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Hygienetown: The Future of Preventive Care

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Categories: Hygiene;
Hygienetown: The Future of Preventive Care

Are states moving toward mid-level scaling roles?

Across the country, practices are rethinking how preventive care is delivered and who is trained to provide it. Arizona’s newly approved Oral Preventive Assistant (OPA) role is the latest example of a state experimenting with ways to ease hygiene shortages and improve access. While this law applies only to Arizona, the conversation it sparks is national. Many hygienists, assistants, and dentists are watching closely because what happens in one state often influences what happens in the next.

Arizona’s law establishes a certified mid-level role for dental assistants who complete a 120-hour training program and meet prerequisites, including CPR certification, radiography credentials, and coronal polishing certification. Once certified, OPAs may remove supragingival plaque, calculus, and stains using hand or ultrasonic instruments. Importantly, they may do so only on patients who have already been evaluated and are either periodontally healthy or show only mild, localized gingivitis. Supervision rules are strict: A dentist may oversee up to three OPAs at once, while a hygienist may supervise only one. Working outside that scope is considered unprofessional conduct. Arizona’s dental board must track how many OPAs become certified, how they’re used, and any related complaints, and report the results in 2029.

Supporters in Arizona see this as a practical response to persistent hygiene shortages, a challenge not limited to one state. Practices nationwide have felt the strain as hygiene wages rise, schedules back up, and preventive visits take longer to accommodate limited staffing. Under this model, experienced assistants can step into a narrowly defined scaling role, allowing hygienists to devote more time to periodontal therapy, diagnostics, and more complex care. Those speaking in general terms say this approach may stabilize staffing, increase access, and relieve bottlenecks in high-growth or rural areas.

But hygienists are also raising questions that resonate far beyond Arizona’s borders. The American Dental Hygienists’ Association has expressed concern that abbreviated training pathways could erode standards and compromise patient safety. It has opposed legislative efforts in multiple states to lower educational requirements for similar roles. Their position is that hygiene education is not just about technique, but about deep clinical understanding of disease progression, early diagnosis, and comprehensive periodontal management. Although the Arizona Dental Hygienists’ Association has not issued a formal response to this bill, its stated policy underscores the need for rigorous academic and clinical preparation for anyone performing preventive procedures.

Arizona is not alone in exploring this kind of delegation. Kansas and Illinois have long permitted assistants to perform supragingival scaling under narrow conditions, and Missouri is testing a pilot program for scaling assistants. National organizations have drafted model legislation for states interested in creating their own version of a mid-level preventive role. Some see this as a natural evolution of team-based care; others view it as the beginning of a larger debate about training standards and professional boundaries.

Looking internationally adds more perspective. In Canada, dental assistants are not permitted to scale. Hygienists are independently regulated providers with their own licensing bodies, the ability to practice without a dentist present in many provinces, and responsibility for all preventive and periodontal procedures. The Canadian model reinforces the hygienist’s deep clinical role rather than creating mid-tier positions.

For practices in Arizona, and potentially in other states watching this experiment unfold, the most immediate impact will be on the hygiene schedule. Healthy patients can be moved into shorter, more flexible appointments, while hygienists focus on periodontal care, diagnostics, and patient education. Assistants gain a career ladder, and practices gain a tool for managing labor costs and workflow. Nationally, some predict this direction may appeal especially to large groups and DSOs looking to expand capacity within existing staffing constraints.

But whether this shift ultimately strengthens the dental team, or blurs the lines in ways that create new challenges, will depend on outcomes still years away. Will access improve? Will wait times shrink? Will training prove sufficient? Will supervision ratios work as intended? Arizona’s 2029 report will offer the first clear set of answers, and the rest of the country will be watching.

If states continue exploring mid-level preventive roles, how do you believe this will affect the long-term balance between assistants, hygienists, and dentists—and what safeguards should be in place to protect patient care?
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