The Bills: SB 178 and HB 970

These bills are commonly described as workforce expansion route B. They would create/expand a “preventive/preventative dental assistant” role and authorize that role to perform limited preventive cleanings (often described publicly as above-the-gumline scaling/polishing) under dentist supervision.

What supporters say

Supporters (including the Virginia Dental Association, as reported publicly) say the goal is to:

• reduce long waits for routine care;
• increase practice capacity;
• let dental hygienists focus on below-the-gumline care while assistants handle limited above-the-gumline tasks.

What opponents are concerned about

Opponents argue this approach risks:

• incomplete care and delayed identification/treatment of periodontal disease;
• patient confusion (a “cleaning” that is not a full cleaning);
• insufficient or inconsistent training/competency verification;
• “productivity pressure” that can undermine safeguards in real-world settings.

Key questions legislators should answer (before expanding scope)

If lawmakers advance these bills, they should answer—clearly and in statute/regulation—at minimum:

1. Patient eligibility: Which patients qualify for “above-the-gumline” scaling/polishing? How is periodontal status determined?

2. Supervision definition: Is this direct or indirect supervision? Is a dentist required to examine the patient the same day?

3. Independent competency: Is competency verified by an independent clinical exam, or primarily by employer attestation?

4. Disclosure & consent: Will patients be told—explicitly—when care is provided by a preventive dental assistant rather than a hygienist?

5. Outcome reporting: What adverse-event reporting, audits, or quality measurement will exist?

6. Sunset & evaluation: Will Virginia require a time-limited pilot (sunset clause) and independent evaluation before permanent statewide expansion?

Recommended guardrails (if the bills move)

If the bills are not stopped, basic guardrails should include:

• clear eligibility criteria (exclude high-risk patients);
• explicit informed consent and patient-facing disclosure;
• independent competency testing and standardized curriculum;
• strong supervision requirements;
• mandatory reporting and Board oversight;
• a sunset clause.

Next: Patient safety • Take action