Missouri Hygienists Sue Dental Board Over Rule Letting Assistants Perform Scaling

Edited by Dentaltown staff

The Missouri Dental Hygienists’ Association has sued the Missouri Dental Board to block a proposed rule that would let specially trained dental assistants perform supragingival scaling and comprehensive periodontal charting. The association argues that state law reserves those procedures for dentists and licensed hygienists.

The suit was filed Sept. 29 in Cole County Circuit Court. Lori Crawford, a former association president who has been a licensed dental hygienist in Missouri since 1986, joined as a plaintiff. The plaintiffs ask the court to declare the rule invalid and to issue preliminary and permanent injunctions barring the board from finalizing it or issuing permits under it.

The proposed amendment to 20 CSR 2110-2.120, published in the Sept. 15 Missouri Register, adds a periodontal category to the expanded functions permits the board issues. Permit holders could perform supragingival scaling and comprehensive periodontal charting when delegated by a Missouri-licensed dentist. Subgingival scaling would remain among the procedures dentists may not delegate to assistants. Assistants who held permits under the state’s oral preventive assistant pilot could submit proof of competence and receive the new permit before Feb. 1, 2027. A companion amendment sets a $10 permit fee.

Missouri statute defines dental hygiene practice to include removing hard and soft deposits from teeth and performing clinical examinations of teeth and surrounding tissues. The lawsuit argues that state law limits what the board can delegate to assistants in that area to polishing, sealants, and fluoride, and that the board cannot add scaling and charting by regulation. It also challenges the conversion of pilot participants into permanent permit holders. It contends that the rule drops a pilot requirement that patients be told an assistant is providing their care and consent to it.

The pilot ran from January 2024 to October 2025 under a 2022 statute that allowed temporary projects to test new care models for underserved patients. That authority expired Aug. 28, 2026. According to the project’s final report, 15 assistants who completed its training treated 1,626 patients under direct supervision. Supervising dentists rated their clinical performance 9.6 out of 10. Patients rated their care 9.8, compared with 9.7 for dentists and hygienists. The report recorded no adverse incidents, injuries, or patient complaints.

Other results were mixed. Three clinics where assistants handled more than 4% of appointments saw capacity gains, while clinics below that level showed no significant increase. In gingivitis therapy, 76% of 33 patients treated by assistants improved on re-evaluation, compared with 93% of 30 patients treated by dentists or hygienists the year before. The report attributed every case that did not improve, in both groups, to poor home hygiene. It also noted that dentists and hygienists had re-evaluated their own patients, a potential source of positive bias.

The two sides read those results differently. The hygienists’ association says the pilot failed to show a significant increase in clinic capacity or improved access for patients with more serious periodontal disease. The Missouri Dental Association, which helped develop the pilot and provided editorial review of the report, points to high clinical performance and satisfaction ratings, the absence of adverse incidents, and capacity gains in clinics that used the assistants more.

Diann Bomkamp, the hygienists’ association’s legislative chair, said the legislature let the pilot expire and that making it permanent is not a decision the board can make on its own. The board voted 4–3 on May 14 to move the rule forward, according to the association.

The board is accepting public comment on the proposed rule through Oct. 15. No public hearing is scheduled.

Sources:
Missouri Secretary of State, Missouri Register, Vol. 51, No. 18, proposed amendments to 20 CSR 2110-2.120 and 20 CSR 2110-2.170, Sept. 15, 2026: sos.mo.gov/moreg/2026/v51n18Sept15
Missouri Dental Hygienists’ Association, “Missouri Dental Hygienists’ Association Sues Dental Board to Stop Rule Letting Assistants Perform Hygiene Procedures,” Sept. 30, 2026: missouridha.org/current-events
St. Louis Business Journal, “Missouri dental hygienists sue board over assistant rule,” Sept. 30, 2026: bizjournals.com/stlouis/dental-hygienists-challenge-state-rule-scaling
Missouri OPA-EFDA Pilot Project final report, March 2026: ada.org/mo_efda_pilot_project_2026.pdf
Missouri Dental Association, “Periodontal EFDA (OPA)”: moefda.org/course-information/oral-preventive
Missouri Revisor of Statutes, Section 332.091: revisor.mo.gov/section=332.091
Missouri Revisor of Statutes, Section 332.325: revisor.mo.gov/section=332.325