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Hygienists have the power! Or do we?

Oct. 4, 2022
While it was exciting to be very in-demand when practices reopened after the shutdown, the lofty feeling quickly faded for Kirsten Brancheau.

Dental hygienists are in demand! Salaries have gone up! We have the power! It’s a great time to be a hygienist! … Or is it?

While it’s true that the pandemic has created new opportunities for hygienists, they sometimes come at a price. The first and most obvious is that those of us who remained in the field during the current pandemic are working in more stressful conditions with additional PPE and … well … working within inches of people’s mouths during a pandemic.

But there are other downsides as well, and some may not appear to even be downsides at first.

Many of us who chose to return to work after the 2020 shutdown were pleasantly surprised to find that we were now in demand. I, an older hygienist who had previously experienced age discrimination, suddenly was inundated with requests to work in different offices. Some requests came from dentists with whom I’d worked previously, asking me to help out when they reopened their offices after three or four months of shutdown, and they were inundated with requests from patients wanting to come into the office.

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Other offers to work came from total strangers, headhunters, and temp agencies. I was offered jobs without asking for them and without sending a résumé or interviewing. If I wanted the job, it was mine! I must say, this was something of a shock since jobs were scarce prepandemic. Suddenly I was in demand and in command. I had power! I could name my price, and I did. Since I was only working two days a week in my regular office (there was a full-time hygienist there as well), I was available for temping. The temp agency told me their rate, and I said, no thank you, and they raised it to the point where I said, sure, I’ll temp.

Temping was eye-opening. In many offices I had to wonder whether their previous hygienists left the field due to the pandemic or fled from bad situations as soon as other opportunities became available. Disorganized offices, instruments that were so worn down it was like trying to clean teeth with miniature spoons, unhappy employees who showed up late to work (or didn’t show up at all), unreasonable schedules, dentists who never bothered to say hello to me, let alone thank me for coming in … the list goes on.

A lesson I learned from temping was that there are some things more valuable than money, and working in a pleasant office is one of them. Yes, I could have left my current job of 10 years and made a lot more money elsewhere, but I’ve worked in toxic environments before, and the stress is never worth the extra income.

Dentists the “new hygienists”

For many offices, the problem of hygienist shortage remains. Dentists are increasingly doing recare appointments themselves, and this comes with a whole new set of woes. While some dentists (especially those who were hygienists prior to becoming dentists) can perform hygiene duties perfectly well, in my experience—and in speaking with many other hygienists—most dentists simply can’t compare with hygienists when it comes to providing preventive services and periodontal treatments. They’re not properly trained. I’ve seen dentists do 15-minute adult recare appointments and half-mouth scaling and root planing in 30 minutes. Patients express surprise that their appointments are so quick.

A lesson I learned from temping is that some things are more valuable than money, and working in a pleasant office is one of them.

What will happen when these patients return in six months and see the hygienist? X-rays will reveal tons of sub calculus on those 30-minute scaling-and-root-planing patients. How will the hygienist explain that patients need scaling and root planing again? How will the hygienist answer a patient who says their last cleaning took 15 minutes and why is it taking so long this time? How will a hygienist respond to patients who say their last cleaning hurt and they bled a lot, and, by the way, what’s this newfangled thing you’re using (a Cavitron)? Even worse, how many new patients who had a cleaning by a dentist will decide not to return simply because their teeth didn’t feel clean or their mouths hurt too much?

In addition, what do these quick and inadequate prophies/scaling and root planings say about the value the dentist places on the hygienist’s skills? If a dentist with a mirror and one hand scaler can do the job in less than half the time of a hygienist, and if the dentist thinks this is perfectly acceptable treatment, what do they think we’re doing with our time? And what do they think about the hand skills that we’ve worked so hard to perfect, to remove all that biofilm and calculus as gently and thoroughly as possible?

Or the educational skills we’ve developed, tailoring individual home care regimes for each patient? Do they really think we’re doing the same thing they’re doing but just taking more time to do it? Where is the appreciation for the technical, clinical, and interpersonal skills we spent years perfecting, the skills that keep patients returning because they love their hygienist?

The hardest part to accept about dentists being the “new hygienists” is that the patients are too often being cheated of quality care, and they don’t even know it.

The value of hygienists

Patients generally spend more time with hygienists than with dentists. We are the ones who develop rapport, suggest treatment so patients feel comfortable accepting that treatment when the dentist diagnoses what we’ve already mentioned, ease their fears, and continually improve our techniques because through the years we’ve seen what works and what doesn’t. I’m not saying dentists can’t do all these things, but do they really understand and appreciate all that we do? We are not just 15-minute tooth cleaners.

Dentists who are desperately searching for hygienists at this time should ask themselves if their office is one that a hygienist would actually want to work in. Offering a high salary and benefits may entice someone to accept a job offer, but those may not be enough to keep hygienists once the reality of the office problems sets in.

Yes, at this time an increased salary and benefits are nice, but an understanding and appreciation of our real worth is priceless. Sharp new instruments, giving thanks for our services, complimenting us in front of our patients, giving us time to do our jobs without being rushed, giving us guaranteed hours rather than telling us to come in late or leave early when there are cancellations, and not pressuring us to produce-produce-produce for fear of missing some quota are ways dentists can show their appreciation.

Higher salaries, benefits, and appreciation may not solve the hygienist shortage, but they might be enough to keep valuable hygienists who are staying in the field from leaving. That initial feeling of power when dentists were coming to me, begging me to work for them, faded quickly. I realized that I was content in my current office, working with people I like, at a reasonable salary. Yes, I could have been making more in another office, but, as the saying goes, money can’t buy happiness.