Recruit, Reward, and Retain: How to Build Hygiene Loyalty to You and Your Practice

Dentistry Today


Whether you are looking for your first hygienist to take over the prophies you are presently doing, or replacing or adding a hygienist to expand your patient care opportunities, the first step is to evaluate your hygiene philosophy and the vision for your practice. Without a clear understanding of what you believe and what you need, you won’t be able to recruit with clarity, and you may hire someone with the hope that it will just work out. Sometimes it does: you get lucky and the perfect person arrives at your door. Sadly, this doesn’t happen often.
Preparation for addition or replacement requires that you understand that not all hygienists have been trained in the same way. Since schools of hygiene dispense graduates with AS, BS, and other degrees, and since schools may be located in regions of the country where hygienists are trained and/or allowed to perform different types of patient care (eg, anesthesia) and/or trained to work under direct, indirect, or general supervision, their expectations of a patient care appointment and respective salary might be different than yours. This leads to disappointment and disillusionment for both of you.

Illustration by Brian Green

The basic “job” of dental hygiene is changing in ways that can be helpful to your practice and free you from some tedious responsibilities. For instance, in many areas of the country hygienists can give anesthesia for quadrant scaling and root planing, which frees you from having to deglove, leave your patient, glove, give an injection, return to your patient, and reglove, losing time and momentum. In the event the anesthesia does not provide enough relief for the patient, you might have to repeat the process. With noninjection anesthetics such as Oraqix (DENTSPLY Pharmaceutical), your hygienist can treat the patient from start to finish and leave you to your phases of treatment, a win-win for everyone.


Let’s start at the beginning. What type of practice do you have? Is it general with lots of children and young adults (little perio, mostly prophies)? Is it a general practice with a highly educated, transient, and professional population that needs lots of intermittent care and desires cosmetic treatments? Or is it rapidly filling with patients who are aging and in need of careful, concentrated periodontal evaluations to diagnose situations based on systemic medical considerations-a population with recession, sensitivity, xerostomia, and a myriad of interactive clinical conditions that require more frequent maintenance and therapy?
Take a step back and evaluate your patient population. If you need a demographic interpretation, check your computer and ask it to give you a breakdown of your patient pool by age. You may be surprised at what you see. If, like most practices, your patients mirror your own age, the pool may be getting older, and you may have missed it. Hopefully, many of your patients started with you at the beginning and are joining you for the full ride. The reason so many feel like “old friends” is because they probably are!
Once you have determined the type of practice you have, the next step is to assess the available hygiene pool within your office. Can your present hygienist add a half or full day and spare you the aggravation of adding a new set of variables to your group? Does your present hygienist have a friend who might be interested in your office? If your hygienist is part of the local hygiene component, have him or her share your need with the group. Not only does this reduce the cost of advertising, but you already have a built-in “good neighbor” detector. Attracting, motivating, and retaining staff is the single most difficult responsibility for any team. It’s doubly hard for a dental practice. The delivery of patient care is something you were taught in school, and with time it becomes easier to do. Staffing issues present another set of challenges. How do you find, hire, and train quality staff when your time is spent in an active patient care role? Further, where do you begin to look? If this is your first hygiene position, contact your colleagues and see if they can help. Where did they find their hygienists? Do they have someone who wants to add time or has a friend looking for a new position? Some hygienists’ sole motivation is to help a new practice build and to be part of a new team. Remember, the best teams are built from within. Check it out!


If recruiting from within is not an option, then think outside the box. Times have changed, and a majority of workers now cruise the Internet when they are looking for a change of scenery. With dentistry, since positions are generally “frozen” with little growth potential (dental assisting, dental hygiene, laboratory technician, etc), opportunities for better pay and benefits sometimes come with job changes. Job postings on the Internet can be specific to the industry, posted as employment opportunities at major job search Web sites, or can be part of online journal classified ads. Rather than limiting your search to a geographic area and local newspaper, broaden the search to include possible candidates who may be moving to your area for other reasons (spouse, family, etc). Be as specific as possible within your ad by clarifying the duties and responsibilities of the position. Clarify the work schedule.
Request resumes, not phone calls. You and your present staff are busy enough and shouldn’t have to answer calls from prospective employees asking questions about the position, salary, and work hours. Resumes also give you a chance to look for work patterns and attention to detail. (I can’t tell you the number of times I have seen the word hygienist spelled with 2 t’s.) Gaps in employment can be questioned at the interview, if everything else looks good.
The Internet is your best ally for recruiting, and when paired with the nearest big-city newspaper, it may deliver the biggest bang for your buck. Limit your Internet search to those sites with a dental focus such as,, dentaljobs. com (Georgia), (Florida), or your state hygiene organization.
Check out salaries with placement groups. If you haven’t had to look recently, salaries in your area may have escalated. To attract the best candidate you may have to pay the going rate, especially if your benefits don’t cover medical, retirement, profit sharing, or a bonus plan.
Weed through the resumes as they come, checking for accuracy of information, details of previous positions, and length of service at each one. They can be printed or saved in a folder for later review. A resume should be clear and precise. Spelling should be accurate, because chart notes are legal documents, whether written by hand or computerized. If the resume is from another geographic area, there should be an explanation in the cover letter as to why the candidate is moving. If licensure is necessary, it should be current and appropriate for your state. If you want a new graduate, he or she may have little clinical experience but a great deal of enthusiasm for the new profession. Salary expectations may be lower than those of someone with experience, and they may need more time with patients, but they also may be more adaptable than someone who has worked in the same practice for years.


Contacting possible candidates by phone is a good way to check whether they are still available and interested in the position. It’s also a great way to see how they sound on the phone. Because your hygienist might confirm patients in downtime, you want good phone manners and a pleasant speaking voice and tone. There have been times when I contacted candidates who answered their cell phone at work, while working! Since most offices don’t allow that, I scratched those names off my list of potentials. In addition, one candidate could not talk to me because “I have to meet my friends at the mall.” Lots of energy represented, but, as far as I was concerned, her priorities were off.
When you have a list of potential hires, the next step is a personal interview. Make sure you ask the same questions of all candidates. If you are adding a staff member, then add some of your team to the interview process. The most interesting information comes when the doctor is not in the room! If you are replacing a staff member and you are not ready to clue in present staff, suggest a time and place where you can meet a candidate in comfortable surroundings. Include a third party when possible or meet where there are others around. Just an aside, gentlemen, don’t conduct personal interviews alone with a female candidate. The same goes for women if the candidate is male; make sure you bring someone else along.


With clinical positions such as dental assisting and hygiene, job specifics are vital and beyond the interview. A “working interview” is a great way to see if a person can function within your team. There are times when personality and the ability to cooperate are more important than the specific function of the job. However, clinical skills should not be a given, and if you need experience, then be specific: “This position requires a high level of skill with ultrasonic instrumentation and nonsurgical periodontal therapy…” or, “We are a paperless clinical environment; experience with intraoral cameras, digital radiographs, and photography is required.” To reduce the learning curve, state your expectations up front.
Ask clinical questions to assess the candidate’s knowledge base and how current it is. For instance, is he or she fully trained in perio charting, local antibiotic therapy, local anesthesia, oral cancer screenings, and ultrasonics? Is the candidate used to a   30-, 40-, or 50-minute patient schedule? Be specific when you discuss your patient care hours and other times you will need the person to be at the office (staff meetings, morning huddles, group activities, etc). If you have a monthly meeting after hours, emphasize that it is part of the position and not optional. Candidates will appreciate it if you let them know in advance what they can expect. If the person can’t meet after hours for family or other reasons, then there is no reason to continue the interview. Thank the candidate and  excuse him or her. If you begin to be flexible with new hires, then you will risk the ire of those already employed. No exceptions!
Don’t hesitate to ask candidates about previous experiences. When the schedule had openings, what were their responsibilities? What did they like best about their previous job? Is or was the person a member of a team? How did they work in a group? A fuller picture of the candidate helps find motivating factors that can enhance your opportunities for a successful hire. Once someone is a potential hire, have the person spend a day at the office for a “working interview” to see if he or she can “walk the walk.”
If compensation issues have been agreed upon and the person seems to be a good fit (or as my father would say, “can bat left and throw right…”), then make the offer with a period of adjustment built in: 30, 60, or 90 days. This is the time when either of you can decide to sever the agreement and move on with no consequences. Hopefully, within that time you both will know if you have made the correct choice.


Once hired, how often is a new hygienist simply thrown into the job? Think about it: learning how your office runs and what is expected in an appointment takes time.
What is your protocol for a perio diagnosis? What about x-rays? Are they taken yearly, every 6 months, vertical or horizontal bite-wings, anterior PAs? How much time do you allocate for each appointment? Does the hygienist schedule the appointments? If there is a communication system in the office, how does it work?
How long does it take to find your way around a new office, locate the supplies and equipment, learn the paperwork, and blend in with present staff? Schedule a couple of lunches in the first few weeks to help with the cooperative effort. Meet with your new hygienist regularly to discuss philosophy of care and what criteria you use to diagnose disease. Discussions like these will help when you and your hygienist find yourselves at odds with a diagnosis or treatment plan. It also helps build teamwork. Your office is as unique as your team is. A new hire needs to learn your pace, style, and attitude. Be clear about the reporting structure and who gets the call if someone is out sick or has an emergency. Be sure the new hire has your office telephone number and a personal number for you and/or the manager. I am amazed at how often a new hire has no number to call when stuck in traffic or with a flat tire!


Training shouldn’t be limited to your new staff member. It should be ongoing for all staff. This means that the team has regular, focused meetings each week, goes to continuing education classes, or takes a quarterly afternoon for bowling! The more you learn with your team, the more you learn about your team. Staff members who become connected are more likely to be supportive of others. Your group doesn’t have to interact after work, just work together at work! Be consistent. Incidentally, a fully functioning team can function even if the coach is not there. Witness the times when a doctor is out with a serious illness and the team bands together to keep the office functioning with an interim doctor. Imagine the group effort involved at even the smallest level to keep an office producing income and happy patients. How does that happen? How can you make it happen for you?


Rewards for good employees are not always financial. Retention studies show that while a competitive paycheck is necessary, it’s the camaraderie and sense of belonging that keeps team members from leaving. In general, people choosing dental hygiene or nursing as a career are not motivated exclusively by money. They have chosen a “service” career with a dedication to people. Their motivation is in doing a good job, receiving praise when doing so, and having a feeling of helpfulness with their patients.
By contrast, staff turnover is easy to track and gives off a big signal that there is something “wrong” in the office. Advertising for the same position multiple times is a dead giveaway. The dental community is small, and word travels quickly. If you have turnover, check it out. Find out why people leave your group. Ask questions when notices are given and be ready to listen. Some of the answers may be difficult to hear, but the problems may be easy to fix. The perception of unfairness is generally a big issue. Do you favor one employee over another? Are there special arrangements for one person and not another? Does someone just not understand your vision? Have you been doing this so long that you forgot to explain where you were leading the group? How do the team members know if they are doing a good job? Retention is not about the money; it’s about the team.
When recruiting for any position in your practice, take a minute to assess what your team does well and what it needs to move forward. Recruit with that in mind. Weed out candidates who don’t match. Spend time questioning candidates on their experience and expectations. Is this person someone who will represent your practice well in the community?


This article has spent a lot of print time on recruitment. The reason for that is simple: recruit with dedication and focus. Weed out candidates ruthlessly. Know what you are looking for; don’t settle or rearrange your vision for one person. Advertise in association journals, ask for credentials. Once someone is on board, spend time training and integrating that person  with other team members. Be aware of your office “culture” and understand that each office is a unique imprint of its leader. Be the leader; hold onto your vision.
Remember that your team is a reflection of you. Choose with this in mind. You won’t be disappointed!

Ms. Cary is a hygienist with over 30 years in the field. Her background includes clinical hygiene in pediatric dentistry, general, group and solo practice, management with her own company (Creative Solutions), which focuses on total practice growth and team improvement for success, and presently as Corporate Hygiene Administrator with Intelident Solutions based in Tampa, Fla. She can be reached at