California’s System of Providing Dental Care Is in Crisis

According to recent reporting by the San Francisco Standard, California’s dental hygiene workforce is contracting at the very moment practices face greater operational and financial pressure. Although the number of licensed dental hygienists in the state has grown, the Bay Area has seen its hygiene workforce shrink by nearly 9% in 4 years. The resulting supply–demand imbalance has amplified economic hardship for practice owners while accelerating a shift toward alternative providers performing work traditionally done by dental hygienists.

For dentists, the financial piece has become increasingly difficult. High wages for dental hygienists, soaring overhead costs, and stagnant insurance reimbursement rates leave many practices with slim margins. In some markets, per-diem hygiene compensation exceeds what a new associate dentist earns, prompting practice owners to rethink staffing models. When reimbursement fails to keep pace with labor costs, even routine preventive services become financially challenging to deliver, particularly for small, single-dentist practices with limited negotiating power against large dental insurers.

This financial squeeze intersects with a second and more controversial trend: the expansion of preventive care duties to other clinicians. Several states have authorized dental assistants to perform limited scaling and other hygiene-related procedures, and similar proposals continue to surface nationwide. California dentists have increasingly turned to associate dentists to manage prophylaxis appointments. While such stopgaps help maintain patient flow, they can compromise scheduling efficiency, reduce availability for more complex procedures, and raise questions about whether less-experienced clinicians should be handling preventive care.

For dental hygienists, the shifting landscape underscores longstanding challenges related to workload intensity, physical strain, and limited access to benefits. Many hygienists work part-time to manage ergonomic demands, which often excludes them from employer-sponsored health insurance, retirement plans, or paid leave. With wages capped in many markets and limited avenues for career advancement, some hygienists have begun leaving the profession altogether, transitioning into fields such as nursing that offer stronger support structures, clearer progression pathways, and more comprehensive benefits.

Taken together, these economic and workforce dynamics point to a pivotal moment for dentistry in California. Practices are navigating an unprecedented convergence of staffing shortages, reimbursement pressures, and scope-of-practice debates. Without coordinated strategies to stabilize the dental hygienist pipeline, improve compensation models, and reinforce professional standards, the gap between demand for preventive care and the availability of qualified providers will only widen. Click here to read more.