The Hygiene Shortage Debate: What If We're Asking the Wrong Questions?

Few topics create more heated discussions in dentistry right now than the hygienist shortage.

Before we go any further, these are my opinions. It's completely okay if you disagree.

Can There Be a Shortage and a Retention Problem?

Personally, I believe there is a hygienist shortage. And a dentist shortage. And an assistant shortage (but I digress).

I also believe there are practices struggling with retention because of poor systems, lack of support, burnout, physical strain, limited benefits, and workplace culture issues.

These ideas are not mutually exclusive. There can be a shortage AND a retention issue.

For years, many hygienists experienced stagnant wages and limited benefits despite bringing tremendous value to dental practices. As a matter of fact, when I was in school (I graduated in 2008), I was told, "Hygienists don't really get raises."

While I am fully in support of hygienists being paid what they're worth, I don't believe simply demanding higher and higher wages is the long-term solution. Many practices are financially strained, and rising labor costs are forcing them to explore alternative workforce models.

Long-Term Solutions vs. Today's Problems

One solution often discussed within our profession is expanding hygienist autonomy through independent practice, advanced degrees, and expanded practice models.

I would love if hygienists had more options for career advancement!

But here's the question I've been asking myself:

How does that help the average dental practice that can't fill a hygiene schedule next month?

That doesn't mean these efforts aren't valuable. They absolutely are. But they are largely long-term solutions focused on access to care, professional advancement, and workforce development.

Many practices are facing immediate staffing challenges today.

The Silent Killer: Insurance Reform

There's another issue that I believe doesn't get enough attention: insurance reimbursement.

In my opinion, poor insurance reimbursements (or lack thereof) is the silent killer slowly eroding dentistry.

The reality is, practices are being squeezed from every direction.

Team members deserve fair compensation. Patients deserve quality care. Practices need to remain financially healthy enough to support both.

When people ask why alternative workforce models are being considered, I think financial pressure is a major reason.

Could Assisted Hygiene Be Part of the Solution?

Let's talk about assisted hygiene.

Not the version where hygienists are double-booked, running between rooms, and rushing through patient care.

I'm talking about thoughtfully designed assisted hygiene models where highly trained assistants help with appropriate tasks so hygienists can focus on the work that truly requires their education, skill, and clinical judgment.

Done correctly, assisted hygiene could:

• Increase access to care

• Improve efficiency

• Help practices see more patients

• Allow hygienists to practice more at the top of their license

• Potentially increase earning opportunities

  
  

Is it the perfect solution? Maybe not for everyone.

But I think it's worth discussing instead of automatically dismissing it.

Is It Time to Rethink Compensation?

Another conversation worth having is compensation.

Historically, most hygienists have been paid hourly regardless of production, schedules, or performance.

What if compensation evolved?

What if hygienists received a strong base pay plus production-based incentives or commission?

This could potentially align the interests of both the practice and the provider while creating opportunities for hygienists to earn more when helping the practice grow.

Again, I don't claim to have the perfect answer. I simply think these are conversations worth exploring.

What About OPAs, Foreign-Trained Dentists, and Dental Students?

This is probably where I'll lose some people.

Do I think someone should be able to walk into a dental office and start doing hygiene procedures without proper education, testing, competency assessments, and accountability?

Absolutely not.

When I see that some want dental students, foreign-trained dentists, and assistants to "just get trained" and start doing hygiene duties, I cringe. And I worry for patient safety and health.

I worked hard for my education and license, and I believe patient safety should always come first.

That said, we have to acknowledge reality.

Across the country, conversations are already happening around Oral Preventive Assistants (OPAs), foreign-trained dentists becoming hygienists, and dental students being allowed to perform certain hygiene-related duties.

Whether we agree with these ideas or not, they are being discussed (and in some areas, already being used).

When I first heard of the OPA, and training dental students and internationally trained dentists to do hygiene, I cringed. While I still do and wish we weren’t here, we are.

And that's exactly why I think hygienists need a seat at the table.

Instead of simply saying "no," what if hygienists were the ones helping establish the standards?

What if hygienists were responsible for training these providers?

What if hygienists helped develop competency assessments and determine what skills are required before someone is allowed to provide care?

Who better to define quality hygiene care than the professionals who provide it every day?

In fact, this could create an entirely new career path within dental hygiene.

Imagine experienced hygienists serving as educators, trainers, evaluators, mentors, and "competency specialists" responsible for maintaining the standards of care we value so much.

I wish we weren’t here; I wish we had plenty of hygienists, dentists, and assistants that we didn’t need to have this conversation. I wish all team members were compensated appropriately and supported in their jobs.

But the reality is we are here, and we must have these hard conversations.

But if these workforce models continue to move forward, I'd rather see hygienists helping shape them than watching from the sidelines while others make those decisions for us.

What If We Rethought the Entire Practice Model?

I also wonder if dentistry can learn from other healthcare professions like physical therapy.

I've been to physical therapy more than a few times, and each time, I was evaluated by the PT, then handed off to an assistant who walked me through the exercises. This allowed the PT to see more patients and provide more care.

Could dentistry learn something from that model?

Could hygienists evaluate patients, identify risk factors, determine the level of care needed, and help direct patients to the most appropriate provider? Almost like a triage system?

What if hygienists played a larger role in determining who needs advanced care versus routine preventive services?

What if hygienists were the ones helping train and establish competency standards for new provider models?

Here's My Fear:

My fear is that hygienists become so focused on protecting the current model that we miss the opportunity to help design the next one.

If OPAs, alternative provider models, foreign-trained dentists, dental students, assisted hygiene, insurance reform, and new compensation structures are all being discussed, then hygienists deserve a seat at every one of those tables.

I don't claim to have the answers (I have more questions than answers, really), but I do have some ideas. And I think we all need to be willing to open our minds so we don't get left behind.