How Dental Hygiene Went from Thriving to Threatened

Lori Hendrick, PhD, MS, RDH, CDA, CDT, has filled various roles on the dental team for more than 30 years, including certified dental assistant, certified dental lab tech, registered dental hygienist, and dental hygiene educator. She currently manages her husband’s dental office while also practicing clinical dental hygiene. Additionally, Hendrick owns a dental lab and dental continuing education business in North Carolina. She and her husband, Joe Hendrick, DDS, champion the vital role that dental hygienists play and are actively working to expand the scope of dental hygiene. Hendrick is the current dental hygiene member on the North Carolina State Board of Dental Examiners.

The opinions and views reflected in this editorial are her personal views and not those of the dental board.    

Do you remember when it was easy to find a fill-in dental hygienist, or when it was difficult for new graduates to find a job? In fact, according to the United States Bureau of Labor Statistics (BLS), from 2008 to 2018, the dental hygiene job market was considered oversaturated with new graduates who struggled to find jobs. In 2018, the BLS expected the profession of dental hygiene to grow 38% over the next decade. Currently, the BLS is projecting dental hygiene growth at only 9% from 2023 to 2033 with an estimated 16,400 openings each year on average.¹ Today we are witnessing a complete reversal of the once oversaturated hygiene market. We are experiencing a shortage of working dental hygienists across the US.

Currently, the US has 335 accredited dental hygiene programs with an overall capacity of 9,815 positions for students/learners annually. Data analyzed from the American Dental Association (ADA) Health Policy Institute’s Survey of Dental Hygiene Education Programs show some alarming statistics from the class of 2022. The research notes that of the 7,430 students originally enrolled only 6,426 (86.5%) completed the program. One disturbing statistic was, that of the 6,426 who completed the program, only 5,796 (90.2%) were employed in a dental-related activity.² Across the US, the dental profession is facing a growing challenge – a national shortage of dental auxiliaries — especially dental hygienists and assistants. According to the ADA, 33% of current dental hygienists are expected to retire within 5 years with a median age of 51.5.³ Because this impacts the ability of patients to secure appointments for routine hygiene visits and preventive care, it is getting the attention of many local news networks. The Health Policy Institute reports dental office capacity is down as much as 11%.³ The shortage is likely a culmination of factors including the pandemic, dissatisfaction with current working environments, and a shift in career choices for various reasons.

Recently, Sarah Pless, DDS, a dentist in Wilmington, North Carolina, was interviewed on the local news regarding the shortage of dental hygienists in the state (click here to watch the interview). She attributed the shortage to the loss of dental hygienists following the COVID pandemic as well as burnout. While the number of licensed and practicing dental hygienists has always outnumbered dentists, the gap closed significantly in 2024. As of January 2025, there were only 515 more registered dental hygienists than dentists in North Carolina. With an allowed ratio of 2:1, dentists continue to struggle filling open hygiene positions.

In 2021, the North Carolina Dental Society formed a workforce committee to evaluate the shortage of dental auxiliaries. Working with dental hygienists, dental assistants, dental lab technicians, and the community college system under the leadership of Martha Ann Keels, DDS, PhD, the goal was to see where we could develop new programs or grow existing programs. In 2024, North Carolina graduated 216 dental hygiene students from community college programs — a 20% increase over previous years. Currently, the state has 13 dental hygiene programs (12 community college programs and one university program), one new program starting in 2025, and two new programs starting in 2026. However, with the recent success in new startups, the struggles continue. Thus, it is time for our profession to take a deeper dive into the attrition that is fueling this current shortage. What other factors are at play?

Fewer than 50% of the hygienists who left the profession in 2020 have returned.² However, that does not account for the totality of the shortage. This multifactorial problem actually began with the oversaturated market from 2008 to 2018. As new dental hygiene graduates faced difficulties finding positions, research shows they entered other professional fields such as nursing or radiography, leaving dental hygiene behind.¹ Furthermore, approximately 5% of dental hygiene graduates each year pursue dental school, never utilizing their dental hygiene degrees. As Pless articulates in her interview and research confirms, current dental hygienists are leaving the profession or electing to work part-time due to increased dissatisfaction with the office environment, low pay, inadequate benefits, feeling overworked, and lack of growth opportunities.^3,4 So it is time to raise the question, is there a true workforce shortage or is this a self-made crisis created due to the attrition of dissatisfied and devalued hygienists.

Currently, it seems that everyone has a solution to the problem of workforce shortages without sitting down at the table for discussions with those involved the most –  dental hygienists. It is time for dental hygienists have a seat at the table to discuss their perspective rather than dismantle our profession! Recently, the ADA proposed policies that would remove some protective restrictions to the educational processes for dental hygiene students/learners. These are protective restrictions that protect the public from untrained professionals. While these policies were intended to “complement, not replace, the vital role of hygienists on the dental team,” they have in fact placed dental hygiene under attack by state dental associations as they work to introduce legislation to allow foreign-trained dentist to practice dental hygiene without requiring hands skills hygiene exams, to allow dental students to practice dental hygiene, and to increase the student to teacher ratio for dental hygiene education clinics.⁴ These legislative agendas are being pushed without having conversations with dental hygienists and dental hygiene educators. Many dentists who truly see the value of their dental hygienists are as equally appalled at this decision on behalf of the ADA as we are.

In June, the Nevada Dental Association introduced legislation that would allow dental hygienists to be trained chairside by a dentist while placing oversight on the shoulders of the State Board of Dental Examiners. Dental boards are reactive, so it would take complaints or harm before they become involved. If dental boards are to become more proactive as Nevada dentists propose, they will have to increase budgets and staff to support this increase in oversight. It is likely that patient complaints will increase exponentially if educational and skills are reduced. The American Dental Hygienists’ Association has been both proactive and reactive in assimilating and distributing information to state associations. This has included call to action on several legislative proposals via social media outlets and direct email campaigns in an effort to educate not only dental hygienists of these legislative proposals, but to also advise the public to question who is providing them care. As hygienists we must remain vigilant and diligent to add to the conservation!

While the workforce shortage is not likely to be resolved immediately or even within the next 5 years, we should come together as a profession to demand the best care possible for our patients and to protect the public. The role of dental hygienist on the dental team should not be sacrificed to solve this issue. Dental hygienists should have a seat at the table to help resolve this shortage. Legislators prefer productive, respective dialogue, and evidence-based presentations when engaging with professionals on policy matters. In fact, prolonged disputes between professionals are often perceived negatively by legislators and challenges credibility. As one of our North Carolina legislators recently said when legislation was presented that found professionals on different sides of the table: “Come back to us when you have your house in order.” While we must defend our profession, when dentists and dental hygienists are fighting against each another, no one wins. In fact, it will be the public that loses. Our patients will suffer. Now is the time to advocate for our profession and defend the practice of dental hygiene with evidence. It’s time to work together to advance oral health care for all!

References

1. United States Bureau of Labor Statistics. Occupational Outlook Handbook, Dental Hygienists.
2. American Dental Association Health Policy Institute. Commission on Dental Accreditation 2023-24 Survey of Allied Dental Education: Report 1 – Dental Hygiene Education Programs.
3. American Dental Association Health Policy Institute in Collaboration With American Dental Assistants’ Association, American Dental Hygienists’ Association, Dental Assisting National Board, and IgniteDA. Dental Workforce Shortages: Data to Navigate Today’s Labor Market.
4. Anderson, O. New ADA Policies Empower States to Alleviate Dental Workforce Shortage.