Key Highlights
- Workforce shortages and systemic misalignments are undermining collaboration and patient care in dentistry.
- Implementing intraprofessional education can strengthen relationships and attract new talent to the dental field.
- Administrative and scheduling practices often compromise thorough assessments, leading to hygienist burnout and suboptimal patient outcomes.
- Economic pressures and insurance models favor volume over value, hindering preventive care and clinical excellence.
- A cultural shift towards purpose-driven teams and strategic problem-solving can foster a more sustainable and collaborative dental environment.
The dental industry stands at a pivotal moment. What seems to be a crisis is, truthfully, the threshold of redefining health-care delivery. The deeper issue isn’t just workforce shortages—it’s how dentists and hygienists have unconsciously shaped a professional dynamic that undermines collaboration, fulfillment, and the oral health of the American population.
It’s time for dental professionals to ask ourselves: How did we create this situation? How can we change it for the betterment of our profession and the patients whom we have taken an oath to serve?
Moral fatigue = burnout: The hygienist experience
Hygienists often feel torn between high production demands and their commitment to delivering comprehensive care. This systemic misalignment starts with dentists and hygienists being segregated in school. Hygienists are taught a standard of care outlined by the Commission on Dental Accreditation (CODA) that is often not followed in private practice. Implementing dental hygiene programs within dental schools can foster a better working relationship and understanding of each other’s supporting role, with the potential to build stronger and longer-lasting relationships. When professionals are happy in their daily work life, this will attract more candidates to a career in dental health care. This model of intraprofessional education could be a sustainable strategy to address workforce shortages, demonstrating a collaborative approach to care, which can have a positive impact on the current landscape of the dental field.
In a 2024 study of 264 dental hygienists, perceptions of collaboration with dentists were generally positive, yet production pressure and feeling isolated in the practice presented a negative correlation with collaboration measures, suggesting that communication is essential.1
Administrative team members are asked to generate a productive schedule; however, when practice leaders do not take the time to educate and collaborate on the standards of care for our preventive practice and patient experience, admin members lack an understanding of what hygienists need to achieve within the scheduled appointment time. The schedule becomes a game of Tetris rather than building time blocks for successful assessment, rapport building, and thorough treatment outcomes.
In addition, when patients arrive late and administrative staff allows them to be seen, this sends a message to both our patients and our team. Patients learn that we do not value the time commitment required to uphold our standard of care. Hygienists are expected to provide the same standard of care in 30 minutes as opposed to 60, to stay on schedule, work through lunch, or leave work later than scheduled. Over time, this can lead to feelings of fatigue and burnout, as it sends the message that we do not value the time needed for thorough care. Furthermore, a volume-based approach fosters a culture in which hygienists do not have the time to maintain the standard of care in assessments; therefore, they provide services without gathering proper data. Ultimately, this is a missed opportunity to properly assess patients’ needs from restorative, cosmetic, periodontal, and preventive perspectives.
Reflection for hygienists: Where have you compromised your clinical standards to meet system pressures? How does this impact your perspective on your role in patient care?
Economic pressure and survival: The dentist’s perspective
Dentists face mounting cost pressures, such as decreased insurance reimbursement and increased costs of investing in technology. Current dental insurance models exacerbate the workforce challenge by incentivizing volume over value. Limited coverage for preventive periodontal therapy and arbitrary frequency restrictions force practices into reactive, treatment-focused models rather than proactive health partnerships. When dental insurance companies decline services and reimburse for lesser procedures such as prophylaxis every six months regardless of periodontal risk, it undermines the clinical judgment of both dentists and hygienists.
True reform requires recognition that personalized preventive care intervals, based on systemic health risks and clinical assessment rather than policy restrictions and calendar dates, deliver better outcomes and lower long-term health-care costs.2 Until insurance models align with evidence-based care and provide more benefits for preventive care, practices will continue struggling to balance economic survival with clinical excellence.
Three approaches to systematic transformation
1. Business model innovation.
When dentists view hygienists as cost centers, models tend to justify extraction. Shift the lens to hygiene as a preventive health consultancy, educating patients that bacterial imbalances lead to dental disease and inflammation and are risk factors for noncommunicable systemic diseases. Integrate preventive workflows, technologies, and adjunctive therapies that enhance patient engagement and experience, and observe how to start making prevention profitable.
2. Purpose-driven cultural revolution.
Teams that are aligned with a purpose have a better workplace culture.3 Get clear on your practice mission and vision, together. Strong relationships thrive on trust, mutual respect, and shared purpose. Environments that foster this show better satisfaction and outcomes.4
3. Collaborative problem-solving through strategic questioning.
Rather than imposing change, encourage discovery.
Dentists:
- What drew you to become a dentist?
- What’s the cost of hygienist turnover—emotional, financial, and relational?
- How does current pressure impact hygienists’ ability to deliver quality care?
- Have you set your hygienists up for success?
- How do you mentor or contribute to their professional growth?
- In what ways can you better support your hygienists to enhance your practice and patient experience?
Hygienists:
- What drew you to become a dental hygienist?
- How does today’s model support or hinder that passion?
- Which standards of care have you been unable to uphold?
- What would it take to restore them?
- What would it be like if you had the autonomy to upgrade instruments to align with modern clinical approaches, such as biofilm management?
- How would you feel if you had autonomy over your schedule?
These future-paced inquiries prompt visualization and engagement—turning potential conflict into cocreated solutions.
How do we make prevention profitable?
A robust body of evidence links periodontal disease with systemic conditions such as cardiovascular disease, diabetes, and dementia. Therefore, identifying and modifying risk factors for patients can be life-altering, and emphasizing the role of the dental hygienist is crucial.5
Despite this evidence, the dental workforce is under pressure due to staffing shortages, increasing patient demand, and evolving care standards. How do we strengthen the collaboration between dental hygienists and dentists? Research indicates that when these professionals collaborate effectively, patient outcomes improve, and both provider and patient satisfaction increase.3 Dentists mentoring hygienists to lead a preventive business within the dental practice can create a positive shift. Providing hygienists with more autonomy and an annual education and equipment budget can encourage them to elevate patient care. Set annual goals and key performance indicators, and meet quarterly to review the department’s progress and growth.
Reflection for teams: How would patient care and perception shift if we began to reeducate our patients and stopped referring to what we do as “cleaning,” instead, referring to it as an “oral-health preservation visit” rooted in systemic well-being? How will our patients respond? What is our timeline for implementing and executing this new approach? Ensure that all team members are involved and establish the steps and requirements that each department needs to be successful.
From crisis to collaboration
The workforce challenge is not rooted in pay or policy; it’s rooted in relationships. We’ve collectively created a system that pits dentists and hygienists against each other. Yet, evidence shows that collaboration drives excellence and sustainability.
We find ourselves out of alignment because, over the past five years, our world has undergone drastic changes in the way we live and do business. Yet, despite these changes, we are still holding tightly to many legacy approaches that no longer fit our current landscape.
The real question now is not “Can we afford to change?” but rather, “How much longer can the patients we serve afford for us not to?”
Editor's note: This article appeared in the October 2025 print edition of Dental Economics magazine.Dentists in North America are eligible for a complimentary print subscription. Sign up here.
References
- Walker KRJ, Giblin-Scanlon LJ, Vineyard J, McCarthy J. Intraprofessional education experiences in dentistry: Dental hygienists' perceptions of collaboration with dentists. J Dent Hyg. 2024;98(5):22–33.
- Clinical Insights Drive Better Outcomes. Cigna. 2019. https://www.cigna.com/static/www-cigna-com/docs/dental-white-paper.pdf
- Huang D, Wang YY, Li BH, Wu L, Xie WZ, Zhou X, Ma B. Association between periodontal disease and systemic diseases: a cross-sectional analysis of current evidence. Mil Med Res. 2024;11(1):74. https://doi.org/10.1186/s40779-024-00583-y
- den Boer JCL van Dam BAFM, van der Sanden WJM, Bruers JJM. Collaboration between general dental practitioners and dental hygienists: a qualitative study. BMC Health Services Res. 2022;22(1):501. https://doi.org/10.1186/s12913-022-07933-3
- Chamorro-Premuzic T, Bersin J. 4 ways to create a learning culture on your team. Harvard Business Review. July 12, 2018. https://hbr.org/2018/07/4-ways-to-create-a-learning-culture-o your-team
About the Author
Melissa A. Obrotka, BA, RDH
Melissa A. Obrotka, BA, RDH, has over 25 years of experience and specializes in functional health and the connection between oral and systemic wellness. She emphasizes prevention, nonsurgical therapies, and guiding patients toward disease remission through a whole-body perspective. Melissa was honored as a Master Clinician by the ADHA in 2016 and named one of the "Six Dental Hygienists You Want to Know" by Dimensions of Dental Hygiene in 2017.