Two bills moving through the Virginia General Assembly are fueling a growing fight inside the state’s dental community, as lawmakers look for ways to reduce long waits for routine dental care.
The legislation, backed by the Virginia Dental Association, aims to address workforce shortages that have left some patients, particularly in rural and underserved communities, waiting months for cleanings and checkups.
One bill would allow dental assistants to earn a new certification to perform limited preventive cleanings, specifically above the gum line, after completing on-the-job training. Another would create a faster licensing pathway for some internationally educated dentists to qualify as dental hygienists, if the state Board of Dentistry determines their education meets Virginia standards.
Supporters, mostly dentists, said the changes would help dental offices see more patients by expanding who can provide basic care.
But dental hygienists are pushing back, saying the bills can lower standards of care and oversimplify the role and training of hygienists.
Derik Sven, president of the Virginia Dental Hygienist Association, raised health concerns about the measure allowing dental assistants to perform partial cleanings.
“The reason why the entire tooth has to be thoroughly cleaned, both above and below the gums, is if you don't do that, it can create the beginnings of gum disease, “ Sven said. “It creates what we call dysbiosis. It causes inflammation to progress. So, what they're doing right now is literally trying to legislate malpractice.”
Ryan Dunn, chief executive officer of Virginia Dental Association, said the measure is intended for patients with healthy teeth, such as younger people who “take good care of their oral health” and do not have significant plaque buildup.
“What it is going to do is create a certification that will allow a dental assistant to scale and polish,” Dunn said.
Dunn did not comment on the health concerns raised by hygienists, but cited a study from Missouri, where oral preventive assistants – who typically receive additional training beyond that of dental assistants – are allowed to perform limited preventive cleanings under dentist supervision. The study reported no adverse events and acquired high scores in patient satisfaction rates.
He said allowing dental assistants to do partial cleaning does not mean to “replace” dental hygienists but rather keep the dentist-led care model intact while giving practices more flexibility to meet patient demand.
Internationally-trained dentists could become hygienists
Hygienists said the proposal involving internationally educated dentists treats dental hygiene as a simplified version of dentistry, even though the two professions have distinct training and clinical roles.
Sven warned that allowing licensure based largely on testing, without requiring comparable clinical training in the U.S., could put patients at risk.
“They're trying to cast dental hygiene as dentistry light,” Sven said. “Everything hygienists do is preventive and non-surgical, and our entire purpose is to prevent the public from needing a dentist in the first place. Dentists are trained as surgeons. They do not possess the same training and non surgical techniques that hygienists do.”
Dunn said the proposal involving internationally educated dentists is intended to provide an immediate workforce boost.
“We've actually heard from the Board of Dentistry and others that there are a lot of internationally educated dentists,” Dunn said. “So this is just a way to engage those that are certainly capable and have been educated internationally to pass the same licensure standards.”
Dunn said he does not know the exact number of internationally educated dentists in Virginia, but he said it will be “a significant number and will be somewhat of an immediate help.”
The pathway for international dentists to acquire hygienist’s licence would only apply if the board determines the applicant’s training is sufficient.
Paul Logan, director of strategic initiatives at Virginia Dental Association, said in many other countries, dentists also receive preventive care training and routinely perform both dental and hygiene-related work.
“They have great experience that they would like to be using and to treat patients in the community in which they're living. This gives them a pathway,” Logan said.
Factors behind the hygienist shortage
The bills have also reopened a long-running debate over whether giving dental hygienists more independence would help address the shortage.
Sven, the hygienist, said states that allow hygienists to practice with greater autonomy have been more successful at retaining them.
In Virginia, hygienists must work under a dentist’s supervision and cannot operate their own clinics or provide care without a dentist’s oversight.
He pointed to places such as Colorado and California, where hygienists can operate without dentists’ supervision, saying the flexibility helps keep people in the profession longer.
“If somebody else is governing you, and they can effectively sabotage you, they can minimize your ability to serve the public they have. At some point, you have to look at this and go, ‘Well, you know what? I can work in a different field,’” Sven said. “So if you want these hygienists who are still leaving the field to stop and stay, you have to create opportunities for them to be able to fully utilize their potential.”
On the other hand, Dunn said states that allow independent hygiene practices have not seen meaningful gains in access for rural or underserved patients.
He said those practices tend to open in suburban areas where demand is already high.
“It's really adding inefficiency to the oral health care instead of creating efficiency,” Dunn said.
Sven said Virginia’s hygienist shortage does not stem from training, but retention. He cited studies from American Dental Association that say hygienists often leave the field because of negative workplace culture, lack of growth opportunity and inadequate benefits.
Chelsea Fosse, study researcher and vice president of the American Academy of Pediatric Dentistry, found that many hygienists leave because of day-to-day working conditions, not pay.
“I think some of the workplace culture elements that we saw were the need for flexibility,” Fosse said. “What did drive satisfaction is feeling connected to the patient's care, feeling important in the patient's care.”
Sven said the association plans to push for changes that focus on retention, including calling for a state-level study to track why licensed hygienists leave and exploring career pathways that give them more control over their work.
The bill allowing dental assistants to perform limited cleaning procedures passed out of the Senate Subcommittee on Health Professions on Jan. 30.
