The dental hygiene profession stands at a critical crossroads. There’s a widening divide in our industry—one that threatens not only the integrity of our profession but also the health of the patients we serve. Currently, there is approximately one hygienist per doctor in dentistry, whereas a thriving, productive practice that actively treats periodontal infections requires at least the recommended three hygienists per doctor (Ahearn & Gagnon, n.d.).

Despite the shortage, the number of employed dental hygienists is declining each year. The imbalance has created a supply-and-demand crisis. Hygienists are demanding higher pay, and in response, some states are approving measures that allow dental assistants to scale teeth. This is a pivotal moment, and hygienists have a choice: we can either be part of the solution—or part of the problem.

The Reality of Oral Health in America

Let’s not lose sight of the mission. Over eighty percent of the population currently has some form of oral infection. Of those, nearly half of U.S. adults over 30 are affected by periodontal infections with bone loss (Eke et al., 2015), over 50% of adults have gingivitis on an average of 3 or more teeth while 67% of the population have subgingival calculus present (Li, et al, 2010). That leaves roughly 25-30% of the population with a clinically healthy mouth. If we shift to a model where assistants are scaling and hygienists aren’t fully practicing to their license, 75% of the population will be inadequately treated. That is not acceptable.

We have a responsibility to shift this trajectory. That starts by embracing both models—supporting dental assistants while also empowering hygienists to operate at the top of their licensure. This is not just about cleaning teeth. This is about managing infection and saving lives.

Elevate the Standard: From Technician to Clinician

We can’t elevate our profession without elevating ourselves. Too often, hygienists ask for higher hourly wages without committing to treat periodontal disease or engaging in oral-systemic conversations with patients. But here’s the reality: understanding oral-systemic inflammation and its burden on the body is foundational to what we do. We are not technicians—we are clinicians. We are biofilm managers.

Biofilms are responsible for up to 80% of all disease (Fleming & Rumbaugh, 2017). The mouth is a gateway to systemic illness. Chronic inflammation stemming from untreated periodontal disease is linked to heart disease, diabetes, Alzheimer’s, and more. Subgingival detoxification, bacterial disruption, and ongoing inflammation management are not optional—they are essential.

When I practiced, I lived to educate on oral-systemic conditions. It gave me purpose. It made me a true partner in patient care. My associate degree gave me the technical foundation, but the education I sought out post-hygiene school taught me to think critically, to treat the whole patient, and to practice with intention and impact.

If you haven’t had the opportunity to take advanced courses in periodontology, public health, or oral-systemic connections, now is the time. Rise above the role of technician. Lead with knowledge. Lead with purpose.

Redefining Value and Production

Let’s talk numbers. If we’re earning $60 an hour, our production should be at least $198/hour of adjusted production to justify our salary as a clinician—not just a technician. A daily production of $800-$1,000 doesn’t sustain a thriving hygiene department or support our compensation request. If we’re doing prophy after prophy while perio cases go undiagnosed and untreated, we’re leaving patients—and our practices—at risk.

How to Lead the Change

1. Shift the culture. Advocate for a model where dentists, therapists, hygienists and assistants work collaboratively and support each other to the top of their scope of practice.
2. Think like a partner. Suggest implementing oral-systemic protocols in your practice. Work with your practice owner to improve outcomes, versus waiting for direction.
3. Upskill. Advance your education with online certificate programs and certifications for dental hygienists. Many short, focused and comprehensive training programs now exist to make upskilling more affordable and flexible than going back to school for a degree.
4. Educate with confidence. Engage patients and their medical providers in conversations about the role of inflammation and biofilm in systemic disease and your case acceptance will naturally rise.
5. Ask your employer to invest in you. Advanced education will build your confidence and improve patient care, it’s a wise investment. 

It's time we take the focus off oral health only, and instead think about helping people live longer, healthier lives. You are not “just” a hygienist. You are a critical thinker and a valuable team member in healthcare. 

The future of dental hygiene depends on us owning our role fully. It is our time to rise and shine as the clinicians and prevention specialists we are.

Author

Amy Brown Williford, MS, RDH, SHRMA, CoS

Amy has 25 years experience in the dental field, first as an RDH, secondly as a leader of operational excellence. Her consulting company, Amplify3 focuses on three main areas she has identified as required for operational excellence; culture, operations, and strategy. Amy loves leveraging her experience as a clinician to take teams to the next level. Connect with her on LinkedIn.

Citations

Ahearn, J., & Gagnon, G. (n.d.). How many hygienists per dentist? Dental Economics. Retrieved from https://www.dentaleconomics.com

Eke, P. I., Dye, B. A., Wei, L., Thornton-Evans, G. O., & Genco, R. J. (2015). Update on prevalence of periodontitis in adults in the United States: NHANES 2009 to 2012. Journal of Periodontology, 86(5), 611–622. https://doi.org/10.1902/jop.2015.140520

Fleming, D., & Rumbaugh, K. P. (2017). Approaches to dispersing medical biofilms. Microorganisms, 5(2), 15. https://doi.org/10.3390/microorganisms5020015

Li, Y., Lee, S., Hujoel, P., Su, M. F., Zhang, W., Kim, J., … & DeRouen, T. A. (2010). Prevalence and severity of gingivitis in American adults. American Journal of Dentistry, 23(1), 9–13.