Virginia is engulfed in a firestorm as hundreds of angry dental professionals battle over what will become of routine services at your next dental office visit. Legislators thought they would follow suit with a few other states and allow changes as to who could work in a dental office. They are considering allowing dental assistants to scale after some quick on-the-job training and allowing dentists who graduated in a foreign country to work as dental hygienists.
Four bills are currently under consideration in the Virginia legislature: HB970/SB178 and HB1036/SB282. Both Senate bills -- SB178 and SB282 -- passed the Virginia Senate unanimously (40-0) on February 10 and are now moving through the House of Delegates. The companion House bills are also advancing through committees. More protesting and testimony are planned by both sides. These proposed changes have generated so much attention that WHRO Public Media reported on it.
The irony of these two possible new job opportunities is so wild that I still cannot believe that many who support this legislation cannot see why it is a horrible idea. I have decided to break this down.
The Missouri pilot program
First, let's discuss the pilot program in Missouri. This program is what proponents argue proves their idea of allowing expanded function dental assistants (EFDAs) to scale is OK. Was it a good study? It seems so. The patients reported feeling safe and well cared for. The study was tested for validity.
However, I want to point out that Virginia not only has EFDAs. In fact, Virginia has a wide range of legislation that defines the term "dental assistant." If this pilot study only looks at EFDAs, will it really fix the job shortage? How many EFDAs are currently licensed and employed in Virginia? Are they in the critical access areas where they are needed? Furthermore, who, when, and where will train these EFDAs?
Dental hygiene is a licensed and regulated healthcare profession. As a hygienist, I am limited to specific duties and working within state lines because of legislation. Now, this same legislation wants to make it seem like the scope of my practice is not a big deal for EFDAs, but the governing bodies are not expanding dental hygienists' education and training.
If our industry truly cares about improving access to care for the public, why aren't we expanding legislation so that dental hygienists don't have to work under a dentist's scope and can have more autonomy?
The periodontal disease problem
The most obvious argument that must be addressed is that dental offices often feel their output is not accurate. We are told that periodontal disease is constantly underdiagnosed. Research by the U.S. Centers for Disease Control and Prevention suggests that 42% of U.S. adults have periodontal disease.
If more patients need advanced care and the EFDA dental assistant is only allowed to treat "healthy" patients, will they really be treating a high patient load? We cannot turn a blind eye to periodontal disease to make a patient "acceptable" for an EFDA to see and treat when they need the assistance of a registered dental hygienist.
Foreign-trained dentists as hygienists
Additional Virginia legislation would allow foreign-trained dentists to perform cleanings. This seems even wilder than the first change to legislation.
Can foreign-trained dentists practice dental hygiene? Wouldn't these professionals who spent a number of years in school and training to become dentists want to practice dentistry, not hygiene? How much training in dental hygiene practices, such as scaling, remineralization, and periodontal disease, have foreign-trained dentists received? Also, other states have attempted this measure: How did that pan out?
The real issue
A dental hygienist is the oral healthcare provider who spends much of the appointment with the patient, on average, for two dental appointments per year. Dental hygienists are a reliable way for dental offices to retain patients and provide routine care. Rather than supporting and improving dental hygiene, it seems as though dentists want to introduce shortcuts and loopholes into the system.
Is this really best for patients, and will it fix the system? I'm not sure I understand the train of thought. If this legislation is one attempt to fix a broken system due to a shortage of hygienists, there are many possible solutions that could be investigated.
If we, as an industry, invested as much energy into changing legislation as has been done in these last few months in Virginia, how much more could be accomplished for our patients and our profession?
The bottom line
No matter how you feel about it, the debate raised by this legislation is not solely about job titles or workforce shortages -- it's about public health, patient safety, and the integrity of the dental hygiene profession built on rigorous education and evidence-based care.
Registered dental hygienists are trained to identify pathology, arrest disease, and protect the long-term health of the communities we serve. Shortcuts will not solve access-to-care issues, but thoughtful investment in the dental hygiene workforce, expanded practice models, and sustainable recruitment pathways will. If we want meaningful change, we must advocate for solutions that strengthen the system, not weaken it. Our patients and profession deserve nothing less.
Tracee S. Dahm, MS, RDH, is an adjunct instructor for the North Idaho College School of Dental Hygiene. In addition, she serves as an educator and moderator at Young Innovations. She is a key opinion leader in cutting-edge hygiene innovations and is currently conducting a scoping review on access to care for the institutionalized elderly population. Dahm's additional scholarly work includes research on periodontal pathogens, and her ongoing interests span emerging trends in dental hygiene, strategies to improve access to oral care for the underserved, and the role of mental health in dentistry. She can be reached at [email protected].
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