Access to Care or Compromise in Care? A Closer Look at Virginia’s New Laws

Virginia is making headlines with two newly signed bills aimed at addressing what’s being called a dental hygiene “shortage.” On the surface, the intention sounds reasonable: increase access to care by expanding who can provide it.

But as with many quick fixes, the real question isn’t just can we—it’s should we.

The first bill allows foreign-trained dentists to practice as dental hygienists. The second permits dental assistants to perform supragingival scaling—both by hand and with ultrasonic instruments—above the gumline.

There’s no denying the challenge. Yes, there is a demand for dental hygienists. Yes, offices are struggling to hire. But is lowering the educational and clinical standard truly the solution?

Let’s take a closer look.

Foreign-Trained Dentists as Hygienists

At first glance, this might seem like a win. Dentists are highly trained providers, after all. With proper training, a dentist should be well educated, right? While this can be true, dental education varies significantly across countries—both in depth and in scope.

So the question becomes: What standards will be in place to ensure these providers are qualified to practice dental hygiene at the level patients deserve?

Dental hygiene isn’t just “dentistry-lite.” It’s a distinct discipline focused on prevention, biofilm management, patient education, and early detection. Without clear, rigorous pathways for evaluation and competency, we risk creating inconsistency in care—and confusion in roles.

Scaling Assistants: A Fragmented Approach to Care

The second bill raises even more questions.

Allowing dental assistants to perform supragingival scaling sounds simple enough. But dentistry is rarely that simple.

First, what does the appointment look like? Does the dentist or hygienist assess the patient first and determine they’re “healthy enough” for a scaling assistant? If subgingival calculus is present—as it often is—does another provider step back in? Are we now breaking a single, comprehensive visit into multiple handoffs?

And perhaps most importantly: Does supragingival scaling alone even benefit the patient?

We need to be honest about what a “teeth cleaning” actually is.

It’s not just about removing visible, hard deposits. It’s about disrupting biofilm—a living, dynamic, and potentially pathogenic community that exists both above and below the gumline. If we focus only on what we can see, we ignore what’s actively contributing to disease.

Incomplete care isn’t just inefficient—it can be harmful.

Have We Forgotten the Purpose of Care?

Somewhere along the way, it feels like we’ve reduced dental hygiene to a task instead of a clinical service.

Prevention requires assessment, critical thinking, and clinical judgment.

The “Access to Care” Argument

These changes have been positioned as a solution to access issues. But access to what kind of care?

If the standard of care is lowered, are we truly improving access—or simply increasing volume?

Programs have closed. I experienced this firsthand teaching in Virginia, where low pay and lack of support contributed to closures.

Now What?

These bills have now been signed into law.

Still, patients deserve transparency. Ask: “Is the person performing my cleaning a licensed dental hygienist?”

And for hygienists—this is the time to lean in.

Advocate. Educate. Stay curious.

A Better Path Forward

We do need more providers—but not at the expense of care quality. Lowering the bar shouldn’t be the solution.

Because this isn’t just about staffing. It’s about patients.

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