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Thriving at a DSO: 4 hygienists share their experiences

Aug. 30, 2021
DSOs remain a controversial topic among hygienists, but many have no experience with them. We asked four DSO hygienists to share their thoughts.

Dental service organizations (DSOs) remain a controversial topic among hygienists, who tend to see the group model practice at odds with patient-centered care. But because DSOs still represent a minority of dental practices, most hygienists have not worked, and may not personally know anyone who has worked, at a DSO. As part of this issue focusing on nontraditional career paths, RDH invited four DSO hygienists at different stages of their careers to share their experiences.

I have worked for a DSO in some capacity for the last 10-plus years and have loved it. It has given me a stable job, steady income for my family, good benefits, and opportunity for growth—essentially everything that I ever needed.

I recently saw a thread on social media where a hygienist posed the poll question about where she should go to work: office A (private practice) or office B (DSO). It was a landslide response of almost 100% of the votes going for office A. Imagine the difference between my own experiences with DSOs and the ensuing onslaught of negative responses about “corporate dentistry.” It was really
disheartening. What was even more disheartening was that the majority of the responses started off with “I have heard...” or “A friend of mine told me...” with very few coming from personal experience.

That kind of behavior makes a little bit of sense, if you think about it, because not many people actually have worked in a DSO. In 2017, the ADA did some research that states about 7.4% of dentists were affiliated with a DSO. That number has since increased with one recent publication, claiming it to be as high as 10.4% of dentists having an affiliation with a DSO.3

With so few offices actually being affiliated, it is alarming at how quickly many of us clinicians claim insider knowledge. Not every practice is a good fit for every personality type. The thing that fills one’s cup may be the thing that completely drains the cup of another. I do think that some of the early DSOs did make some huge missteps, which is a contributing factor to the stereotype, but we need to look at each one as they currently stand and evaluate its merits against our own needs and wants.

Admittedly, it might be hard to navigate how one might find a great company to work for, so let me give some advice that would benefit you for any employer, not just a DSO.

I would recommend that you start your search by looking at who is running the company. When you find clinicians in the leadership of the companies, you’ll often see that the practices are being run with a patient- and provider-centric mentality. I would also recommend that you look into the metrics that they are asking you to achieve and if they are patient-care related. Ask potential employers how they made decisions for particular products or instruments they have on their formulary. It’s a great way to see what drives the decision-making process of the company. Finally, ask them about what they are doing to support their clinicians.

My role as director of dental hygiene is one of support. The fact that my company has a position like mine speaks volumes. I am a clinician who is here to help other clinicians become successful. With this mindset, I am very predictable with how I begin many of my conversations with our hygienists. I tell them, “I want you to be successful, but success is different for everyone. What does it mean for you?” Follow-up questions always include, “How can working here support that vision for you?”

Once we are aligned on what success is for them—whether that means their goal is to make an impact on every patient they meet, make a lot of money and go on fabulous vacations every six months, further their career through leadership opportunities, or any number of things—we can begin the process for figuring out how providing comprehensive care for each patient will lead to that success. And the secret is … doing the right thing every time will lead to the success they are looking for and have a positive impact financially for the company. Be an ethical clinician by using evidence-based dentistry and you will also be successful.

Stereotypes are tough to shake, but I am so happy to be working at a company that has its priorities straight and that is taking the lead to create new, more positive ones. I enjoy working with a leadership team who truly values the work that hygienists accomplish as health-care providers. I hope you all have the same positive and uplifting feelings toward your places of work as I do mine. 

Andrew Johnston, BSBM, RDH

Dental hygiene is an honorable profession dedicated to helping patients achieve optimal oral health. We accomplish this through education on causative factors; preventive and therapeutic services to treat and prevent the disease; and the recommendation of at-home and in-office products.

Dental hygienists are fortunate to be able to work in multiple settings, including academia, sales, leadership, speaking, and consulting.
For the purpose of this article, we will be focusing on the traditional clinical setting of patient care within a group practice, otherwise known as a dental service organization (DSO).

DSOs often have a negative connotation among dental professionals, including hygienists. My view is a bit different from what the common perception may be. Some see a DSO as a factory service. Others feel it is all about production, and still others feel it is all about pushing products. I have had the opportunity to work for both private practices and DSOs, in both clinical and administrative positions, for the past 19 years.

The ADA has published new data revealing that 7.4% of all dentists practicing in the US are affiliated with DSOs. That number jumps up to 16.3% for dentists ages 21-34.1 According to Gordon J. Christensen, DDS, MSD, despite controversy, DSOs have continued to evolve and enlarge in the United States. It is estimated that there are at least 1,000 DSOs, emerging DSOs, and large-group practices in the US with many others planning to start.2

There are many models of DSOs; however, all clinical decisions in the office are led by the dentist, who has the clinical autonomy of the practice and leads the team. The DSO helps establish procedures and protocols that align with the American Dental Association and American Academy of Periodontology guidelines to support the dentist’s overall clinical viewpoint. DSOs partner with offices to ensure that standards of care are being maintained through quality assurance, risk management, and compliance. In addition, infection control protocols are established to ensure that safety is provided to office team members and patients alike. Tools and training are provided to allow dental practices to reach their highest potential.

Working within a community keeps your viewpoint fresh and gives you access to valuable partnership and networking opportunities. There are many other benefits to being part of a DSO, such as the ability to negotiate better insurance rates for your patients, the opportunity to learn from your peers, expand your skill set, and be part of mentoring younger colleagues. In addition, you will benefit from the lower pricing on materials and products, which means you can have higher quality items.

Regardless of the business model, profitability is important. For a DSO, profit is established by ensuring adequate services are being provided and/or distributed based on the patient’s needs. As with private practice, DSOs are patient-centered and focus on the delivery of customized treatment plans to prevent and treat disease. Regardless of our practice setting, as dental professionals we need to ensure we are providing standardized individual care. The question is, how is this obtained? Through gathering the necessary data through clinical tools, you will establish the best standard of care.

Once a comprehensive assessment is complete, the doctor is able to provide an appropriate diagnosis, and the dental hygienist can use the correct procedure codes. This may be the area where services may be done and not coded correctly.

At a DSO, the findings that have been gathered should be reflected in the diagnosis and aligned with the procedures that are being performed, as well as finalized in the documentation on the progress notes. As with private practice, in the DSO setting, the process needs to be aligned with the two entities that should be followed in the dental profession, the American Dental Association and American Academy of Periodontology. As professionals, we need to ensure we dot all i’s and cross all t’s so that we effectively document treatment and prevent risk. DSOs tend to be more scrutinized than our private practice colleagues, so we must be meticulous and precise in our documentation.

To address the perception that DSOs push products, we must acknowledge that homecare is key to oral health success, but getting patients to follow through is tricky. The key is how to not only find out what patients need but also how to get them to comply.

Since hygienists are prevention specialists, it is appropriate for in-office and take-home products to be part of a patient prevention program. As part of daily patient care, hygienists should determine which home-care products are best for each patient to achieve optimal oral health. Based on the clinical assessment, medical history review, and patient receptivity, the dentist and dental hygienist must partner with the patient to personally commit to investing in preventive measures and/or products for his or her oral health.

It is no easy task for the patient to filter through the vast array of home-care products available. Ultimately, the provider’s job is to help the patient build a routine that is easy, cost-effective, and sustainable. Being able to provide products in the office makes it easier for the patient to make a decision. Remember, when it comes to a patient reaching optimal oral health, it takes two to make it happen!

Personally, I have had the opportunity to be part of DSOs for quite some time now, and it has been a great experience. I’ve learned, grown, and initiated processes in our patients’ standardization of clinical care. As the vice president of hygiene operations at Coast Dental based in Florida, we continue to elevate our profession with an amazing team. We appreciate having the ability to be able to train, coach, and inspire other hygienists in this organization.

When you put your heart into what you are doing, patients will trust you and accept your recommendations. It is not just offering and recommending treatment to patients; it is also educating them to want the necessary treatment for a healthy mouth. In doing so, you and your office will become successful. 

Providing appropriate care so that patients may obtain health also helps the practice remain healthy. As with any business, there is a cost for services and this fee allows the business to remain financially healthy so that services may continue to be provided. A financially viable dental practice allows dental hygienists to remain employed, which in turn further supports the provision of patient care—the cycle is dependent upon one another. 

Rafael Rondon, BS, RDH

I started my career in dental hygiene on the advice of my awesome sister-in-law. She is now a practicing dentist in the Huntsville,
Alabama area. A year after graduating from my dental hygiene program, I was hired by a DSO. That was in June of 1998, and I am still happily working with the same company today.

I attribute my long career with Coast Dental to their continued efforts to maintain the highest quality of care to their patients. Most important for me is their continued dedication to providing their hygienists with the most up-to-date information and treatments to maintain the newest and highest standards of care. Another thing I really appreciate is that there is an entire team dedicated to the success of every hygienist working at Coast Dental. Using new technologies, training, and mentoring, I have the confidence that I am delivering the best, most current care to each one of my patients.

In summary, I am proud of the positive effect I have been able to have on my community through each patient I have treated. I am thankful that I have had an entire team in partnership with me to ensure my success as a clinician. And I have been so blessed that Coast Dental has been there for me these last 23 years, providing me the opportunities to be successful in both my professional and my personal life! 

Renee Koch, RDH

I graduated from Tallahassee Community College in May 2020. I was so excited to start working as a hygienist and thankful to Coast Dental for giving me this opportunity. Starting with a DSO office was not what I initially expected. I grew up in a small town where there is only one private practice and so naturally, I assumed I would work somewhere similar.

In school, I got the impression that a DSO would be more focused on money than patient care. After talking with the hygiene director, I
felt assured this was not the case. I am so glad I followed my instincts, which were further proven true when they allowed me to start with a modified schedule while I built up speed. We did this so that the patients still received the care and treatment they deserved in a controlled environment.

One thing I am still learning about and working on is the APT, a metric we use that stands for Appropriate Patient Treatment. This is a number that is calculated and a quick way to measure the effectiveness of comprehensive patient treatment. As I continue to improve my skill level, my ability to increase the level of patient care will improve as well.

One of the aspects of my position that I did not expect was the utilization of advanced technology for patient communication, diagnosis, and treatment planning, but it turns out that I am pleasantly surprised by the process. It allows us to see patients for hygiene care that has been postponed in the last year due to the pandemic, while reducing person-to-person interaction to keep everyone as safe as possible.

As a recently graduated hygienist starting my career in an office without a current dentist and no other hygienist, the hygiene assistant has been invaluable. Working together, we can see a full column of established hygiene patients and a full column of new patients. Having the column of new patients also allows us to convert patients to the hygiene column when there are cancellations.

Overall, starting my career with a DSO was an excellent decision and opportunity.

Amber Singletary, RDH

Editor's note: This article appeared in the August 2021 print edition of RDH magazine.


  1. Garvin J. HPI: 7.4 percent of US dentists are affiliated with dental service organizations. ADA News. March 7, 2017. https://www.ada.org/en/publications/ada-news/2017-archive/march/hpi-7-4-percent-of-us-dentists-are-affiliated-with-dental-service-organizations
  2. Christensen GJ. The cons and pros of DSOs. DentalTown. June 2018. https://www.dentaltown.com/magazine/article/7054/the-cons-and-pros-of-dsos
  3. How big are dental service organizations? ADA Health Policy Institute. July 2020. https://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIGraphic_0720_1.pdf