Dentistry's hygienist shortage is actually a retention problem, with practices losing experienced staff to burnout, early retirement, and better-paying alternatives like temp work, while expanded scope-of-practice models like oral preventive assistants offer potential relief but raise significant training and patient safety concerns.
- Only 60% of dentists report adequate hygiene staffing, with roughly 2 out of 5 practices reporting shortages despite hygiene schools graduating more students annually.
- Hygienists are leaving clinical dentistry due to burnout, early retirement, reduced hours, and shifts to higher-paying temp work, with many not expecting to remain in clinical roles within a decade.
- Financial pressure stems from flat or declining insurance reimbursements while hygienist wages and overhead costs climb, forcing practices to pay hygienists more than some dentists earn.
- Expanded scope-of-practice models like oral preventive assistants (OPAs) could ease staffing pressures but face criticism over training gaps, patient safety concerns, and liability questions.
- A potential middle ground involves structuring OPA roles as credited stepping stones toward full RDH licensure, creating career advancement pathways while addressing immediate staffing needs.
Ask 10 dentists whether there's a hygienist shortage, and most will say yes without hesitation. Ask them why, and the answers start to diverge fast.
The ADA's data back up what practices are feeling: Sixty percent of dentists say they currently have adequate hygiene staffing. Roughly 2 out of 5 practices report they're shorthanded, and many open positions sit unfilled for months. What's notable is that these numbers haven't moved much in years, even as hygiene schools report graduating more students annually.
So if more hygienists are entering the field, why does it still feel like there aren't enough of them?
It's not just a pipeline problem
Denise Ciardello.
The shortage isn't purely a numbers issue. It's also a retention issue, and the reasons hygienists are stepping away from full-time clinical work are varied:
- Early retirement or career exits
- Reduced hours to accommodate family or personal life
- Burnout
- A shift into temp work, which often pays more and offers greater scheduling control
- Moves into dental sales, product demos, or teaching
A striking number of practicing hygienists say they don't expect to still be in clinical dentistry a decade from now.
Underneath much of this sits a financial squeeze that rarely gets enough attention. Insurance reimbursements have stayed flat or declined even as hygienists' production and pay expectations have climbed.
Add rising overhead, equipment and lab costs, and many practices find themselves in an uncomfortable spot: paying a hygienist more annually than the dentist takes home while still struggling to cover the gap between what insurance pays and what the role now costs.
Enter the OPA debate
In response, some states have started exploring expanded scope-of-practice models, including allowing certain foreign-trained dentists to work as hygienists and creating new certifications, like the oral preventive assistant (OPA), that permit dental assistants to take on limited hygiene functions.
It's one of the more polarizing conversations in dentistry right now, and reasonable people land on very different sides.
The case for it
Supporters argue that expanding who can deliver preventive care could:
- Free up hygienists to focus on periodontal therapy and other complex, higher-value procedures, while OPAs handle routine cleanings
- Give dental assistants a real path to higher earning potential, potentially keeping more of them in the field long-term
- Ease the financial pressure practices feel between reimbursement rates and hygienist wages, since OPA-delivered care may cost less to staff
The case against it
Critics raise real concerns:
- Training gap. Hygienists complete two to three years of education covering periodontics, instrumentation, pharmacology, oral pathology, and clinical judgment, not just cleaning technique. Most OPA certification programs require a small fraction of that, sometimes around 120 hours, which critics argue isn't enough to safely handle scaling and assessment.
- The "healthy patients only" assumption doesn't hold up. OPAs are typically limited to patients without periodontal disease, but subgingival issues are common and frequently undiagnosed until a hygienist is already in the chair looking closely. That raises real questions about whether deposits could be missed or whether damage could be caused by someone with less training.
- A two-tiered system. Would patients treated by an OPA receive the same standard of care as those treated by an RDH, and would they even know the difference?
- Liability. Dentists remain ultimately responsible for care delivered in their practice. It's unclear whether adding OPAs would require increased malpractice coverage and who would be expected to carry that cost.
Finding a middle ground
Neither camp seems inclined to budge, and I understand why. However, entrenchment doesn't solve a workforce problem; it just delays reckoning with it.
Here's an idea worth exploring: What if the OPA role became a structured, credited stepping stone toward becoming an RDH rather than a permanent parallel track? A kind of on-the-job training credit for dental assistants who want to advance into hygiene but can't put their career on hold for two or three years of school.
Hygiene programs might initially resist that idea. However, if they helped shape it from the start rather than reacting to it, it could become a genuine win: a real career ladder for assistants and meaningful relief for practices currently sitting with empty hygiene chairs.
I'll be honest: I don't know if the OPA model is the right long-term answer ... but it is an answer, and dentistry doesn't have many on the table right now. If this is the direction the field moves, patient safety and proper training have to stay at the center of the conversation, not as an afterthought to solving a staffing problem.
Most of my close friends are current or former hygienists, and every one of my consulting clients is a dentist. I hear real frustration from both sides of this, and I don't think either side is wrong to feel it.
Denise Ciardello is co-founder of Global Team Solutions, a practice management consulting firm. Ciardello’s book, The Human Side of Business, is a guide to building a cohesive team while creating a successful, productive practice. She can be contacted at [email protected].
The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.
