- The Washington Times - Sunday, June 3, 2012

A proposal that would allow a new class of dental assistants in Virginia to work in patients’ mouths with high-speed instruments has many in the professional community gnashing their teeth.

The state Board of Dentistry is scheduled on Friday to take up the matter, which was proposed by Denice Burnette, the only dental assistant II (DAII) in the state. “DAIIs,” effective March 2011, require much more extensive schooling and training than regular dental assistants.

Ms. Burnette went to dental assistant school, then went back to get an “expanded functions dental assistant” license - which is equivalent to Virginia’s DAII status, she said.

“Using the high-speed in other states is not an uncommon thing, and there are guidelines on it,” she said. “You’re not cutting tooth structure or tissue or anything like that.”

“In order to do that filling … like it should be, you need the high-speed,” she continued. “At this point, I can’t get it perfect like it should be, so I have to get the doctor to come back in.”

A dental assistant I must complete a course or earn certification to operate X-ray equipment, and must be certified in basic resuscitation techniques or as an anesthesia assistant.

Meanwhile, a DAII has to undergo more extensive training, which includes taking 50 hours of instruction in dental anatomy and operative dentistry and passing a written exam. The sponsoring program, which can be an accredited dental, dental hygiene or dental assisting program, can offer the instruction online.

DAII applicants then must undergo 150 hours of laboratory training in modules such as cementing crowns and bridges, 300 hours of clinical experience in a dental office under the direct supervision of a dentist, and pass a comprehensive exam.

But Dr. Roger Wood, president of the Virginia Dental Association and past president of the Board of Dentistry, said allowing advanced assistants to use the high-speed instruments would not be a good idea.

“It takes four years of intense training at dental school to turn anybody out to the public to use a high-speed handpiece,” he said. “I don’t understand where they’re coming from - they can use a slow-speed handpiece.”

Nancy Daniel, dental assisting program head at J. Sargeant Reynolds Community College in Richmond, said one reason the new category was added was to increase job prospects for dental assistants and help out rural parts of the state, which may not have as many dentists as more-densely populated areas.

She thought those objecting to the change - such as the flurry of commenters on Virginia’s Regulatory Town Hall website - didn’t realize there is a lot more to the position than meets the eye.

For the Virginia Community College System, “there [are] no courses that are developed right now for this,” she said. “I’m trying to develop some courses. It’s going to be awhile before we offer a program. It can be kind of dangerous using a high-speed handpiece.”

Dr. John Marino, a Northern Virginia dentist who helped craft the current regulations, was adamantly opposed to having anyone but a dentist operate instruments that can move as fast as 400,000 revolutions per minute. He said crafting and outlining the limits for a DAII was done quite deliberately.

“You make a mistake, you make a huge hole in something,” he said. “Usually the patient’s soft tissue.”

Having served in the military as a dentist for three years, Dr. Marino said he didn’t want to see any more “OJT” - or on-the-job training - workers in his profession.

“I saw some serious damage done by these OJT hygienists on occasion because they weren’t really trained as hygienists, even,” he said. “When it goes south, it’s going to go south big-time.”

Ms. Burnette said the whole controversy might well have been averted if the name - “dental assistant II” - were changed to “expanded-function dental assistant” to drill home that the position entails more than just cleaning teeth - such as placing and finishing fillings.

“I really wish they would have called it EFDA, because it really does separate the two,” she said. “And not try to compare it to hygienists. They went to school to clean teeth, but they can’t fill teeth. I went to school to fill teeth, but I can’t clean teeth.”

“It’s not like you can graduate high school and go straight to expanded-function school and be an expandedfunction [dental assistant] next year,” she continued. “It’s not a weekend course.”

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