by Erin Haley-Hitz, RDH, BSDH, MS, FADHA, MAADH, Lancette VanGuilder, BS, RDH, PHEDH, CEAS, FADHA and Jessica August, MSDH, CDA, RDH, FADHA 
December 26, 2024

Dental hygienists serve a vital role in oral and overall healthcare, yet many are leaving the profession. This concerning trend impacts both the profession and those in our care. Understanding the reasons behind this exodus can help address the challenges and identify solutions. Five key factors driving hygienists include:  

1. Burnout: Workplace and Physical
Dental hygiene is both physically and emotionally demanding. Hygienists often endure long hours in repetitive, ergonomically challenging positions, leading to musculoskeletal issues such as chronic pain in the back, neck, and wrists. These physical demands and workplace burnout are significant contributors to attrition.  

High-volume practices that prioritize production over patient care exacerbate these challenges. The COVID-19 pandemic has led to increased workloads and amplified anxiety surrounding health risks, further intensifying these challenges. Without adequate support and recovery time, many hygienists are reevaluating their careers.  

2. Lack of Professional Autonomy
Dental hygienists often feel constrained by a lack of professional autonomy. In many states, dental hygienists are required to work under the supervision of a dentist, limiting their ability to fully apply their training and expertise. This lack of independence can leave hygienists feeling unfulfilled, especially when their aspirations to make meaningful contributions to healthcare are stifled. Restrictive practice laws create frustration and may lead to higher attrition rates, particularly in states with limited opportunities for hygienists to work independently or expand their roles. 

3. Insufficient Compensation and Benefits
Many hygienists feel their compensation package does not reflect the value of their contributions. Rising living costs make it challenging to maintain financial stability as part-time, and many full-time hygienists lack access to essential benefits like health insurance, paid time off, or retirement plans.

4. Challenges in Workplace Culture
A positive workplace culture is essential for job satisfaction, yet many hygienists report negative experiences, including micromanagement, lack of appreciation, and poor communication. In addition, conflicts with dentists or office managers over ethical issues—such as prioritizing production over appropriate infection control guidelines, HIPAA, appropriate determinants for dental imaging, and patient care—can create toxic environments.  

Such challenges can make hygienists feel powerless and cause them to disengage which contributes to workforce attrition.  

5. Career Advancement Opportunities May Lie Elsewhere
For some, clinical dental hygiene can feel like a career with limited opportunities for growth. Clinical practice doesn’t have to be the end of the road. While many hygienists enjoy their full career working chairside, others may aspire to diversify into roles in education, public health, research or administration.  

Transitioning into these areas requires self-challenge to seek out opportunities, put in the work, invest in oneself and be willing to face some uncertainty. Choosing to further education or earning advanced certifications requires time and financial investment and may divert the career path away from clinical practice. Systems and resources are available for hygienists seeking to expand into alternative career paths. For those willing to invest in additional training or certifications, rewarding opportunities are achievable, making long-term growth in the field a realistic and worthwhile goal. 

The Path Forward
Retaining skilled dental hygienists requires addressing these challenges. Here are actionable solutions:

1. Ergonomic Training and Wellness Programs: Providing ergonomic equipment, wellness initiatives, and regular breaks can mitigate physical strain and reduce burnout. Access to physical therapy is another effective measure.  
2. Increased Autonomy and Expanded Roles: Advocating for legislative changes to expand the scope of practice or remove supervision requirements can empower hygienists. Research findings on direct access suggest that allowing dental hygienists to work independently in specific settings can lead to improved job satisfaction.^1,2
3. Competitive Compensation and Benefits: Offering competitive pay, health insurance, paid leave, and retirement options can make the profession more sustainable. Loan forgiveness programs for hygienists in all areas may also encourage retention. Employers should restructure employment models to provide full-time opportunities with benefits. It is important to acknowledge that insurance reimbursements need to be restructured to enable dental practices to offer these benefits, and small employers need access to human resource programs. In addition, existing dental hygienists need a firm understanding of the business of dentistry and how to effectively contribute to it. 
4. Fostering Positive Work Environments: Building a respectful, collaborative workplace culture is essential. Employers should engage HR experts to improve communication, recognize employee contributions, and proactively address conflicts. This can reduce stress for employees and practice owners. 
5. Career Development Opportunities: Supporting career growth through mentorship, scholarships, and professional development programs can help hygienists explore diverse career roles and opportunities. Advanced entry-level education requirements, similar to those in other autonomous healthcare fields, could further empower the profession.  

Dental hygienists are essential to oral healthcare. However, retaining them requires addressing burnout, improving compensation packages, fostering supportive workplace cultures and expanding career opportunities. Ensuring the well-being of dental hygienists benefits the profession and the individuals and communities they serve.

Meaningful action can create a more sustainable and rewarding future for all dental hygiene professionals.  

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References:

¹Turner, S. & Ross, M. (2017). Direct access: how is it working? British Dental Journal. 222(3):191-197. doi: 10.1038/sj.bdj.2017.123. PMID: 28184066.

²Patel, B.M., Boyd, L.D., Vineyard, J., et al. (2021). Job satisfaction, burnout, and intention to leave among dental hygienists in clinical practice. Journal of Dental Hygiene. 95(2):28-35.

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This article was authored by 2024-2025 ADHA President Erin Haley-Hitz, President-Elect Lancette VanGuilder and Vice President Jessica August. To reach ADHA leadership email [email protected].