The shifting role of dental hygienists: Are we moving from leadership to limitation?
The role of dental hygienists has undergone a noticeable transformation during recent years. Having worked in dental offices for more than 10 years and in many roles, I’ve witnessed firsthand how essential hygienists are to the heart and health of a practice. Traditionally, dental hygienists hold not only a clinical role but a leadership role, quietly orchestrating much of the patient experience and practice workflow.
Hygienists are the ones who know which patients have just lost a parent or are undergoing chemotherapy. They know when the supply cabinet needs restocking. They anticipate the doctor’s next move and create a rhythm in the practice that allows for smooth, efficient patient care.
Most importantly, they build and maintain strong relationships with patients based on trust, familiarity, and continuity. It’s common to hear patients say, “I came in today just to see my hygienist.” Additionally, hygienists often catch potential treatment needs early, keeping patients engaged in their oral health and helping the practice grow.
I’ve recently noticed things shifting
Today’s hygienists seem to be hanging back and focusing on their operatory more than the broader flow of the office. Many no longer step into the informal leadership role. Fewer are coordinating care across departments, advocating for treatment plans, or contributing to the office culture in a holistic way. They still provide excellent clinical care, but they don’t always take ownership of the wider patient experience or the practice’s daily rhythm. The “glue” that held the office together feels thinner. So, what’s driving this change?
Post-COVID dental workforce shifts
The COVID-19 pandemic led to a major turning point. Many veteran hygienists retired early or transitioned out of clinical work entirely. They were told that despite how important the oral-systemic link is or how educated they were, they were not essential.
In many practices, this resulted in a loss of mentorship and institutional knowledge. The new wave of hygienists entered the workforce during or shortly after the pandemic, a time marked by high stress, increased requirements, and a more transactional approach to patient care due to compressed schedules and increased cost of materials. Unfortunately, this seems to have become the new normal.
Underappreciation and burnout in RDHs
Many hygienists began to re-evaluate their careers and realized their compensation and recognition didn’t match the value they were providing. In some practices, hygienists have felt more like production units than patient advocates, especially when office managers push production instead of focusing on patient care. I’ve heard the term “scaling machine” more times than I can count when comparing job experiences with other hygienists.
One major concern that surfaces is the lack of benefits for many hygienists. In numerous practices, paid time off, health insurance, and other standard employment benefits are either limited or nonexistent. Compounding this issue is the growing trend of working extended hours, late evenings, and weekend shifts, which can be especially challenging for those striving to maintain a healthy work-life balance.
The majority of hygienists are women, many of whom are in their childbearing or caregiving years. While practice owners may see extended hours as a way to boost profitability, the reality is that being expected to sacrifice time with family, often without adequate support or job security, can lead to resentment and burnout. Without meaningful involvement in practice decisions or strategic planning, it’s easy to see why many of us have pulled back from taking on additional responsibility.
Economic pressures and productivity demands
Then there is the economic landscape of dentistry itself. Insurance reimbursements have not kept pace with inflation, leading to thinner margins for many practices. To maintain profitability, some offices have felt the need to shorten appointment times and increase patient loads. This model leaves little room for patient relationship-building or extra-mile care—the very things that previously defined the hygienist’s leadership role.
Who has time to ask about a patient’s personal life or look for anything besides calculus when we only have 30 minutes to fit in everything to uphold our standard of practice? Shorter appointment times for dental hygienists also increases the risk of developing musculoskeletal disorders (MSDs). This intensifies the repetitive nature of our tasks and reduces opportunities to recover from prolonged static postures and awkward positioning required during patient care.1
Tightening profit margins have led to a decline in the quality of instruments available to us, and some instruments we use are well past their usable lifespan. I’ve temped at offices where instrument packs included broken scalers or mirrors so scratched they were nearly unusable. If a practice is cutting costs this way, it raises an important question: how can they expect patients to return or hygienists to stay when the tools the practice provides compromise both care quality and professional standards?
Where do we go from here?
The answer to this is not simple, but it starts with awareness. If practice owners, dentists, and office managers want to bring back the full potential of hygienists’ role and maintain the high standard of care patients deserve, they must begin by reassessing how the clinical team is valued, not just in terms of pay (although that’s a great starting point), but also in respect, resources, and long-term investment.
Hygienists are not auxiliary; they are essential. By equipping them with the tools, time, and support they need to lead and connect, we don’t just improve office morale—we improve outcomes, patient loyalty, and the overall health of the practice. It’s time to recognize that empowering hygienists is not a cost, but a strategy for sustainable success.
Hygienists are more than managed care providers of preventive care. We are educators, advocates, and often, the connective core of the dental office. When we are valued and empowered to our full potential, the entire practice not only benefits, it thrives.
Reference
1. Saccucci M, Zumbo G, Mercuri P, et al. Musculoskeletal disorders related to dental hygienist profession. Int J Dent Hyg. 2022;20(3):571-579. doi:10.1111/idh.12596
