.

DR AN

I would like to voice my concerns on the DAII issue.  I am in favor of course work and training developed  which would allow dentists to utilize DA II to provide additional levels of care under the supervision of a dentist.  Specifically, I would like to see these assistants able to do the following:

1.  Place and carve amalgams or composites

2.  Pack and remove retraction cord for impression procedures.

3.  Make temporary crowns.  Adjust the temporaries.  Cement the temporaries and remove the temporary cement.

Lanny R. Levenson, DDS

I am supporting the effort of allow Dental Assisting II to include scaling

I know through some of my new patients testimony that this is a potentially damaging issue to our profession.  Some practices are engaging in ethically questionable behavior of allowing dental assistants to comlete almost all aspects of a prophylaxis and exam while allowing hygienists to simply scale some surfaces.  I have personal and professional experience that proves this to be devastating to some patients.  Let thoroughly trained dental hygienists perform these duties.  The majority of hygienists have demonstrated a committment to the profession and their patients.  Can we say the same for many assistants with respect to dedication and training?  If they are allowed to provide in depth care for patients, how many practices will set up more elaborage "hygiene mills" for profit without respect of patient well-being.  We must self regulate for the safety of the public.  There already exists a system to train hygienists.  Prospective dental assistants who want to scale teeth can take the appropriate courses.  Thank you.   

Dear sirs,    I support allowing properly trained dental assistants to scale teeth as they are allowed in the Indian Dental Services.     DR Rich Fischer

The issue of dental technicians scaling and polishing teeth has been addressed by the military long ago.  I would estimate that such technicians, well-trained and supevised,  safely and effectivey provided preventive dental services to include scaling and polishing of teeth to approximately 90% of active duty personnel.  Surely there is a comparable patient population that would be well-served in the private practice environment.  The training model is already established.

I would encourage the Board to favorably consider this and other expanded duties.  Specifically, there is a role in oral and maxillofacial surgery for dental assistants trained in venipuncture and monitoring of sedation and anesthesia.  The key to success in expanded duties is training and supervision.

I support regulations ,as supported by the Virginia Dental Association, to allow expanded prophylaxis duties including scaling for dental assistants. I also support the broadening of allowable duties for all dental assistants.

No.  I do not support dental assistants to provide scaling to patients. 

Please including scaling and polishing of teeth for Type I periodontal patients in the allowable duties for the appropriately trained Dental Assistant II working under the direct supervision of a dentist..

there are many services that should be available to the public for financial and  non threatenind reasons.. Da ii  and particularly the scaling issue is well in the competancy od  trained individuals other than dentists and hygienists.. this change is lonfg overdue,. helpps the consumer financiallt and opens anothe door to access to care  neil

Dear Board of Dentistry,  I think it appropriate to add supragingival scaling to the allowable procedures for an expanded duty dental assistant to preform.  I am a rural dentist whose practice and patients would benefit from this change.  Respectfully,  Scott Ruffner

Re: Dental Assisting II Training«
«
Dear Members of the Board:«
«
«
More than ten years ago I began writing to the Board of Dentistry in
reference to allowing licenced hygienists to administer local anesthetic
under the supervision of the dentist. As you know this is now in the
process of implementation.«
e«
My rationale for the above was to enhance the dental team's ability to
deliver services to the public at a reasonable cost and at the same time
make those services more readily available to a larger segment of the
population of Virginia. The same rational now applies to the training of
Dental Assistant II's. It is my understanding that the DA II would be
allowed to perform supragingival scaling of Type I Periodontal patients
under the supervision of the dentist. Given the proper training and
certification, these assistants can enhance the dental team's ability to
deliver quality services in the quantities that will be demanded in the
near future.«
«
If I may, I believe that the dental team of the near future must
incorporate something similar to the following hierarchy of treatment
skills:«
«
   »1) More and better trained dentists who are able to deliver a broad
range of dental services.«
«
   »2) More hygienists who are better integrated into the dental team so
that they can relieve the dentist of some of the daily tasks of dental
practice such as the administration of dental anesthesia as mentioned
above.«
«
   »3) Dental Assistant II's to relieve the hygienist of some of the daily
tasks of hygiene in the dental practice so that the hygienist has the time
to perform higher functions for the dentist.«
«
   »4) Dental Assistant I's to keep all of the above team members supplied
with the materials and instruments to accommodate the increased flow of
patients and to provide the level of comfort and care patients have come
to expect.«
«
You are of course aware of the expanding need for dental services,
especially in underserved areas of our state. It is no secret that
economics plays an important role in underserved areas. Only by creating
new categories of dental team members and enhancing the skill sets of the
existing members, can the capacity to deliver dental services be
significantly increased while, at the same time, controlling costs to the
public. Increasing the productivity of the dental team will make the
establishment of dental treatment centers in underserved areas more
practical and more attractive for dentists and all other dental team
members.«
«
«
«
«
Sincerely,«
«
«
«
John A. Marino, DDS«
   »Delegate to the Virginia Dental Association House of Delegates
 

Scaling by properly trained and supervised dental assistants should be allowed.  This type of program has been present in the military for many years.  When properly trained and supervised,  U.S, Air Force Assistants have provided scaling on acitve duty patients.  This could improve access for care in many areas, it can be used to lower costs (dentist and patient), and it can free up a dental hygienist to better treat more complex cases.

I do not support allowing the Dental Assistant II to scale supragingival calculus.

Consider this. Calculus requires a trained and skilled hand to remove biofilm as well as calculus. In order to effectively and properly remove bacterial plaque which is the etiological agent that causes periodontal disease and gingivitis, hand instrumentation in conjunction with ultrasonic/ piezo electric scalers are often required. I use these techniques daily on many young adults and some children in the practice where I work. If calculus and plaque are only removed supragingivally in the presence of inflammed and ulcreated tissue, these tissues can be damaged and uncomfortable for the patients if not removed thouroughly and carefully. This is not comprehensive care.

Many cases of periodontal disease goes untreated and undiagnosed by dentists who do not actively screen for periodontal disease in their practices. I see it in new patients often, too often. I have seen it routinely in former active duty military patients who have been under the care of dental techs. Somewhat of a cleaning is being done, but is the standard of care being maintained. It is often not the case.

A patient can present with fairly good oral hygiene supragingivally, but may exhibit periodontal pocketing only detected by periodontal probing that MUST be done by a dentist or dental hygienist. Dental hygienists are the "ORAL HEALTHCARE SPECIALISTS".  It is ALL we do. I love my profession and assisting my patients in managing their oral health.

Consider the overall potential consequences. Please do not include scaling as an expanded function for dental assisatnts.

Dear VA BOD Members, 

  As a past member of the BOD I am fully aware of how much time & energies you spend on matters of Dentistry with respect to legislation, licensure & disciplinary procedures.  I commend you for your dedication.  

I am asking that you not include Scaling as one of the many new Dental Procedures to be included in the list for the "new position" of Dental Assistant II. The dental assistant has always worked very closely with the dentist in the restorative field of dentistry.  The many "new" restorative duties that have been proposed are exciting & will add to the overall performance of the dental team. However, adding Scaling on Perio I patients should not be one of those duties.  As defined, a Perio I Patient would require Scaling of 3mm. or less Subgingivally.  Those duties are currently part of the Dental Hygienist Role on the Dental Team (a preventive Procedure) which the Dental Hygienist has spent 2 - 4 years in Training.  There are NO States in the United States that currently allow a Dental Asst. to scale subgingivally to 3mm.  If the purpose of this proposal is to provide care to a greater number of patients, then why has it never been practiced in any state?  Why would Virginia want to be the first state to try this? 

A program would be required to train the Dental Assistant II to treat the Perio I Patient (subgingivally scale 3mm or less.)  It has been mentioned that a model for this training program already exists with the "Indian Health Services".  Is this the standard of care that we want for the citizens in Virginia?  I fear that the quality of care would be greatly compromised.

I do not know how this proposal originated with the DA II (Scaling Subgingivally 3mm or less).  There are no other states that allow this.  I believe there are only two states that even allow a Dental Asst. to scale Supramarginally (above the gum).  If having "expanded duty dental assistants" perform even supramarginal scaling is suppose to be so successful, then why are there so few states that allow this practice?  I ask that you not include scaling as an expanded duty for the Dental Assistant II.

I know that as members of the Board you sacrifice a good deal of your time to the Commonwealth.  I commend you for your dedication.  

Sincerely,

Trudy Levitin RDH

I am not in support of allowing dental assistants to do these procedures.

I support the concept of allowing certified dental assistants to scale in type I perio under the supervision of a dentist. This change does nothing to detract from the role of the hygienist and improves access to care for all Virginians.

If Dental Assistants were to provide scaling, polishing, injections, etc. this would all be under the license of the dentist and the dentist would be responsible for anything that results.  I personally am not comfortable with an assistant who does not have the experience or education of a dentist to perform such duties on myself.  This feeling is also held by many patients I have come into contact with.  Patients are paying to come and see a professional for their expertise.  Thank you.

In respect to the recent discussions on access to care, I believe this is an innovative way to address some of these issues. With proper education, testing and supervision a type II assistant can be a great asset to any practice and its patients.

Scaling should not be part of the expanded duties of the Dental Assistance II. 

I read the comments from the rural dentist who seem to think  his lack of a hygienist was enough reason to allow an assistant to do scaling.  Unless, lack of dentist in rural areas is a reason to allow someone other than a dentist to preform dentistry, I don't follow this logic.  Please increase the number of dentist and hygienist in our colleges and universities.  I do encourage the continuing education of all dental personal to serve the public better.

I have been a dental hygienist for 38 years.  I feel preventive dentristy has been successfully promoted by my profession by doing "complete" scalings and by the education of each patient about how to improve their dental health.   

Please consider only the many suggested expanded duties that relate directly to working with the dentist. 

Dear Honorable Board Members,

As a former Board member, I would like to encourage the Board to include the following responsibilities as part of the expanded duty functions for Dental Assistants:  Assistants acting as scaling technicians, a Periodontal assistant and assistants performing duties such as packing/carving amalgams and packing composites. During my tenure as the Board President (2000-2001), the Board received a petition for rule-making from a Dentist in the Southwest portion of the Commonwealth to allow dental assistants to become scaling technicians.  The petitioner argued that the lack of hygienists in the southwestern portion of the state made it impossible to keep up with the restorative needs of his patients. He further argued that the standard of care might be breached because the restorative and preventive needs of his patients were not being met.  In the end, the Board chose not to take up the issue at that time. The access to Dental care throughout the Commonwealth since 2001 has declined significantly.

In this era of shrinking dental manpower, it is incumbent upon the Board to assist the dental community in finding innovative ways to help with the access to care issues with the delicate balance of protecting the public at the same time. I believe with proper training a certified dental assistant can deliver quality care under the expanded duties as outlined by Board regulations under the direct supervision of a Dentist.  Currently the military and Indian/Alaskan native communities are training assistants as prophy technicians. There is a training facility in San Antonio, Texas, for the military training, and the federal government has created “periodontal expanded duties basic courses” for the Indian/ Alaskan natives scaling technicians.

The Board needs to consider all options in dealing with access to care issues because the crisis will get only worse with inaction.  Please carefully study this critical issue.

Thank you for you time and service to the Commonwealth,

Michael J. Link, D.D.S.

I have been a Dental Hygienist for 28 years.  Could it be possible for me to do some light restorative care and take over some of the duties of the Dentist.  Should we propose that? The patient deserves the best dental care. This care should be provided by professionals who have had the best education and training available. I am not licensed or qualified to provide those services. It is the overall education that prepares the Dentist for his role not just the mechanics of the restoration. The same thing is true for the role of the hygienist!  I would hate to think that the motivation behind this is to reduce the cost to the Dentist for providing these services at the expense of the patient!   I do not support Dental Assistants scaling or providing this treatment . This feeling is also held by many patients I have come into contact with throughout the Commonwealth. Thank you!

dental assistants in no way should be allowed to do any kind of scaling. what will happen to the quality of care? i think a solution to the problem is to have more hygiene students graduating from v.c.u.  or more 2 year programs. the problem is distribution of hygienists to rural areas.

  i graduated from west virginia university in 2000.  every hygienist  had to do a rural rotation before we graduated. it helped us see the importance of rural healh care. if there were some kind of rotation with each hygiene student, they might see the importance of not staying in only the urban areas where all the hygiene schools seem to be located. 

  i feel very strongly that there is another solution to the shortage of hygienists. please don't let  assistants scale teeth!  we will not be improving anybody's oral health care!!!!!!

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.

NO. Scalling should not be included in Dental Assistant II duties or training This will lower the care of dentistry in VA!