Today, the field […] faces a shrinking workforce, especially in the Bay Area, where there is only one hygienist for every 2.5 dentists, though most practices function best with three to four hygienists per dentist. Even high wages can’t stem an outflow caused by a lack of support, an unsustainable workload, and policies that are straining the industry.

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Between 2019 and 2023, the number of registered dental hygienists in seven Bay Area counties fell 8.6% from 3,262 to 2,980, even as the number of licenses statewide increased by 426, according to the California Department of Consumer Affairs.

The shortage has driven up compensation. Registered dental hygienists in the Bay Area earn an average hourly wage of about $69 or $142,751 annually for full-time work, according to Revelio Labs. Even a three-day workweek pays well above the region’s median annual earnings. But many hygienists work part time and receive no benefits.

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Unlike other roles in healthcare with similar educational requirements, like nurses, many hygienists do not benefit from employer-sponsored health insurance, sick leave, and retirement accounts.

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Nationally, women make up 94% of registered dental hygienists but only 38.8% of dentists, according to the Bureau of Labor Statistics (opens in new tab), reflecting the history of male dentists recruiting their wives and daughters to clean patients’ teeth throughout the early and mid-20th century. Part-time schedules are crucial to manage the physical demands of a job in which carpal tunnel and repetitive strain injuries are commonplace.

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Facing chronic vacancies, some states are letting lower-paid dental assistants take on tasks once reserved for hygienists. Model legislation from the conservative think tank American Legislative Exchange Council and the American Dental Association has opened the door to expanded assistant duties.

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California dentists have begun hiring associate dentists to do preventive care.

“[A hygienist] frees up my schedule to do dentistry and deliver better care, but numbers-wise, I just can’t make it work,” says Travis Smith, a dentist who opened an office in San Francisco this year. “Since the shortage is so profound, the salary demands of a per diem hygienist is going to be more than an associate dentist.”

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Some 60% of dentists polled (opens in new tab) by the ADA in 2022, the latest data on record, reported that their rates were stagnant (opens in new tab), and 25% said their rates had decreased over the previous year. Consolidation in the insurance industry has weakened small providers’ negotiating power, and there’s a lack of regulation in dental insurance compared with medical insurance.

Given that backdrop, it’s no surprise that some hygienists have pivoted to nursing. “In nursing, you have the union, you have the support, you have the hospitals that can work for you,” Markopoulos said. “There are more options for nurses, and they have the benefits and retirement.”