The Latest Updates on Nevada’s Bid to Let Dentists “Train” Dental Hygienists on the Job

UPDATE (6/3/2025):

SB 495 died as a result of the legislature running out of time.  While it did pass in the Nevada Senate, the Assembly did not have the opportunity to vote since the session ended at midnight.  The Nevada legislature will convene again in 2027, so it’s possible this effort could return.  In the meantime, other states will likely try to implement this type of legislation (on-the-job training for dental hygienists) or similar means to increase what is claimed to be a shortage of dental hygienists.  For example, Arizona just passed a measure to implement Oral Preventive Assistants (OPAs) who will perform supragingival scaling procedures on “healthy” patients.  Stay aware, and fight to preserve the high standards of the dental hygiene profession.

6/2/2025

As I write this, the decision in Nevada has not yet been made regarding the outrageous proposal to train dental hygienists “on the job.”  In case you aren’t aware, the Nevada Dental Association and the American Dental Association are proposing this as a “solution” to the lack of dental hygiene workforce in the state.  This is a bad idea for so many reasons, most important it jeopardizes the safety of the patients we are bound to treat.  The dental hygiene Code of Ethics states, “Our education and licensure qualify us to serve the public by preventing and treating oral disease and helping individuals achieve and maintain optimal health.”  We must uphold that premise, and on-the-job training by a dentist flies in the face of maintaining high standards.

Not all dentists support the Nevada proposal. The Academy of General Dentistry has formally written its opposition, and individual dentists are also stepping forward to support high education standards for our profession.  One example is below.

We must stay vigilant – unfortunately I suspect this is not the only state that will attempt to dilute our profession. We must oppose all such efforts and enlist others to do so.  We must educate the public about our educational qualifications and what that means to public safety.  We must unite and support our national association, the ADHA, that is working diligently to address such threats.

 

The Honorable Fabian Donate

Chair, Nevada Senate Health & Human Services Committee
401 S. Carson Street
Carson City, Nevada 89701

Dear Mr. Donate:

Re: Proposed changes to Nevada laws aimed at “improving access” to dental care

Numerous State’s Dental Associations are pushing — in the name of creating better access to care — to downgrade the quality of care provided in dental offices to dental hygiene patients. Unfortunately, efforts to change state law to this effect are now underway in Nevada.

Also unfortunately, the American Dental Association (ADA), wracked in recent years by poor financial management and loss of members, finds itself arguing for similar changes.

The American Dental Association and states’ dental associations too often conflate doing what’s right for needful patients with doing what amounts to little more than rent-seeking on behalf of their members. Even the American Academy of Periodontology (AAP) — that I once led — plays along with this nonsense for fear of angering general dentists who occasionally refer patients to them.

Here’s a few things that may interest you:

— Dental students get little training in diagnosing and managing gum disease and even less in how to treat it. This is because these diseases are chronic and most of the money to be made in dentistry lies elsewhere. One quick example I can provide, is that despite being a highly credentialed specialist in periodontology, my instrumentation skills, compared with the skills required of a dental hygienist, are laughably poor. And it’s my reasoned estimate that 99% of general dentists have lesser skills.

— Organized dentistry and even the AAP have failed to promulgate clinical guidelines for the long-term management of periodontitis (gum disease). This is because they’d rather not fret about best practices in the context of diseases that often go unnoticed by patients until severe. And yes, this abuse of needful patients continues, despite all the links showing gum diseases are associated with serious and life-threatening diseases, including cancer, heart disease and stroke. I have worked for nearly a half-century to change this… so far unsuccessfully.

— It hurts me to say this, but the ADA, state dental organizations and even the AAP let money get in the way of doing what’s right for needful and trusting patients.

The legislation you are considering would permit general dentists — the same cohort that gets minimal training in diagnosing and managing periodontitis… and even less training in how to treat it — to “train” any individual they chose and turn that person loose to perform dental hygiene services ostensibly “under the supervision of a dentist”.

The aphorism of the “blind leading the blind” comes to mind and is not an understatement here.

Indeed, such an approach to dental workforce issues is absurd on its face. IOW, the solution that dental organizations suggest is to “improve access” by facilitating that “care” by individuals who have little or no training… and what training they do have is provided by others who only seldom have much of a clue as to what they are doing themselves in the relevant realm….

You will hear that other states are doing similar things. That’s true and it’s just as dumb in those states as it soon will be in Nevada if this legislation is made law.

I am fully free to make these statements because despite my personal and ample history in numerous roles at the ADA and AAP, neither can stifle me… because I am retired as both a clinician and scientist. I worked within both the AAP and ADA to improve the mindsets of these organizations — to at least put the welfare of needful patients on par with the financial welfare of their members. But not with much success, I’m sorry to admit.

Others still in practice often can’t say the truth for fear of the approbation that they will get as a result.

So please do the right thing and bury this plan to render worthless the practice of dental hygiene in Nevada. You are, of course, free to share my views with anyone with whom you see fit. Some of my colleagues may be angered as a result. But I care more about needful and trusting patients whom I don’t know — than I do about colleagues who would betray the trust of those patients.

Sincerely,
Michael P. Rethman DDS, MS