Toxic culture is costing you staff—time to fix your dental practice

As a dental hygienist for more than 21 years, this article is a cry for help and intervention. It is not filled with whining and complaining, but rather a case for quality control and improvement in what’s going on behind the scenes in many practices. It is an eye--opener for the unaware or dismissive.

There is little doubt many dental practices have thriving and harmonious cultures, where colleagues collaborate and get along. However, many do not, and dentists oftentimes either do not know this or do not have the knowledge or skills to get involved and help employees make the necessary changes. Negative workplace culture is a silent epidemic, causing practices to lose dental assistants and dental hygienists.¹

Signs of a culture breakdown inside the practice

Healthy boundaries, open communication, respect, trust, and integrity have been replaced by disrespect, gossip, backbiting, complaining, and dishonoring others in words, tone, actions, and body language. Dysfunctional teams create toxic environments that make employees disengage, contributing to poor outcomes.²

Distrust often hides behind questioning decision--making with regard to patient care, recommended treatment, or practice operations. A hygienist’s recommended periodontal treatment (in collaboration with the dentist) or the amount of time treatment may take could be questioned or opposed by other staff members. Lack of teamwork or harboring bitterness can contribute to lack of efficiency or quality care given to patients.

While these are just a few examples of what might occur in your office, there are numerous other issues hiding behind smiles that contribute to ongoing tension in your practices, slowly eroding trust and contributing to poor performance.³ Such challenges are adaptive challenges, because they do not have a clearly defined or easy way to be solved, and “are difficult because they usually require changes in people’s priorities, beliefs, roles, and values.”⁴

It is time for all team members to acknowledge disrespectful and unprofessional behavior and put an end to toxic forms of communication, whether passive or direct. As the leaders of their teams, dentists must take inventory to find out what’s really going on behind the facade. I suggest one--on--one meetings with each team member to solicit feedback and concerns and create a plan to address the issues presented.

3 tools to gather information

1. Surveys: Including questions about values, attitudes toward work and colleagues, patient care, punctuality, office duties, etc.⁵

2. Anonymous suggestion box: Participants anonymously submit concerns or suggestions about work environment, responsibilities and duties, and issues within the office without feeling anxious and fearful of being judged.⁶

3. Dialogue: This follows completion of the first two tools. An open dialogue improves listening and speaking skills, addressing differences among team members, exposing expectations, confronting issues, and facilitating problem--solving, helping to reach consensus as a team.

6 actions to help solve challenges⁷

1. Acquire a new perspective—see the big picture; see things as they really are

2. Identify the adaptive problem—pinpoint the underlying issues correctly

3. Monitor members’ concerns—do regular check--ins and provide guidance

4. Maintain consistent focus—encourage people to do the tough work and confront problems

5. Empower people to complete the work—they are the ones responsible

6. Ensure that all perspectives are heard—attentively listen to all voices and be open to the ideas of those who may be marginalized

In conclusion, dentists should motivate their teams and monitor stress levels of each member. They must step back and transfer ownership of problem--solving to employees, empowering them and helping increase confidence in their own abilities.⁴ 

Dentists are the resource and support for others, but the team must still do the work to learn to change and adapt.⁴ Both the leader and the team must work together to overcome challenges. Authority must not be used to control but rather to help others do the work and make necessary changes and adjustments.^4,8 Dentists have the role of assisting others in dealing with change. They must acknowledge each voice in the practice, empower individuals to be responsible members of the team,⁴ and create a safe environment,⁹ because a safe environment is critical for the process of change and adaptation. 

Editor's note: This article appeared in the April 2026 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.

References

1. Dental workforce shortages: data to navigate today’s labor market. American Dental Association. 2022. https://www.ada.org/--/media/project/ada-organization/ada/adaorg/files/resources/research/hpi/dental_workforce_shortages_labor_market
2. Shuck B, Herd AM. Employee engagement and leadership: exploring the convergence of two frameworks and implications for leadership development in HRD. Human Resource Development Review. 2012;11(2):156–181. doi:10.1177/1534484312438211
3. Lencioni P. The Five Dysfunctions of a Team. Jossey-Bass; 2002.
4. Northouse PG. Leadership: Theory and Practice. 8^th ed. Sage; 2019.
5. McWhinney W, Webber JB, Smith DM, Novokowsky BJ. Creating Paths of Change: Managing Issues and Resolving Problems in Organizations. 2^nd ed. Sage; 1997.
6. Heifetz RA, Grashow A, Linsky M. The Practice of Adaptive Leadership: Tools and Tactics for Changing Your Organization and the World. Harvard Business Press; 2009.
7. Doyle A. Adaptive challenges require adaptive leaders. Perform Improv. 2017;56(9):18–26.
8. Jefferies SS. Adaptive leadership in a socially revolving world: a symbolic interactionist lens of adaptive leadership theory. Perform Improv. 2017;56(9):46–50.
9. DeRue DS. Adaptive leadership theory: leading and following as a complex adaptive process. Res Organ Behav. 2011;31:125–150.