Reimagining the Role of Dental Hygienists
Resolving the staffing shortage amid increased demand will require transformative change
Cindy Roark, DMD, MS, and Misty Mattingly, RDH, BSDH
For the past several years, the entire continuum of healthcare has been overwhelmed by workforce shortages. Nonetheless, the shortage of dental hygienists is particularly severe. The field of dental hygiene has long experienced the effects of staffing shortages, with hygienists citing high rates of burnout even before the pandemic. Simultaneously, patient behaviors have continued to shift, forcing dental practices that want to deliver high-quality care to navigate a complex web of evolving patient expectations with limited staff and resources.
As communities grapple with an insufficient number of dental hygienists, the risk of delayed or inadequate oral healthcare grows, contributing to the overall burden of preventable dental conditions. Therefore, while navigating the increased demands of patients, it is imperative for practices to reevaluate and redefine the roles of dental hygienists to help alleviate administrative burdens and streamline clinical workflows. Their involvement in preventive care and patient education adds urgency to the need for this reassessment in order to ensure that their roles align with the evolving needs of oral healthcare.
With 31% of dental hygienists expected to leave the profession within the next 5 years, it's becoming even more imperative that we take the necessary steps to address the staffing shortages that continue to impact all aspects of dentistry.1 From education and training programs to policy reform, a comprehensive approach is necessary to attract more individuals to the profession of dental hygiene, create an environment that fosters their growth, and increase retention. By prioritizing these initiatives, dental practices can not only address the immediate challenges posed by staffing shortages but also fortify their capacity to provide sustained, safe, and quality care to patients in the face of ongoing challenges.
Vital Contributors to Health
The job of a dental hygienist extends far beyond just cleaning teeth; hygienists play a critical role in the maintenance of patients' overall health. Although hygienists conduct thorough assessments to detect decay and tooth cracks, monitor the status of dental work, identify signs of teeth grinding, and more, they also provide patient education to inform individuals about the benefits of maintaining good oral hygiene. This educational aspect of their job is crucial in fostering a proactive approach to oral health among patients.2 In practice, this translates into the formulation of customized oral health plans for patients with tailored treatments that not only address their immediate concerns but also contribute to their overall well-being.
Moreover, hygienists also actively participate in the early detection of oral cancer, which underscores the importance of their work in the broader context of healthcare. Unbeknownst to many patients, oral cancer is one of the most common cancers. It affects thousands of people across the United States. However, when it is detected early, morbidity is significantly reduced.3Dental hygienists' understanding of oral anatomy provides them with a solid foundation to efficiently identify oral pathoses, such as cancer, in patients.
Perhaps most importantly, we now understand that periodontal disease has far-reaching implications for overall health. It is intricately linked to numerous inflammatory conditions in the body, including diabetes, coronary artery disease, Alzheimer's disease, and more. Because dental hygienists serve as the first line of defense in detecting and treating periodontal disease, the staffing shortage is severely undermining the efficacy of treatment and maintenance protocols for this prevalent condition, and that could have significant systemic health repercussions for patients.
A Complex Problem
The imbalance between the increased patient demand for dental services and the workforce available to provide such services is presenting a significant challenge in the profession of dentistry. Many factors, including an aging population, the prevalence of chronic diseases, and advances in technology, have contributed to an unprecedented surge in the need for dental healthcare professionals. However, despite efforts to expand educational programs and training opportunities, many practices struggle to attract and retain qualified hygienists. The consequences of this disparity are clear. Providers are struggling to meet the needs of their patients, and oftentimes, this results in longer wait times, increased workloads for existing team members, and compromises to the quality of care delivered.
Although the COVID-19 pandemic contributed to the current shortage of hygienists, it is only one factor in a complex problem that the industry continues to face.4 Hygienists are retiring in increasing numbers. Education and training challenges also stand as barriers, hindering the entry of new professionals into the field. This has led to an inability to sufficiently replace the diminishing workforce with fresh talent. In addition, many hygienists are resigning, citing circumstances such as inadequate pay, inflexibility in work hours, a lack of professional development opportunities within their practices, and poor workplace dynamics as factors leading to their decisions. With so many contributing factors, addressing the shortage of hygienists will require a multifaceted approach that encompasses strategic workforce planning, innovative recruitment strategies, and renewed investment in educational infrastructure to ensure an adequately sized and resilient workforce of dental hygienists that is capable of meeting the evolving demands of a burgeoning population.
The Need for Reevaluation
Many of the current solutions to address the shortage of hygienists only scratch the surface of the problem and are temporary workarounds at best. To truly address the root causes, the dental industry needs to consider more innovative solutions. Meeting the evolving demands of both patients and hygienists requires a proactive reassessment of the roles and responsibilities of dental hygienists as well as the value that practices place on them. This not only acknowledges the changing needs of patients but also positions dental hygienists as integral players in the broader healthcare narrative. In this vein, there are many actions that the industry can take to achieve this goal, including the following:
• Crafting effective marketing strategies that promote the evolving role of dental hygienists and grant them the recognition that they deserve within dentistry and the overall framework of healthcare.
• Expanding the availability of educational programs while integrating cutting-edge technologies and learning modalities, such as AI-driven simulations and data analytics that optimize dental education by crafting real-world scenarios and providing personalized feedback, to equip future hygienists with the skills needed in today's dynamic healthcare environment.5
• Advocating for policy changes to streamline licensure processes so that dental hygienists from nearby states can practice across state lines.
• Exploring telehealth solutions to extend dental care services even further and improve efficiency across practices.
Reshaping the Narrative
In recent years, the persistent shortage of dental hygienists has posed a formidable challenge, and how it will be resolved in the future remains unclear. As the dental industry confronts this obstacle, the need to initiate transformative change and establish new standards has never been more pressing. Now is the time to redefine the roles of dental hygienists, expand their scope, and increase the value that we place on their contribution so that we can attract more people to the profession and retain them. Hygienists are not just promoters of healthy smiles; they are a part of the foundation of their patients' overall health. Although dentistry faces a difficult situation, the time is ripe for it to reshape the narrative surrounding dental hygienists and empower them to pave the way to the future of dentistry.
About the Authors
Cindy Roark, DMD, MS, is a senior vice president and the chief clinical officer at Sage Dental. Misty Mattingly, RDH, BSDH, is a senior vice president and the chief dental hygiene officer at Sage Dental.
