Dental Workforce
Shortages:
Data to Navigate
Today’s Labor Market
TABLE OF CONTENTS
Page 2
Table of Contents
Executive Summary .................................................................................................................................... 3
Background ............................................................................................................................................... 3
What the Research Tells Us ...................................................................................................................... 3
Considerations for Dental Employers as We Look to the Future .............................................................. 4
Why This Matters ........................................................................................................................................ 5
About this Study ........................................................................................................................................ 5
Putting the Challenge in Context............................................................................................................... 5
Impact of Workforce Shortages on Dental Practice .................................................................................. 6
What’s Behind the Shortage? Greater Outflows, Slower Inflows .............................................................. 7
Preparing for the Long Road Ahead.......................................................................................................... 8
Results ....................................................................................................................................................... 10
Tenure ..................................................................................................................................................... 10
Job Satisfaction ....................................................................................................................................... 12
Pay Raises .............................................................................................................................................. 13
Benefits ................................................................................................................................................... 14
Attrition Factors ....................................................................................................................................... 20
Retention Factors .................................................................................................................................... 24
Retention Strategies ................................................................................................................................. 25
Risks to Retention ................................................................................................................................... 25
Retention Strategies ................................................................................................................................ 26
Methods...................................................................................................................................................... 28
Sample .................................................................................................................................................... 29
Contributors .............................................................................................................................................. 30
Appendices ................................................................................................................................................ 31
Dental Assistant Workforce Shortages Survey ....................................................................................... 32
Dental Hygienist Workforce Shortages Survey ....................................................................................... 39
Dentist Polling from Economic Outlook and Emerging Issues in Dentistry............................................. 45
Innovations in Shoring up the Pipeline, Recruitment, and Retention...................................................... 48
References ................................................................................................................................................. 49
EXECUTIVE SUMMARY
Page 3
Executive Summary
BACKGROUND
The dental sector is facing a serious workforce shortage. Vacant positions in dental assisting and dental
hygiene have reduced dental practice capacity by an estimated 10% nationally. One in three dentists who
do not have full appointment schedules indicate that trouble filling staffing positions is a contributing
factor. Workforce shortages were initially attributed to the COVID-19 pandemic. We now know that is just
part of the story. Enrollment in dental assisting programs has been trending downward since 2015, and
the pandemic had a negative impact on dental hygiene program enrollment. While there has been some
recovery of enrollment in dental hygiene programs, data suggest that dental assisting program enrollment
will not rebound in the near future. As a result, workforce shortages are likely to remain an issue for years
to come.
To identify strategies for shoring up the workforce, a deeper understanding of the various factors
contributing to workplace satisfaction and retention is needed. Stakeholders must ask the following:
Among dental assistants and dental hygienists satisfied in their positions, what keeps them coming to
work each day? What workplace conditions are to blame for dental assistants and dental hygienists
leaving their positions? The ADA Health Policy Institute (HPI) engaged with partners at the American
Dental Assistants Association (ADAA), American Dental Hygienists’ Association (ADHA), the Dental
Assisting National Board (DANB), and IgniteDA to conduct primary research on these issues. Using data
collected from thousands of dental assistants, dental hygienists, and dentists in 2022, this report offers a
comprehensive outlook on the levers available to sustain and improve workplace satisfaction among
dental practice personnel. These levers can enhance the recruitment and development of a high-quality
workforce within the dental sector.
WHAT THE RESEARCH TELLS US
Approximately one-third of the dental assistant (33.7%) and dental hygienist (31.4%) workforce
indicate they expect to retire in five years or less.
The majority of dental assistants and dental hygienists are satisfied in their current job.
Roughly half of dental assistants and dental hygienists indicate they have received a raise within the
past year. The majority of wage increases are in the 1-3% range.
The majority of dental assistants and dental hygienists indicated that they receive dental benefits,
paid holidays, paid vacation, and retirement savings from their employers. Health insurance, paid sick
time, paid leave, and continuing education or professional development funds are rare overall. These
benefits matter for recruitment and retention.
Factors associated with retention include work-life balance, positive workplace culture, and ability to
help patients.
Factors associated with attrition include negative workplace culture, insufficient pay, lack of growth
opportunity, inadequate benefits, and feeling overworked.
EXECUTIVE SUMMARY
Page 4
CONSIDERATIONS FOR DENTAL EMPLOYERS AS WE LOOK TO THE FUTURE
Dental practices need to remain competitive as employers when it comes to
employee benefits. Paid vacation and paid holidays are now the norm in dentistry.
The majority of dental practice employees are also offered retirement savings
options and paid sick time. However, in order to recruit and retain a robust
workforce, dental employers need to offer health insurance and paid leave. Within
dentistry, these benefits are much more common in public health and dental service
organization (DSO) work settings.
Responsive compensation is a must. Wages need to be assessed annually.
Ideally, raises should incorporate performance measurement, which may help
dental team members feel more connected to practice goals and offer a sense of
professional fulfillment.
Workplace culture cannot be overlooked. Among employees who are satisfied in
their roles, positive workplace culture, work-life balance, and ability to patients are
the most commonly cited contributing factors. Poor communication in dental
practices is one of the top risks to retention. Traditional dental practices are small
businesses that typically lack a dedicated human resources team to evaluate and
improve upon these aspects of the work environment.
Consolidated dental practices have an edge when it comes to employee
benefits. Dental service organizations and group practices are better positioned to
offer employee benefits. However, there are lower levels of overall workplace
satisfaction among dental assistants and dental hygienists working in these
practices, likely driven by differences in other aspects of the workplace. This merits
further research.
Shoring up the workforce pipeline will require long-term changes. The
numbers of new dental hygienists and dental assistants graduating from allied
education programs may not be enough to compensate the losses of team
members who permanently left the profession during the pandemic. There may be
another wave of retirements in the next few years that will put additional pressure
on the workforce pipeline. Innovations are necessary to shore up the pipeline for
long-term sustainability of the dental workforce.
WHY THIS MATTERS
Page 5
Why This Matters
ABOUT THIS STUDY
The ADA Health Policy Institute (HPI) engaged with multiple partners to better understand dental
assistant and dental hygienist employment patterns and identify factors associated with both the attrition
and retention of dental team members. Partners included the American Dental Assistants Association
(ADAA), American Dental Hygienists’ Association (ADHA), Dental Assisting National Board (DANB), and
IgniteDA. Other organizations have contributed informative key insights on the impact of pay rates and
workplace benefits on job satisfaction, such as the Dental Salary Survey administered by DentalPost,
Dental Assistants Salary and Satisfaction Survey, and the National Network for Oral Health Access
Community Health Center Workforce Survey.
1
,
2
,
3
For instance, the DentalPost report revealed that pay
rates and benefits offerings are more substantial in corporate settings than in private practices and that
the most common dissatisfying feature of jobs among dental hygienists is inadequate pay. Using data
collected from thousands of dental assistants, dental hygienists, and dentists in 2022, this report
offers a comprehensive outlook on the levers available to sustain and improve workplace
satisfaction among dental practice personnel. These levers can enhance the recruitment and
development of a high-quality workforce within the dental sector.
PUTTING THE CHALLENGE IN CONTEXT
U.S. Surgeon General Vivek Murthy released the Addressing Health Worker Burnout report in May 2022,
sounding the alarm for more supportive workplaces for all who are “engaged in protecting and improving
the health of individuals” in order to sustain a robust workforce.
4
Health workers such as nurses, long-
term care facility staff, and many others have left their jobs in droves over the past few years, some
rejecting their field entirely. If not addressed, the health worker burnout crisis could impede patient access
to care, cause health care costs to rise, hinder the nation’s ability to prepare for the next public health
emergency, and worsen health disparities.
Dentistry is not exempt from these workforce challenges. The dental sector is subject to the same labor
market forces faced in other sectors of health care and in other industries, such as The Great Resignation
and The Great Retirement. The disruptions and pressures caused by the pandemic have also taken their
toll on workers’ mental health. In late 2020, more than one-quarter (28%) of dental hygienists experienced
symptoms of anxiety, and 17% reported symptoms of depression.
5
Meanwhile, the dental sector is
experiencing a phase of accelerated practice consolidation and shifts in practice patterns, dentist
demographics, and workplace culture.
6
,
7
,
8
WHY THIS MATTERS
Page 6
IMPACT OF WORKFORCE SHORTAGES ON DENTAL PRACTICE
Staffing issues were cited as the most significant concern among dentists in January 2022
9
and remained
the top concern in July 2022.
10
This is consistent with other industries predominantly structured as small
businesses, where – despite recent record-breaking inflation – workforce shortages remain the most
significant problem.
11
The shortages have caused an estimated 11% reduction in dental practice
capacity.
12
In July 2022, 4 in 10 dental practices indicated they were recruiting or had recently recruited dental
assistants (DA), and nearly the same share indicated they were recruiting dental hygienists (DH). Among
dentists recruiting for these positions, the vast majority – 9 in 10 – indicated it was “extremely” or “very”
challenging. Additionally in July 2022, about 1 in 3 dentists who did not have full schedules indicated that
vacant staff positions were at least part of the problem.
10
Recruitment activity in dental offices and its associated level of difficulty have gradually increased over
the two years that HPI has polled dentists on these topics.
10
WHY THIS MATTERS
Page 7
WHAT’S BEHIND THE SHORTAGE? GREATER OUTFLOWS, SLOWER INFLOWS
Greater outflows: Due to a multi-year partnership between the ADA and ADHA, we know that fewer than
half of dental hygienists who left employment early in the COVID-19 pandemic returned to the workforce
in 2021.
13
Further, an estimated 3.75% of dental hygienists voluntarily left the workforce in 2021, including
1.6% who permanently left due to retirement or a career change. The most common reasons cited for not
returning to work – aside from “waiting until the COVID-19 pandemic is under control” – included
concerns about workplace safety and insufficient childcare.
Slower inflows: Enrollment in dental hygiene and dental assisting programs declined from pre-pandemic
levels in 2021-22, with a downward trend in accredited dental assisting programs that started prior to the
pandemic.
14
There was about a 7% drop in first-year enrollment in dental hygiene programs nationwide in
the 2020-21 academic year, which was the first cohort to enroll since the start of the pandemic. That drop
is due in part to more programs not enrolling first year classes that year because of the pandemic. There
was about a 4% drop in the number of graduates in 2020 compared to 2019. The most recent data
indicate that both first-year enrollment and graduates are rebounding in dental hygiene. However,
enrollment declines in dental assisting seem to be part of a long-term downward trend, as is the number
of accredited dental assisting programs in operation.
WHY THIS MATTERS
Page 8
PREPARING FOR THE LONG ROAD AHEAD
When dentists were asked about the specific challenges they were experiencing with respect to
recruitment, a lack of applicants for dental assisting and dental hygiene positions was the most common
reason for the struggle. For open hygienist positions, the wage and benefit requirements of the applicants
has also been a challenge for dentists. Dentists also indicated a lack of qualified assistant applicants.
Increasing the supply and/or qualifications of dental team members could take years to address.
12
77.8%
28.4%
8.7%
8.0%
2.8%
0.0%
57.5%
17.3%
0.9%
42.5%
2.0%
6.6%
0%
20%
40%
60%
80%
100%
Not enough
applicants /
shortage
Demand for high
wages, benefits
Applicants do not
want to work
advertised hours
Applicants not
qualified / poor
quality
Location of
practice /
commute
required
Applicants not
showing for
interview
What specifically has been challenging about recruiting dental
assistants and dental hygienists?
Dental hygienists Dental assistants
WHY THIS MATTERS
Page 9
Dentists have been relying heavily on online recruitment and word of mouth to bring new employees into
their offices. Fewer are turning to local hygiene and assisting programs, and about 1 in 4 are using
staffing agencies or recruiters. To ease recruitment woes, more than 8 out of 10 dentists who are
recruiting dental hygienists or assistants have raised their starting pay rates. About 45% of recruiting
dentists have also changed hours to meet applicant needs. Dentists facing “extreme” challenges in hiring
are being even more proactive on their recruitment approach, relying on a wider range of recruitment
outlets and being more willing to offer recruitment perks.
15
Despite these measures, recruitment
challenges persist.
The 2020-2030 job growth outlook for both dental assistants and dental hygienists (11% for both
occupations) exceeds that of the national average across all occupations (8%), according to the U.S.
Bureau of Labor Statistics (BLS).
16
,
17
BLS data also indicate that as of July 2022, employment in dental
offices was 105.3% of what it was in January 2020.
18
While the number of jobs (not necessarily
employees) in dental offices is greater than it was pre-pandemic, the data are clear that plenty of room
remains within dental teams. Given the projected increase in demand over the coming years and
stagnant or declining supply of these dental team members, it is safe to assume that these workforce
challenges will be a longer-term challenge.
RESULTS
Page 10
Results
TENURE
More than half of the
dental assistant and
dental hygienist workforce
has been or was in the
field for at least 11 years.
The majority of
currently employed
dental assistants and
dental hygienists
indicate they have
been in their current
position for 5 years or
less.
Approximately one-
third of both the
dental assistant and
dental hygienist
workforce indicate
they expect to retire
in 5 years or less.
4.2%
14.2%
12.4%
13.1%
17.2%
38.9%
2.2%
7.9%
11.0%
16.4%
25.2%
37.3%
0%
10%
20%
30%
40%
50%
Less than 1
year
1-2 years 3-5 years 6-10 years 11-20 years More than 20
years
Tenure in the Field (All Hygienists and Assistants)
Dental assistants Dental hygienists
6.6%
10.9%
16.2%
18.6%
21.0%
26.8%
4.1%
9.6%
17.7%
21.3%
27.5%
19.8%
0%
10%
20%
30%
40%
Within the next
12 monhts
In the next 1-2
years
3-5 years from
now
6-10 years
from now
11-20 years
from now
More than 20
years from
now
Expected Timing of Retirement
Dental assistants Dental hygienists
RESULTS
Page 11
The number of employers a dental assistant or dental hygienist have naturally increases with their tenure
in the field. For instance, among dental hygienists who have been in the field for 1-2 years, 36% have
been with the same single employer for that duration whereas only 2% of dental hygienists who have
been in the field for more than 20 years are still with the same single employer.
77.5%
47.7%
27.3%
16.8%
12.1%
7.2%
14.8%
34.8%
35.4%
23.9%
17.7%
13.8%
3.0%
9.4%
20.2%
23.1%
22.2%
17.1%
3.9%
7.5%
14.1%
16.0%
16.8%
5.9%
11.0%
13.0%
14.4%
10.2%
16.9%
25.5%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Less than 1 year
1 - 2 years
3 - 5 years
6 - 10 years
11 - 20 years
More than 20 years
Number of Employers
Tenure in Field
Dental Assistants: Number of Dental Employers by Tenure in Field
1 2 3 4 5 6 - 10 11 - 15 16 - 20 21-40
68.7%
36.3%
12.0%
6.2%
5.3%
18.2%
27.2%
26.5%
15.5%
15.1%
6.6%
17.8%
27.4%
23.4%
18.1%
11.7%
7.1%
7.9%
12.7%
18.7%
16.1%
12.4%
7.8%
13.7%
14.2%
14.3%
4.0%
5.1%
10.3%
19.7%
26.3%
41.5% 7.4%
0.0% 20.0% 40.0% 60.0% 80.0% 100.0%
Less than 1 year
1 - 2 years
3 - 5 years
6 - 10 years
11 - 20 years
More than 20 years
Number of Employers
Tenure in Field
Dental Hygienists: Number of Dental Employers by Tenure in Field
1 2 3 4 5 6 - 10 11 - 15 16 - 20 21-40
RESULTS
Page 12
JOB SATISFACTION
The majority of currently employed dental assistants (60.0%) and dental hygienists (54.5%) indicate they
are satisfied in their role (rating satisfaction in the 8 to 10 range on a 10-point scale). Less than 1 in 10
(DA: 7.2%, DH: 7.7%) indicate a low level of satisfaction (rating satisfaction in the 1 to 3 range on a scale
of 10) in their roles.
Among both dental assistants and dental hygienists, a lesser share of dental service organization (DSO)
employees and part-time employees indicate high job satisfaction. Dental hygienists working in public
health indicate higher levels of satisfaction than their private sector peers.
7.2%
32.7%
60.0%
Dental Assistants: On a scale of 1 to 10,
how satisfied are you in your current
role? (1 = Not at all satisfied, 10 =
Extremely satisfied)
1-3
4-7
8-10
7.7%
37.7%
54.5%
Dental Hygienists: On a scale of 1 to
10, how satisfied are you in your current
role? (1 = Not at all satisfied, 10 =
Extremely satisfied)
1-3
4-7
8-10
60.4%
55.8%
63.5%
55.5%
45.3%
62.6%
40%
50%
60%
70%
Full-time
Part-time
Private solo
Group practice
DSO
Public health
By Employment
Status
By Practice Type
Dental Assistant Job Satisfaction
(% indicating at least 8/10 job
sastisfaction)
Average (60.0%)
55.1%
52.9%
54.9%
52.7%
45.9%
57.5%
40%
50%
60%
70%
Full-time
Part-time
Private solo
Group practice
DSO
Public health
By Employment
Status
By Practice Type
Dental Hygienist Job Satisfaction
(% indicating at least 8/10 job
sastisfaction)
Average (54.5%)
RESULTS
Page 13
PAY RAISES
Most dental assistants and dental hygienists indicate that they received wage increases within the past
year (DA: 49.2%, DH: 45.5%) or 1-2 years ago (DA: 19.7%, DH: 17.5%). Among those who indicated they
have never received a raise at their current place of employment, the majority (DA: 78.0%, DH: 89.2%)
indicate they have been working with their employer for less than three years. Among those who indicated
they have received a raise, it was most commonly an increase in the 1-3% range.
Employer Dentists’ vs. Employee Dental Assistants’ and Dental Hygienists’ Perceptions on Pay
Raises
The pay raise results from dental assistants and
dental hygienists were not consistent with results
from employer dentists. In June 2022, the
majority of dentists indicated they had issued pay
raises to dental assistants (84.6%) and dental
hygienists (79.9%) within the past year.
19
It is
worth noting that the dentist, dental assistant,
and dental hygienist participating in the study are
all from separate cohorts; they do not represent
the same places of employment. It is possible
that there is an inflated sense of generosity with
respect to benefits offered from the employer
dentist’s perspective and/or a deflated sense of
generosity from the employee’s (dental assistant
or dental hygienist) perspective.
49.2%
19.7%
5.5%
3.4%
22.2%
45.5%
17.5%
5.9%
5.4%
25.8%
0%
20%
40%
60%
80%
Within
the past
year
1-2 years
ago
3-4 years
ago
5 or more
years
ago
Never
Timing of Last Raise
Dental assistants Dental hygienists
68.2%
18.0%
5.6%
8.2%
62.0%
19.1%
7.9%
11.1%
0%
20%
40%
60%
80%
1-3% 4-6% 7-9% 10% or
more
Amount of Last Raise
Dental assistants Dental hygienists
84.6%
49.2%
79.9%
45.5%
0%
20%
40%
60%
80%
100%
Dentists
(issuing
raise)
DAs
(receiving
raise)
Dentists
(issuing
raise)
DHs
(receiving
raise)
Dental Assistants Dental Hygienists
Self-reported wage increase in the
last year
RESULTS
Page 14
BENEFITS
Dental assistants and dental hygienists were asked which workplace benefits they receive. The majority
indicated that they receive dental benefits, paid holidays, paid vacation, and retirement savings. Most
benefits were slightly more common to be offered to dental assistants, though continuing education
funding was more prominent among dental hygienists.
78.3%
54.5%
78.2%
68.1%
49.2%
65.5%
37.3%
22.8%
8.4%
25.7%
70.1%
44.8%
66.2%
61.5%
36.7%
71.9%
44.0%
15.2%
5.0%
13.2%
0%
20%
40%
60%
80%
100%
Share of dental assistants and dental hygienists
receiving select workplace benefits
Dental assistants Dental hygienists
RESULTS
Page 15
Dental assistants and dental hygienists who indicated a high level of workplace satisfaction (8 to 10 on a
10-point scale) receive more workplace benefits than their colleagues who indicated low levels of
satisfaction in their roles (1 to 3 on a 10-point scale).
0%
20%
40%
60%
80%
100%
Share of dental assistants
receiving workplace benefits by
level of job satisfaction
DA Satisfied (8-10) DA Dissatisfied (1-3)
0%
20%
40%
60%
80%
100%
Share of dental hygienists
receiving workplace benefits
by level of job satisfaction
DH Satisfied (8-10) DH Dissatisfied (1-3)
RESULTS
Page 16
Health insurance, paid sick time, paid leave, and continuing education or professional development funds
– while rare overall – are available to the majority of dental hygienists working in public health settings.
These benefits are also more common in DSOs and group practices than in private solo practices. Similar
trends are true for dental assistants.
Among the dental assistants and dental hygienists not receiving these workplace benefits, the majority
indicate that almost all of these benefits are “very desirable.” Less than half of dental assistants and
dental hygienists not receiving membership association dues indicated this as a “very desirable” benefit,
and less than half of dental assistants find licensure or certificate fees to be “very desirable.”
38.9%
20.9%
37.4%
6.4%
44.4%
38.8%
46.7%
11.6%
51.1%
72.8%
52.7%
29.3%
73.8%
86.1%
75.9%
64.6%
0%
20%
40%
60%
80%
100%
Paid sick time Health insurance CE or professional
development
Paid leave (e.g. FMLA)
Share of dental hygienists receiving select
workplace benefits by practice type
Private solo practice Group practice Dental service organization Public health
39.6%
62.6%
61.8%
61.1%
64.4%
75.5%
73.5%
80.0%
82.0%
80.9%
91.6%
77.2%
74.3%
62.7%
50.8%
45.5%
34.5%
31.9%
21.8%
21.7%
Membership in professional association
Paid leave (e.g., FMLA)
Licensure or certificate fees
CE or professional development funds/time
Health insurance
Paid sick time
Dental benefits (e.g., free in-house care)
Retirement savings (e.g., 401K, 403B, SEP IRA)
Paid holidays
Paid vacation
Share of dental assistants not receiving these workplace benefits,
and the share not receiving who find the benefit "very desirable"
Very Desirable
Not receiving
RESULTS
Page 17
EMPLOYER DENTISTS’ VS. EMPLOYEE DENTAL ASSISTANTS’ AND DENTAL HYGIENISTS’
TAKE ON BENEFITS OFFERED
We also polled dentists on the benefits they offer their employees.
19
The results were not consistent with
the findings from the dental assistant and dental hygienist surveys. While more dentists indicated they
were offering these benefits to their employees than was reported by dental assistants and dental
hygienists, the relative availability of these benefits was consistent. In other words, dentists, dental
assistants, and dental hygienists all indicated that dental benefits, paid vacation, paid holidays, and
retirement savings were the most common benefits being offered, while benefits like health insurance and
paid leave were less common. It is difficult to interpret the variations in data collected from dentists and
that from dental assistants and dental hygienists, as these were not matched samples (i.e., not employer-
employee pairs). However, as with pay raises, it could indicate different perceptions about the generosity
of the benefits. Further, self-selection bias could be a factor in these discrepancies. Dentist employers
who are proud of their practices and who offer benefits may be more likely to participate regularly in HPI
polling. Conversely, dental assistant and dental hygienist employees who do not have such workplace
benefits may have more readily chosen to participate in this study to voice these shortcomings.
31.3%
44.5%
54.7%
57.1%
57.1%
74.1%
79.0%
79.8%
79.5%
66.0%
95.0%
86.8%
84.8%
63.3%
56.0%
55.2%
38.5%
33.8%
29.9%
28.1%
Membership in professional association
Paid leave (e.g., FMLA)
Licensure or certificate fees
CE or professional development funds/time
Health insurance
Paid sick time
Dental benefits (e.g., free in-house care)
Retirement savings (e.g., 401K, 403B, SEP IRA)
Paid holidays
Paid vacation
Share of dental hygienists not receiving these workplace benefits,
and the share not receiving who find the benefit "very desirable"
Very Desirable
Not receiving
RESULTS
Page 18
5.0%
15.2%
13.2%
36.7%
44.8%
44.0%
61.5%
66.2%
70.1%
71.9%
8.4%
22.8%
25.7%
49.2%
54.5%
37.3%
68.1%
78.2%
78.3%
65.5%
16.4%
21.2%
32.6%
44.9%
70.1%
71.2%
76.0%
87.2%
91.2%
92.7%
0% 20% 40% 60% 80% 100%
Membership in professional association
Paid leave (e.g. FMLA)
Licensure or certification fees
Health insurance
Paid sick time
CE or professional development
Retirement savings
Paid holidays
Paid vacation
Dental benefits
Share of assistant and hygienist employees receiving select
workplace benefits as reported by dentists, dental assistants, and
hygienists
Dentists Dental assistants Dental hygienists
RESULTS
Page 19
Similar to reports by dental assistants and dental hygienists, a greater share of dentists in public health
settings and DSOs offer health insurance than their colleagues in private solo practice.
Dentists who do not offer their employed dental assistants and dental hygienists health insurance were
asked why, and the overwhelming majority indicated cost as a reason. While cost was also the
predominant reason among dentists not offering paid leave, nearly 1 in 3 also indicated that they do not
offer the benefit because it is not the industry norm and/or not their obligation.
19.1%
37.2%
71.2%
88.5%
24.5%
59.1%
84.9%
95.8%
30.0%
80.0%
96.7%
90.0%
73.4%
90.6%
87.5%
90.6%
0%
20%
40%
60%
80%
100%
Paid leave Health insurance Retirement savings Paid vacation
Dentists offering employees benefits by practice type
Private solo Group practice DSO Public health
0.7%
6.3%
9.9%
13.3%
15.5%
83.1%
0% 20% 40% 60% 80% 100%
Don't feel it's important
Don't feel it's my obligation
Don't know how/unfamiliar with vendors
Not the industry norm
Staff has other source of coverage
Too costly
Dentists' reasons for not offering health insurance
RESULTS
Page 20
ATTRITION FACTORS
Dental assistants and dental hygienists who indicated low levels of job satisfaction were asked what
contributed to their dissatisfaction. The top three reasons (in order) among dental assistants were
insufficient pay, feeling overworked, and negative workplace culture. The top three factors contributing to
dissatisfaction among dental hygienists were negative workplace culture, insufficient pay, and feeling
overworked. These factors held true regardless of employment status or practice type.
2.1%
4.1%
7.7%
29.4%
30.9%
68.6%
0% 20% 40% 60% 80% 100%
Don't feel it's important
Decreases productivity / Cannot operate
Don't know how/unfamiliar with vendors
Don't feel it's my obligation
Not the industry norm
Too costly
Dentists' reasons for not offering paid leave
RESULTS
Page 21
TOP 3 REASONS FOR DISSATISFACTION AT WORK
DENTAL ASSISTANTS
DENTAL HYGIENISTS
1. Insufficient pay
2. Overworked
3. Workplace culture
1. Workplace culture
2. Insufficient pay
3. Overworked
About 62% of dental assistants and 80% of dental hygienists indicated they have voluntarily left a dental
assisting or dental hygiene position, respectively, in the past.
Among dental assistants and dental hygienists who are no longer working in the field, voluntary
departures were most common.
62.2%
37.8%
Have you ever voluntarily left or
quit a dental assisting position?
Yes
No
79.5%
20.5%
Have you ever voluntarily left or
quit a dental hygiene position?
Yes
No
66.8%
43.1%
13.0%
8.5%
5.7%
5.8%
2.70%
2.70%
11.7%
40.0%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Dental Hygienist
Dental Assistant
If not currently working as a dental assistant/dental hygienist, please
indicate the primary reason why.
I voluntarily left my position
I have a health condition that prevents me from working right now
My employer permanently let me go from my position
My employer laid off/furloughed me
Other
RESULTS
Page 22
Dental assistants and dental hygienists who are no longer working in the field and opted to leave
voluntarily were asked why they stopped working in assisting or hygiene, respectively. The most common
reasons among dental hygienists were negative workplace culture, lack of growth opportunity, and
inadequate benefits. The most common reasons among dental assistants were insufficient pay, negative
workplace culture, and feeling overworked.
14.1%
14.7%
17.4%
22.8%
23.9%
25.5%
26.1%
26.6%
27.2%
32.1%
32.6%
34.8%
42.9%
0.5%
5.6%
11.6%
15.2%
20.7%
10.6%
18.2%
8.6%
46.0%
25.8%
34.8%
29.8%
33.3%
34.8%
0% 10% 20% 30% 40% 50%
Pursued dental hygiene as a career
Patient attitudes
Flexible work schedule needed
Planned to retire at this time in my career
Family situation changed, wanted/needed more time at
home
Practice philosophy
Career has not been satisfying
Safety concerns related to COVID-19
Insufficient pay
Communication concerns in the practice
Overworked
Inadequate benefits
Lack of opportunity for growth and advancement
Culture (e.g., poor leadership, toxic environment)
Reasons for Voluntarily Leaving the Field
Dental Assistants Dental Hygienists
RESULTS
Page 23
Dental assistants and dental hygienists who voluntarily left positions were asked if there was anything
that could have prevented their departure. “Better pay” emerged as the clear top factor. Management and
communication were also frequently cited.
Dental assistants and dental hygienists who have left the field were asked a similar question: “What, if
anything, would have made you stay working as a dental assistant?” Aside from “better pay,” respondents
also indicated benefits, flexibility, respect, and “nothing.”
RESULTS
Page 24
RETENTION FACTORS
Dental assistants and dental hygienists who indicated high levels of satisfaction in their current role were
asked what contributes to this satisfaction. Overall, both dental assistants and dental hygienists attributed
their satisfaction to positive workplace culture, ability to help patients, and work-life balance. There is
some variation in the order of these benefits by employment status and practice type. For instance, part-
time and DSO-employed dental assistants rate flexible scheduling highly. Among both dental assistants
and dental hygienists working in DSO and public health settings, “helping patients” is the top reason for
workplace satisfaction. Fair pay and adequate benefits ranked highly among dental hygienists in DSOs
and public health as well as dental assistants in public health.
TOP THREE RETENTION FACTORS
1. Work-life balance
2. Positive workplace
culture
3. Ability to help patients
RETENTION STRATEGIES
Page 25
Retention Strategies
RISKS TO RETENTION
From this research, we have identified six significant risks to retention for dental practices. The top
six reasons for voluntarily leaving the field correspond to the top six reasons for being dissatisfied in one’s
role. Further, the top six reasons for dissatisfaction or leaving the field align between dental assistants
and dental hygienists.
DENTAL ASSISTANTS
DENTAL HYGIENISTS
1. Insufficient pay
1. Negative workplace
culture
2. Negative workplace
culture
2. Lack of growth
opportunity
3. Overworked
3. Inadequate benefits
4. Lack of growth
opportunity
4. Overworked
5. Inadequate benefits
5. Communication
concerns
6. Communication concerns
6. Insufficient pay
RETENTION STRATEGIES
Page 26
RETENTION STRATEGIES
Benefits offerings need to get up to speed with other industries. Dental offices
are generally offering a basic set of benefits to employees, including paid vacation,
paid holidays, and retirement savings. The next challenge to remain a competitive
employer and recruiter is to offer health insurance and paid leave. These are widely
available in other industries (71% of U.S. workers have health insurance available to
them),
20
and dentistry risks losing existing and prospective incoming dental team
members if the sector fails to make this adjustment. One dental assistant respondent
commented, “I loved the work. I worked hard for 19 years [but] was often left with no
health insurance or retirement. I have joined a labor union with incredible benefits,
and I encourage other dental assistants to leave and find better workplaces.” The
U.S. Chamber of Commerce issued a report in August 2022, conducted by Avalere
Health, indicating a significant return on investment of employer-sponsored insurance
driven by improved productivity, a reduction in direct medical costs, tax benefits, and
retention of employees.
21
Wages should make sense in current economic environment. Wages should be
assessed on at least an annual basis, as is done in most other industries. In the
current economic environment, inflation is outpacing growing wages.
22
Dentists and
other dental employers need to look outside their own practices to ensure their wages
are fair. The Bureau of Labor Statistics produces state-level employment and wage
statistics to guide these decisions.
23,24
Practice personnel crave growth opportunities. Just as dentists often seek to
learn new clinical skills and keep up with the latest technology, other members of the
dental team have a similar inclination to keep growing professionally. However, to
some, the career pathway in a dental practice can seem like less of an exciting ladder
and more like a flat, narrow road. One respondent commented, “Dental hygiene is a
dead-end job with no room for growth.” Others cited “monotony in the job” and “not
working at the highest skill level” as their reasons for leaving the field. Most members
of the team are seeking challenge. When they reach new goals, they feel further
connected to their work and workplace. Dentists can engage employees by setting
performance goals and identifying skillsets outside of their traditional roles that they
could contribute to the practice.
RETENTION STRATEGIES
Page 27
Employers must encourage a positive workplace culture and work-life balance.
Fostering a positive environment with healthy team relationships and good
communication is paramount. When asked why they were not currently working in
dental assisting or dental hygiene, some respondents stated they felt unappreciated,
disrespected, overworked, and/or underpaid by their employers. Conversely, those
who have high levels of satisfaction commented, “The dentist verbally appreciates our
hard work,” and “The dentist does great work and the atmosphere is very pleasant.”
Creating this type of atmosphere takes time and energy, and it is not as clear-cut as
adding a benefit to the employee package. The payout to the employer and the
employees is invaluable.
25
Workers are also demanding that their professional lives
complement rather than detract from their personal lives. They need workplace
conditions that align with their lifestyle and offer flexibility.
As stated in Milbank’s Getting Health Care Workers Back to Work and Other Workforce Shortage
Challenges report, “Responses to the health care worker shortages can most usefully be viewed in two
categories: those that can be implemented in the short term versus those that will require more time
before they can be implemented.”
26
There are a few levers available to dental employers that will have
impact in the short term; many of these challenges will require long-term innovations and investments
working with seasoned and new partners. As leaders of the dental team, dentists need to embrace these
opportunities to support and grow their teams.
METHODS
Page 28
Methods
METHODS
This research had two primary study populations: dental assistants and dental hygienists. Any individual
at least 18 years old who is or had ever been a dental assistant or clinical dental hygienist was eligible to
participate. Study participants were recruited via email invitation to participate in the survey research.
The American Dental Assistants Association (ADAA), Dental Assisting National Board (DANB), and
IgniteDA distributed the survey invitation to their contact lists. Approximately 133,000 emails were sent to
current or past dental assistants in the initial recruitment effort: 15,000 from ADAA; 100,000 from DANB;
and 18,000 from IgniteDA. The American Dental Hygienists’ Association (ADHA) distributed the survey
invitation to its contact list of roughly 124,000 current or past dental hygienists.
The Dental Team Workforce Shortages survey included questions on workplace satisfaction, factors
contributing to satisfaction or dissatisfaction, timing and amount of most recent wage increase, benefits
received and the importance of these benefits, and reasons for leaving past jobs.
The contact lists for these organizations were comprised of members, past members, examination
applicants, and educational event attendees. The contact lists for the dental assisting organizations
involved in participant recruitment were not necessarily mutually exclusive; there are individuals who are
on multiples of these email lists. To maintain anonymity of the sample, the contact lists were not
compared, and therefore the unique number of current or past dental assistants who received the
invitation is not known. Each organization also had the option of posting the survey opportunity to their
social media accounts and conference attendee apps.
The survey was administered anonymously and exclusively online in June 2022 using the Qualtrics
(Provo, UT) platform. Qualtrics functionality was used to identify and manage suspected duplicate
responses on a case-by-case basis, generally by disposal of the less complete observation. There was no
incentive for participating in the survey. The project was deemed exempt from ongoing review by the
American Dental Association Institutional Review Board.
The dental assistant and dental hygienist survey research was supplemented by polling research of
dentists. Questions that complemented the dental assistant and dental hygiene surveys were fielded as
modular components of the Economic Outlook and Emerging Issues in Dentistry monthly poll
administered by HPI. The dentist polling research had been deemed exempt from review by the American
Dental Association Institutional Review Board in the past.
METHODS
Page 29
SAMPLE
A total of 4,255 dental assistants (DA) and 5,122 dental hygienists (DH) participated in the Dental Team
Workforce Shortages surveys. Respondents were predominantly female (DA: 96.3%, DH: 97.5%), White
(DA: 79.0%, DH: 86.8%), and non-Hispanic (DA: 87.0%, DH: 90.5%). The majority were employed full
time in the field (DA: 63.6%, DH: 53.7%) and working in private solo (DA: 39.4%, DH: 50.4%) or group
(DA: 22.0%, DH: 24.0%) dental practices. Additional sample characteristics are included in Table 1.
Table 1: Sample Characteristics
Dental
Assistants
n=4225
Dental
Hygienists
n=5122
Gender
Female
96.3%
97.5%
Male
2.5%
1.6%
Non-binary/Other description
1.2%
0.9%
Age
Under 35
31.4%
23.7%
35-44
20.0%
25.6%
45-54
19.3%
22.4%
55-64
22.2%
20.2%
65 and over
7.1%
8.1%
Race
White
79.0%
86.8%
Black or African American
6.5%
2.9%
Asian
3.6%
3.5%
American Indian or Alaska Native
2.0%
0.5%
Native Hawaiian or Pacific Islander
0.2%
0.3%
Other or missing
8.8%
6.0%
Ethnicity
Latino or Hispanic
13.0%
9.5%
Not Latino or Hispanic
87.0%
90.5%
Employment
Status
Full-time (as a DA or DH, 32 hours or more per week)
63.6%
53.7%
Part-time (as a DA or DH, fewer than 32 hours per week)
10.4%
28.8%
Employed in a different occupation in dentistry
11.1%
4.5%
Employed in a different occupation outside dentistry
4.3%
2.3%
Semi-retired/limited work
2.4%
4.7%
Fully retired
3.9%
3.0%
Not employed
4.1%
3.0%
Primary
Practice
Setting
(among those
currently
employed)
Private solo practice
39.4%
50.4%
Group dental practice
22.0%
24.0%
Specialty practice or multi-specialty clinic
14.3%
4.6%
Dental service organization
7.1%
9.0%
Public health
8.0%
5.8%
Academic
2.7%
1.8%
Military
1.2%
0.4%
Other
4.4%
3.1%
Independent hygiene practice
n/a
0.4%
CONTRIBUTORS
Page 30
Contributors
This report was written in partnership between the ADA Health Policy Institute, American Dental
Assistants Association, American Dental Hygienists’ Association, the Dental Assisting National Board, and
IgniteDA. Contributing authors from each organization are listed below.
ADA.org/HPI
The Health Policy Institute is a thought
leader and trusted source for policy
knowledge on critical issues affecting
the U.S. dental care system. HPI
strives to generate, synthesize, and
disseminate innovative research for
policymakers, oral health advocates,
and dental care providers.
Chelsea Fosse
Rachel Morrissey
Adriana Menezes
Marko Vujicic
ADAAusa.org
The American Dental Assistants
Association mission is to advance the
careers of dental assistants through
education, credentialing, legislative
advocacy, and professional activities
that improve the delivery of quality
dental health care.
Jay Casper
ADHA.org
The American Dental Hygienists’
Association works to support dental
hygienists throughout their career
lifecycle and advance the dental
hygiene profession by developing new
career paths, expanding opportunities
for care, and providing the latest
training and information.
JoAnn Gurenlian
Ann Lynch
DANB.org
The Dental Assisting National Board
mission is to promote the public good
by providing credentialing services to
the dental community. DANB
accomplishes this mission through the
creation of valid dental assisting
exams; recertification requirement
integrity; and exams, certificates and
certifications.
Hanna Aronovich
Laura Skarnulis
IgniteDDS.com/IgniteDA
IgniteDA is dedicated to engaging,
educating, and empower dental
assistants.
Kevin Henry
APPENDICES
Page 31
Appendices
1. Dental Assistant Workforce Shortage Survey
2. Dental Hygienist Workforce Shortage Survey
3. Dentist Polling from Economic Outlook and Emerging Issues in Dentistry
4. Innovations in Shoring Up the Pipeline, Recruitment, and Retention
APPENDICES
Page 32
Dental Assistant Workforce Shortage Survey
Screener
1. Have you ever worked as a dental assistant?
Yes
No
Background/Employment Status
2. In what year did you first start working as a dental assistant?
Please enter year in the format YYYY:
________________________________________________
3. Since then, have you taken time away from being a dental assistant at any point?
Yes
No
If Since then, have you taken time away from being a dental assistant at any point? = Yes, display this
question:
4. How long were you away?
Years ________________________________________________
Months ________________________________________________
5. How many different dental employers have you worked for or did you work for as a dental assistant
throughout your career?
Number of employers: ________________________________________________
6. Which of the following best describes your current employment status?
Full-time as a dental assistant (32 hours or more per week)
Part-time as a dental assistant (fewer than 32 hours per week)
Semi-retired/limited work as a dental assistant
Fully retired from dental assisting
Employed in a different occupation in dentistry
Employed in a different occupation outside dentistry
Not employed
If Which of the following best describes your current employment status? = Fully retired from dental
assisting, Employed in a different occupation in dentistry, Employed in a different occupation outside
dentistry, or Not employed, display this question:
7. In what year did you stop working as a dental assistant?
Please enter year in the format YYYY: _____________________________________
If Which of the following best describes your current employment status? = Fully retired from dental
assisting, Employed in a different occupation outside dentistry, Not employed, display this question:
8. If not currently working as a dental assistant, please indicate the primary reason why:
I voluntarily left my position
My employer laid off/furloughed me
My employer permanently let me go from my position
I have a health condition that prevents me from working right now
Other reason, please specify: ________________________________________________
APPENDICES
Page 33
If If not currently working as a dental assistant, please indicate the primary reason why: = My employer
laid off/furloughed me, My employer permanently let me go from my position, display this question:
9. If your dental practice let you go from your position, please indicate the primary reason why are you not
currently practicing:
I have not yet found a new position
I am waiting to be rehired by my dental practice
I do not want to work as a dental assistant while COVID-19 pandemic disruptions continue
I do not want to work as a dental assistant any longer
I prefer not to say
Other, please specify: ________________________________________________
If If not currently working as a dental assistant, please indicate the primary reason why: = I voluntarily left
my position, display this question:
10. Please indicate the reason(s) why you stopped working as a dental assistant (select all that apply):
Planned to retire at this time in my career
Insufficient pay
Inadequate benefits
Family situation changed, wanted/needed more time at home
Lack of opportunity for growth and advancement
Overworked
Culture (e.g., poor leadership, toxic environment)
Communication concerns in the practice
Flexible work schedule needed
Practice philosophy
Patient attitudes
Safety concerns related to COVID-19
Career has not been satisfying
Pursued dental hygiene as a career
Other, please specify: ________________________________________________
If If not currently working as a dental assistant, please indicate the primary reason why: = I voluntarily left
my position, display this question:
11. Please briefly describe what, if anything, would have made you stay working as a dental assistant?
________________________________________________________________
________________________________________________________________
Currently Employed Questions
For the following questions, please respond based on your current or most recent PRIMARY place of
employment as a dental assistant. Your primary place of employment is where you work the most hours.
12. On a scale of 1 to 10, how satisfied are you in your current role?
(1=Not at all satisfied, 10=Extremely satisfied)
If On a scale of 1 to 10, how satisfied are you in your current role? = 1, 2, 3, 4, 5, display this question:
APPENDICES
Page 34
13. You indicated that you are at least somewhat dissatisfied in your current role. What are the top 3
reasons why?
Insufficient pay
Inadequate benefits
Work-life balance
Lack of opportunity for growth and advancement
Overworked
Workplace culture (e.g., leadership style, values, coworkers)
Communication in the practice
Rigid work schedule
Practice philosophy
Unpleasant patients
Safety is not a priority (e.g., COVID-19 protocols)
Other ________________________________________________
If On a scale of 1 to 10, how satisfied are you in your current role? = 6, 7, 8, 9, 10, display this question:
14. You indicated that you are at least somewhat satisfied in your current role. What are the top 3 reasons
why?
Fair pay
Adequate benefits
Work-life balance
Opportunity for growth and advancement
Reasonable workload
Workplace culture (e.g., leadership style, values, coworkers)
Communication in the practice
Flexible schedule
Practice philosophy
Pleasant patients
Safety is a priority (e.g., COVID-19 protocols)
Helping patients improve oral health
Other ________________________________________________
15. Which of the following best describes the location of your primary place of employment?
Private solo dental practice
Group dental practice (multiple dentists in one location)
Specialty practice (i.e., periodontology)
DSO (Dental Service Organization, i.e., a corporate dental office such as Aspen Dental or Smile
Brands)
Multi-specialty clinic
Public health clinic/agency
Federally Qualified Health Center (FQHC)
Community health center (CHC)
Academic/university/college
School-based setting
Military
Other, please specify: ________________________________________________
16. Please indicate when you began working at your current primary place of employment:
Please enter year in the format YYYY: ____________________________________________
APPENDICES
Page 35
17. When did you last receive a raise (wage increase) at your current primary place of employment?
Within the past year
1-2 years ago
3-4 years ago
5 or more years ago
Never
If When did you last receive a raise (wage increase) at your current primary place of employment? =
Within the past year, 1-2 years ago, 3-4 years ago, 5 or more years ago, display this question:
18. How much was your last raise (wage increase)?
1-3%
4-6%
7-9%
10% or more
19. Which of the following benefits do you have through your primary employer? Please select all that
apply:
Paid vacation
Paid sick time
Paid holidays
Retirement savings (e.g., 401K, 403B, SEP IRA)
Health insurance
Dental benefits (e.g., free in-house care)
CE or professional development funds/time
Paid leave (e.g., FMLA, other forms of maternity or family leave)
Membership in professional association (e.g., ADHA, ADAA, ADA)
Licensure or certificate fees
Other, please specify ________________________________________________
Carry Forward Selected Choices - Entered Text from "Which of the following benefits do you have through
your primary employer? Please select all that apply:"
20. Below are the benefits you currently receive. Please indicate how important these benefits are to you:
Very important Somewhat important Not at all important
Paid vacation
Paid sick time
Paid holidays
Retirement savings (e.g., 401K, 403B, SEP IRA)
Health insurance
Dental benefits (e.g., free in-house care)
CE or professional development funds/time
Paid leave (e.g., FMLA, other forms of maternity or family leave)
Membership in professional association (e.g., ADHA, ADAA, ADA)
Licensure or certificate fees
Other, please specify
Carry Forward Unselected Choices from "Which of the following benefits do you have through your
primary employer? Please select all that apply:"
APPENDICES
Page 36
20. Below are the benefits you do NOT currently receive. Please indicate how desirable these benefits
are to you:
Very desirable Somewhat desirable Not at all desirable
Paid vacation
Paid sick time
Paid holidays
Retirement savings (e.g., 401K, 403B, SEP IRA)
Health insurance
Dental benefits (e.g., free in-house care)
CE or professional development funds/time
Paid leave (e.g., FMLA, other forms of maternity or family leave)
Membership in professional association (e.g., ADHA, ADAA, ADA)
Licensure or certificate fees
Other, please specify
21. Have you ever voluntarily left or quit a dental assistant position?
Yes
No
If Have you ever voluntarily left or quit a dental assistant position? = Yes, display this question:
22. Thinking about the most recent position you left or quit voluntarily, please briefly describe the
reason(s) for your departure:
________________________________________________________________
________________________________________________________________
If Have you ever voluntarily left or quit a dental assistant position? = Yes, display this question:
23. Was there anything that could have prevented your departure from the most recent dental assisting
position you left voluntarily? Please describe.
________________________________________________________________
________________________________________________________________
24. Given your current work situation, what is your best estimate as to when you will retire from dental
assisting?
Within the next 12 months
In the next 1-2 years
3-5 years from now
6-10 years from now
11-20 years from now
More than 20 years from now
25. Are you currently a member of any of the following professional associations? Select all that apply.
American Dental Assistants Association
American Dental Hygienists' Association
American Dental Association
Other professional dental association(s):
_____________________________________________
APPENDICES
Page 37
26. What initially influenced your decision to start working as a dental assistant? Select all that apply.
A personal dental experience
Your dentist or dental office
Family member or friend who is/was a dental assistant
Job openings in dental assisting
Outreach information from a local dental assisting training program
Other: ________________________________________________
27. What best describes your dental assisting educational background? Select all that apply:
Primarily trained on the job
High school dental assisting program
Community college, technical school, or similar training program that was less than 3 months
Community college, technical school, or similar training program that was between 3 and 12
months
Community college, technical school, or similar training program that was more than 12 months
Other, please specify: ________________________________________________
28. Are you personally registered or licensed as a dental assistant in your state?
Yes
No
I don't know
My state does not offer registration or licensure for dental assistants
29. Do you have a license or permit to perform expanded functions (i.e., are you an expanded function
dental assistant or "EFDA"?)
Yes
No
I don't know
My state does not license EFDAs
If Do you have a license or permit to perform expanded functions (i.e., are you an expanded function... =
Yes, display this question:
30. Does your employer delegate expanded functions to you?
Yes
No
Demographics
31. Please indicate your gender:
Male
Female
Non-binary
Prefer not to say
Prefer to self-describe: ________________________________________________
32. What best describes your ethnicity?
Latino or Hispanic
Not Latino and not Hispanic
APPENDICES
Page 38
33. What best describes your race?
White (includes individuals with origins in Europe, the Middle East, and North Africa)
Black or African-American
American Indian or Alaska Native
Asian (includes individuals with origins in the Far East, Southeast Asia, and the Indian
subcontinent)
Native Hawaiian or Pacific Islander
Prefer not to say
Prefer to self-describe: ________________________________________________
34. In what year were you born?
Please enter in the format YYYY: ________________________________________________
35. What is the zip code where you primarily work or most recently worked as a dental assistant?
Zip code: ________________________________________________
36. (OPTIONAL) If you are interested in participating in other research by the ADA Health Policy Institute
in the future, you are welcome to provide your email address. Please note that your email address will
NOT be attached or connected to your survey responses to ensure anonymity.
Email address: ________________________________________________
APPENDICES
Page 39
Dental Hygienist Workforce Shortage Survey
Screener
1. Have you ever worked as a clinical dental hygienist?
Yes
No
Background/Employment Status
2. In what year did you first start working as a clinical dental hygienist?
Please enter year in the format YYYY: ___________________________________________
3. Since then, have you taken time away from being a clinical dental hygienist at any point?
Yes
No
If Since then, have you taken time away from being a clinical dental hygienist at any point? = Yes, display
this question:
4. How long were you away?
Years ________________________________________________
Months ________________________________________________
5. How many different dental employers have you worked for or did you work for as a clinical dental
hygienist throughout your career?
Number of employers: ________________________________________________
6. Which of the following best describes your current employment status?
Full-time as a dental hygienist (32 hours or more per week)
Part-time as a dental hygienist (fewer than 32 hours per week)
Semi-retired/limited work as a dental hygienist
Fully retired from dental hygiene
Employed in a different occupation in dentistry
Employed in a different occupation outside dentistry
Not employed
If Which of the following best describes your current employment status? = Fully retired from dental
hygiene, Employed in a different occupation in dentistry, Employed in a different occupation outside
dentistry, Not employed, display this question:
7. In what year did you stop working as a dental hygienist?
Please enter year in the format YYYY: ___________________________________________
If Which of the following best describes your current employment status? = Fully retired from dental
hygiene, Employed in a different occupation outside dentistry, Not employed, display this question:
8. If not currently working as a dental hygienist, please indicate the primary reason why:
I voluntarily left my position
My employer laid off/furloughed me
My employer permanently let me go from my position
I have a health condition that prevents me from working right now
Other reason, please specify: ________________________________________________
APPENDICES
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If If not currently working as a dental hygienist, please indicate the primary reason why: = My employer
laid off/furloughed me, My employer permanently let me go from my position, display this question:
9. If your dental practice let you go from your position, please indicate the primary reason why are you not
currently practicing:
I have not yet found a new position
I am waiting to be rehired by my dental practice
I do not want to work as a dental hygienist while COVID-19 pandemic disruptions continue
I do not want to work as a dental hygienist any longer
I prefer not to say
Other, please specify: ________________________________________________
If If not currently working as a dental hygienist, please indicate the primary reason why: = I voluntarily left
my position, display this question:
10. Please indicate the reason(s) why you stopped working as a dental hygienist (select all that apply):
Planned to retire at this time in my career
Insufficient pay
Inadequate benefits
Family situation changed, wanted/needed more time at home
Lack of opportunity for growth and advancement
Overworked
Culture (e.g., poor leadership, toxic environment)
Communication concerns in the practice
Flexible work schedule needed
Practice philosophy
Patient attitudes
Safety concerns related to COVID-19
Career has not been satisfying
Other, please specify: ________________________________________________
If If not currently working as a dental hygienist, please indicate the primary reason why: = I voluntarily left
my position, display this question:
11. Please briefly describe what, if anything, would have made you stay working as a dental hygienist?
________________________________________________________________
________________________________________________________________
Currently Employed Questions
12. For the following questions, please respond based on your current or most recent PRIMARY place of
employment as a clinical dental hygienist. Your primary place of employment is where you work the most
hours.
13. On a scale of 1 to 10, how satisfied are you in your current role?
(1=Not at all satisfied, 10=Extremely satisfied)
If On a scale of 1 to 10, how satisfied are you in your current role? = 1, 2, 3, 4, 5, display this question:
APPENDICES
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14. You indicated that you are at least somewhat dissatisfied in your current role. What are the top 3
reasons why?
Insufficient pay
Inadequate benefits
Work-life balance
Lack of opportunity for growth and advancement
Overworked
Workplace culture (e.g., leadership style, values, coworkers)
Communication in the practice
Rigid work schedule
Practice philosophy
Unpleasant patients
Safety is not a priority (e.g., COVID-19 protocols)
Other ________________________________________________
If On a scale of 1 to 10, how satisfied are you in your current role? (1=Not at all satisfied, 10=Ex... = 6, 7,
8, 9, 10, display this question:
15. You indicated that you are at least somewhat satisfied in your current role. What are the top 3 reasons
why?
Fair pay
Adequate benefits
Work-life balance
Opportunity for growth and advancement
Reasonable workload
Workplace culture (e.g., leadership style, values, coworkers)
Communication in the practice
Flexible schedule
Practice philosophy
Pleasant patients
Safety is a priority (e.g., COVID-19 protocols)
Helping patients improve oral health
Other ________________________________________________
16. Which of the following best describes the location of your current primary place of employment?
Private solo dental practice
Group dental practice (multiple dentists in one location)
Specialty practice (i.e., periodontology)
DSO (Dental Service Organization, i.e., a corporate dental office such as Aspen Dental or Smile
Brands)
Multi-specialty clinic
Public health clinic/agency
Federally Qualified Health Center (FQHC)
Community health center (CHC)
Academic/university/college
School-based setting
Military
Independent dental hygiene practice (owned by an RDH)
Other, please specify: ________________________________________________
17. Please indicate when you began working at your current primary place of employment:
Please enter year in the format YYYY: ___________________________________________
APPENDICES
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18. When did you last receive a raise (wage increase) at your current primary place of employment?
Within the past year
1-2 years ago
3-4 years ago
5 or more years ago
Never
If When did you last receive a raise (wage increase) at your current primary place of employment? =
Within the past year, 1-2 years ago, 3-4 years ago, 5 or more years ago, display this question:
19. How much was your last raise (wage increase)?
1-3%
4-6%
7-9%
10% or more
20. Which of the following benefits do you have through your primary employer? Please select all that
apply:
Paid vacation
Paid sick time
Paid holidays
Retirement savings (e.g., 401K, 403B, SEP IRA)
Health insurance
Dental benefits (e.g., free in-house care)
CE or professional development funds/time
Paid leave (e.g., FMLA, other forms of maternity or family leave)
Membership in professional association (e.g., ADHA, ADAA, ADA)
Licensure or certificate fees
Other, please specify ________________________________________________
Carry Forward Selected Choices - Entered Text from "Which of the following benefits do you have through
your primary employer? Please select all that apply:"
21. Below are the benefits you currently receive. Please indicate how important these benefits are to you:
Very important Somewhat important Not at all important
Paid vacation
Paid sick time
Paid holidays
Retirement savings (e.g., 401K, 403B, SEP IRA)
Health insurance
Dental benefits (e.g., free in-house care)
CE or professional development funds/time
Paid leave (e.g., FMLA, other forms of maternity or family leave)
Membership in professional association (e.g., ADHA, ADAA, ADA)
Licensure or certificate fees
Other, please specify
Carry Forward Unselected Choices from "Which of the following benefits do you have through your
primary employer? Please select all that apply:"
APPENDICES
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22. Below are the benefits you do NOT currently receive. Please indicate how desirable these benefits
are to you:
Very desirable Somewhat desirable Not at all desirable
Paid vacation
Paid sick time
Paid holidays
Retirement savings (e.g., 401K, 403B, SEP IRA)
Health insurance
Dental benefits (e.g., free in-house care)
CE or professional development funds/time
Paid leave (e.g., FMLA, other forms of maternity or family leave)
Membership in professional association (e.g., ADHA, ADAA, ADA)
Licensure or certificate fees
Other, please specify
23. Have you ever voluntarily left or quit a dental hygiene position?
Yes
No
If Have you ever voluntarily left or quit a dental hygiene position? = Yes, display this question:
24. Thinking about the most recent dental hygienist position you left or quit voluntarily, please briefly the
reason(s) for your departure:
________________________________________________________________
________________________________________________________________
If Have you ever voluntarily left or quit a dental hygiene position? = Yes, display this question:
25. Was there anything that could have prevented your departure from the most recent dental hygienist
position you left voluntarily? Please describe.
________________________________________________________________
________________________________________________________________
26. Given your current work situation, what is your best estimate as to when you will retire from practicing
dental hygiene?
Within the next 12 months
In the next 1-2 years
3-5 years from now
6-10 years from now
11-20 years from now
More than 20 years from now
27. Are you currently a member of any of the following professional associations? Select all that apply.
American Dental Hygienists' Association
American Dental Assistants Association
American Dental Association
Other professional dental association(s):
________________________________________________
APPENDICES
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28. What initially influenced your decision to start working as a dental hygienist? Select all that apply.
A personal dental experience
Your dentist or dental office
Family member or friend who is/was a dental hygienist
Job openings in dental hygiene
Outreach information from a local dental hygiene training program
Other: ________________________________________________
Demographics
29. Please indicate your gender:
Male
Female
Non-binary
Prefer not to say
Prefer to self-describe: ________________________________________________
30. What best describes your ethnicity?
Latino or Hispanic
Not Latino and not Hispanic
31. What best describes your race?
White (includes individuals with origins in Europe, the Middle East, and North Africa)
Black or African-American
American Indian or Alaska Native
Asian (includes individuals with origins in the Far East, Southeast Asia, and the Indian
subcontinent)
Native Hawaiian or Pacific Islander
Prefer not to say
Prefer to self-describe: ________________________________________________
32. In what year were you born?
Please enter in the format YYYY: ________________________________________________
33. What is the zip code where you primarily work or most recently worked as a dental hygienist?
Zip code: ________________________________________________
34. Thank you for your participation in this survey. Data collection for this project is complete and you may
click "Submit" below if you do not wish to provide your email address for future research.
35. (OPTIONAL) If you are interested in participating in other research by the ADA Health Policy Institute
in the future, you are welcome to provide your email address. Please note that your email address will
NOT be attached or connected to your survey responses to ensure anonymity.
Email address: ________________________________________________
APPENDICES
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Dentist Polling from Economic Outlook and Emerging Issues in Dentistry
Theme
Question
Polling Wave
Core questions
Which of the following factors prevented your dental practice’s
appointment schedule from reaching 100% last week? (Select all
that apply.)
- Patient no shows or cancellations <24 hours in advance
- Patient cancellations at least 24 hours in advance
- Not enough patients making appointments
- Trouble filling vacant staff positions
- COVID safety protocols
- Other, please specify: __________
All
Have you recently or are you currently recruiting any of the
following positions in your dental practice?
- Dental hygienists
- Dental assistants
- Dentists
- Administrative staff
All
How challenging has it been to recruit the(se) position(s)?
- Extremely challenging
- Very challenging
- Moderately challenging
- Slightly challenging
- Not challenging at all
- Not sure/Not applicable
All
Recruitment
What specifically has been challenging about recruiting dental
hygienists and dental assistants?
(free response)
February 2022
What tools have you used to find applicants for your dental
hygienist and/or dental assistant positions?
- Dental society classifieds or ads
- Online recruitment websites
- Posted to dental-specific job boards
- Social media
- Local hygiene or assisting programs
- Used a staffing agency or recruiter
- Word of mouth
- Other, please specify: ____________
April 2022
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Have you offered any of these new benefits to dental hygienist or
dental assistant applicants that you did not prior to the COVID-19
pandemic?
- Raised starting pay rate
- Offered new retirement plan
- Offered health insurance
- Offered a sign-on bonus
- Offered paid time off
- Changed hours for applicant needs
- Other, please specify: ____________
- None of the above
April 2022
Reduced
capacity
When your practice is FULLY STAFFED, what is the maximum
number of patients it could see in a typical week?
(numerical response)
February 2022
Considering your practice’s CURRENT STAFFING situation, what
is the maximum number of patients it could see in a week?
(numerical response)
February 2022
How many patients did your practice ACTUALLY SEE last week?
(numerical response)
February 2022
How many of each of the following positions in your practice are
currently filled?
(numerical response in full time equivalents)
May 2022
How many open positions does your practice have in each of the
following?
(numerical response in full time equivalents)
May 2022
Pay raises
When did you last give dental hygienists and dental assistants on
your staff a wage increase?
- Within the past year
- 1-2 years ago
- 3-4 years ago
- 5 or more years ago
- Never
June 2022
How much was the wage increase, on average?
- 1-3%
- 4-6%
- 7-9%
- 10% or more
June 2022
APPENDICES
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Benefits
Which of the following benefits do you offer to your employees?
(Select all that apply.)
- Paid vacation
- Paid sick time
- Paid holidays
- Retirement savings
- Health insurance
- Dental benefits
- CE or professional development
- Paid leave
- Membership in professional association(s)
- Licensure or certificate fees
- Other, please specify: ____________
June 2022
Why do you not offer health insurance? (Select all that apply.)
- Too costly
- Don’t know how/Unfamiliar with vendors
- Not the industry norm
- Don’t feel it’s my obligation
- Don’t feel it’s important
- Other, please specify: ____________
July 2022
Why do you not offer paid leave? (Select all that apply.)
- Too costly
- Don’t know how/Unfamiliar with vendors
- Not the industry norm
- Don’t feel it’s my obligation
- Don’t feel it’s important
- Other, please specify: ____________
July 2022
Note: Complete results are available in the data reports posted at ADA.org/HPIpoll.
APPENDICES
Page 48
Innovations in Shoring up the Pipeline, Recruitment, and Retention
Below are some of the innovations championed by state agencies, health centers, dental associations,
dental schools, and employers to shore up the dental workforce pipeline, fill vacant positions, and support
the retention of the dental team.
Professional Advancement
Peak Dental Services offers equity in practice to dental hygienists.
Tend DSO: Supporting dental assistant employees as they head off to dental school
Pipeline & Training
Maine Health Care Provider Loan Repayment Pilot Program. “The program will attract and retain
health care professionals in Maine by repaying outstanding student loans of selected participants
who commit to living and working in Maine for at least three years. [The Finance Authority of
Maine] will pay up to $25,000 per year.” Dental hygiene is one of the prioritized occupations.
Maine Department of Education has provided funding to St Apollonia Dental Clinic to develop a
hybrid-format dental assistant training program.
Partnership Community Health Center in Wisconsin initiated dental assistant training program for
refugees with dental experience.
Virginia Commonwealth University School of Dentistry is on a “tour” of community college
campuses across the Appalachia region, educating students on the opportunities provided by a
career in dental hygiene or dental assisting – or dentistry.
California Dental Association advocated successfully for additional funding for High Road Training
Partnerships to expand dental assisting training programs to new regions of the state.
Staffing
Harbor Dental Society partners with DirectDental to fill vacant job postings.
onDiem staffing platform connects dental practices with dental staff in real time.
Stynt technology (endorsed by the ADA) “allows dentists to connect with dental professionals for
temporary or permanent employment, lets potential workers bid on office openings and eases the
onboarding process by providing credential and reference checks.”
REFERENCES
Page 49
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1
DentalPost. 2022 Dental Salary Survey: The Annual Report. Available from:
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2
Dental Assisting National Board. 2020-2021 Dental Assistants Salary and Satisfaction Survey. Available
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3
National Network for Oral Health Access. Community Health Center Workforce Survey: Analysis of 2021
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American Dental Association. Racial and ethnic mix of the dentist workforce in the U.S. Infographic.
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organization/ada/ada-org/files/resources/research/hpi/hpigraphic_0421_1.pdf. Accessed September 26,
2022.
9
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of January 17, 2022. Health Policy Institute. Available from:
https://www.ada.org/resources/research/health-policy-institute/economic-outlook-and-emerging-issues.
Accessed September 26, 2022.
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American Dental Association. Economic outlook and emerging issues in dentistry. Results from the
week of July 11, 2022. Health Policy Institute. Available from:
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Accessed September 26, 2022.
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Goldman Sachs. Survey: small business challenges worsen amid record inflation and workforce
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businesses/US/infographics/small-businesses-fear-looming-recession/index.html. Accessed September
26, 2022.
12
American Dental Association. Economic outlook and emerging issues in dentistry. Results from the
week of February 14, 2022. Health Policy Institute. Available from:
https://www.ada.org/resources/research/health-policy-institute/economic-outlook-and-emerging-issues.
Accessed September 26, 2022.
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Morrissey RW, Gurenlian JR, Estrich CG, et al. Employment patterns of dental hygienists in the United
States during the COVID-19 pandemic: an update. J Dent Hyg. 2022; 96(1):27-33.
REFERENCES
Page 50
14
American Dental Association. 2021-22 Dental Education Program Enrollment and Graduates Report.
Available from: https://www.ada.org/resources/research/health-policy-institute/dental-education. Accessed
September 26, 2022.
15
American Dental Association. Economic outlook and emerging issues in dentistry. Results from the
week of April 18, 2022. Health Policy Institute. Available from:
https://www.ada.org/resources/research/health-policy-institute/economic-outlook-and-emerging-issues.
Accessed September 26, 2022.
16
Bureau of Labor Statistics. Dental Assistants. Occupational Outlook Handbook. U.S. Department of
Labor. Available from: https://www.bls.gov/ooh/healthcare/dental-assistants.htm. Accessed September 26,
2022.
17
Bureau of Labor Statistics. Dental Hygienists. Occupational Outlook Handbook. U.S. Department of
Labor. Available from: https://www.bls.gov/ooh/healthcare/dental-hygienists.htm. Accessed September 26,
2022.
18
Bureau of Labor Statistics. Current Employment Statistics. U.S. Department of Labor. Available from:
https://www.bls.gov/ces/. Accessed September 26, 2022.
19
American Dental Association. Economic outlook and emerging issues in dentistry. Results from the
week of June 13, 2022. Health Policy Institute. Available from:
https://www.ada.org/resources/research/health-policy-institute/economic-outlook-and-emerging-issues.
Accessed September 26, 2022.
20
Bureau of Labor Statistics. Employee benefits in the United States. March 2021. U.S. Department of
Labor. Available from: https://www.bls.gov/news.release/pdf/ebs2.pdf. Accessed September 26, 2022.
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Chamber of Commerce. June 28, 2022. Available from:
https://www.uschamber.com/assets/documents/20220622_Chamber-of-Commerce_ESI-White-
Paper_Final.pdf. Accessed September 26, 2022.
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Dubay C. How fixing our worker shortage can fight inflation. U.S. Chamber of Commerce. July 7, 2022.
Available from: https://www.uschamber.com/workforce/how-fixing-our-worker-shortage-can-fight-inflation.
Accessed September 26, 2022.
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Bureau of Labor Statistics. Dental Assistants (31-9091). Occupational Employment and Wages. May
2021. U.S. Department of Labor. Available from: https://www.bls.gov/oes/current/oes319091.htm.
Accessed September 26, 2022.
24
Bureau of Labor Statistics. Dental Hygienists (29-1292). Occupational Employment and Wages. May
2021. U.S. Department of Labor. Available from: https://www.bls.gov/oes/current/oes291292.htm.
Accessed September 26, 2022.
25
Murphy MB. The green thumb advantage: Cultivating and keeping a happy dental team. Dental
Economics. July 12, 2022. Available from: https://www.dentaleconomics.com/money/article/14277408/the-
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Wilensky GR. Getting health care workers back to work and other workforce shortage challenges. The
Milbank Quarterly. April 13, 2022. Available from: https://www.milbank.org/quarterly/opinions/getting-
health-care-workers-back-to-work-and-other-workforce-shortage-challenges/. Accessed September 26,
2022.
REFERENCES
Page 51
SUGGESTED CITATION
ADA Health Policy Institute in collaboration with American Dental Assistants Association, American Dental
Hygienists’ Association, Dental Assisting National Board, and IgniteDA. Dental workforce shortages: Data
to navigate today’s labor market. October 2022. Available from: https://www.ada.org/-/media/project/ada-
organization/ada/ada-org/files/resources/research/hpi/dental_workforce_shortages_labor_market.pdf