The body on the floor? Profitability. The suspect? $100-an-hour hygiene wages.
But the wage didn't kill your margins. Your model did. Across the country, practice owners are staring at hygiene payroll and asking how the math stopped working. Hourly rates have climbed to $50, $75, even $100 in some markets. Payroll feels bloated. Margins feel compressed. The instinct is predictable: Hygiene is too expensive.
The issue isn't what hygienists are paid. It's that most practices never redesigned hygiene to support what it is now expected to produce.
Hygiene evolved. The system didn't
Today's hygienists are expected to:
- Identify periodontal disease earlier and more consistently
- Strengthen exam workflows with better documentation
- Educate patients on their systemic health risks
- Support retention and long-term case acceptance
- Contribute significantly to daily production
That's a revenue engine. Yet many practices still run hygiene like it's 1998 using the same appointment blocks, the same exam bottlenecks, and the same undefined expectations.
When wages rise in an outdated structure, the numbers will break. Not because hygiene is overpaid, but because it's underdesigned.
The part no one says out loud
Most practices didn't lose profitability because hygienists became "too expensive." They lost it because hygiene productivity was never intentionally engineered.
There was no recalibration of these factors:
- What success in a hygiene visit truly means
- How diagnosis, education, and documentation fit into the hour
- How doctor exams depend on hygiene preparation
- How technology should drive consistency
Instead, the response has been reactive: "They need to produce more." "We can't afford this."
The legislative shortcut
In response to workforce shortages and rising wages, some states are advancing expanded roles for dental assistants, creating oral preventive assistant models to offset hygienist demand.
On paper, it's logical: increase capacity, reduce labor strain, control costs. But adding a new role does not fix a misaligned structure.
If diagnostic standards are inconsistent and workflows are undefined, expanding the scope spreads inefficiency across more people. Workforce innovation may buy time. It won't replace design.
The real hijack
This wasn't sudden. Hygiene gradually absorbed more responsibility. Wages rose. Practices adjusted just enough to keep going. By the time owners declared hygiene "too expensive," the structural gap was already years old.
Hygiene didn't hijack profitability. An outdated business model did. Until practices rebuild hygiene around clarity, calibration, and intentional design, the numbers will keep telling the same story — long after the lights are off.
Mary K. Hughes, RDH, is a nationally recognized leader at the intersection of clinical dentistry and business strategy. As co-founder and managing partner of Dental Education Partners, she works with dentists and hygiene teams across North America to transform hygiene departments into aligned, high-performing growth engines.
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.
