Are dental assistants the new dental hygienists? Some seem to think so

By now I’m very sure you’ve heard … read … argued that the American Dental Association (ADA) has recently endorsed a shift in dental workforce policy—aka the allowing of dental assistants (and I’ll air quote) “with proper training and certification” to perform duties historically reserved for dental hygienists. One example of this is scaling and plaque removal.

So far, this move has been made in Arizona and is being considered in several other states.

First, I’m going to share that this is one dentist’s opinion who happens to be the chief editor at DentistryIQ. Second, here’s a breakdown of what this means—and why it matters to you.

How we got here

This is a hot—or let’s be honest, a heated—debate. Is there a shortage of hygienists? Or is there a shortage of hygienists willing to work in subpar situations?

I want to be crystal clear on how I see us getting here. Some—not all but enough—dental practices just didn’t treat their hygienist teammates in the best of ways for many years. Dentists, if we want to truly overcome what’s happening, we as a collective need to own that this is true.

Next, COVID hit. And as badly as some of those dentists behaved over time—hygienists, it’s your turn—some hygienists behaved badly, very badly in fact. Just as we dentists need to own our end, you’re going to need to own this. It’s true.

As we dentists sit here today, we decided to flex back. And again—this is one dentist’s opinion—we behaved badly with this present action. Medicine is a fail in the US. The concept of adding another layer of providers under the protection of access to care … I’m sorry, but I don’t buy it. This is a reaction to a hygiene action, which was in itself a reaction to decades of action.

Merit or not …

Dental hygienists are in short supply across many regions, creating bottlenecks that limit preventive care access—especially in rural and underserved areas. The ADA’s new model, including the midlevel provider role of oral preventive assistant (OPA), is meant to relieve pressure on clinics and ensure more patients receive timely care.

Here’s the problem: that will never work!

• Dental pros have proven time and again that they do not want to live and work rurally in underserved areas—i.e., these added providers will live and work where they always have: where everyone wants to live and work
• More dentists graduate every year who could very easily fix the problem if we simply incentivize more of them to practice two to three years in said areas. The new grads need the experience; the aforementioned areas need the clinicians. This isn’t rocket science.
• The flip side: assisted hygiene done well is a win!
• Done well, assisted hygiene—which has been in existence for decades—is an extraordinary example of how great teams deliver great care to more patients without compromise. If this model is the model that is followed with the added education, then we can all get along. And our patients will not get the watered-down care that medicine has fallen to.
• Arizona’s bill (SB 1124) is the first of its kind. It requires assistants to complete 120 hours of training; hold CPR, coronal polishing, and radiography certification; and either have DANB certification or graduate from a CODA‑accredited program.

Concerns from all sides

The American Dental Hygienists’ Association (ADHA) firmly opposes this, warning that:

• Scaling is a complex procedure requiring extensive biological and clinical understanding. It’s not simply something one can adequately replace with short-term training programs.
• Also, “there’s no current evidence proving the safety or efficacy of these models, raising red flags about patient outcomes.”
• I agree! If you want to perform hygienist activities, go to hygiene school. But hygiene friends, if you want to perform dentist activities, go to dental school. We can’t it both ways.

How do we move forward together?

I can’t say this enough—and these are my opinions alone, but here it goes. First and foremost, we need to fulfil the promises we all made when we crossed that graduation stage: first do no harm! Our promise to our patients must come first.

Second, let’s put out more facts. Emotion is winning over logic. We need to flip that script by continuously putting facts first.

Last but not least, what if we addressed how we got here … and actually worked together to overcome it? There is no room for ego-driven decisions in this. Let’s not try and prove ourselves right—let’s work on being better.