HYGIENE HOTSPOT Factors Affecting Dental Hygiene Employment Patterns

By: Morgan Wong, and Sarah Justus, M.Ed., RDH

In 2019, 43% of dental hygienists stated they were looking for a new job due to unsatisfactory pay and not feeling valued or respected. Approximately 3,300 dental hygienists have voluntarily left the profession since 2021 (Morrissey et al., 2022). Dental hygiene has 16,300 available positions every year in the United States, and 214,000 are currently employed. The U.S. Bureau of Labor Statistics (2022) projects that in 2021-2031 dental hygiene will increase 9%, which is faster than the average for all other occupations. Once a dental hygienist graduates from an accredited program, it is expected that those graduates would fill those open positions. However, only 7,300 dental hygiene students graduate annually, which is less than half of the open positions every year (Jones-Teti et al., 2021). The reason causing dental hygienists to leave the profession has limited research, but some studies have shown that the shortage in the field could be due to burnout, dissatisfaction with current workplace and career, or Covid-19related issues (Gorter, 2015; Gurenlian et al., 2021; Vick, 2016; Ylipää, 2022).

When an individual is “burned out” it has a deeper meaning than simply fatigue. To understand burnout, one must first understand stress and strain. For example, a material will return to its original shape after mild pressure is applied to it, which is called stress. However, strain occurs when excessive pressure is put on a material such that it deforms and is unable to return to its original state. This example applies to the human psyche as well; an individual can only withstand a certain amount of pressure and still recover from it without strain (Gorter, 2005). Once the human mind starts becoming strained, the person may start to develop negative thoughts, depression, irritability with people, lack of energy, and possibly an unhealthy lifestyle (Gorter, 2005; Mayo Clinic, 2021). Pressure on the mind can be caused by many factors, but when it is acquired directly from the profession, career burnout happens. The main symptom from burnout is mental fatigue that deteriorates the ability to mentally take care of oneself. This is especially detrimental to dental hygienists and other professionals because if they cannot tend to themselves, they will struggle to take care of their patients. A study completed by CareQuest Institute for Oral Health (2022) showed that mental burnout played a significant role in dental hygienists wanting to leave the field, and that younger providers aged 18-34 reported the most burnout. The study also found that job burnout is linked with higher suicide rates in health care professionals because it can lead to physical and psychological stress. Burnout makes dental hygienists feel they are not successful with their work, which leads to dissatisfaction in their current workplace (Gorter, 2005).

Dissatisfaction in the current workplace can play a significant role on a dental hygienist’s quality of work and life (Sur et al., 2004; Vick, 2016). There may be several different reasons why dental hygienists are dissatisfied with their current work. One reason is not feeling valued or respected by their employer. Not feeling valued in a current role leads to poor work performance and second-guessing one’s career altogether (Brunner et al., 2019). Work setting, such as private practice or corporate practice, can also affect satisfaction in the workplace. Some dental hygienists thrive in the fast-pace, high-turnover environment of a corporate practice, while others excel with the structure of a private practice. Choosing the wrong work setting can lead to job dissatisfaction over time. Patel et al’s (2021) study on job satisfaction with dental hygienists found that dental hygienists that worked in a corporate dental setting were more satisfied with their fringe benefits than those who were not working in a corporate structure. Working in multiple offices may also result in a decrease in work performance, which then leads to career complaints. With the high demand for dental hygienists, it is imperative for the employer and dental hygienist to understand the key factors of the discontent and create a plan for the longevity of these positions (Vick, 2016). Even with a well laid out plan to combat dissatisfaction in the workplace, other unforeseen reasons could make dental hygienists leave the profession.

Covid-19 and its impact on certain professions was not something anyone could have predicted to happen. The virus had a significant negative impact on the labor market, especially female-dominated professions who are the main caregiver for children and elderly adults. Due to dental hygiene being predominantly female (98%), the profession was severely impacted by the virus (Gurenlian et al., 2021). During the beginning of the pandemic, individuals left the profession for many reasons. Daycares and schools were shut down, which led parents to have to take care of their children, placing their careers on hold. Some individuals in the profession were worried about contracting it themselves or passing it to their loved ones due to the exposure risk of aerosolized viral particles. According to the World Economic Forum (2020), dental hygiene was one of the riskiest non-hospital jobs during the pandemic. This was due to close contact with patients and high exposure to disease and infection (Gurenlian et al., 2021). A study done in September 2020 showed Covid-19 was the biggest reason why most individuals left the profession voluntarily (Gurenlian et al., 2021). At the time of the study, a vaccine was not available, personal protective equipment (PPE) was limited, and schools and daycares were shut down which forced many dental hygienists to be the sole caregiver. Because the height of the pandemic has passed, now is the time to conduct research to understand if the shortage in dental hygiene is still due to the virus (Gurenlian et al., 2021).

The purpose of this study is to identify factors influencing dental hygienists’ employment patterns and attitudes. This study utilizes an electronic survey to evaluate the attitudes of licensed dental hygienists regarding their current workplace and career plans. The results of this study provide insight on the current shortage within the field of dental hygiene. With the results, dental professionals will be able to understand why dental hygienists are leaving the profession. This will help develop methods to address the concerns of not being able to retain dental hygienists in the profession.

Methods

This study was a non-experimental, simple descriptive research project using an electronic survey design. The research protocol and survey were approved by the University of Oklahoma Health Science Center Institutional Review Board (IRB # 14859). The survey was sent to 2,499 Oklahoma-registered dental hygienists through OUHSC Qualtrics. Two reminder emails were sent: the first one was sent 2 weeks after the initial email, and the second one was sent 2 weeks after the first reminder email. An informed consent including the study’s purpose and investigator’s contact information were emailed to every recipient. Participants were informed that the completion of the survey was strictly voluntary. The survey investigated dental hygienists’ attitudes toward their current workplace, career, and if they intend on leaving the profession. The survey consisted of 49 questions including multiple choice, Likert-type scale, and open-ended questions that took approximately 10 minutes to complete.

An email list in alphabetical order of all registered dental hygienists in Oklahoma provided by Oklahoma Board of Dentistry was used to recruit participants. The first 2,499 emails on the list were sent the survey. Out of the 2,499 emails, 92 email addresses were inactive and never delivered to participants; 2,407 emails were successfully delivered. The results of this study were quantitatively analyzed. Respondents who did not complete at least 70% of the survey were considered incomplete responses and were excluded from the analysis. Descriptive statistics were used, and the tests were analyzed by Chi-square and Fisher’s Exact to make group comparisons.

Results

Out of the 2,407 individuals who received the survey, 281 (11%) completed the survey with 70% completion or higher. The majority of the participants were cis-gender female (95%, n=265) and predominantly White or Caucasian (82%, n=230). Participants were age 20 and over. The participants mainly worked in an urban setting (69%, n=177), and 34% (n=96) have been working for over 21 years. Concerning job status, more than half of the respondents worked full time (31 or more hours) in one job setting (59%, n=152) and the next highest was part time (30 hours or less) in one job (23%, n=59). According to the survey, 97% (n=247) work in a general dentistry practice setting with 75% (n=192) working in private practice, and 16% (n=42) in another dental practice setting such as corporate dental or nonprofit. See Table 1. For those participants who responded, “not working currently” (n=27), 37% (n=10) voluntarily left their position due to career change, and 25% (n=7) voluntarily left due to mental burnout. See Table 2.

Of the 254 currently working dental hygienists in Oklahoma, 27% (n=70) reduced their working hours in the past 3 years; 50% (n=35) reduced their hours due to physical burnout, while 37% (n=26) worked fewer hours due to mental burnout. Due to Covid-19 concerns, 14% (n=10) reduced their working hours and, 27% (n=69) plan to leave the profession in the next 5 years. The main reason for leaving the profession was retirement at 41% (n=27), second was mental burnout at 21% (n=14), and third was physical burnout at 16% (n=11). One way the participants were compared was by age (<40 years [N=123] versus 40 years and older

[N=131]). This research showed a strong association between age and planning to leave dental hygiene (p<0.0001). Of the individuals who are planning to leave the profession in the next 5 years, 16% (n=20) were younger than 40 years of age, and 37% (n=49) were 40 years and older (p=0.0002). The participants who were younger than 40 years of age, 40% (n=8) are planning on leaving due to mental burnout. Looking at the individuals who are older than 40 years of age, only 13% (n=6) plan to leave the profession due to mental burnout. See Table 3.

In this study, private practice only (N=179) and other employment settings (N=75), such as corporate setting or nonprofit, were compared. This research did not show a strong association between work setting and plans to leave the profession or reasons for reducing working hours. 32% of respondents working in private practice only reported reducing their working hours in the past 3 years, and 25% reported plans to leave the profession in the next 5 years. In contrast, only 16% of respondents working in other employment settings, including multiple settings, reported reducing their working hours in the past 3 years, and 32% reported plans to leave the profession in the next 5 years. See Table 4. Among respondents working in private practice, 33% (n=59) were “dissatisfied” with fringe benefits, while only 18.7% (n=14) from other employment settings were “dissatisfied.” Regarding satisfaction with operations of the workplace, 29% (n=22) of other employment setting responded “dissatisfied,” while 14% (n=25) in the private practice setting chose “dissatisfied.” Among dental hygienists working in other employment settings, 26% (n=20) “agreed” that they speak about their work in a negative way, while only 19% (n=34) of the private practice setting “agreed.” When asked if during work they feel emotionally drained, 45% (n=34) of other employment setting “agreed”, and 34% (n=62) of private practice “agreed.”

Participants were asked about their concerns regarding Covid-19 with 51% (n=132) reporting they were “not concerned at all” about the risk of Covid-19 transmission to their patients, and 2% (n=6) were “very concerned.” Regarding the risk of Covid-19 transmission to themselves, 47% (n=120) of respondents were “not concerned,” while only 3% (n=8) were “very concerned.” This study looked at the comparison between female to other genders and did not find positive association. This is likely due to the majority of the participants being female (n=238) and a lack of “other gender” individuals (N=12) in this study.

Discussion

Dental hygienists play an imperative role regarding oral health. However, with the shortage of dental hygienists in the United States, it is important to understand the key factors that are causing the reduction of the workforce. The outcome of this research noticed trends that are currently affecting the profession. With dental hygienists who left the profession, this study found that the most common reason was career change, and the second most common answer was mental burnout. In this study, mental burnout was the reason why dental hygienists reported reducing their working hours in the past 3 years or planning to leave the

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Tables and references on page 45 profession in the next five years. An article by CareQuest (2023) showed that mental burnout plays a role in dental hygienists wanting to leave the field, supporting the findings in this research.

When it comes to dissatisfaction with current workplace or career, individuals who worked in another employment setting that was not private practice said they often think about getting another job that better suits their needs. Additionally, they were more likely to speak about their current workplace in a negative way. Dental hygienists who worked in a private practice setting were more satisfied with the operations and communication at their workplace than other employment settings. The main dissatisfaction in the private practice setting was the fringe benefits. Research by Patel et al. (2021) found that dental hygienists who were employed in a corporate setting were more satisfied with their fringe benefits than those who were not, which aligns with the results from this research. Regarding Covid-19, this study shows that a limited number of participants voluntarily left due to the virus. Additionally, it shows that only 3% are concerned about transmitting the virus to patients and to themselves. Gurenlian et al.’s (2021) study showed that most dental hygienists left the profession in 2020 due to Covid-19, which is not supported by this study. The difference from 2020 to today is Covid-19 vaccines have been developed, the level of PPE has increased, and schools and daycares are operational. Based on the results of this study, Covid-19 is less of a threat to dental hygienists leaving the profession now than it was in 2020.

Research on factors affecting the shortage in the profession of dental hygiene is limited. With this study, the data show that mental and physical burnout, as well as job dissatisfaction, play a role in dental hygienists leaving the profession. This study has limitations due to it only representing a small percentage of dental hygienists in the United States (Oklahoma). Further research should focus mainly on mental and physical burnout to get a deeper look at these trends. Most of the participants in this study worked in a private practice setting (75%) with few in the corporate setting. For future research endeavors, it would be beneficial to have a more equal number of participants in the private practice setting to compare with corporate dental setting.

Conclusion

The results of this study show that burnout and job dissatisfaction are the main trends that influence dental hygienists’ decisions about leaving the profession. Given the increase of oral health awareness and the shortage of dental hygienists, dental offices are going to face challenges when recruiting dental hygienists. It is important for dental offices to understand the leading factors implicated in this trend and brainstorm strategies to avoid burnout and dissatisfaction in the workplace. Furthermore, it is important for dental hygienists to understand conditions that could possibly affect their profession and have open communication with their dental offices. Also, when it comes to burnout, it is important for health care providers to know that resources are available to help them overcome this battle. If a dental hygienist is satisfied with their job and is not burned out, they will be able to provide better patient care.

ABOUT THE AUTHORS:

Morgan Wong is a dental hygiene student at the University of Oklahoma College of Dentistry where she will receive her Bachelor of Science in Dental Hygiene degree May of 2023. While attending school, Morgan was a finalist for the Don M. Ishmael Scholarship Award in 2023 for her research on “Factors Affecting Dental Hygiene Employment Patterns.” She is passionate about oral health awareness and helping individuals understand the importance of oral health. Outside of dental hygiene, Morgan enjoys spending time with her husband and dog.

Sarah Justus completed her Bachelor of Science in Dental Hygiene degree at the University of Oklahoma College of Dentistry. During her schooling, she received several leadership awards, the 4.0 grade point average medallion, and was inducted membership into the Sigma Phi Alpha dental hygiene honor society. Sarah completed her Master of Education degree at the University of Central Oklahoma and is currently a doctoral student at Oklahoma State University.

Sarah worked in a private dental office in Oklahoma City before becoming a faculty member in the dental hygiene program at the University of Oklahoma College of Dentistry. Currently, she is the Dental Hygiene I clinic coordinator and provides didactic instruction in Preventive Dentistry, Clinical Dental Hygiene Theory I and II, and Research Methods.

Sarah serves as the American Student Dental Hygienists’ Association advisor, the Sigma Phi Alpha Beta Delta chapter secretary, and the Student Research Program mentor. Sarah is a member of the American Dental Educator's Association, the American Dental Hygienists' Association, the Oklahoma Dental Hygienists' Association, and the Oklahoma County Dental Hygienists' Association. Sarah also serves on the Dental Hygiene Admissions Committee, the Health and Safety Committee, the Research Committee, and chairs the DH I PAC Committee. She enjoys serving others at Oklahoma Mission of Mercy, OU’s Kid’s Day, and OU’s Veteran’s Day.

Sarah's enjoyments outside campus include the lake, exploring the great outdoors, deer hunting, sports, traveling, and spending quality time with friends and family.

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