Don't box me in: Five ways to push for comprehensive dental hygiene

It’s 11:55 am on a Friday and into my operatory comes the office manager with that look on her face. I close my eyes and inhale a slow, deep breath.

It’s been a long year of battling for every single thing—not just equipment, but the very permission to serve—and I’m exhausted. It’s in this moment that I realize I could more easily make a man fly to the moon on a marshmallow than make one change in this office. My time here is officially limited, and I know I’m not alone.

Staffing woes uncovered by a pandemic

The hygiene shortage is no secret. In April 2021, a study showed that 37.2% of hygienists reported “retiring from dental hygiene practice,” despite 20% being under the age of 55.¹ Fast-forward to quarter three of 2024 and 76.8% of dental offices still report that it’s “extremely difficult” to hire a hygienist.² This tells me that the pandemic was a mere catalyst for a much bigger movement. How did we get here, and how do we fix it so that we all—patient, practice, and hygienist—win?

The top three reasons for job change reported by RDH magazine in the 2024 Salary Survey Report were location, pay, and work environment.³ This falls in line with their 2023 survey showing that 40% leave for office culture reasons.⁴ Even though pay has increased, 42% are still on the lookout for something else. Maybe money really doesn’t buy happiness?

The contrast between what we learn in school about the importance of the assessment process and comprehensive care and what we experience in the real world is stark. The career becomes a job of how many teeth scrapings and x-rays can be billed per day. If you’re like me, it’s not what you signed up for.

We’ve been placed in a box. A prophy mill box (without a window!), and we’ve allowed it. Maybe instead of leaving the profession, we should secure our position on the team as the drivers of excellent standards in our area of oral care expertise.

Practicing comprehensive dental hygiene

For this hygienist, practicing comprehensive hygiene means having the tools/support to perform assessments, make recommendations, and deliver treatment that is in my patients’ best interest. Assessments like full oral cancer screenings, sleep apnea screenings, complete periodontal evaluations, thorough medical history reviews, nutritional impact discovery, alignment evaluations, saliva testing, and caries rate investigations. Adjuncts like guided biofilm therapy (GBT), preventive laser bacterial reduction (LBR) and curettage, desiccation gel, desensitizers, oral probiotic applications, and most certainly various home-care strategies including hydrogen peroxide gel application trays, oral irrigation additives, and dry mouth solutions.

It also means growing beyond what “we’ve always done” to “what we know now” and bringing patients with us to increase their dental IQ so that they can move beyond an insurance-driven mindset.

This isn’t really the money issue it seems to be. No, this is a fear issue. Practice owners (reasonably) fear losing patients, credibility, and livelihoods. Couple those fears with even a shred of poor communication, ego, or insecurity, and it’s a recipe for conflict. The reality is that dental offices are filled with all kinds of people in different places in their careers, and not everyone moves at the same pace. So, if you’re a hygienist who wants to push for a comprehensive approach to dental hygiene but feels handcuffed, here are five suggestions that may help.

**1. Vet potential employers before accepting a position**

Alignment is the key to long-term success. No amount of money is enough if we’re firmly misaligned in practice philosophy. During the interviewing process, talk openly about philosophies, “I firmly believe that routine laser treatment has an integral place in preventive care for all patients” sets clear expectations as opposed to “I really like the laser.” Express your boundaries: “I require 90 minutes to perform a new-patient exam including x, y, and z. Is this something that the practice is in alignment with?” Finally, ask future-based questions. “What are the practice goals? Are you interested in expanding beyond what you currently do now? What is your tolerance level for incorporating new things in the practice?” This last question will tell you a lot. It can be uncomfortable to have these discussions, but having them when frustrated and full of resentment is much more uncomfortable.

2. Seek understanding

When progress isn’t embraced as was discussed in the interview, ask open-ended questions without judgment that can explain where the fear is coming from. “What is your hesitation for using the laser preventively?” or “I’ve noticed that my recommendation for adult ortho often isn’t supported. Can you tell me why?” It’s not always about money. It can be as simple as philosophy differences. “I don’t believe healthy tissue benefits from laser treatment” or “I don’t believe adults will wear retainers.” If the issue is philosophy, ask if there is room for discussion to help bridge the gap with education. If it’s money, ask, “Can we discuss possible solutions to make the suggestion make financial sense?” Neither can happen without understanding first.

3. Educate with kindness

Approach is everything. Come with evidence, implementation, and positivity. Ask if a meeting/conversation can be scheduled to discuss a possible improvement to patient care in the hygiene department. Bring evidence to back why you believe that change will help patients and the practice. Be prepared to answer how that change will affect the team. Will the assistants be needed? Will the business team have more work? What are the potential drawbacks and what verbiage is best to gain patient acceptance? How much is this change going to cost and how long will that investment take to be profitable? Keep an open mind to objections or concerns and request an opportunity to resolve objections.

4. Be patient

Change is hard for some and exciting for others. Apply patience by offering one idea at a time. Give that idea/product/protocol time to become standard practice before offering up the next. If money is the issue, maximize available resources first. Many practice owners are hesitant to buy new equipment when the last thing is sitting unused in the supply closet. Receiving partial objections with an open mind is crucial. A “yes, but in another way” is a step in the right direction and shows an open mind.

5. Leave

If every idea for elevated care is met with a “no” regardless of evidence, and a willingness to work through objections isn’t an option, it’s not a good fit. There are offices that want hygienists to scrape eight sets of teeth and leave, but not every office. When it’s clear that alignment just isn’t possible, leave the practice before leaving the profession.

Ultimately, if change has minimal draw on the team, patient acceptance is likely, patient health can improve and revenue potential is there, a practice owner is more likely to view your comprehensive hygiene practice goals as an alliance. There are many offices desperately searching for hygienists who want to do more and who are dedicated to elevated care. Don’t give up!

Editor's note: This article appeared in the January/February 2025 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.

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