The scene feels like something out of the Wild West: two figures facing each other on a dusty main street—not drawing weapons but waiting for the other to move first. Dentists on one side, tightening the reins on overhead and struggling to keep practices afloat. Hygienists on the other, standing firm for fair pay, flexibility, and respect in a profession that has long undervalued their voice.
This is the standoff playing out across dental practices today. But unlike a Western, there can be no winner if one side refuses to budge.
How We Got Here
It’s tempting to blame the pandemic as the spark, but this conflict has been smoldering for decades. COVID-19 only magnified the cracks already spreading across the profession.
Hygiene programs have not kept pace with patient demand, and attrition is accelerating. Nearly one-third of hygienists plan to retire in the next five years (1). At the same time, the U.S. Bureau of Labor Statistics projects a 7% job growth for hygienists between 2024 and 2034, creating more than 15,000 openings annually (2). Unless training programs expand, the workforce gap will only widen.
Compensation has become another flashpoint. From 2018 to 2023, wages rose nearly 27%—about 5% annually—yet many hygienists report that these raises haven’t kept pace with inflation or the value they bring (3). Dentists, meanwhile, point to shrinking reimbursements, escalating compliance costs, and payroll burdens that leave them equally cornered (4).
Layered over this is a cultural shift: the old model of “salary, benefits, and fixed schedule” no longer satisfies. In North Carolina, hygienists average $45–50 per hour, yet temporary or flexible positions often pay $55–65 per hour or more (5,6). Many hygienists are leaving traditional office roles for higher pay and greater autonomy. At its core, this standoff isn’t just about money—it’s about respect, independence, and being valued.
Why Hygienists Choose Temping
Beyond the numbers, conversations with hygienists reveal another layer of the divide. Many are choosing temporary work over traditional office roles not only for higher pay, but for autonomy and variety.
They cite:
Flexible schedules that allow better work-life balance.
Exposure to different practice models—from private offices to corporate groups.
Insight into leadership styles and workplace culture that reveals which environments truly support their role.
Variety and change that keep their careers engaging.
A consistent belief that traditional offices undervalue their contribution.
This pattern shows that the standoff is about far more than hourly rates. For many hygienists, temping offers both financial reward and professional dignity—two areas where traditional offices too often fall short.
Layered on this is new graduates, guided by some hygiene programs suggesting they “temp for a while,” are prolonging their entry into full-time employment further widening the access gap for patients and the workload strain on existing teams.
The Bonus Trap: When Incentives Backfire
Beyond compensation, flexible schedules, and temping lies another powerful disruptor in this workforce crisis, the sign-on bonus war. What began as a simple hiring incentive has turned into a bidding battlefield, destabilizing both recruitment and retention. Across multiple states, sign-on bonuses now range from $2,500 to $20,000. On paper, they look enticing, but most come with strings attached such as one- to two-year commitments and repayment clauses if the hygienist leaves early. Those under contract, with or without a bonus clause, are bound by legalese written to protect the practice, making it difficult or costly to exit even when the environment no longer fits.
The result is a frozen job market. Hygienists tied to repayment terms hesitate to reenter the hiring pool, while practices without deep pockets can’t compete, widening the gap between corporate and private offices. Ultimately, the sign-on bonus frenzy isn’t about attraction, it’s about desperation. These temporary incentives may fill vacancies, but they can’t fix the void.
If You Don’t Take Care of Your Own, Someone Else Will
And while it’s easy to pony up the money to backfill a position for a new hire, the real cost comes when you neglect the people already on your team. Sign-on bonuses and higher compensation packages might attract fresh faces, but if your long-term employees feel undervalued or overlooked, they’ll start looking elsewhere and they’ll take your practice culture with them. Loyalty can’t be purchased with a one-time payout; it’s earned through consistent recognition, fair pay, and a genuine investment in professional growth.
Trust me employees talk. They compare notes, they share numbers, and they eventually find out who got what. When they realize that newcomers are being rewarded with higher compensation while their own dedication goes unnoticed, resentment builds quietly but steadily. Before long, your best people, the ones who’ve stayed through challenges and change begin to question their worth. True retention isn’t about who you can afford to hire next; it’s about who you can’t afford to lose.
The Cost of the Standoff
The price of this divide is staggering. Patients wait months for hygiene appointments. Practices close rooms and lose hundreds of thousands in production. Teams fracture as loyalty erodes. Resentment festers when new hires are lured with premium pay while long-standing hygienists feel overlooked.
It leaves dentists with one pressing question: Have you truly listened to your hygienists, or are you just assuming you know their needs?
The True Value of Hygiene
The hygiene department contributes 25–35% of total practice production (7). In practical terms, hygienists are responsible for roughly one-third of the revenue stream—but that number understates their true influence. Hygienists drive treatment acceptance, with 75% of restorative needs discovered in hygiene visits (8).
Every restorative case diagnosed, every perio need identified, every referral for advanced care—it all originates in their chair. That downstream revenue is rarely credited back to hygiene but is inseparable from their work.
Now consider this: closing one hygiene room can translate to $300,000 in lost annual production. At 98% collection, that equals $294,000—nearly $24,500 per month. Add restorative and perio treatment generated by hygiene, and the financial impact easily doubles or triples.
Do you know these numbers in your own practice? If not, it’s time to calculate them (9). Hygienists should produce about three times their wages, yet their true value often stretches far beyond that benchmark.
From the Hot Seat: Lessons as a Dental Operations Director & Consultant
As someone responsible for both practice sustainability and team satisfaction, I’ve had a front-row seat to this standoff. I’ve listened to hygienists who feel overlooked and underpaid, and I’ve listened to dentists who worry about keeping the lights on under rising costs.
Here’s what I’ve learned from the hot seat of this hot topic: both sides are right. Hygienists are undervalued in many practices, and dentists are squeezed by shrinking margins. Assumptions on both sides only widen the gap. Dentists often assume hygienists only want higher wages, when many actually seek flexibility and respect. Hygienists sometimes assume dentists are unwilling to adapt, when many are simply trying to balance overhead.
In these moments, managers and consultants become translators. My role often involves interpreting each side’s language—helping dentists see the long-term ROI of valuing hygiene and helping hygienists understand the business realities that shape decisions. It’s not an easy seat to occupy, but it has taught me this: the only way forward is through honest dialogue and shared solutions.
Lessons to Learn
The Wild West didn’t settle because one side won. It settled when people realized survival required cooperation.
The same applies here. This isn’t dentists versus hygienists—it’s a shrinking workforce. If the standoff continues, patients lose, practices crumble, and the profession weakens. The way forward is not through holding ground, but through partnership.
One of the most powerful steps we can take is to create panel discussions where dentists and hygienists sit together, speak openly, and uncover the root causes of this divide. These conversations can move us from blame to solutions, mistrust to collaboration, and ultimately from attrition to rebuilding.
Only by sitting at the same table—designing fair compensation, embracing flexibility, and rebuilding trust—can we repopulate the workforce and protect the patients at the heart of what we do.
References
- ADA Health Policy Institute. Dental Workforce Shortages: Data to Navigate Today’s Labor Market. https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/hpi/dental_workforce_shortages_labor_market.pdf
- U.S. Bureau of Labor Statistics. Dental Hygienists: Occupational Outlook Handbook. https://www.bls.gov/ooh/healthcare/dental-hygienists.htm
- RDH Magazine & DentalPost. 2025 RDH Salary Survey. https://www.rdhmag.com/career-profession/compensation/article/55249984/2025-rdh-dentalpost-salary-survey-the-truth-about-income-and-benefits
- Focus Partners. Trends in Dentistry: Navigating High Overhead Costs / Staffing Costs.https://www.focuspartners.com/resources/business-ownership/trends-in-dentistry-navigating-high-overhead-costs
- ZipRecruiter. Dental Hygienist Salary in North Carolina. https://www.ziprecruiter.com/Salaries/Dental-Hygienist-Salary–in-North-Carolina
- Salary.com. Dental Hygienist Salary in North Carolina https://www.salary.com/research/salary/benchmark/dental-hygienist-salary/nc
- RDH Magazine. Understanding Your Numbers: The Dental Hygienist’s Role in Business Success https://www.rdhmag.com/patient-care/article/16405346/understanding-your-numbers-the-dental-hygienists-role-in-business-success
- Today’s RDH. Understanding the Monetary Value of the Essential Dental Hygienist https://www.todaysrdh.com/understanding-the-monetary-value-of-the-essential-dental-hygienist/
- Hygiene Mastery. The Value of Hygiene Production https://www.rdhmag.com/patient-care/article/16405346/understanding-your-numbers-the-dental-hygienists-role-in-business-success
