January 2017
Volume 38, Issue 1

Doing the Math: Adding Dental-Hygiene Value

Penny Reed

As dentists face decreasing reimbursements from benefit plans, they may feel a need to evolve the practice and expand the roles of highly trained team members such as their dental hygienists. Such expanded functions are vital to short- and long-term practice growth. From the delivery of local anesthesia to utilizing lasers and placing restorations, dental hygienists in your practice can provide myriad additional services.

In some states, the hygienist’s role is constantly expanding, and in others, little has changed. Washington and other states include restorative services in their dental-hygiene undergraduate curriculums, while other states such as Tennessee offer it as a postgraduate course. However, in many states, it is not possible for a hygienist to receive this certification.

Another factor influencing the practice of dental hygiene is the rapidly increasing number of hygienists in the field. According to the US Bureau of Labor Statistics, 200,500 dental hygienists are in the workforce, and that figure is expected to grow 19% by 2024. For dental-practice owners, this means a plentiful supply of hygienists to support them in their practices.

The dental-practice owner has an increasing number of options for advanced continuing education and certifications available for hygienists on the team. Refer to your practice act to see what is legal in your state. Another great place to cross-reference this information is the American Dental Hygienists’ Association’s website: adha.org.

Dental professionals can evaluate the needs of their practice by looking at the revenue per chair hour for the practice. How much “doctor” time will be gained by delegating the delivery of local anesthesia to one or more hygienists? Assigning more duties to the dental hygienist in the dental practice can yield a significant savings in the dentist’s time, allowing the operative department to be more productive. For example, by adding a soft-tissue laser to the hygiene department’s periodontal protocol, a dental office can keep in-house many procedures that were once referred out.

Making the Investment

So now the question becomes this: Should the dentist or the hygienist pay for these courses? Rachel Wall, RDH, BS, president and founder of a consulting business called Inspired Hygiene, believes hygienists should pay for all their basic education and additional certifications. However, if the employer requires the hygienist to complete a specific continuing-education (CE) program, the dentist should cover the costs for that program. In addition, employers are required to pay employees for time spent on CE they require that is above and beyond CE needed for license renewal.

If the training is optional or the hygienist approaches the doctor and asks about acquiring additional certifications, Wall recommends that both the doctor and hygienist participate in the cost of the education. One scenario would be for the hygienist to pay for the course, and the dentist would reimburse a portion 6 to 12 months later. This encourages the hygienist to stay in the current practice and put the new skill set and education to use. It is always best business practice to get any arrangements like this in writing and have both parties sign their acknowledgements of the terms to prevent any misunderstandings.

One question that may be on a dentist’s mind when making an investment in a team member’s education is whether that person will stay with the practice. Wall suggests, “One of the key ways to protect your investment in your hygienist’s continuing education is mentoring. Work with them to implement and master their new skills.”

It is also important for doctors and hygienists to understand the return on investment for additional training and certifications. Wall stresses the importance of asking these key questions when considering dental education for the hygienist: What is the return for the patient? What is the return for the provider? What is the return for the practice?

Not all advanced training will yield a certification or brand-new skill. While most offices have computers in the operatories, most hygienists say they want to reduce the time it takes to chart and make notes in the system. Most dental team members learn the basics about their practice management software and stop short. However, by completing advanced training on the clinical components of the dental software used in the practice, documentation is more efficient and accurate and this provides valuable chair time.


The future growth of a dental practice greatly depends on the ability to delegate procedures to highly trained and qualified dental team members. The hygienist plays a key role in the profitability of the dental practice.

About the Author

Penny Reed


Penny Reed & Associates


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