Why Dental Hygienists Leave

A new study published in the Journal of Dental Hygiene dives right into workplace culture and abuse.¹ The results are, frankly, not surprising. After 20 years in the chair and 15 years mentoring dental hygienists, I believe the dental hygiene shortage isn’t only about pay or schedules. It’s also about the environment we have to work in.

Researchers surveyed 137 clinical hygienists in the United States and Canada about abusive supervision (AS), which the authors describe as a supervisor’s sustained hostile verbal or nonverbal behavior toward the people they supervise.¹ Of the participants, 81% reported at least some AS, and about a third said it happened moderately to very often. In this article, “supervisor” is defined anyone with a role of oversight, such as a dentist or office manager.

The most common complaints from dental hygienists were not getting credit, broken promises, rudeness, and negative comments made about them to others. I am sure this sounds familiar. These complaints aren’t small potatoes, especially if they happen regularly and your concerns aren’t being heard.

The psychological numbers are hard to ignore. About 32% of respondents scored at or above the threshold for serious psychological distress on a screening tool, which is not the same as a diagnosis. About a third said everything felt like an effort most or all of the time, and more than one in five said they felt hopeless that often.

Earlier research cited by the authors links AS to emotional exhaustion, anxiety, and depression.¹ To me, that is the definition of burnout! It also affects the practice: the same research connects AS to lower productivity and workplace inefficiency, with one estimate putting the cost to US organizations at $23.8 billion a year in lost productivity, absenteeism, and turnover.¹

Explaining the Shortage

The presence of AS pushed clinicians to leave about twice as strongly as psychological distress did. Of respondents, 40% said they often considered leaving, and more than half said they dreamed about another job most or all of the time. The American Dental Association Health Policy Institute reported in 2022 that negative workplace culture was the most common reason dental hygienists leave clinical practice.² This latest study offers a look at what that culture can be.

A single survey cannot prove AS causes the dental hygienist shortage, but I believe AS plays a significant part. We are not losing dental hygienists because they stopped loving patient care. We are losing them because the environment is not optimal, and with no federal law addressing general workplace mistreatment, it can go unchecked.

No study is perfect. The survey was shared on social media, so people with bad experiences may have been more likely to respond. Most respondents were between 20 and 39 and about 80% were white, so we can’t say how AS differs for veteran or minority dental hygienists. The study found no link between AS and age, experience, or hours worked, so I don’t see this as a generational problem. The results also line up with research on nurses and other helping professions.

What I See From the Chair

As an active clinical hygienist and mentor, I have often been asked by a dentist or practice administrator to help improve a dental hygienist’s performance. Sometimes a new hygienist joined the team and was never trained on the office’s expectations. Sometimes a problem team member makes everyone’s lives miserable, and administration has never had the difficult conversation. In other offices, the dentist and dental hygienist are not complementary partners, so the hygienist feels stifled and can’t practice to the full extent of his or her license. And sometimes it’s simply micromanaging.

To be fair, I have also been brought in where the dental hygienist was part of the problem, and I have seen clear, fair feedback received as an attack. Holding someone to a standard isn’t AS. The difference is in the pattern and the intent: correcting the work vs diminishing the person, once vs constantly, in private vs in front of the team.

I have had to leave a couple of offices in my career for similar reasons. The causes differ, but the root is the same: a toxic work environment. When I share these observations, most dentists and administrators get defensive and refuse to believe it.

That defensiveness is understandable, but the data suggest it is worth a closer look. The good news is that culture can change.

What Dental Hygienists Can Do

You can’t fix a toxic environment alone, but you aren’t powerless. Here are some tips:

• Document incidents with dates and details.
• Address concerns directly and professionally when it is safe to do so.
• Ask for clear expectations and policies in writing.
• Find mentors and peers who understand and can support you.
• Know your worth! Your skills are in high demand.

What Dentists and Managers Can Do

If you lead a team, this study is an opportunity, not an accusation. Earlier research points to four common contributors to AS: supervisors’ leadership styles, how they view their employees, difficulty managing their own reactions, and their current well-being.¹ That means the behavior often has causes you can work on. Give credit where it is earned, keep your promises, and address frustration privately and professionally. The authors also recommend leadership development for supervisors, manageable workloads, adequate staffing, and access to mental health support. Your team knows running a practice is challenging and stressful. They extend you that grace, and awareness of how you are coming across returns it.

The business behind the chair is people. When we treat each other with respect, everything else gets easier, from the schedule to the patient experience. This research gives our profession data for a conversation we have needed to have for a long time. Let’s have it.

References

1. Hope C, Boyd LD, Vineyard J, Capozzi B. Association of abusive supervision with psychological distress and turnover intention among clinical dental hygienists. J Dent Hyg. 2026;100:34-43.
2. American Dental Association Health Policy Institute. Dental Workforce Shortages: Data to Navigate Today's Labor Market.