Occupational Duties

According to the Bureau of Labor Statistics (BLS), U.S. Department of Labor (DOL)- Occupational Outlook Handbook, Dental Hygienists

" remove soft and hard deposits from teeth, teach patients how to practice good oral hygiene, and provide other preventive dental care. Hygienists examine patients’ teeth and gums, recording the presence of diseases or abnormalities. They remove calculus, stains, and plaque from teeth; perform root planing as a periodontal therapy; take and develop dental x rays; and apply cavity-preventive agents such as fluorides and pit and fissure sealants. In some States, hygienists administer anesthetics; place and carve filling materials, temporary fillings, and periodontal dressings; remove sutures; and smooth and polish metal restorations. Although hygienists may not diagnose diseases, they can prepare clinical and laboratory diagnostic tests for the dentist to interpret. Hygienists sometimes work chairside with the dentist during treatment. Dental hygienists also help patients develop and maintain good oral health. For example, they may explain the relationship between diet and oral health or inform patients how to select toothbrushes and show them how to brush and floss their teeth. Dental hygienists use hand and rotary instruments and ultrasonics to clean and polish teeth, x-ray machines to take dental pictures, syringes with needles to administer local anesthetics, and models of teeth to explain oral hygiene."

The occupational duties described by the BLS mirror the responses from the Healthcare Navigator study regarding occupational duties with one major exception: Hygienists in the South Bay Area and Peninsula do not work chairside with Dentists or serve in an assistant capacity. Dental assistants instead work chairside with the Dentist. Many Bay Area hygienists enjoy a high level of independence in the dental office and some may assume a role similar to an independent contractor.

Because hygienists' salaries are escalating, some dentist's offices cannot afford to hire multiple dental hygienists. As a result, the dental hygienist's work day has become highly scheduled–even down to the minute–and hygienists may see as many as 10 patients per day. Because health needs and cleaning time vary with each patient, dental assistants may perform more of the ancillary duties once performed by hygienists in an effort to help hygienists adhere to their tight schedule.

Significant Points

• Demand for hygienists has been relatively consistent for a few reasons: hygienists provide a vital service and the age of the hygienist population is well distributed because of continued interest in the field and high visibility of hygienists. In recent years, the increase in salary of hygienists has drawn even more attention to the occupation and as a result, more people than ever are applying for training programs.
  

• Flexible scheduling is a distinctive feature of this job and is what attracts many individuals to the Dental Hygiene profession. Dentists frequently hire hygienists to work only 2 or 3 days a week, and because Dental Hygiene is physically demanding, the majority of hygienists work no more than 30 hours per week.

• Experienced hygienists in the Bay Area can earn more than $400 per day.

• Many Hygienists form close relationships with their patients over the years and cite this as an enjoyable part of their job. Individuals contacted for interviews indicated that being compassionate about patients' fears of dental work and having the ability to put patients at ease are paramount to success in the occupation.

• Hygienists advise the dentist of their periodontal and calculus findings on each patient and may make recommendations for treatment. Advising and sharing specialized knowledge with the dentist can be a source of pride for individuals working as hygienists.

• If an individual is interested in a healthcare career in patient care, but would prefer to work with patients that are not critically ill, the Dental Hygiene profession could be a good fit. Because the majority of patients see hygienists for preventative care and cleaning services, the dental hygienist occupation is considered to be less stressful than Nursing, Respiratory Therapy and other emergent care professions.

• Dental hygienists come in contact with blood, which may be of some concern to candidates. The dental industry has strict safety protocol in place to protect individuals working in the dental occupations from pathogens and radiation from x-rays.

• Dental Hygiene work is considered to be physically demanding and requires stamina. Some hygienists experience chronic neck and back pain. Repetitive stress injuries are somewhat common and hygienists must take great care to maintain safe and comfortable working conditions.

• The vast majority of dental hygienists are female which may discourage men from considering a career in dental hygiene.

• Several individuals interviewed suggested that the spike in dental hygienists' salaries (it is not uncommon for experienced hygienists to earn upwards of $50/hr) has led to resentment among dental employers. Concerns over dental reimbursement, changes in dental procedural needs, and changes in the patient population utilizing dental care have led to a concern about the bottom line in dental offices. Nonetheless, hygienists are essential to the dental care delivery system and cannot be cut out of the dental office team as a cost-saving measure.

• There are a number of political issues driving the dental hygienist and other dental occupations. Several individuals interviewed indicated that they feel that dental hygiene is facing a professional crisis because legislative changes expanding the scope of practice for Registered Dental Assistants (RDA) will threaten the value of the Registered Dental Hygienist (RDH) credential and the future of Dental Hygiene. Several other individuals did not believe that the extended functions would impact hygienists whatsoever. Several individuals also indicated a belief that introducing Dental Hygiene certificate programs into the local vocational colleges or private program setting is an attempt by dentists and dentist's organizations to flood the hygienist market in an effort to drive down the ever-increasing salaries of hygienists. It is of utmost importance to note that these are the opinions of individuals interviewed only and concrete data on these issues is not available.

• Training programs at community colleges and universities are impacted and prerequisities are extensive. Individuals transitioning to a career in Dental Hygiene may find that they spend several years completing prerequisite courses and waiting to be selected for community college Dental Hygiene training programs.

Demand

Unlike Nursing, Radiologic Technology, Respiratory Therapy, and Clinical Laboratory Science, interest in Dental Hygiene did not experience a dramatic decline due to the tech boom. Demand for hygienists is steady and has been for years. The age of the hygienist workforce is evenly distributed and traditionally, a consistent number of individuals have entered the occupation and a consistent number retired. Occupational attrition is not common in Dental Hygiene, unless it is the result of disability.

The costs associated with opening a new dental practice are often prohibitive for new dentists and it is common for new dentists to work per diem as dental hygienists. Some dentists in established practices are unable to pay hygienist salaries and will clean patients' teeth themselves. Note: The individuals interviewed for the Navigator project were clear that the trend of dentists cleaning their patients' teeth is not the result of an unmet need for hygienists, it is a cost-cutting measure.

Several individuals interviewed indicated that hygienists feel threatened by the change in scope of practice for Registered Dental Assistants (RDA). Because the RDA scope of practice will still be limited, RDAs will never replace hygienists in the dental office and it is unlikely that the change in scope will have an effect on the number of jobs available for hygienists.

Several individuals interviewed indicated that it may be possible in the future for dental hygienists to open up independent practices. Note: The Healthcare Navigator is unaware of any local independent Hygiene practices currently in operation.

Wages

The salary band for hygienists in the Bay Area is remarkably broad. It is common for new graduates working part-time to earn $30-$40/hr, while experienced Hygienists with an established clientele may earn $45-$55/hr. Hygienists who work 2-3 days per week or work at several dental offices are unlikely to receive benefits but may receive higher salaries. The vast majority of individuals working full-time for one dental office receive benefits. Click here to view the wage survey for Santa Clara County and here for San Mateo County.

Education / Training

Dental hygiene training programs are available through Foothill College, Cabrillo College, Chabot College, University of the Pacific (San Francisco campus) Western Career College. The University of California-San Francisco Dental Hygiene Program closed in 2005. The number of applications that local Dental Hygiene training programs currently receive is at an all-time high and programs are impacted State-wide.

Western Career College opened in 2006 and is an accelerated vocational program that admits Dental Hygiene students twice per year. Because this program has opened in an area that for many years had only three training programs and Western Career College is admitting students twice per year (the other programs admit only once per year), several individuals interviewed predicted that the addition of more new graduates will change the job market for Dental Hygienists and increase competition for open jobs. Increased competition for jobs and a small glut in the Dental Hygienist market in the future could put an end to the ever increasing salary hikes that this occupation has enjoyed in the last few years.

Individuals interested in becoming a hygienist must complete an ADA-approved training program in Dental Hygiene. Click here to see which schools are California State and American Dental Association (ADA)–approved. In California, Dental Hygiene programs are offered at community colleges, vocational colleges and universities. Community college Hygiene programs are approximately two years long and full-time study is required. Some students may be able to work at a part-time job in the evening or on the weekends, but the time demand for the program is great and the atmosphere is competitive. Dental Hygiene programs are considered to be among the most demanding allied health training programs and some students may find they have to spend several hours a day studying outside of the classroom to earn a competitive score on tests.

Accessing Hygiene training programs at community colleges and postsecondary universities is difficult due to the extensive prerequisites and number of individuals applying for admission. It may take two to four semesters for individuals to complete the prerequisites necessary to apply for admission.

Admission procedures vary among training programs and each program uses different admissions criteria. Wait-lists, lotteries, and "first come-first served" procedures are all used in this area and some schools use a combination of these admissions tools. In order to be eligible for community college training programs, students must complete a physical examination, have Hepatitis B vaccinations, and have current CPR certification.

Individuals who have worked as a dental assistant may be viewed favorably in the admissions process and individuals who completed dental assistant training at a community college that also has a dental hygienist training program may be given preference. Foothill College Dental Hygiene Program gives consideration to Foothill College Dental Assistant Program graduates.

Local community college training programs require that students purchase an instrument kit, which can cost as much as $5,000. Financial aid is available, and individuals may qualify for scholarships through their training provider and the American Dental Hygienists’ Association Student Scholarship site. Currently, Cabrillo College hosts the only dental hygiene training program on the ETPL.

Licensure and Certification

Dental hygienists in California must be licensed to practice Dental Hygiene. Once an individual obtains a certificate or associate degree in Dental Hygiene from an institution accredited by the American Dental Association, s/he is qualified to take the Dental Hygiene National Board Examination and California State Licensing Exam, and must pass both to practice as a Hygienist in California. Dental hygienists must renew their license every two years and are required to complete twenty-five hours of continuing education in those two years. Dental hygienists must also renew their CPR certification every 2 years. Though the employer must provide malpractice insurance for Hygienists working in the dental office, many Hygienists also carry their own malpractice insurance.

Career Ladder

Click here to view the Dental Career Ladder Diagram developed by the Navigator.

Dental hygienist is not typically viewed as a step on the career ladder toward becoming a Dentist. Though some individuals do choose to complete a bachelor's degree, 4 years of dental school, and then establish a practice, it is relatively rare for a hygienist to pursue this path due to cost, lack of part-time training options, satisfaction with the Dental Hygiene profession, and the sheer time it would take to become a dentist as an associate degree prepared hygienist.

Some individuals do choose to completed a bachelor and an advanced degree and go on to teach at the community college level. Salaries are much lower in education and many choose to stay in an office practice for financial reasons and a desire to work with patients.

There may also be opportunities in dental product sales and consulting, or dental office or group management. As mentioned, the vast majority of Hygienists work in clinical office practice.

Resources

Additional Information

UCLA Dental Workforce Report

UCSF Dental Industry Report

Health Professions Network

Silicon Valley Roots: Foundational Occupations with Growth Potential "Dental Hygienists "

Professional Associations

American Dental Hygienists' Association

American Dental Association

California Dental Association

Santa Clara Valley Chapter-California Dental Hygienist Association

Peninsula Chapter–California Dental Hygienist Association

California Dental Hygienist Association

Regulatory Agencies

California Department of Consumer Affairs

Committee on Dental Auxiliaries