Trends in Dental Hygiene: Shaping the Way Dental Practitioners Do Business

Dentistry Today


Wouldn’t it be great if you had a crystal ball and could foresee the future? You’d know exactly where to be and what to do to tap into the next big thing. Barring this type of magic, there certainly are trends we can look at today that can give us an insight into the future.

Through the Wall Street flurry of the 1980s and the Silicon Valley explosion in the 1990s, dentistry has remained a constantly growing service industry. It enjoys success as the markets go up, and is somewhat cushioned as the markets go down. Switching from needs-based dentistry to wants-based dentistry and back again as economics demand is as easy as switching toothpastes for some practitioners. Economic forces such as supplies of qualified dentists, dental hygienists, and auxiliaries combined with the financial security of our nation cannot be ignored. With each stage of development, dentistry becomes a more exciting and challenging field in which to serve.

Before looking at individual trends, let’s examine the driving force behind changes in dentistry. First, the demand for services is at an all-time high. Second, the numbers of dentists, hygienists, and trained auxiliaries are decreasing. Third, we are experiencing more real wealth among Americans than ever before. We can only imagine the influence of these trends. So here are a few thoughts, particularly as they relate to dental hygiene.

Changes in consumer choices create changes in business operations. There are as many different but correct models of practicing dental hygiene as there are in practicing general dentistry. Once a practice is built with solid management principles and systems, the differences are really a matter of style. I see this continuing to emerge as a trend as we move into the platinum age of dentistry. An example of this is assisted hygiene versus nonassisted hygiene this is really only a matter of work style, and your decision should be based on four factors:

(1) Demand. What is the demand for dental and dental hygiene services in your community, and more importantly, what is your commitment to supplying this demand? If you are a mainstream practice with a commitment to serving as many people as possible, your style is different from a more boutique-type practice focusing only on a small segment of the population.

(2) Capacity. How many operatories do you currently have, and are you willing to expand? For instance, there are practices that have up to five or more operatories dedicated to hygiene services?just to meet the demands of the community. This practice style takes a great deal of coordination, and there is generally a wonderful mixture of hygiene services in these types of practices. It makes for an enthusiastic environment too, because it would be difficult for the hygiene team to see five operatories of prophies all day long. Calculate capacity as follows:

  • One RDH/one Op serves 800 patients of record.
  • One RDH/two Ops /one assistant serve 1,200 patients of record.
  • Two RDHs/two Ops serve 1,600 patients of record.
  • Two RDHs/three Ops /one assistant serve 2,000 patients of record.
  • Three RDHs/three Ops serve 2,400 patients of record

(3) Availability. How available are hygienists in your area? Some parts of the country struggle to meet the demand. Utilizing an assisted hygiene model where a hygienist is paired with a competent dental assistant can be a very cost-effective way to expand the department in a high-quality way. Practitioners who have embraced this concept have learned that the hygiene cotherapist quickly becomes one of the most influential people in the practice, so this person needs to have, or be trained in, high-level communication skills to support the hygiene team.

(4) Style. Many hygienists (and dentists) have developed a pattern over time that fits their current work styles. Changing to a more efficient system can be difficult, even when the benefits are clear, the strategy simple, and the rewards apparent.


The “tiers” of responsibilities in hygiene are becoming apparent through our language. There is a lot of talk about various roles and duties. We now have hygienists, restorative hygienists, periodontal hygienists, aesthetic hygienists, assistants, preventive assistants, hygiene cotherapists, and coordinators, to name a few.

Again, I don’t think there is any right or wrong title or scope of duties. Your aim should be to keep your practice needs aligned with your vision. Continually re-identify the needs of your practice. Do they reflect your vision? Even if they do, be prepared to make changes. If shortages in personnel continue as predicted, expect to see more of the surface duties of the hygienist shifted, allowing the hygienist to focus more time on direct patient care.


Practices may tend to become larger as dentists take on more patients and expand their range of services. In addition, female dentists entering the field tend to move toward multiple employee/associate models or small partnership models, rather than solo practitioner models. With this the number of operatories, employees, and patients increases; hence management issues increase. How can you manage this overall growth and stay focused on dentistry? Take a cue from industrydepartment coordinators. Specifically, the hygiene coordinator would be accountable for all aspects of the hygiene business and business development to ensure department profitability. This includes creating a productive scheduling template, looking at capacity issues, forecasting future physical and capital needs of the department, coordinating the hygienists’ clinical needs, and being a patient advocate. A hygienist, an administrator, or a high-level assistant can fill this role; the key is the ability to focus on the business side of care.

The educational background of hygienists is becoming recognized by general dentists throughout the country. An understanding of the hygienist’s training in medical implications of prescription drugs, the effect of periodontal disease on systemic health, the correlation of occlusion to periodontal disease, and the full spectrum of preventive medicine positions is now being grasped by the profession.

As licensed professionals, hygienists are taking on expanded roles and support of the doctor in areas of triage, emergency management, and restorative aspects of the practice. The state of Washington is one of the most progressive in the country: hygienists can provide anesthesia; place, condense, and adjust composite restorations and anterior direct composite veneers; use soft tissue lasers for periodontal therapy; and work under the general supervision of a licensed dentist. This is in stark contrast to many state practice acts that literally restrict hygienists to the removal of calculus and stain.

Increased patient demand coupled with a decrease in supply of qualified personnel means that expansion of duties and responsibilities makes good sense for both patient and practice. In this author’s opinion, hygienists can and should be elevated to the same status as physicians’ assistants are to physicians.

Growing a practice just for growth sake is passe. The growth and evolution that is predicted to occur in the new millennium will occur as a natural progression met through satisfying each patient’s diverse needs. The focus will be on a controlled growth pattern that allows dental teams to provide high-quality, comprehensive care. Expect to see delegation as part of this model.

With the advent of digital radiography and computerized charting, there may be a new model emerging, particularly in areas with a major corporate presence. Imagine a three- to four-operatory facility on the ground floor level of Microsoft, IBM, or a Saturn automotive plant. Dental hygiene departments would be staffed to provide care to employees on-site, with dental records transmitted to attending doctors in a centralized location.

General and specialty dentists could be located off property and share space to take advantage of economies of scale. By employing dental hygienists, a higher percentage of employees would receive preventive care, lowering absentee rates caused by emergency situations. Paying hygienists a flat salary for preventive care and creating self-insurance programs for restorative care would reduce administration costs. This could be a cost-effective way for companies to increase benefits at relatively the same cost per person.

Look for this trend to begin within the next 5 to 10 years, and look for dentists and dental hygienists who are willing to join the ranks as employees of major corporations. With attractive compensation packages, possible stock options, and retirement plans, without the headache of administrative duties and overhead concerns, this could be appealing to a great many new hygiene graduates.

Right now advertising as a cosmetic or aesthetic dentist creates a unique selling proposition, much like being a prosthodontist in the early 1960s. Back then, with huge decay rates and no fluoridation, few dentists focused exclusively on crown and bridge restorations, certainly not the full-mouth restorations of today. These days you wouldn’t dream of being a general dentist and referring out all crown and bridge work.

So goes the way of cosmetic dentistry. Today it is new; 5 to 10 years from now it will be the bare minimum expectation of consumers. Patients will naturally expect their dental needs to be met in a highly aesthetic fashion.

How will this trend affect the practice of dental hygiene and research information? The role of patient advocate and educator will continue to expand as new materials flood the market. Helping consumers understand the distinctions and use of products will become more appreciated.

In 1960, there were three flavors of ice cream: chocolate, vanilla, and strawberry. Just for fun, we combined them and had Neapolitan. Now there are hundreds of flavors. This reflects two things: first, a great marketing strategy within the dairy industry, and more importantly, a demand from consumers to “give it to me my way.” Your patients are trained to get what they want, when they want it. If you don’t have convenient appointment times, they’ll find someone who does. If you don’t speak to them as individuals, someone else will. If you make them feel guilty about their home care, rather than giving choices and options, they’ll move on!

Each month your team should mastermind how to customize services to your particular clientele. Having patients actively participate in surveys and conducting exit interviews with anyone leaving your practice is mandatory. You MUST understand what your patients like, don’t like, and want more of. This type of listening pays off!

Juried research is bringing new light to the impact of oral health on total wellness. Identification of low-grade oral infection has been moved to the high priority list for many surgeons. There is an emerging trend to gain medical clearance from dentists of record prior to cardiovascular surgery, joint replacement, or other forms of complex surgical procedures to reduce risks of postoperative infection. This provides increased emphasis on identification of periodontal disease and decay at earlier stages. It is no longer acceptable to wait for rampant decay or generalized periodontal disease to take hold prior to treatment. Anticipate continued focus on prevention and early treatment of disease.

The popular press and disillusionment with mainstream medicine is propelling consumers to seek alternative medical treatments in record numbers. Chiropractic care, acupuncture, nutritional counseling, aromatherapy, herbal supplements, massage therapy, and other alternatives are making traditional medicine the second choice of many Americans. As our society shifts into a more holistic, natural approach to healthcare, dentistry will be expected to shift as well. We have always had the tools to impact the patient’s total health. Expect to incorporate more diet and nutritional counseling, smoking cessation programs, in-depth medical histories, and routine blood pressure screening. Dentists and dental hygienists are in a unique position to diagnose many health conditions in the earliest stages.

Dentistry has always tried its best to comply with the rule, “first do no harm.” At the time mercury filling materials became popular, they were an inexpensive and reliable way to address the rampant needs of society for dental care. Dentistry, to the best of its knowledge, was providing the best care at an affordable cost for the mass needs of the population. There were few cost-effective alternatives in materials. Today we have a greater choice of composite polymers and porcelain materials. Again, we are providing the best we can with the resources we have. However, who’s to say that patients may not be allergic or sensitive to the new materials as well.

Expect to see customized allergy testing of materials become the norm in dental practices. Instruments available today include vega resonance meters. These will continue to be refined for accuracy, and will spur interest in research on environmental and materials sensitivity, until we create biocompatibility for the masses.

While no one has a crystal ball, it is interesting to look at how our industry is being affected by changing consumer behavior and supplies of qualified personnel. Think ahead, embrace these changes in the dental world, and your practice will continue to grow and evolve.

Ms. McManus is the director of Hygiene Mastery, a coach with Fortune Management, and author of the collaborative book, Fundamentals of Outstanding Teams. She can be reached at (888) 347-4785 or