Only a licensed dental hygienist who has graduated from an accredited dental hygiene education program, or a licensed dentist, is qualified to deliver preventive dental hygiene services such as the oral prophylaxis. Allowing unlicensed personnel, like dental assistants, to perform dental hygiene services indiscriminately without first assessing the status of oral health, determining the need for specific services, and formulating a dental hygiene treatment plan is poor oral health care. Dental groups who are in favor of shifting dental hygiene duties to dental assistants usually say they are doing it because they believe there is a national shortage of licensed dental hygienists. However, there is no valid evidence to substantiate this claim. In fact, the number of dental hygiene program graduates has exceeded the number of dental school graduates for the past six years.
Oral health faces the same challenges in rural areas as other kinds of health care services.
The problem is a limited number of practitioners trying to serve a widely dispersed population. Laws that require dental hygienists to practice in the immediate presence of a dentist make the situation worse. Since dental hygienists are restricted from practicing on their own, they are forced to go where the jobs are, instead of where patients need them.