Written by: Dr. Maggie Augustyn, FAAIP, FICOI
Round One: The Hygienist Versus the Dentist
It feels like we’ve been thrown into the ring of an epic Las Vegas showdown—the kind you see plastered on billboards, with neon lights screaming about the fight of the century. On one side, the hygienists—nimble and precise; on the other, the dentists—powerful and calculating. This is no lightweight bout. This is the main event, the one that has drawn the eyes of the entire arena. The stakes? Higher than they’ve ever been. People are betting big—no, massive—on both sides, laying down not just cash but livelihoods, reputations, and futures.
When I wrote my articles over the last two years—Bridging the Gap and You Are Not a Tooth Scraper—I didn’t anticipate I’d be watching this fight unfold quite like this. And while it might feel like the spotlight is new—with roaring crowds and glitzy headlines—the truth is, this fight has been simmering for decades. Back then, fewer people noticed, fewer people cared, and fewer lives were caught in the fallout. But now, the lights are brighter, the stakes are higher, and the world is watching.
The Hygiene Shortage: A Heavyweight Problem
What am I talking about? I’m talking about what everyone has been talking about… the hygiene shortage. From the dentist’s perspective, the rates to hire a hygienist have gone up so significantly that the previously established standards of profitability in the hygiene chair no longer make sense. I gave some insight on this a couple of years ago here. From the dentist’s perspective, fewer hygienists are available for hire as permanent employees, and thus the practice owner has had to rely on temp agencies. These employment services establish fluctuating rates, negotiate based on availability, and leave practice owners with a lack of stability for their patients—a foundation they have grown to depend on.
With the cost of supplies and equipment going up steadily (and dare I say rapidly), and the rates of pay for service stagnant for decades (if you rely on insurance reimbursement), creating economic feasibility within a practice has become more of a challenge today than ever before.
Hygienists Strike Back: Breaking Free from the Mold
From the hygienist’s perspective, the long-established culture of top-down authoritarian, toxic leadership—bordering on abusive—got to be too exhausting. Years of dedication to the practice owner, the practice, and its patients—without medical benefits, a retirement plan, or vacation—led them to renegotiate the terms of this long-standing contract.
Contrary to popular belief, the shortage is not just caused by a lack of hygiene school graduates. To truly understand the multifaceted reasons behind why dental hygienists have experienced dissatisfaction in their roles and made the decision to leave, it is essential to explore the intricate findings presented in The Dental Workplace Shortage Report, which delves deeply into this complex and nuanced issue. An issue that has steadily unfolded over decades has now, regrettably, culminated in reaching its critical peak.
Swinging Solutions: Are We Hitting the Mark?
As both parties stand on opposite sides of the divide, each is attempting to solve the issue—and the solutions vary. There are the ADA Resolutions 513H, 514H, and 515H, which may become laws in various states and might allow foreign-trained dentists and dental students to work as hygienists. The ADA 401H Resolution proposes a revision in the student-to-faculty ratio to increase hygiene graduates.
There is the rise of new roles in dentistry such as the Oral Preventive Assistant, which is already legal in Arizona (SB1124), Illinois (source), and Kansas. There is some talk of ‘on-the-job training’ for dental hygienists in Nevada via Senate Bill SB495.
These proposed changes are efforts to address the shortage of hygienists. More importantly, they present options for practice owners to allow caregivers into the hygiene operatory at a much-reduced cost (more on this in a moment). Yet, all of these changes feel like blows to the hygiene profession—punches in the boxing ring. Because in the minds of hygienists, the reasons behind their dissatisfaction and decision to leave full-time positions are being ignored and unaddressed. At the same time, they feel that organizations supporting dentists are lowering patient care standards. Hygienists believe they are the only ones still prioritizing the patient.
Dentists in the Corner: Fighting to Stay Afloat
Dentists, in this equation, are also taking punches, struggling to make sense of the upside-down profitability in the hygiene operatory. A hygienist might request a pay rate of $60–$125 per hour, depending on the region. When you factor in taxes and benefits, this increases to $78–$162.50. Reimbursement rates for a prophy are $94 and bitewings $62 in my ZIP code—for in-network dentists. And that’s the Chicagoland area; rates may be lower in other parts of the country.
The math here just doesn’t work. The dentist feels not only financially strained—some might even say gouged—but also abandoned by hygienists and left to manage patient care alone. “If you cared so much about these patients, why are you leaving them?” The dentists have their own set of wishes for the hygienist: please understand how business works. Understand how this math simply doesn’t work. And so, some of the comments that have come from dentists sound like: “You want independence? Open your own practice and see how hard it is to make the numbers work.”
I have not outlined all the grievances on both sides because that is not the point of this discourse. As we keep throwing punches in this ring, can we really afford a winner? We will fight until we lose one another. We might fight until we lose this relationship. Is this really what we want?
Mutual Hurt, Mutual Healing
Admitting that there is pain on both sides is one of the first steps in healing. In many of my talks on stage, I say: “I have been broken,” and then I take a long pause. I follow it up with: “I have been broken, and I have done the breaking.”
The solution here is to acknowledge that we are in this situation together, and that both sides are hurting. There isn’t a scale to measure who is hurting more or less. Pain isn’t a competition. It’s a simple truth: both sides are hurting.
Think of it like a switch—on or off, yes or no. Are the hygienists hurting? Yes. Are the dentists hurting? Yes. Have dentists hurt hygienists? Yes. Have hygienists hurt dentists? Yes. It’s not about degrees or timelines. It’s about recognizing the truth of the situation. Both sides are in pain. Both sides have caused pain. And that’s where we start.
If we can find truth in this statement—“I have been broken, and I have done the breaking”—for both the dentist and the hygienist, we can leave the rumble. We can walk away from the fight and begin to look for solutions, together.
I know you may want to label me ignorant, as though I can’t grasp the weight of what I’m asking you to set aside in order to acknowledge this truth. And don’t dismiss me as simplistic either. The reality remains that ego—on both sides—must yield if we are to confront the pain we’ve inflicted. The anger is undeniable, shared equally by both parties, no more or less valid for one than the other. It is a truth that demands recognition.
But how do we begin to untangle the threads of that anger—or the wounds that fuel it? Through compassion—compassion for ourselves and for one another. Through accountability—a reckoning with our own actions. Only then can we hope to move forward.
Throwing in the Towel: Time to Rebuild
It is time to pause and take a step back from the ring. This is not a fight we win by landing blows; this is a relationship we mend by extending a hand. Dentists and hygienists alike entered this profession driven by a shared purpose—caring for patients, improving lives, and strengthening communities through oral health. Somewhere along the way, the burdens grew heavy, the cracks deepened, and we started fighting each other instead of fighting for solutions.
The truth that binds us must be stronger than the scars that divide us. When we recognize that this isn’t a war to be won but a partnership to be rebuilt, we can begin to heal.
To the dentists—acknowledge the value of the hygienist’s expertise, their aspirations, and their needs. To the hygienists—understand the immense pressures and complexities of running a practice in today’s environment. This isn’t about who bears more or whose pain looms larger; it’s about realizing the “hurt” belongs to all of us, together.
Compassion and collaboration are not weaknesses—they are bridges. The bridge to a better future begins with the collective willingness to listen, adapt, and find common ground.
We have the power to build something different—something better—but only if we are willing to stop swinging and start reaching. Reach for understanding, reach for compromise, and above all, reach for the shared purpose that brought us here in the first place. For the sake of our patients. For the sake of our profession. For the sake of each other. The bell is ringing—it’s time to end the match.
REFERENCES
- Based on hundreds of hours of research and interviews that I’ve done to date on the subject with hygienists who have used this specific term and worse.
- https://adanews.ada.org/ada-news/2025/april/arizona-oral-preventive-assistants-bill-becomes-law
- https://dimensionsofdentalhygiene.com/illinois-passes-bill-help-ease-shortage-oral-health-professionals/
- https://pubmed.ncbi.nlm.nih.gov/15022523
- https://legiscan.com/NV/bill/SB495/2025
ABOUT THE AUTHOR
Dr. Maggie Augustyn, FAAIP, FICOI, is a Dawson-trained practicing general dentist, owner of Happy Tooth, author, and inspirational keynote speaker. Featured on 4 dental magazine covers and recognized by Dentistry Today as one of the top 250 leaders, she inspires others through her writing, helping them find healing and connection. Dr. Augustyn serves as the national spokesperson for the Academy of General Dentistry and as a faculty member for the Productive Dentist Academy. She contributes monthly to her “Mindful Moments” column for Dentistry Today and AGD Impact and writes for other publications as well. With unwavering compassion and a dedication to excellence, Dr. Augustyn addresses audiences ranging from a few dozen to thousands, guiding them toward fulfillment and meaningful impact. To contact her, email drmaggie@myhappytooth.com.
FEATURED IMAGE CREDIT: Dnipro Assets/Shutterstock.com.
