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Top 5 Reasons Dentists and Hygienists Clash, and How to Fix It

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Categories: Practice Management, HR and Accounting;
Top 5 Reasons Dentists and Hygienists Clash, and How to Fix It

The working relationship between general dentists and dental hygienists is at a breaking point in many practices across the United States. Dr. Eric Block, also known as “The Stress-Free Dentist,” recently posed a question on Dentaltown that opened the floodgates: What are the biggest sources of stress between dentists and hygienists today?

The responses were raw, candid, and eyeopening, and they paint a picture of a profession grappling with shifting power dynamics, broken economic models, and cultural mismatches that threaten team cohesion and patient care.

The perio protocol problem
The single most repeated flashpoint in the thread was the lack of clarity and agreement on how periodontal disease should be managed in general practice. Dentists lament hygienists who avoid recommending SRPs out of fear of offending patients, while others complain about bloody prophies being passed off as “maintenance.” Some dentists have stopped doing SRPs altogether, choosing instead to refer to periodontists and avoid the internal drama.

One user put it bluntly: “Dentists and hygienists are not even speaking the same clinical language when it comes to perio. But periodontists and hygienists? They’re aligned. Why? Because they both live and breathe it.”

The solution, many agree, lies in written, codeveloped protocols that set clear expectations on probing, staging, SRP indications, and referral thresholds. But very few offices actually take the time to do this. And the result is daily misalignment, patient confusion, and rising tension.

Wage inflation meets PPO reimbursement
Hygienists, particularly since COVID, are commanding higher wages than ever, $65 to $100 an hour is not uncommon in many urban markets. Meanwhile, insurance reimbursements haven’t kept up. Dentists feel squeezed between staffing costs and stagnant production numbers.

“I had to raise everyone’s pay after one hygienist threatened to leave. That one comment cost me $20,000 a year,” one dentist shared.

At the heart of it is the contradiction many practice owners now face: they depend on hygiene to drive exams and restorative work, but often lose money on the hygiene itself. The math no longer works, especially for PPO-driven offices.

Some dentists are pushing back, eliminating hygienists altogether, switching to assisted hygiene models, or doing the cleanings themselves. But most admit it’s not sustainable at scale.

The hygiene labor market is broken
Dentists across the country are frustrated by what they describe as a “diva mentality” among some new hygienists, expecting high salaries, minimal accountability, and flexible schedules. Others note the rise of hygienists leaving clinical practice entirely for temp work, education, or other roles.

The shortage is real, but some argue it’s not just about numbers. It’s about retention. “We don’t just need more hygienists,” one user wrote, “We need more who want to be in the chair five days a week and care about patient outcomes.”

There’s also tension between hygiene schools and private practice. Some feel hygiene instructors foster adversarial attitudes toward dentists, teaching students to view themselves as “patient advocates” who must police doctors and assistants. Whether fair or not, the perception alone is corroding trust.

Office culture: The invisible stressor
More than pay, more than protocols, the issue that kept bubbling up in this thread was culture, how teams communicate, resolve conflict, and respect each other’s roles.

In practices with strong leadership, open dialogue, and aligned expectations, dentists and hygienists reported thriving relationships. But in practices without those foundations, every disagreement over timing, diagnosis, and communication style turned into a power struggle.

One veteran hygienist said it best: “I’ve worked in great practices and toxic ones. The difference was never money, it was whether the dentist respected me and whether the team had each other’s back.”

Is the hygiene-driven practice model failing?
Several dentists argued that the root of the problem isn’t hygienists at all, it’s the business model. Practices have become too dependent on hygiene for diagnosis, production, and patient retention. When hygienists leave or demand more, the whole operation teeters.

One solution floated repeatedly was to diversify marketing and scheduling to bring in more patients needing treatment, not just cleanings. Emergencies, new patients with decay, and surgical consults. “Stop relying on hygiene to drive production,” one dentist said. “Build your own diagnostic engine.”

Others took it further, suggesting that the general practice model needs to split entirely, either integrate hygiene under tight systems and leadership, or restructure around a leaner, FFS, treatment-focused model.

Conclusion: Is the rift fixable?
At the end of the thread, no one suggested there’s a magic fix. But some clear themes emerged:
Written perio protocols and regular team calibration reduce friction.
Hygienists deserve good pay, but production, communication, and accountability must match.
Leadership and culture are the foundations for any successful practice.
The PPO system is fueling unsustainable dynamics.
Many dentists are considering radical restructuring, not out of spite, but survival.

As one contributor put it, “You can’t blame people for negotiating their worth. But you also can’t run a business at a loss. We either fix the structure or brace for more exits, more burnout, and more tension.”

Dentistry is a team sport. But right now, many teams are breaking apart. Whether we rebuild stronger or splinter further depends on how honestly we address the cracks..

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