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The future of dental hygiene in the DSO model

Nov. 4, 2020
DSO hygienists and leaders can define what excellence in dental hygiene looks like now and in the future. Now is the time to implement strategies to close the gaps that we discovered in this survey.

Editor’s note: DSO Hygiene Excellence is a program created by two dental hygienists who have a message to support the clinical advancement of other RDHs who are working with, or considering working with, a DSO.  They have created four pillars of knowledge that will benefit the professional growth and these tips will be featured in four articles in RDH magazine in upcoming months. 

DSO Hygiene Excellence set out to explore the future of dental hygiene within the dental service organization (DSO) model. This summer, we conducted a national survey, identifying two groups we wanted to survey, DSO hygienists and DSO leaders. The survey’s purpose to elevate the dental hygiene profession within a DSO by exploring each group’s expectations and experiences. We received feedback from 100 hygienists and 30 leaders.

The following results show areas where we can improve communication between hygienists and leaders to ensure the best patient outcomes. DSOs have a unique ability to change the landscape of dentistry—and will do so going forward. DSO hygienists and leaders can define what excellence in dental hygiene looks like now and in the future. Now is the time to implement strategies to close the gaps that we discovered in this survey.


It was clear from the research results that both groups felt obstacles in today’s environment. The data revealed there is miscommunication when it comes to accountability within hygiene departments. Most hygienists felt they had a clear understanding of their department’s expectations, while DSO leaders felt hygienists were not accountable to their departments. DSOs can have anywhere from two offices to hundreds of offices, so there is an excellent opportunity for community within these structures. We asked hygienists if they felt a sense of community within their DSOs. Almost half felt a sense of community and wanted to collaborate with other hygienists. Of the hygienists surveyed, about half wanted a mentor. DSO leaders also viewed their hygienists as mentors when it came to leadership roles. The majority of DSO hygienists felt some support or no support when it came to professional growth. DSO leaders felt there are growth opportunities in training and education. The following is the raw data collected.


In our survey, the 78% of DSO hygienists stated they had a clear understanding of their hygiene department’s expectations related to patient care. Only 37% of leaders felt their hygienists were accountable in their hygiene department.


DSO hygienists expressed time for infection control and personal protective equipment (PPE) as their main obstacles. They also expressed that they did not feel they were considered in decision-making and were undervalued. DSO leaders responded that staff turnover, recruitment, COVID-19, and low hourly production were their main challenges.


DSO hygienists responded as to how strongly they feel a sense of community within their DSO. Our survey revealed 25% felt no sense of community, 48% felt some, and 27% felt a strong sense of community. Of the hygienists surveyed, only 20% were not interested in collaboration, while 80% expressed interest in collaborating with other hygienists within their DSO.


DSO Hygiene Excellence believes hygienists are leaders within the dental practice. We asked hygienists if they were interested in having a mentor. The results showed 55% of hygienists wanted a mentor, with 45% saying they did not want a mentor. We asked DSO leaders how they saw hygienists in leadership roles. DSO leaders viewed hygienists as mentors, team leaders, and as leaders in their hygiene departments. Only one respondent did not see hygienists as leaders at all.

Professional growth

DSO hygienists responded in what ways their DSO supported their professional growth and how strongly. The results found 25% felt very supported, 45% felt somewhat supported, and 30% did not feel supported. DSO leaders responded that opportunities existed to elevate their hygiene departments, with 24% viewing training and education as ways to elevate hygiene. Additionally, 12% felt exclusively having their hygienists performing periodontal procedures would elevate their hygiene departments, with only 4% feeling that introducing new technology would promote professional growth.


It is worth noting that 56% of DSO leaders reported they did not feel they have consistency throughout their hygiene departments. Additionally, 70% also said they would benefit from a system-based hygiene program. Given this data, it is evident that this is a “call to action” for dental hygienists to elevate their dental hygiene practice and set protocols to create consistency within their hygiene departments.

The DSO Hygiene Excellence National Organization

In our quest to define what dental hygiene excellence is in the DSO space, we started DSO Hygiene Excellence National Organization. As DSO hygienists, we have the opportunity to build a community that defines what DSO Hygiene Excellence looks like now and in the future.

We are committed to elevating the profession of dental hygiene in the DSO model. We are excited to announce that DSO Hygiene Excellence has created a Diplomat Certification Program based on these national survey results. The five pillars of the Diplomat Certification are Leadership, Diplomacy/Teamwork, Dental/Medical Synergy, Clinical Excellence, and Business Excellence. These pillars address the needs revealed by both hygienists and leaders. We will be introducing the DSO Hygiene Excellence Academy—details coming soon. Please go to dsohygieneexcellence.com and sign up for a free membership.

Christine Diehl, BS, RDH, has been practicing clinical dental hygiene for 28 years and currently working full time in a DSO, Decision One Dental partners. She graduated from Parkland College and received a BS from Northern Illinois University. Over her career, she has attended a multitude of continuing education, including LVI for Advanced Dental Studies, and received an Associate Fellowship from the World Clinical Laser Institute. Christine is a cofounder of DSO Hygiene Excellence.

Sarah Varney, BSDH, RDH, has been employed as a hygienist with Kendall Pointe Dental, a DSO office, since 1988. Sarah received an associate in applied science in dental hygiene from Parkland College in 1995, and graduated with honors from the University of Bridgeport with a bachelor of science in dental hygiene in 2008. She is the charter recipient of the Irene Newman Award. Her certifications include include soft tissue laser and advanced periodontal coach. Sarah is the founder of CE2 and founder and CEO of DSO Hygiene Excellence. Currently, Sarah is a graduate student at the University of Notre Dame in the executive MBA program.