There is a chapter in my memoir, Smiling on the Inside, where I confess something that I suspect most dentists would rather not put in writing: that my dental hygienist was constantly after me to get my own teeth cleaned, and I was always ready with an excuse. She worked with several dentists (in addition to me) and noticed that many of us avoid hygienists and don't get regular cleanings. 

My story as a dentist

This made me slightly less embarrassed, but it also made me realize something important. Here was a person who knew more about my avoidance patterns than I ever admitted to myself, and she was telling me the truth in a direct and honest waybecause our relationship was built on genuine professional trust. That, in a single story, is what 30 years in practice taught me about working with dental hygienists. 

I practiced family dentistry in Indiana for over 30 years before the pandemic brought my career to an unexpected close in 2020. In that time I learned a lot about teeth, patients, and running a small practice through every imaginable complication. But the lesson I return to most often is one that took me years to fully understand: the strength of a dental practice is built not in the operatory, but in the relationships between the people who work there. The relationship between the dentist and the dental hygienist is especially unique. 

My practice was small. I had a receptionist, one assistant, and a hygienist who worked part-time, splitting her schedule between my office and another. Because she was not always there, I did many of my own cleanings, which gave me a firsthand appreciation for what that work actually requires. It is not simply a matter of scaling and polishing, which in itself is difficultydifficult physically and mentally. It is also listening, observing, and building the kind of relationship with a patient that makes them willing to tell you things they might never confess to the dentist seated across from them. I saw this play out repeatedly throughout my career; we had a running joke that patients told my team something completely different than what they would tell me. 

One of the things I describe in my memoir is the morning huddle, something I was slow to implement. For years, I thought a daily team meeting felt forced for such a small office. But once we started, I could not imagine running the day without it. It was during those morning reviews that my team and I would talk through the patients scheduled that day, flag anything unusual, and anticipate needs before they became problems. As simple as it sounds, that communication changed how we functioned as a team. We were no longer reacting to the day—we were preparing for it together. It set a positive tone for the day and was a large part of learning to work as a cohesive unit. 

The hygienist's role goes far beyond the clinical

Hygienists are the consistent voice, the familiar face, the person who remembers that a patient was nervous last time or had a difficult year. I wrote in my memoir about a patient with special needs who had been coming to my office since the very beginning of my practice, brought by his father, who had been one of my instructors at dental school. I was profoundly humbled that my instructor would choose me as a new dentist to be the dentist for his son. That patient loved to talk. His father would gently hush him during procedures. When his father died, his mother brought him to his appointments, and after her death, his care was passed to his sister. Through all those years and all of those transitions, the continuity of familiar faces in that office was what kept him comfortable. The hygienist is often the anchor of that continuity. For me personally, I was blessed to have team members who stayed with me for the long term. 

Dental hygienists also see things that dentists miss, not because dentists are inattentive, but because patients behave differently in a cleaning appointment than they do in a treatment appointment. They are more relaxed, talkative, and more likely to mention something offhand that turns out to be clinically significant. In addition, when one is scaling a tooth, every aspect of that tooth is studied from every angle. That time spent analyzing each tooth is significantly more than the dentist’sexam.  learned to actively ask my hygienist what she had observed during an appointment before I entered the room. Not as a formality, but as a genuine clinical inquiry. The answers frequently shaped how I approached treatment in ways that improved outcomes for the patient. 

A lesson to learn from

One moment that stays with me from my years in practice came from my dental laboratory technician, not my hygienist, but it speaks to the same truth about the power of being seen by the people you work alongside. Over lunch one day, he told me he knew I was a good dentist because my impressions were consistently well done. He could tell, he said, that I had strong hands. I had spent years second-guessing myself, carrying insecurities from dental school that I could never quite shake. And here was someone who worked with my cases every week telling me, plainly and directly, that I was good at what I did. I had to choke back tears. He said, “don’t you dare cry,” so I choked back the tears and maintained my composure. But it changed something in me. From that point on, I practiced with more confidence and fewer internal doubts. 

I tell that story because I think it applies directly to the relationship between hygienists and dentists. We do not say enough to each other. We do not acknowledge what we observe in each other's work. And we do not always create the kind of practice culture where honest, direct communication flows naturally in both directions. That silence costs us more than we realize. My hygienist knew I could be a perfectionist and a bit of a micromanager, but she also had the unique ability to recognize when office relationships were stressed and offered practical suggestions for improvement.  It is easy to be critical, but much harder to praise good effort. 

3 must-knows for success in your practice

For hygienists in particular, I want to offer three practical observations from 30 years of working in a small practice where every person's contribution was visible every single day: 

Say what you observe. Your clinical observations belong in the conversation, not just in the chart. If you notice something during a cleaning that concerns you, say it directly and without hesitation. Not every practice culture will welcome this easily, but you have the professional responsibility to communicate what you see. The patient's outcome may depend on it. 

Your relationship with the patient is a clinical asset, not just an exchange of pleasantries. Patients who trust their hygienist are more likely to comply with treatment recommendations, return for regular care, and communicate honestly about symptoms and concerns. The trust you build over years of consistent, compassionate appointments is one of the most powerful tools in the entire practice. Treat it accordingly. 

The culture of a dental practice is shaped as much by hygienists as by anyone else. How you show up, how you communicate with colleagues, how you treat patients on a difficult day all contribute to the environment in which care is delivered. That environment affects clinical outcomes, patient retention, and the experience of every person who walks through the door.

I closed my practice in 2020 with gratitude for every patient who trusted me, and for every member of the team who showed up alongside me. I wrote about those 30 years because I believed the stories deserved to be told. But the lesson underneath all of them is the same one I would offer to any dental professional: the work is better when we do it together, honestly, and with the kind of trust that only comes from genuinely seeing one another.

Editor's note: This article appeared in the July 2026 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.