Dentists Innovate to Tackle the Hygiene Staffing Crisis


Author: Rachel Wall, RDH, BS

The shortage of dental hygienists has posed a significant challenge for dental practices across the US. This shortage not only affects the efficiency of the practice but also compromises patient care. Proactive dental teams are recognizing the critical need to innovate and evolve in order to serve their patients and protect the future of their practice. At Inspired Hygiene, we have the opportunity to interact with dentists every day in private forums, at study club events and in our interaction with our coaching clients. 

What we’ve observed this year is a higher level of innovative strategies to address the hygiene staffing crisis. These strategies include, but are not limited to utilizing associates for hygiene duties, implementing assisted hygiene programs, and integrating expanded function dental assistants (EFDAs) into their teams.

Associates Taking on Hygiene Duties 

One effective strategy employed by dentists to combat the hygiene staffing crisis is the utilization of associates for hygiene duties. In some cases, dentists with additional training and experience in dental hygiene are able to step in and perform preventive services and exams. This approach ensures that patients continue to receive essential oral healthcare while the team continues their search for a great fit hygienist.

Assisted Hygiene Model

An increasing number of dental practices are adopting an assisted hygiene model, which involves a team-based approach to patient care. In this model, dental assistants work alongside hygienists to perform certain tasks, such as taking radiographs, applying fluoride treatments, or conducting oral health education. This collaboration optimizes efficiency and enables hygienists to focus on their core responsibilities, such as periodontal assessments, therapies and maintenance. This model not only improves productivity but can also provide opportunities for skill development among dental assistants and provide elevated patient care in the team approach. 

Expanded Function Dental Assistants (EFDAs) 

The integration of expanded function dental assistants (EFDAs) has emerged as another promising solution to the hygiene staffing crisis. EFDAs receive specialized training that allows them to perform advanced dental assisting tasks and in some states, scaling for pediatric patients. While some may view this as a threat to hygienists, in practices with a significant backlog of patient appointment requests, EFDAs can take some of the burden off hygienists by doing simple pediatric recare visits with the supervision of dentists, conducting critical screenings to free up hygienists to focus on more complex treatments. By incorporating EFDAs into their teams, dentists can also expand their productivity by delegating allowed procedures. This approach has proven particularly effective in underserved areas where access to dental care is limited.

Comprehensive Staff Training

One of the key aspects of Inspired Hygiene’s approach is team training and calibration. Administrative team members may not diagnose periodontal disease however, when they have knowledge of the basis for that diagnosis, it increases their confidence in the clinicians in the practice and the treatment they are recommending. 

Whatever alternative approach a team takes to address the hygiene shortage, education of the entire team will increase the chances for success. When the entire team understands the goals and purpose of assisted hygiene, for example, they can speak confidently to patients about the care they are receiving in this model. The admin team can understand why there are periodontal therapy blocks and the importance of honoring them when they understand the urgency in treating active disease. 

Inspired Hygiene’s coaches provide training that goes beyond clinical skills to provide the team with support in communication, patient education, and teamwork. This holistic training ensures that the entire team is aligned and works collaboratively to achieve optimal patient care.

Dental practice owners are actively addressing the hygiene staffing crisis by implementing creative strategies. Through the utilization of associates for hygiene duties, assisted hygiene programs, and the integration of EFDAs, dental practices are striving to maintain the delivery of timely oral healthcare services. These innovative approaches not only address immediate staffing challenges but also enhance patient access to essential dental care.

Ready to elevate the hygiene department in your practice?  Schedule a Discovery session with our Founder and CEO, Rachel Wall to discover how our tailored coaching programs can transform your practice and enhance patient care.

Dental Hygiene Compensation Models


Author: Rachel Wall, RDH, BS

Hygiene compensation has always been a hot topic. In light of current hygiene staffing challenges, it has become a critical element in securing and retaining hygienists. In addition to incentivizing hygienists, for a compensation model to be sustainable, it must provide structure to ensure the hygiene department remains a profitable part of the dental practice.

For the last 20 years at IH, we’ve contributed to the development of healthy hygiene compensation plans for hundreds of practices. One of my dental CPA friends recently reminded me of this piece I did a few years ago and these principles still hold true.

A long standing industry benchmark for hygiene profitability is that hygiene production should be at least 3 times the total hygiene compensation and that hygiene produces 25-30% of total practice production. Of course there are variables that affect this such as insurance participation and doctor procedure mix.  In this article, we will explore several hygiene compensation models that dental practices use to incentivize their hygienists and a few pros and cons of each model. 

  1. Hourly Pay Model
    The hourly pay model is the most straightforward compensation model for dental hygienists. Hygienists are paid a set hourly wage for the hours they work. With this model, we often see a team bonus in place that provides an equal distribution of additional income for team members based on hours worked.  

Pros: This model is easy to administer and provides a predictable income for hygienists. 

Cons: It may not incentivize hygienists to work more efficiently or improve protocols and systems to improve patient care. Hygienists may come to expect regular pay raises regardless of performance. 

  1. Commission-Based Model
    The commission-based model ties hygienist compensation to the amount of revenue they generate for the practice. Hygienists are paid a percentage of the revenue they generate, which can incentivize them to work more efficiently and provide better patient care through higher level services and adjuncts. This model can calculate pay based on individual or group performance. 

Pros: Hygienists can see a direct relationship to their performance and their income. When based on net production, the model ensures hygiene is producing at the desired level compared to compensation. 

Cons: This model can be difficult to administer, and hygienists may feel pressure to upsell unnecessary treatments to increase their commission. Also, when there are no patients on the schedule, there may

  1. Hourly Plus Commission Model
    The hourly plus commission model combines the predictability of an hourly pay model with the incentives of a commission-based model. Hygienists are paid a set base hourly rate and can earn additional commission based on the revenue they generate compared to their base pay. This model can incentivize hygienists to work more efficiently and provide better patient care while still providing a predictable income.

Pros: Hygienists have a stable base income to count on while the opportunity to  earn more once they reach a certain production level. The practice owner can determine what percentage of the hygienist’s compensation is hourly vs commission and ensure the first profitability point is reached before the commission starts. 

Cons: This model requires careful math and clear communication between practice administrators and hygienists to make sure the hygienist knows how their commision is calculated and which procedures count toward their production goals. 

Changing your dental hygiene compensation model
Over nearly 20 years, Inspired Hygiene has worked with numerous practice owners to elevate dental hygiene services, systems and hygiene profitability. When our clients ask us for help with restructuring dental hygiene compensation, we are eager to help because we’ve seen this touchy situation result in a successful transition when a few key components are implemented simultaneously. 

1-Create a compensation plan that is easy for the hygienists to understand and have very clear communication around expectations, fears and concerns from all parties. Have a transparent method for reporting production and commission on the agreed upon timeline (monthly, quarterly).

2-Incorporate very specific clinical and communication training and coaching to give hygienists the confidence, knowledge and skills to implement clinical services and increase patient acceptance. 

3-Map out a plan for the hygienists to reach the goals they set for their compensation. Use sample schedules to run different scenarios for hitting their goal and arm them with the proper equipment and products to achieve clinical outcomes that elevate patient health and profitability. 

In the vast majority of practices, both employee and employer desire a dental hygiene compensation model that is fair and supports ethical clinical behavior as well as creating an income growth plan for both the practice and the providers. It’s important to consider the impact of the model on the hygienists’ attitudes and effectiveness in meeting compensation benchmarks. 

No matter the model you choose, clear communication of expectations and the system for compensation is critical. We recommend a written agreement between employer and employee to

A few points you’ll want to be very clear on are: 

  • The threshold at which commission on production will begin
  • The percentage of production that will be shared
  • Duties expected of the hygienist during open time on the schedule 
  • Expectations of team work and support of the productivity of the entire practice
  • Clinical protocols that must be honored 

In conclusion, the right hygiene compensation model will depend on the practice goals and philosophy and the hygienists willingness to see it as a growth opportunity. By choosing the right hygiene compensation model, dental practices can incentivize their hygienists to provide better patient care, ensure the profitability of the hygiene department, and adapt in an ever-changing industry. 

Check out this article and video interview I did with Patient Prism founder, Amol Nirgudkar.

Are you interested in learning how Inspired Hygiene can help your dental practice? Use this link to Book Your Discovery Meeting.