State dental boards exist for a fundamental reason: to protect the public. They license and regulate dental professionals, establish standards, enforce dental practice acts, investigate violations, and help ensure that individuals providing care possess the education, training, and competency required to perform it safely. Tennessee’s Board of Dentistry, for example, states its mission explicitly: to “safeguard the health, safety, and welfare of Tennesseans” by requiring dentists, dental hygienists, and dental assistants practicing within the state to be qualified.¹

But recent developments in Missouri and Tennessee raise an uncomfortable question: When a dental board seeks to expand what a less-educated or less-regulated member of the dental team may perform—particularly when questions exist about whether that expansion exceeds the authority granted by statute—whose interests are actually being protected?

Missouri: When rulemaking collides with state law

In September 2026, the Missouri Dental Hygienists’ Association (MDHA) and former MDHA president Lori Crawford filed suit against the Missouri Dental Board seeking to block a proposed rule creating a periodontal expanded-function permit for dental assistants. The proposed rule would allow qualifying assistants to perform supragingival scaling and comprehensive periodontal charting under a dentist’s delegation.²^,³

Missouri law defines the practice of dental hygiene to include removing hard and soft deposits from teeth and performing clinical examinations of the teeth and surrounding tissues for diagnosis by a dentist.⁴ More importantly, Missouri statutes specifically prohibit the Dental Board from promulgating rules allowing dental assistants to perform delegated acts that conflict with the statutory definition of dental hygiene, with limited exceptions including polishing, sealant placement, and topical fluoride application.⁵^,⁶ MDHA therefore argues that the Board lacks statutory authority to create the new periodontal permit.²

Whether that interpretation ultimately prevails is a question for the court. But the controversy raises a larger question every licensed health-care professional should consider: If changing a profession’s scope requires changing the law, why shouldn’t that conversation happen through the legislature?

Tennessee: Different procedure, familiar question

Now, Tennessee dental hygienists are raising concerns of their own. At its January 2026 meeting, the Tennessee Board of Dentistry considered whether air polishing could fall within the scope of coronal polishing performed by registered dental assistants. According to the Board’s meeting record, the issue arose as the Board examined education and competency surrounding the procedure.⁷ The Board ultimately moved toward treating air polishing as a form of polishing rather than an entirely separate procedure. This distinction is important.

Tennessee law already provides the Board with authority regarding dental assistants performing polishing and gives it regulatory authority over the education and competency requirements associated with those functions. Therefore, the legal issue is not as simple as declaring that the Board possesses no authority over polishing.

Instead, the more important question is this: Can an administrative board broaden the meaning of an existing delegated function to encompass a technology or technique not previously included—particularly when questions exist about whether assistants have received specific education in its use? That is precisely the kind of question that deserves transparency, professional input, and careful legal scrutiny.

Access to care—or access to cheaper labor?

Dental workforce shortages and access-to-care problems are real. Patients in many communities struggle to obtain timely dental care. Those problems deserve consideration and solutions. But “access to care” cannot become a blanket justification for lowering educational or regulatory standards.

Dental hygienists graduate from accredited programs requiring at least two academic years of program curriculum and receive extensive education in biomedical sciences, periodontology, instrumentation, patient assessment, radiology, infection control, and supervised clinical care. Missouri law itself defines an accredited dental hygiene school as a program accredited by the Commission on Dental Accreditation with a minimum two-year curriculum in an institution of higher education.⁸

If policymakers believe another dental professional should be permitted to perform procedures currently outside that professional’s established scope, there is a transparent mechanism for considering such a change: the legislative process. Introduce legislation. Present evidence. Invite testimony from dentists, hygienists, assistants, educators, patients, and public-health experts. Debate the risks and benefits publicly. Establish appropriate education and competency standards. Then determine whether state law should change. That process may be slower and less convenient than administrative reinterpretation, but it is supposed to be. Health-care regulation should not prioritize convenience.

Who is the customer of a dental board?

Perhaps we need to reconsider how we talk about dental boards altogether. Dentists, dental hygienists, and dental assistants are not their customers. The public is. A regulatory board should not exist to solve a dentist’s staffing problem, reduce a practice’s labor costs, preserve a dental hygienist’s professional territory, or advance the economic interests of any particular member of the dental team. The board’s responsibility is to the patient sitting in the chair.

That means every scope-of-practice decision should begin with questions such as: What education is necessary? What competencies must be demonstrated? What evidence supports the change? What safeguards protect patients? And perhaps most importantly: Does the board actually possess the statutory authority to make it?

Missouri and Tennessee involve different procedures, different statutes, and different legal circumstances. They should not be treated as identical cases. But together, they raise a question worthy of attention far beyond either state. Because when administrative interpretation begins doing the work traditionally reserved for legislative debate, the issue becomes much bigger than who is permitted to hold an instrument.

It becomes: Who is regulating the regulators—and who, exactly, are they protecting?

More by the author:

• When insurance undervalues prevention: How third-party payers are pushing dental hygiene to the brink
• Beyond turf wars: What Colorado’s collaborative model can teach the dental profession
• “It falls under the dentist’s license”: A risky myth for the entire dental team

Editor’s note: This article first appeared in Clinical Insights newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe.

References

1. About Tennessee’s Board of Dentistry. Tennessee Department of Health. Updated September 24, 2026. https://www.tn.gov/health/licensure/den.html
2. Kirn J. Dental hygienists sue Missouri state board over rule allowing assistants to perform scaling. St. Louis Business Journal. September 30, 2026. https://www.bizjournals.com/stlouis/news/2026/09/30/dental-hygienists-challenge-state-rule-scaling.html
3. Hoskins D. Missouri Register. September 15, 2026. https://www.sos.mo.gov/CMSImages/AdRules/moreg/2026/v51n18Sept15/v51n18.pdf
4. Practice as a dental hygienist defined. Revisor of Missouri. Effective June 13, 1995. https://revisor.mo.gov/main/OneSection.aspx?section=332.091&bid=17659&hl=
5. Practice as a dental assistant defined. Revisor of Missouri. Effective August 28, 2013. https://revisor.mo.gov/main/OneSection.aspx?section=332.093&bid=17660&hl=
6. Expanded-function duties, delegation of—requirements—rulemaking authority. Revisor of Missouri. Effective August 28, 2010. https://revisor.mo.gov/main/OneSection.aspx?section=332.098
7. Minutes. Tennessee Board of Dentistry Meeting. January 8-9, 2026. https://www.tn.gov/content/dam/tn/health/healthprofboards/DN-Ratified-Meeting-Minutes-January-2026.pdf
8. Definitions. Revisor of Missouri. Effective August 28, 2010. https://revisor.mo.gov/main/OneSection.aspx?section=332.011