5 proven strategies to address dentist/hygienist tensions
In the dynamic world of dentistry, tensions between dentists and hygienists can disrupt practice efficiency and morale. Drawing from insights shared by dentists, here are five proven strategies to foster collaboration, reduce friction, and enhance practice success, without having to work harder.
1. Collaboratively establish clear periodontal protocols
A major source of tension in dental practices is inconsistent periodontal protocols, which leads to supervised neglect or inadequate treatment such as bloody prophies. To address this, involve hygienists in creating standardized protocols.
For example, agree that patients with bleeding and 5 mm pockets require scaling and root planing (SRP). Agree to refer to a periodontist if there’s no improvement. As one dentist noted, "Getting hygienists together to write perio policies as a team makes them feel ownership, and this reduces conflict." This approach aligns expectations and ensures evidence-based care.
2. Transition to out-of-network (OON) models
PPO dependency and low reimbursements often make the hygiene department a loss leader, fueling wage disputes. Going OON allows higher fees, which eases financial strain.
One practice owner shared, "We went fully OON with 90-minute new-patient prophies and 60-minute regulars, giving us time to diagnose and educate without rushing." This reduces stress, improves patient care, and supports competitive hygienist wages, which minimizes turnover.
3. Foster a positive office culture
Poor office culture amplifies tensions, especially with post-COVID shifts in work ethics. Strong leadership is key here. Implement regular team meetings to align values and expectations.
As suggested by a practitioner, "Top performers can't stand mediocrity. Ensure everyone buys into the same standards." Encourage mutual respect and open communication to address issues such as hygiene check delays, because this frustrates both parties.
4. Optimize compensation models
High hygienist wages ($65 to $75 per hour for temps) and shortages create pressure on the practice owner. Hourly pay, rather than commission, reduces stress from no-shows, as one dentist explained.
He said, "Switching to hourly pay kept my hygienists happy and stable." Alternatively, performance-based raises for productive hygienists can incentivize quality care without blanket wage hikes, and this balances fairness and profitability.
5. Reduce hygiene dependency
Some dentists advocate for restructuring practices to rely less on hygiene for revenue. They focus marketing on high-value patients needing restorative work or emergencies.
One dentist suggested, "Attract patients with broken teeth, not just cleanings." Others, such as dentists with small practices, do their own hygiene. "I’ve had no hygienists since 1999. This means less stress, though it als means less revenue." In areas such as Arizona, training dental assistants for basic prophies can alleviate shortages, though dentists must ensure perio care standards.
Reflect on a collaborative future
"Working smarter means aligning the team for mutual success," a Dentaltown contributor remarked. By addressing shortages, wage pressures, and protocol misalignments, dental practices can thrive. Tailor these five strategies to your practice’s needs, and you’ll be able to balance clinical excellence with financial and emotional well-being for a harmonious, profitable future.
