The Backbone of Dentistry Is Being Broken—And We’re Letting It Happen - WARNING: LONG & CONTROVERSIAL MESSAGE!
Quick Take
Dental hygienists are the backbone of preventive oral healthcare. Yet, political and professional systems are actively undermining their value. This post exposes the real reasons behind the so-called "hygienist shortage," challenges the ADA's regressive policies, and offers a bold path forward rooted in sustainability, autonomy, and respect.
Key Takeaways:
The "hygiene shortage" is a retention crisis, not a recruitment one.
Political movements like SB495 are part of a broader effort to dismantle dental hygiene as a profession.
Dental hygiene is essential to public health, and undervaluing it puts communities at risk.
Autonomy, proper tools, and a healthy work culture are key to sustainability.
It's time for organized advocacy and legal action against monopolistic practices in dentistry.
Instead of blaming hygienists for their “high hourly rate”, let’s consider the minimal reimbursement we receive from insurance companies.
Introduction:
There’s a quiet but seismic shift happening in dentistry—and it’s not just about staffing. It’s about power, equity, and the future of care. For decades, dental hygienists have held the line on preventive health, serving as the profession’s first responders. But recent political and institutional moves are threatening to erase that line altogether. We can’t let that happen. Not just for their sake—but for all of ours.
As a former RDH for 15 years, I know firsthand what it took to become a dental hygienist and how much more it took to become a dentist. I had always wanted to be a dentist – ever since I realized it at 14 years old. In my younger years, I lacked confidence in my ability to attend dental school. So, I opted for dental hygiene first. To this day, I discuss preventive care with patients before discussing a treatment plan. As we all know, you can’t build a house on a shaky foundation. Patients are always surprised at my passion for prevention, but when I tell them I was a dental hygienist before becoming a dentist, their main comment is, “Well, that makes sense now. No other dentist has ever spent this much time talking to me about brushing my teeth or cleaning them!” I take that as a compliment.
Both the dentist and the dental hygienist need to take responsibility for the prevention side of dentistry. If you are a dentist and you’re not reinforcing what the dental hygienist recommends, how will they have enough respect for you to recommend the treatment you think they need.
I see our roles as symbiotic. I don’t want to clean teeth, but they do, and they love what they do, for the most part. When do they stop loving it? When they aren’t respected or valued for their knowledge or for what they bring to the table.
The Myth of the Shortage
“It’s not about new grads. It’s about who’s leaving.” The mass exodus of people leaving our profession is substantial.
The narrative that there aren’t enough hygienists is incomplete. Many experienced, passionate hygienists are quietly leaving the field—not because they’re disinterested, but because they’re exhausted, unsupported, and undervalued.
🛑 They're told to “do more with less.”
🛑 They're expected to accept poor equipment, toxic culture, and no time to recover.
🛑 They’re denied respect, autonomy, and leadership roles.
And yet, the solution proposed isn’t to fix those problems—it’s to replace them with undertrained, cheaper labor.
Undermining a Profession in Plain Sight
Legislation like Nevada’s SB495 and the ADA’s quiet backing of on-the-job-trained personnel to take on hygiene duties is not a compromise. It’s a hostile takeover. These moves seek to dilute the profession under the guise of “expanding access,” while stripping it of:
Scientific rigor
Clinical safety
Professional dignity
Let’s be clear: this isn’t about patient care—it’s about the monopoly of a profession and control of the profession. Let’s face it…If you have been in the profession long enough, you remember the days of dentists, usually male, who made the lives of their teams a living hell by throwing instruments at them or worse, verbally abusing them in front of patients. This is no way to treat another human, never mind a colleague who has chosen to support your practice, live by your rules, and all they ask is to be paid fairly for what they provide.
Yes, the hourly rate is high. They paid for their schooling just like docs do. They don’t make as much as we do, but they deserve a fair price per hour for what they provide. It’s not their fault that insurance is not reimbursing us fairly – it’s the insurance companies we should be tackling, not our support team!
Now, let’s be clear. Not every dental hygienist or dentist for that matter, will add to the bottom line. There are good ones and bad ones in every profession. However, what I am seeing regularly is the “good” ones leaving in droves; While the “bad” ones who could care less about what they are doing, are just there for the money. We call that the “employee” mentality. You will never motivate an employee mentality. Give me my money on Friday and I’ll see you back again on Monday is how they live their lives.
The Economic Model That Depends on Prevention Failing
Hygienists are trained to prevent disease—and when prevention succeeds, there’s less need for restoration. But dentistry’s revenue model depends on restorative care. This creates a dangerous paradox: the more successful a hygienist is, the less money a practice may make.
And that is the uncomfortable truth no one wants to say out loud. This may be true, but the wild card here is the patient. There are patients that are ready for change and will follow every single word you say, and there are others who have never been educated on dental care who show up in dental offices across the country ready to have all their teeth extracted at 30 years old because they couldn’t bother to brush their teeth. The real problem is a lack of education. This is a bigger systemic problem with our society. If the “powers that be” control what we get educated on, then “we the people” can be controlled. I hope everyone wakes up. We have always only had half the story. The “powers that be” control the narrative. If you don’t wake up and think for yourself, you will never have the education you need to make the right decisions in your life.
Dentistry is the only profession that I have ever seen that actively works to eliminate disease. Our hygienists are the ones leading the charge. We, as a profession, are doing our part. Here’s where it really gets dicey – When we do what is best for the patient, our patient wants us to submit it to their dental insurance company to be paid. We are the only profession where people still come in expecting not to pay for services rendered and expect US to wait to be paid. You can’t go anywhere else thinking you can get services for free and pay later. This paradigm has to change.
What Real Support Looks Like
Real support isn’t lip service or burnout-themed memes. It’s:
✅ Tools That Work: Sharp Instruments, working equipment
✅ Scheduling Power: time for NPEs, time for SCRP, Time for Turnover
✅ Ergonomic Equipment: Supportive Stools And other items that might support
It’s not about making hygienists superheroes—it’s about removing their capes and finally letting them breathe, lead, and thrive.
It’s valuing each other as members of a team. I know I would not have been as successful in private practice without my hygienist, Maria, and my assistant, Tamar. Both of them were with me for 10 years. Over time, I have realized that practices that have long-term staff have learned to treat their staff well. When you do, you get devotion—devotion to each other, to the patients, and to being a part of something bigger than yourself.
What Needs to Change—Now
We don’t need more schools or more Band-Aid solutions. We need:
🟣 Autonomy: Let hygienists lead preventive care. Dentists don’t want to do it anyway! We want to rebuild what our patients destroyed. That’s what we are here for. There may be a day when ALL patients take care of their teeth. It just won’t happen in my lifetime.
🟣 Respect: Value their clinical insight, not just their ability to support your practice. Respect is earned; it is not given. You treat your team right. They will do the right thing for you.
🟣 Organizational Courage: The ADHA must evolve into a policy powerhouse to support their profession, and the ADA must take a serious look at why they are doing what they are doing in the name of “access.” Is it truly access to care that you are after? Or is it control? After being a member of the House of Delegates for close to 15 years, unfortunately, I think it’s the latter. Anyone who attends the HOD of the ADA looks at the stage and realizes that those on the stage voted into their positions don’t represent the dentists who are out there working now. There is a tight grip on “keeping the status quo” vs. how to move forward into the future, supporting each other, our diversity, and the differences we bring to the table in how we communicate and our sex.
FAQ’s:
Q1: Is the hygienist shortage real?
Yes—but it’s primarily about burnout and poor workplace conditions, not lack of graduates.
Q2: What is SB495 and why is it controversial?
It proposes alternative licensure pathways that lower training standards, risking public safety and professional credibility.
Q3: How does this affect patient care?
It increases the risk of inadequate prevention, misdiagnosis, and shortened treatment lifespans.
Q4: What role should dentists play?
Support, not suppress. True leadership means lifting every clinician, not preserving hierarchy.
Q5: What can hygienists do?
Advocate, unify, and amplify your voice—especially with lawmakers and representatives of your state boards.
Q6: Is there other legislation pending in the US like SB495? State-Level Legislation:
Delaware SB 131 (2025): This bill would allow dental hygienists to administer local anesthesia under the direct supervision of a dentist. It aims to expand the dental workforce and improve access to care, especially since Delaware is currently the only state not allowing this practice. The bill is pending in the Senate Health & Social Services Committee.
Connecticut HB 6575 (2025): This bill proposes allowing foreign-trained dentists to qualify for licensure as dental hygienists, aiming to increase the dental hygiene workforce in Connecticut.
Massachusetts: Multiple bills are under consideration, including joining the dentist and dental hygienist interstate compact, enabling dental hygienists to administer nitrous oxide, and expanding their ability to administer dermal fillers and botox. These are part of a broader legislative agenda to improve oral health and workforce mobility in the state.
Interstate Dental & Dental Hygiene Licensure Compact (IDDHLC): Seven states—Oklahoma, Missouri, Maryland, Massachusetts, Mississippi, Texas, and Kentucky—have introduced legislation to join this compact. The compact is designed to streamline licensure, promote workforce mobility, and maintain rigorous standards for dental professionals.
Federal Legislation:
Action for Dental Health Act of 2025: Reintroduced in Congress, this bipartisan bill would reauthorize funding for oral health workforce programs, aiming to address workforce shortages and improve access to dental care, especially in underserved areas.
Other Workforce and Scope of Practice Bills:
States like Arizona and Wisconsin are considering or have enacted laws to expand the dental hygiene scope of practice or streamline licensure for dental professionals.
In summary, numerous states and the federal government are actively considering legislation to expand the dental workforce, enhance dental hygienist roles, and improve licensure portability—measures that mirror the intent and scope of Nevada's SB 495.
Conclusion: A Call to Action
This isn’t about turf—it’s about truth. A field built on prevention cannot thrive by undermining its very foundation. To every hygienist reading this:
We see you.
We need you.
And, we’ll stand beside you.
To dental leadership: it’s time to rewrite the story—not erase the characters. There is plenty of room for all of us to exist together – collaboratively.