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How substitute hygienists can help dentistry recover from the pandemic

May 21, 2020
Here are some simple tips on how both the temporary hygienist and hosting practice can make the most of this relationship, and how dental professionals can advance their careers post–COVID-19.

Rachel and Alicia work in non-traditional leadership roles in dental hygiene, yet they continue to practice clinically. Having met as clinical education faculty members for Align Technology, they were initially drawn to each other, as they share similar experiences in practicing as contingent clinicians. Both authors understand the value of practicing clinical hygiene as they educate clinicians nationwide on high standards of patient care. Using each other’s unique experiences as substitute hygienists, passion for the profession of dental hygiene, and research, Rachel and Alicia collaborated to create a guide for a great experience in navigating the “subbing scene” after COVID-19. We hope you enjoy the article!

We have learned so much about clinical practice before COVID-19, appropriate distancing guidelines during COVID-19… we’ve even gained insight on how to implement personal protection equipment after COVID-19, but how do you recover lost production and decrease the backlogged patients when we return from this unplanned sabbatical? Three words: substitute dental hygienist. Three simple words that hold so much weight. Heavy weight can slow you down or give you the strength to endure the tasks that lie ahead. This article is intended for the reader, whether a hosting practice or a substitute hygienist, to appropriate their weight and ensure a favorable experience for everyone involved, especially the patient.

A substitute dental hygienist may be viewed as a transformational leader. Transformational leadership qualities include the ability to make difficult decisions, entertain new ideas, easily adapt to changing environments, and take the right risks. Transformational leaders are self-motivated/driven and inspirational. Kroon, Woerkom Menting (2017) states that transformational leaders can stimulate existing employees by exhibiting intrinsic motivation.1

While some hygienists sub because they are having a hard time finding full-time work, other hygienists work on a contingent basis to supplement monthly income as they may be leaders in other areas of the dental industry. Many hygienists who sub may be educators, researchers, public speakers, and business owners. All substitute hygienists were not created equal and every substitute should be evaluated on an individual basis and viewed as a potential transformational leader.

How does a substitute fit into your practice post pandemic? There will be a backlog of patients that need to be seen. Due to new guidelines on level of disinfection, time allotted for patients may be increased, requiring for more auxiliary support. Practices may also be adding additional days to accommodate patients. Utilizing a substitute and servicing your patients with the ADHA standard of care, efficiency, as well as a fresh set of eyes that may bring a return on more periodontal and restorative treatments. This article will provide tips on how to maximize the potential of a substitute dental hygienist from the substitute’s and hosting practice’s perspective. Being fair, clear in expectations, open to new ideas, and flexible applies to both parties. These tips and guidelines will help to ensure smooth transition and utilization of a substitute hygienist to minimize backlogged patients.

Tips for the substitute

Avoid disappointment and plan for a great day. Meet your hosting practice with the 4 Es: energy, enthusiasm, efficiency, and empathy. Bring the energy by starting with a great smile and being friendly. Offer to help with opening the back office/sterilization area and be of assistance wherever needed. This enthusiasm and team energy will help to set the tone for the day. Practice with every intention to be efficient and keep up with the pace of the practice. While practices may face internal challenges, practice empathy for the patient entrusted to your care and the practice.

Substitute hygienists should also be flexible with receiving requests from their new patients during the day. Special requests and modifications made by the patient should be obliged. Going with the flow of the practice no matter how accommodating the practice may be, is important for a successful day. Always remember to go the extra mile, keeping the patient’s comfort and experience in mind.

Tips for the hosting practice

Quality armamentarium should be dispersed between all licensed providers. The substitute hygienist should have the appropriate equipment and materials to ensure OSHA standards and ADHA clinical standards can be upheld during patient care. (Please do not put the sub in the operatory with the broken chair and no access to a power scaler.) Removing instruments or withholding technology that advances the standard of care, clinician comfort, and patient experience is the opposite of equity and fairness. As a hosting practice, you must treat your substitute as a licensed professional provider—because they are! Give them the full ability to render proper standard of care. Treat a substitute hygienist as you would a loving first-time guest in your home . . . like you want them to come back.

Contacting the substitute prior to the assignment may yield a positive experience for everyone involved. Clarifying the schedule, appointment lengths, scheduled breaks, and software can help to put the mind of the substitute at ease. For example, the substitute ordinarily arrives 15 minutes ahead of schedule. If the schedule starts at 9:00 am, yet there is a morning huddle scheduled for 8:45 am, the substitute may want to arrive 15 minutes prior to the scheduled huddle.

A courtesy call may also help the practice feel relieved to know that the substitute is confirmed for the assignment. This call may also be used to help the substitute plan for the assignment. Knowing whether there are dining options in the area or if there is a lounge for lunch makes a difference in the day of a substitute! Practices should ensure the sub is properly prepared for the day. Create time for a preliminary review of the schedule and offer emergency contacts for the substitute during your courtesy call. Clear communication and expressed expectations can help your sub to rest easy and arrive to your practice prepared to take on the day.

Being open-minded to welcoming a substitute hygienist to your practice can create an alternative to the back log of patients returning to the hygiene schedule. This in turn can create a positive, valuable, and lasting change in your practice by creating empowered colleagues and leaders on your team.1 Utilizing a substitute hygienist is a step in the direction towards servicing your patient. While many patients have developed a relationship with their provider and prefer whom they will visit when making their appointments, they will appreciate a courtesy call and being made aware of the schedule change. There is nothing worse than the patient canceling the moment they realize they are not being treated by their provider of choice. Patients who are made aware of the provider change prior to presenting to the practice may be more inclined to keep their appointment and feel appreciated for being accommodated during these changing times. With advance notice the practice has an opportunity to champion the substitute as an awesome addition for the day and assure the patient they are in good hands. 

Tips for both parties

Upon arrival, both the substitute and hosting practice should make warm introductions and greetings. There should be someone designated to acclimate the substitute to the practice. No different than when you invite someone to your home, you show them how to make themselves comfortable and where to relieve themselves when the time occurs, because the time will occur.

Returning to ‘normal’ clinical practice may take some time. In the interim, as a substitute and hosting practice it is important to exercise fairness and equity. While there may have been difficult perio maintenance patients prior to COVID-19, these same patients may need new therapies or refreshed patient education. Equity and fairness in scheduling means dispersing patients with difficulty within all licensed providers, ensuring it is not only the substitute or permanent employee seeing complex cases. This means not giving your substitute all the scaling and root planings! Allowing a reprieve in the schedule, designating a hygiene assistant, and allotting additional time for procedures may provide opportunities for the clinician to be graceful and practice the full measure of care.

Finding the right fit

Practices and substitute hygienists alike have a preferred personality type to make working environments more enjoyable. To avoid an awkward or uncomfortable substitute assignment, be clear in your expectations on personality types. Clear and direct communication between the staffing agency, clinician, and dental practice can mitigate a poor experience. With personality assessments and job satisfaction surveys, staffing agencies like DentalPost offer the opportunity for the professional to be more than just a name on a resume. Once the professional has completed assessments relating to DiSC personality types, emotional intelligence, core values, skills, workplace culture, and alignment, the substitute and hosting practice can gauge whether the assignment is going to be a good fit. It may be hard to ensure a remarkable day, however, if you utilize assessments like those offered on DentalPost, you may be one step closer to a great experience with your substitute.

We had an opportunity to consult with Tonya Lanthier of DentalPost and she shared with us the best way to stand out in a job search and how to advance your career post COVID-19.

Tonya states, “If you want to level up and not only find a temp or perm job, but find one that feels like home, then check out DentalPost (www.dentalpost.net). Not only is DentalPost the nation's largest dental job board, but it is the only dental job board that goes beyond just job postings by offering assessments that help you grow in your personal life and professional career. In addition to skills assessments and certifications, DentalPost offers free personality assessments like DiSC and emotional intelligence to help you better understand yourself, maintain a growth mindset, and keep your résumé on the top of the pile! When you take full advantage of what DentalPost offers, you stand out in a sea of sameness to dentists, front office, and hiring managers.” Tonya advised potential candidates to seek clarity in determining the things you are looking for in a dental practice, so that you can confidently make decisions and land in the right place.


Substitute dental hygienist. There are those three words again. When you use those words, we ask that you find value in welcoming a contingent team member, treat your substitute as a valued guest, and view them as a transformational leader. Providing your best face and wearing a cape to save the day may not be what the substitute signed on for, but upon arrival, they must understand their role is critical and crucial to the success of the practice. The three dreaded words, substitute dental hygienist, are no more than a title… what is a title? Before, during, and after this pandemic, we are all health-care providers who pay special attention to reduction of inflammation in the head and neck. Hold your head high, stand strong, pull your weight, and make a lasting impression on the patients we serve as essential members of their health-care delivery team. Our first few weeks back will set a precedent for our patients. With preparation, practicing with fairness, having clear expectations on clinical standards for care, being open to new expectations and remaining flexible. Utilizing a substitute hygienist is a great way to provide a good first impression on your patients, returning team members, and offices that may need the temporary support.


1.    Kroon B, Woerkom MV, Menting C. Mindfulness as substitute for transformational leadership. J Managerial Psych. 2017;32(4):284-297. doi:10.1108/jmp-07-2016-0223

Rachel Smith, RDH, has been in the dental field for over 25 years. Working as a chairside assistant, clinical hygienist, and new patient coordinator gives her a unique outlook on the whole practice. Most of her career has been in occlusion-based practices. She now shares her passion as a highly sought-after speaker and practice consultant. She currently is on the Align hygiene Faculty and principal consultant with Airway Health Solutions.

Alicia Murria, RDH, is a clinician, public speaker, and founder of a nonprofit organization. She practices clinical hygiene in the metropolitan Washington DC area on a part-time contingent basis. Alicia is an author key opinion leader, active in several dental hygiene organizations, and was named RDH Community Connections Influencer of the Month in February 2020.

About the Author

Rachel Smith, BS, RDH

Rachel Smith, BS, RDH, has been in the dental field for over 25 years. Working as a chairside assistant, clinical hygienist, and new patient coordinator gives her a unique outlook on the whole practice, and most of her career has been in occlusion-based practices, creating a perspective still widely overlooked in general dentistry. She is an educator for Align Technologies and has also spoken at the Yankee Dental Congress, American Academy of Cosmetic Dentistry national meeting, and RDH Under One Roof.

About the Author

Alicia Murria, RDH

Alicia Murria, RDH, is a clinician, public speaker, and founder of a nonprofit organization. She practices clinical hygiene in the metropolitan Washington DC area on a part-time contingent basis. Alicia is an author key opinion leader, active in several dental hygiene organizations, and was named RDH Community Connections Influencer of the Month in February 2020.