Renee Knight is a freelance writer and editor who's been covering the dental industry for 15 years. 

Renee Knight

Staying Ahead of the Class. Image: © Framestock - stock.adobe.com

Today’s hygienists are empowered and inspired to be leaders both inside and outside their practices—and that’s being reflected in the type of educational opportunities they’re pursuing.

While both hygiene students and practicing hygienists are taking in the clinical courses they need to provide the best patient care possible, they’re also looking at business courses that teach them how to be coproviders with their dentists, and classes that show them how to prioritize the self-care they need to lengthen their careers.

Hygienists are also looking for opportunities outside of clinical practice, whether that be working with companies to help promote products they believe in, coaching other hygienists, or educating future practitioners. There are so many career paths for hygienists today that didn’t exist before, and investing in the right continuing education (CE) is helping to better prepare them for those opportunities.

Hygiene schools focus on providing the foundation students need to be successful, with CE giving students and practicing hygienists the opportunity to further advance their skills in areas that interest them. They can take that CE via various platforms, whether in person at conferences or retreats or through online courses from the comfort of their home. There’s no shortage of options, making it easy for hygienists to expand their skills and their knowledge base.

Hygienists are attending more meetings for networking and CE opportunities because they want to learn and grow professionally, says Tiffany Wuebben, RDH, founder and CEO of The Hygienepreneur, a hygiene consulting company. They want to be heard and are inspired to lead their departments, and when that happens, “everyone in the practice, including the patient, wins.”

“The industry is calling upon us to serve in a bigger way than just taking care of our patients’ oral health,” Wuebben says. “In the past, hygienists would show up to meetings just to get CE. Now they’re also showing up to be fed emotionally and to really lock [arms] with folks that have the same mindset, and that’s enhancing their careers.”

Traditionally, hygienists and other oral health professionals took the bulk of their CE during the large annual dental conferences, Wuebben says. They would pack into large ballrooms to learn about the latest and greatest dental technologies and then incorporate what they learned when they returned to the office on Monday.

While hygienists still attend those meetings, the vibe is different, Wuebben says. Not only do they get to take in high-quality CE, but they also get to experience great entertainment. Attendees can attend social mixers, concerts, and other live events all geared toward helping them make connections, relax, and have a little fun while they learn. Meeting planners want to make events sizzle with extras that promote professional growth.

Hygienists are also taking more courses through smaller CE programs and networking events, and they are not just relying on the bigger conferences, says Caitlin Parsons, a yoga therapist and ergonomic specialist with The Aligned Hygienist.

Retreat-style learning is an example. Smaller groups are invited to destinations to satisfy their CE needs, Wuebben says, and to really bond with other attendees. Classes are taught in a nurturing environment, giving hygienists a chance to recharge as well, whether near a big city, out in the country, in a tropical location, or on a cruise ship.

Also becoming more popular these days is modular learning, which is more of a master class approach to CE, says Catapult Education Vice President of Operations Shawnie Cahuya, RDH.

“People love to have an expertise on 1 topic,” she says. “You can be looked at as an expert in a specific niche, such as anesthesia, after you’ve completed a master class, and you can use that to market yourself to potential employers.”

Then, of course, there’s online learning. While you miss out on the networking element, you have the convenience of taking a live course from home or watching the lesson on demand whenever it’s most convenient for you. It’s an easy way for hygienists to fit CE into their busy lives and is certainly here to stay, says Susan Boyden, RDH, MBA, senior manager, education, for HuFriedyGroup.

Blended learning also has become popular, Cahuya says, with many hygienists opting to take a few prerequisite courses online and then following them up with an in-person class.

Podcasts offer a way for hygienists to learn on the go, Wuebben says, and have exploded in recent years. At about 30 minutes, they’re a great way for hygienists to pass the time during their commute to and from work, for example.

There are plenty of ways for hygienists to consume information to help them grow professionally and serve their patients better. As they look to take on more leadership roles, many are taking in as much education as they can.

Hygienists are gravitating toward CE that goes beyond how to clean teeth and provide a happy patient experience, Parsons says. They want to take courses that can really help them improve their patients’ lives. Hot topics include the oral-systemic link, oral cancer and blood pressure screening, and sleep apnea/sleep medicine.

They’re also looking for more personal wellness tools, she says, making therapeutic yoga and classes that delve into improving ergonomics popular options. And courses that tackle mental and physical well-being shouldn’t be just one-offs; it’s important for hygienists to keep coming back to them throughout their career.

Total body wellness is of huge interest right now, Stellar Outcomes President Brandi Hooker Evans, RDH-ER, MHE, MAADH, says, with hygienists taking courses on everything from medicinal therapy to stress management to the endocannabinoid system, which is responsible for homeostasis in the body.

Hygienists are always up for learning new methods to improve self-care and to find engaging ways to talk to patients about maintaining their oral health that go beyond telling them to brush and floss.

“Everyone is exhausted [by] the old topics and hearing them over and over,” Hooker Evans says. “To put some passion and excitement and light back into our dental careers, we have to give our brains something new to work on, and topics that go beyond traditional dentistry do that. If we can take a different approach to the way we talk to our patients or learn about something new that reignites our passion, that enables us to show up for our patients in a new and profound way.”

As hygienists aim to become leaders, there’s more interest in learning how to collaborate with their dentist and to truly understand the business side of dentistry.

Courses that cover practice building are also hot right now, Wuebben says, especially for practices that are struggling. Staffing shortages, high supply and lab costs, and insurance issues are among the business-related areas affecting practices today, and any courses addressing such topics are high on the list for hygienists.

“Dentistry is a business,” Cahuya says. “When you get out of school you are well-versed in scaling teeth, but they really don’t teach you the business side of your future career. It’s important for hygienists to understand how to position themselves as coproviders and as business partners as they are the second leading practitioner in the office.”

Hygienists are thinking out of the box when it comes to where they get their education, with some going to small business administrations to take courses, for example, says Cellerant Consulting Group Chief Hygiene Officer Melissa Turner, BASDH, RDHEP, EFDA. They’re also searching for courses that can help guide them on how to work outside of clinical practice, say in a health care facility or at patients’ homes, which is a little bit more difficult to find. Teledentistry is also big these days, helping hygienists reach more patients and opening up more opportunities for their careers.

Artificial intelligence (AI) is another emerging area that hygienists need to keep abreast of, Turner says.

“It’s not here yet, but it’s going to be soon,” she says. “A lot of AI companies are focused on pitching the dentist, but the reality is it’s going to change what hygienists do during an appointment, and that will be huge.”

Courses that focus on mental health are gaining popularity as well, as they can teach hygienists how to identify patients who may have experienced trauma, Cahuya says. There are now classes that teach hygienists how to identify signs that someone is a victim of human trafficking, for example.

On the clinical side, there’s also more of an interest in air quality, aerosol control, and infection prevention post COVID-19 pandemic, says Karen A. Raposa, RDH, MBA, HuFriedyGroup Regional Manager, Academic Sales – East.

“Patients are more keenly aware of the risk of disease transmission during their dental visit,” Boyden says. “The dental team must be vigilant in their compliance to these concerns for their patients’ well-being and their own. Instrument reprocessing, surface disinfection, aerosol mitigation, personal protective equipment are all popular topics right now.”

Courses on advanced technologies for biofilm management, such as air/powder and piezo scaling, and how they tie into advanced hand scaling with various hand instrumentation are also of interest, says Julie Morrill, RDH, MS, HuFriedyGroup Regional Manager, Academic Sales - West, as is dental unit waterline treatment and testing.

“For years, everyone just assumed the water coming from dental units met basic safety standards,” Boyden says. “But with recent [infection prevention] breaches being traced back to contaminated [dental unit waterlines], we now know that is not the case. It is an area of concern for hygienists and the entire dental team.”

Beyond the CE courses hygienists must take, they really should focus on areas that “feel fun to them,” Hooker Evans says. You won’t get much out of sitting in on a Zoom course just to earn credit if you don’t have an interest in the topic. It’s important to find something that interests you and then use what you’ve learned to improve yourself and your practice. Doing so will help keep you passionate about dentistry and avoid burnout.

It comes down to finding CE that will lead to personal growth, Wuebben says.

“Any way we can invest in ourselves with extra training and education is so important,” she says. “And when we do this, all areas of our lives become better. Life outside of hygiene should be nurtured. Life balance is so important for physical and mental health as well as career longevity.”

One of the biggest education trends in hygiene schools is the move away from live patient licensing exams to manikin/objective clinical 3D virtual style exams, Raposa says, leading educators to adjust their curriculum to ensure student success on the new exam structure.

The move to manikin licensing exams came during the COVID-19 pandemic when students were ready to graduate and obtain their licenses, says South College Program Director Tammy Fisher, BSDH, MS.

Before the pandemic, every state required a licensing exam that required every dental hygienist to test with a live patient. The new standardized manikin exam is accepted by most states, a huge change that also gives students a level playing field. Every applicant now completes the same work, Fisher says. With the old exam, it was difficult to find patients who fit the criteria, and if the patients were rejected on exam day, it could mean having to wait months to take the exam again. That isn’t an issue with today’s manikin exams, alleviating that stressor.

COVID-19 didn’t just change the licensing exams; it’s still having an impact on today’s hygiene students who were juniors or seniors in high school during the shutdowns, Fisher says. In addition to the year of lost learning, they also lost socialization and the chance to develop people and life skills—and coming out of that has been a challenge. Many institutions, such as South College, offer mental health resources at no charge to help students through struggles they may experience.

Hygiene schools spent a lot of time putting out fires instead of focusing on care plans during the pandemic, and that had an effect on the students’ learning experience and in some cases their skill sets, Hooker Evans says, creating mentorship opportunities for more experienced hygienists. But that’s behind us, and schools can now spend more time focusing on fundamentals and the emerging topics that hygienists need to have a handle on before graduating.

One of the areas Hooker Evans would like to see schools focus on more is the research that shows the effectiveness of ultrasonic scalers over hand instruments, and how much less structure they remove.

Schools often teach a blended approach to scaling, she says, where hygienists use both ultrasonics and hand instruments for every patient. While it’s crucial for hygienists to excel at using hand instruments, they also should have the skill to use ultrasonic scalers and move away from using the blended approach on every patient.

Business and practice management also should be more of a focus, Turner says, as should innovation. Big-picture courses that cover what’s coming down the pike would help hygienists prepare for the new tools and technologies that can and will change how they practice.

It’s also critical for schools to prepare hygienists for the real world, Cahuya says.

“Looking back, it would have been extremely valuable [for me] to learn what critical factors to look for in an office,” Cahuya says. “For example, what instruments and technology would be available to me, what is the process for ordering supplies, and understanding the potential for my financial growth.”

N95 mask requirements for aerosol-producing procedures, American Society for Testing and Materials level ratings for surgical masks, and Association for the Advancement of Medical Instrumentation level ratings for surgical gown barriers are other areas schools should focus more on, Morrill says. There’s also a need to reinforce the purpose of Gracey scalers vs power and universal curettes as well as more widespread education on piezo scaling technology vs magnetostrictive.

South College has put a focus on new and emerging technology in its clinic and exposing hygienists to as many instruments as possible. For example, every unit has air polishers as well as piezo and ultrasonic scalers so students can learn both methods. The goal is to stay on top of the latest technology so hygienists are prepared to use them when they start practicing.

Educators also encourage students to attend in-person events and to take online courses that can enhance their learning, Wuebben says, giving them more career paths to potentially follow.

It used to be when hygienists graduated from school, they went to private practice and then pretty much hit a ceiling in their career, unless they wanted to be a hygiene educator or go into sales, Turner says.

Today, hygienists are becoming entrepreneurs, Fisher says, with many creating their own coaching and consulting businesses. They’re also pursuing careers in public health and government auditing, becoming managers and trainers who guide other hygienists, and taking on advisory roles for dental companies.

Some of the opportunities created have to do with the introduction of dental service organizations, Turner says, and startups that see hygiene as the future of dentistry.

Investing time and money in the right CE courses puts hygienists in the position to take advantage of these many opportunities, Hooker Evans says, and to give their “highest contribution” to their profession.

“When you take advanced courses on one topic or another, it gives you the opportunity to say you want to learn more or you want to be certified in this area to help promote and teach this topic,” she says. “It keeps you connected to and networking with companies that might be a perfect fit for you to work with to promote either equipment, services, or philosophies that can impact the workforce on a greater level.”

Investing in education also gives hygienists the opportunity to have a positive impact on their practices, Turner says, improving efficiencies and helping dentists shift from a fix-it model to more of a prevention-focused model.

Learning advanced technologies like AI and 3D scanning and how they can benefit the practice financially helps position hygienists as coproviders, Cahuya says, and gives them the opportunity to train other hygienists on how to use them as well.

Wellness courses teach hygienists how to better care for themselves and avoid burnout, Parsons says, and to save patients’ lives by learning how to properly take their blood pressure and screen them for oral cancer. That creates a deeper connection between the provider and the patient and leads to a more rewarding career for the hygienist.

And learning how to use instruments properly can lead to reduced hand fatigue and back pain and shorter prophylaxis appointments, Raposa says, resulting in longer careers.

“Advancing one’s own knowledge through CE courses always presents opportunities for hygienists,” Boyden says. “Improving patient outcomes, providing a safer dental treatment environment, [and] working more ergonomically to extend careers are all positive outcomes that can come with a deeper understanding of various dental topics.”

There are a lot of great educational options available, says Wuebben, who recommends a mix of live in-person events, on-demand webinars, and podcasts. Taking advantage of the different platforms helps keep learning interesting and fun.

When selecting CE, think about which courses you’d prefer to take online vs in person, talk with colleagues about their experiences, and do some research to see what fits best with your interests and your schedule. There are plenty of options no matter the topic, so it shouldn’t be difficult to find the right fit.

“A lot of hygienists get into the habit of taking CE to check off boxes for their license,” Parsons says, “but it’s important to take courses that interest them and that add value for the practitioner, the practice, and the patient.”

It’s also important to look for courses with top-notch speakers who aren’t “just delivering fluff,” Cahuya says. And remember the industry and technology are changing rapidly, so make sure the programs you sign up for offer the most recent, relevant information.

“When choosing continuing education courses, consider the source,” Boyden says. “What group or organization is sponsoring the educational activity? The credentials of the speaker and any commercial bias in the content should be acknowledged. There are many sources for CE, and more influencers today than ever before. Hygienists should do their homework and rely on their own clinical and scientific background on a topic presented to get the most out of any CE program.”

Educating yourself throughout your career is key to professional growth and longevity. You’ll learn skills that will help you practice more efficiently and more comfortably, for example, or build a foundation of knowledge that will help you pursue career opportunities beyond the clinical setting, whether that’s becoming an educator, a trainer, a manager, or a consultant. There are so many opportunities—you just have to narrow down what you’d like to focus on and then go for it.

“It’s not just getting that dental learning to provide great care and help support our practices. It’s also getting fed personally,” Wuebben says. “You always have to have that fun factor when learning so you feel good afterward. And now more than ever we have all of these opportunities in front of us. Attend courses you know you’ll enjoy. There are so many ways to learn—it’s just choosing what we want and when we want it and having a great time.”

Articles

Taking a look at all the latest trends and opportunities in dental hygiene education.

Staying Ahead of the Class

Create Beautiful Temporaries That Last With This Natural-Looking Material | Image Credit: © Jennifer Derse, DDS

Jennifer Derse, DDS, the chief clinical director at Espire Dental, prides herself on creating beautiful temporaries for her patients. Even though theywear them only for a short time, patients still must go about their daily lives, and shouldn’t be self-conscious about esthetics.

“I think one of the worst things you can do for your patients is make a bad temporary,” she says, noting she’s even had some patients ask if they could keep their temps on permanently. “I lecture, and if I were wearing temps, I wouldn’t want anyone to know.”

Patients also shouldn’t have to worry about their temporaries breaking before it’s time for their permanent replacements. No one wants to come back to the dentist for a repair, Dr Derse says. Not only is it time-consuming for the patient, but these appointments cost the provider time and money rather than bringing it in.

To provide patients with esthetic and strong temporary restorations, you have to start with the right material. Dr Derse relied on VOCO’s Structur 2 SC as a workhorse for a long time, but switched to Structur 3 for most cases a few years ago. The enhanced temporary crown and bridge material is stronger and offers improved esthetics, allowing her to create even better temporaries for her patients. The material saves her time in the operatory and gives patients the results they’re after, making it a no-brainer for her group of 30 practices.

The material comes with a long list of benefits you simply can’t find in other products. For example, Dr Derse performs a lot of cosmeticdentistry and full-mouth rehabs, and because of the material’s Wipe&Go technology, she doesn’t have to spend nearly as much time polishing. She also appreciates the material’s fast set time, high compressive strength, and natural esthetics. Then there’s the 1:1 bisphenol A-glycidyl methacrylate to acrylic ratio, which reduces shrinkage and decreases waste—a distinctive advantage Structur 3 has over other materials.

Patient 1

“It’s just a really great material,” she says. “It would be really hard for you to get me to change, and I like trying new things.”

Saves Time, Leads to Better Profitability

Dr Derse uses Structur 3 for anterior full-mouth rehab cases, and says the Wipe&Go technology reduces her polishing time and her chairside time, while still providing her patients with beautiful results.

“You can take an alcohol gauze and wipe off the temporary, removing the oxygen inhibiting layer,” she says. “So you don’t have as much polishing and shining or the need to buff things out. You don’t have to use a gloss; with Structur 3, you wipe it and you’re good to go other than maybe doing a little trimming here and there around the margin.”

The material’s 45-second set time is fast, which is key, Dr Derse says.

“Every minute counts when patients are under your care,” she says. “Their time is as valuable as yours. They want you to be accurate, but they also want you to be efficient.”

Wipe&Go technology reduces and even eliminates the need to polish

Small mixing tips that reduce bleeding before changing mixing tips, which yields at least 20 more units per cartridge compared with 10:1 and 4:1 products

High fracture resistance and compressive strength

Well suited for long-span bridges and long-term provisionals

Dr Derse has seen doctors pull a temporary matrix off too soon when using other materials with a longer set time, leading to a globby mess and, even worse, the need to start over. The faster set time makes this less likely to happen, decreasing the number of temps you have to remake in your practice.

The Structur 3 materials saves at least 15 minutes per patient, and that’s huge when you think about the number of patients seen each day at Espire’s multiple practice locations.

“I think of dentistry in terms of how much I am doing by the hour and I break that down into 15-minute marks,” she says. “If a product can save me 15 minutes, I’m in.”

The material’s high fracture resistance and compressive strength means your temporary restorations will last, whether patients need them for 3 weeks or 3 months. You won’t see any chipping or breaking. In fact, Dr Derse has never had a temporary posterior restoration break with this material.

Structur 3 also features a natural gloss and tooth like fluorescence and is color stable for those longer, more complex cases. And because you don’t have to polish as much to get that shine, you’re able to preserve surface anatomy.

The nanofill technology in the material, which VOCO is known for with its composites as well, creates the beautiful esthetics patients want, even in their temporaries.

“Structur 3 has a more natural gloss because of the nanofill technology,” Dr Derse says. “It gives you a life-like temporary. You don’t get that with most other temporary materials.”

The Wipe&Go technology also contributes to that gloss, quickly bringing teeth to a beautiful shine. And because teeth require less polishing they’re much smoother, making it harder for plaque to attach.

Structur 3 offers a 1:1 mixing ratio of bis-GMA to acrylic, Dr Derse says, while most other temporary materials feature a 4:1 or 10:1 mixing ratio.

“Other temporaries have higher acrylic in them so they shrink more,” she says. “If they shrink more, the mixing ratio is less forgiving and you have to dilute the product more to make sure the mixture is accurate. So you end up using more material, which increases your costs.”

Patient 2

If you’re taking impressions, you can use the same gun for Structur 3 because the cartridge sizes are the same, Dr Derse says. This may seem small, but it eliminates any time you might waste looking for the specific gun required for 4:1 or 10:1 products, and that means there’s 1 less item you need to keep in the operatory.

“That mixing ratio is what really makes this material different,” Dr Derse says. “I remember helping a young doctor in one of my practices who had his gun out for his impression material but couldn’t find the correct gun for the temporary material. He wasted so much time, and the patient was watching all of this go on.”

The small mixing tips also make a huge difference. There’s no more bleeding before changing mixing tips, and that yields at least 20 more units per cartridge compared with 10:1 and 4:1 products—and that’s a huge cost savings.

There are also patients who are allergic to acrylic, so using a material that has less of it lowers the likelihood of an allergic responses, Dr Derse says.

“The material gives you a prettier temporary and because of the lower amount of acrylic it doesn’t smell and it produces less heat,” she says. “That’s also a benefit for our patients. It requires a lower curing temperature and that means less sensitivity, and that all has to do with acrylic.”

While Structur 2 SC is still a great option for back teeth and single unit cases, Structur 3 improves upon that product with the nanofilled esthetics, the Wipe&Go technology, higher compressive strength and low surface roughness—making it ideal for Dr Derse’s cosmetic and full-mouth rehab cases.

Two case studies are highlighted in the photos within this article. Patient 1 (

) showcases restorations completed by Nelson Rego, CDT. While the second case, Patient 2, features work completed by Quint Whipple, CDT (

“We have a lot of volume because of our size, so this material really impacts our profitability,” Dr Derse says. “I don’t want my temps to break. I want them to look good and I want my patients to be happy with them. And it decreases my chair time by 15 minutes. When you multiply that by 30 locations, it starts to add up. It’s a benefit for me as a business owner and also for my patients. They don’t want to have to come back in and deal with a broken temporary. I don’t have to worry about that with this material.”

VOCO’s Structur 3 strong, natural-looking temporary material features technology that creates a natural gloss with less or no polishing, and a 1:1 bis-GMA to acrylic mixing ratio that provides a host of advantages over other options. 

Create Beautiful Temporaries That Last With This Natural-Looking Material

Whether you decide to build a practice from scratch or buy an existing office, there’s a lot that goes into opening a dental office. Although it is an exciting time in a dentist’s career, it also can be pretty stressful. Many critical decisions must be made, from practice location to the type of equipment to invest in to how to attract patients to your new practice.

It can seem a bit overwhelming but remember you’re not the first to go through this process. Many successful dentists once had the same concerns and challenges. Here, we talk to Drs Sarah Jebreil, Jennifer Sanders, John Flucke, Ankur Gupta, and Chad Duplantis about their journeys, what they wish they knew before they opened their practices, and what advice they have for dentists who are ready to take that leap and become practice owners.

When Sarah Jebreil, DDS, AAACD, was ready to open her dental office, everybody told her to buy an existing practice rather than start from scratch. They warned her about the competitive landscape in Southern California and advised that the goodwill from an existing practice was the foundation she needed for success.

But Dr Jebreil wasn’t deterred. She had a clear vision of what she wanted her practice to be, and it was important for her to start with a clean slate. She wanted to choose the equipment and hire team members who understood and shared her philosophy of care. To her, building a new practice was the only option, so she began what became a yearlong process and opened her new office in 2015.

“I didn’t want to inherit somebody else’s way of doing things. I wanted to do things my way. I wanted my practice to reflect my personality,” she says. “Starting a practice from scratch is scary but it’s the greatest feeling in the world. You get to build what you want instead of buying someone else’s goodwill. You don’t know how much of that goodwill will stay with you.”

She was determined but also a little worried that it would take a long time to grow her practice. She didn’t want to overextend herself financially, so she opted to keep her practice relatively small. But her patient base expanded much faster than she expected, and she’s since outgrown the space. If she could go back, Dr Jebreil would have put a plan in place to allow for more growth; she realized she’s capable of more than she imagined.

One of the challenges Dr Jebreil encountered during the building process was obtaining the necessary city and county permits. She had issues with the number of practice parking spots, and she had to go to the city to petition for more. Had she known the issues she would face, she might have selected a different location for her boutique practice, she says. She at least would have been more prepared, making the process less stressful.

Selecting her equipment is another area she wishes she had known more about. Her sales representative talked her into investing in top-of-the-line products for her office because, he said, they last longer.

“In reality, with wear and tear all equipment ends up failing,” she says. “So pick and choose what’s important to you but don’t feel like everything has to be high end because at some point it’s going to break down.”

A lot also goes into the human resources side of a dental practice, and she spent a great deal of time dealing with documentation in the beginning. She has since invested in HR for Health, which streamlines the process and allows her to put her focus elsewhere. She recommends HR for Health to anyone starting out and wishes she would had something like it in those early days.

If you’re thinking of starting from scratch, look at the competition and determine a niche you can make for yourself, she says. Not everybody will be an ideal patient for your practice, so focus on attracting those who are. Get creative with your advertising and take advantage of free opportunities. She offered deals from Groupon, for example, to get more patients in the chair. She also enlisted her social circle to get the word out and asked happy patients to post reviews on Yelp.

And although advice from peers is valuable, take it with a grain of salt, she says. Don’t let it keep you from pursuing your dream dental career.

“After you work as an associate, you see how you want to do things,” says Dr Jebreil, who worked under the mentorship of her father right after she graduated. “It’s hard to go and buy somebody else’s practice when you know exactly what you want to do.” 

knew the practice she decided to purchase in 2014 needed a little work, but there were a few surprises along the way she wishes she had been better prepared for.

The 900-square-f oot practice had 2 chairs, with just 1 dentist and an assistant seeing patients. The dentist was ready to retire and essentially was practicing part time, so things were pretty slow. But it seemed that there was a decent number of active patients, and production numbers weren’t too bad, considering how little he was working. The practice was also the only one in town, which was a big plus. She decided to take the leap and make the practice her own. 

So what were the surprises? Turns out, only about one-third of the active patients were actually active, so she wasn’t nearly as busy as she expected. She also soon discovered that one of the delivery units didn’t work and the other was pretty broken down. Within the first few months of buying the practice, she replaced both chairs and added a third, an expense she wasn’t expecting. She also hired a hygienist, because she knew that would be important to growing her practice.

“It was a bit of an adventure,” she says. “But even if I had known all of that, I probably still would have bought the practice. I knew it was a fixer-upper, but it would have been less stressful to go into the situation with eyes open and to have a plan, to know what I needed to replace right away. I knew I wanted a hygienist and a third chair and a panoramic [x-ray] machine, but I didn’t understand the full scope of it.”

The previous dentist handled everything, including payroll, tracking everything with a spreadsheet and taking deposits to the bank himself. After he left, no one in the practice knew how to do any of those things, so Dr Sanders had to figure it out as she went along. Things would have gone a little smoother had she known more about the business side of dentistry and what questions to ask before purchasing the practice.

The biggest challenge, she says, was learning how to run a business on the fly. The business side is much easier to handle today, even though she opened a new 4000-square-foot practice with 8 operatories and 2 associate dentists in 2020 in Frenchtown, Montana.

“I put a lot more time in running the business than I do now even though it’s bigger and busier,” she says. “It runs better because I have systems in place.”

She implemented those systems over time and trained her team members so they could run them with her oversight, freeing her up to focus on the dentistry and her role as practice CEO.

If you’re ready to open your own practice, it’s important to think about what you actually want, Dr Sanders says. She was OK with buying a practice she saw potential in even though it needed work, but other dentists might prefer to walk into a fully functional practice. You have to think about what kind of business owner you want to be and then find the practice that best suits you.

And know you don’t have to do it all on your own. Although there isn’t much focus on business in dental school, there are plenty of experienced dentists you can reach out to, whether you find a mentor near you or turn to an online forum for advice, Dr Sanders says.

She knows just how valuable it would have been to build a dental-focused team to guide her during the practice purchase, to have a financial planner and an accountant with experience in the industry. Yes, it would have been an extra expense, but it’s one that likely would have saved her money in the long run, not to mention reduce her stress.

It’s also important to realize you can still be successful even if you don’t own your practice, Sanders says. Not everyone wants to be a business owner, and that’s OK. Don’t make yourself miserable; determine the right path for you and then take it.

“Realize that if you’re going to buy a practice, you are an entrepreneur,” she says. “You’re not just a dentist. You’re not going to spend all your time seeing patients, you’re going to spend time being an entrepreneur. You must have that mindset shift and ask yourself if this is something you really want to do.”

Even though John Flucke, DDS,bought an existing practice, he basically had to build his patient base from scratch. The practice’s previous doctor, a retired military dentist, realized he hated private practice and walked away after only a year. The office was closed for a few months before Dr Flucke took over, and he didn’t have much to work with when he did. There was no existing recall, just a list of patients seen in the office who might want to come back, and only 1 treatment room. 

It was a different situation, and Dr Flucke wishes he would have known more about practice marketing and business operations. Although he felt his clinical skills were good, he didn’t know much about how to manage a team or how to grow his patient base.

“It would have been nice to know things like real estate values,” Dr Fluckesays. “I didn’t know how to negotiate a lease. I basically took over the lease from the previous dentist, but it expired about 2 years after I became the owner. I didn’t even know what rent was going for in my area. That was overwhelming.”

Approximately 15 years ago, Dr Flucke left that location to build a new practice in Lee’s Summit, Missouri. Unlike the horror stories you sometimes hear, the process was pretty seamless—and he attributes that to the team he assembled around him.

Dr Flucke knew a local architect who had designed medical and dental practices, so he reached out to him when he was ready to get started. Because he had done this type of job before, the architect already had a team that could handle different aspects of the project. They all worked well together, and that resulted in a low-stress office build-out. So although this can be a challenging, stressful process, working with the right team makes it a lot easier.

Buying an existing practice and building one from scratch are expensive endeavors, and it’s OK if you’re not ready to jump in right after school, Dr Flucke says. There’s no shame in working as an associate for a few years and saving up so you can start your dream career. Determine how much you need to save and how long it will take, and then set a budget to ensure you get there. Avoid unnecessary splurges that will take you off track.

Once you’re ready to open your practice, don’t go overboard buying expensive new equipment, Dr Flucke says. A lot of dentists end up taking on more debt than they can handle because they think they need to buy their scanner, mill, cone beam and 3D printer at once. Instead, plan on buying 1 piece of technology to start and adding more as you grow.

Because they’re in so much debt and eager to start earning, many dentists concentrate too much on the money and selling dentistry once they start treating patients, he says. Patients can sense that, and it makes them more likely to question your treatment recommendations.

“If you focus on doing what’s right, you’ll make a terrific living,” Dr Flucke says. “If you focus on making a terrific living, you probably won’t.”

Once you do start making money, don’t spend it all. Think about putting some away for your retirement so you can have the lifestyle you want once you decide it’s time to step away from dentistry.

“It’s important but hard to realize that when you’re 30, when what you really want to do is celebrate yourself,” he says. “Celebrate a little but don’t spend everything you make.”

When Ankur Gupta, DDS,and his wife Nisha opened their practice in Ohio in the early 2000s, the advice they received was pretty simple: Be nice, be good dentists and patients will flock to your office. That’s exactly what they did, taking continuing education (CE) to improve their skills and building rapports with patients. The problem was, after 5 years, they weren’t nearly as successful as they expected. 

After reading a few business books, it became clear they needed to make some changes. The biggest? Stop behaving the way they thought a dentist should behave. Instead of accepting they were going to be in debt, they stopped buying expensive things just because the bank told them they could. With student loans, car and house payments, and credit card bills, they were paying a significant amount per month to take care of their debt, thinking it was normal and that the only way out was having more success as business owners. He wishes he had realized sooner that wasn’t the case at all.

“We realized we needed to change the way we lived a little and pay more every month to get out of debt,” Dr Gupta says. “And once we did that, we’d have more freedom to upgrade things in the practice and spend more money on marketing. So we began living a lifestyle that was still happy and fruitful and full of great memories, but much more intentional when it came to spending on luxury items that didn’t bring that much fulfillment.”

They also realized they needed to tap into the “incredible power of the internet” to start marketing their practice, something Dr Gupta wishes he had done sooner. Until that point they’d relied solely on word of mouth, and that wasn’t enough. Whenever the team did something remarkable or funny, they’d post a video to YouTube, their website, and Facebook. It didn’t cost anything, and it got people’s attention. The effort resulted in a reservoir of new patients who liked the practice’s fun, happy feel.

Many of these patients work at schools or day cares, creating another opportunity. The team began asking if they could come to the school to teach children about dentistry in a fun way. After every presentation, a few more families would call the office to make new patient appointments. They still do those presentations, expanding to community groups such as the Rotary Club and senior centers.

It’s important for dentists to set a realistic budget for both their home and their practice, Dr Gupta says. Be realistic about the money that is going out and use that as a template to determine what your collections goal should be each month. And it’s not the more the better. That mindset puts you in a “state of financial desperation,” he says, making you likely to take on cases you should be referring out.

Dr Gupta also recommends getting several quotes from distributors rather than going with just 1 when designing and equipping your practice, taking care of your physical health as part of your daily routine, and resisting the urge to lecture to patients about their dental health issues.

“I’ve learned that the more compassionate I am, the more I put myself in their shoes when I make treatment recommendations, the more people actually say yes,” he says. “I take a photo of their teeth, put it on a TV screen, magnify it, look at the screen with them side by side, and ask them what they see. I let the patient talk about their situation and long-term goals.”

After working as an associate for several years, Chad Duplantis, DDS,decided he wanted to be a practice owner. He hired a broker and began looking for the perfect office, but it took time, and he ended up going in a direction he hadn’t expected.

Nearly a year into his search, Dr Duplantis had looked at approximately 30 different practices and still hadn’t found the right fit. Then he met with a dentist who was looking for a partner. Rather than hiring an associate, this dentist wanted to bring someone in with a vested interest in the practice.

“We had a lot of compatibility in philosophy and vision. We both enjoyed working with other people but we also both valued the importance of ownership,” he says. “It was an unexpected surprise how well we meshed together.”

Twenty years later the partnership is still going strong at the Texas practice. 

Although they have been successful, Dr Duplantis still wishes he knew more about the business side of running a practice when they first started. He’s a pretty good leader, he says, but “business is a different animal.” The dentistry and the scientific side become the easiest part of the job; the hardest is “maintaining the positivity and keeping your team motivated day in and day out,” he says. You have to plan ahead and have a keen business sense to be successful.

Maintaining a partnership can be a challenge, but don’t let that discourage you from following that career path. The key to a successful partnership, he says, is finding someone with a similar vision and philosophy and establishing clear communication.

Before looking for a partner, it’s important to develop your personal vision and mission statement, he says. Think about where you want to be 5, 10, 20 years from now, and then find a practice that lines up with your goals.

Treat it like you’re buying a house: You have to find what best suits you. Buying into a practice is a huge commitment, so be patient. Don’t rush into something that isn’t the right fit.

“Don’t just look after hours. Ask if you can be a fly on the wall during business hours to see how the practice is run and make sure it lines up with what you’re trying to do,” he says. “Then make sure you create a work-life balance and that you don’t let the practice consume you. Keep up with CE from a clinical and business sense and make sure you keep striving to become better every single day.”

Five dentists tell us about their experiences and offer advice for dentists who are ready for ownership. 

What I Wish I Knew Before I Opened My Own Practice

Over the last few years, the dental labor market has seen a shift. Many hygienists and dental assistants opted to leave the profession after the COVID-19 pandemic disrupted the industry and their lives, while those who stayed saw an opportunity for change. Today, these critical team members are more selective about where they work. They want flexibility, a culture that promotes growth, and benefits like health care and paid vacation time—and if they don’t find what they’re looking for at one practice, most have no problem moving on to the next.

Many of the hygienists who remain in the labor market are choosing to work part time at private practices and dental service organizations (DSOs), onDiem CEO Joe Fogg says, and becoming acutely aware of key and pivotal differences between their workplaces. As dentistry continues to experience a serious staffing shortage, this means hygienists and assistants in the market have more options available to them, and more leverage to ask for more from their employers. For a dentist or owner to find success in this reality, it’s important for them to develop informed strategies to find and retain quality employees.

“There are roughly 7,000 hygienists graduating from school every year and roughly 15,000 retiring and leaving the industry. We know that nearly 30% of the combined full- and part-time hygienist workforce plans to retire in the next 6 years,” Fogg says. “In addition, the DSO sector is contributing a net positive of 2,000 to 3,000 new dental offices a year. That means fewer hygienists and more practices being built—and as a result, more of a burden on the clinical staff.”

These stressed team members are constantly looking for and taking on new opportunities, leaving dentists scrambling to fill open spots—often leading to bad hires and even more frustration for the employees left behind. In this landscape, you have to put procedures in place to first find the right employees for your open positions, and then create a culture that will make these team members want to stay.

If you’re having trouble attracting and retaining employees, it’s time to take a look at your hiring process, the benefits and compensation you’re offering and the environment you’re creating for your team—and how you compare with other practices. You might find it’s time to make some changes.

“This is an employee’s market,” says Mike Massotto, founder and CEO of New Jersey-based consulting firm Staff Driven Dental. “They can pick and choose what they want and they’re calling the shots. The challenge is, most offices weren’t good at this in the first place and everything has just gotten worse since COVID. Doctors aren’t trained in this; they didn’t go to school to become business owners so many of them make it up as they go along and the results are detrimental. Your team can make or break you.”

You can’t do it all on your own. To run a successful practice, you need a strong team behind you, with employees who are motivated to excel and who want to do their part to help move the practice forward, even if they’re only working 2 or 3 days a week. Finding and retaining high-quality employees will make your days less stressful and your bottom line more robust.

It Starts with Attracting the Right Employees

Dentists have always struggled with hiring the right people, Massotto says, and the more competitive market we have today has only magnified that. Clinicians need to learn the skills required to make better hires, and that likely means getting help from an experienced consultant.

Too often, dentists turn to traditional staffing agencies to handle hiring, Massotto says, but that’s just throwing money at the problem. Such agencies tend to charge 6% to 10% to send resumes your way, but making good hires takes a lot more than that, including pre-qualifying applicants before bringing them in for an interview. It’s also critical to learn how to write a proper job ad that will highlight the incentives you’re offering and attract the type of applicants you’re looking for.

“Today, hiring needs to be considered more of a campaign than a project,” says Darius Somekhian, head of strategic partnerships for Cloud Dentistry. “Posting jobs on multiple platforms, such as the one Cloud Dentistry offers, and social media is key to reaching potential new employees. Cloud Dentistry connects practice owners with the dental workforce through an on-demand/messaging platform that is quicker and more reliable than a traditional staffing agency at a fraction of the cost without any middle-man fees or contracts involved in-between like staffing agencies have.”

Somekhian also suggests contacting local school programs to ask about joining their job fairs, posting open positions on their job bulletin board, or having your job ads broadcast to the alumni association.

Asking the right questions is also critical, Somekhian explains. For example, you have to ensure the hygienist’s philosophies align with the practice’s. But these days, it’s also essential to make sure you understand what applicants are looking for. Be sure to ask if they’re more interested in temping or in taking on a permanent role and if they do want something permanent, at what point might they be willing to commit to that.

Massotto’s Staff Driven Dental also helps dentists find quality employees, working in partnership to pre-qualify applicants and bring in candidates who are the right fit for the practice and the job.

Whether you partner with a consulting firm or work through a hiring platform, it’s time to rethink how you approach hiring, especially in this ultra-competitive market.

“Dentists are trying to operate the way they worked before, but what worked before doesn’t work now,” Massotto says. “The business of dentistry is always changing, just like the clinical side. When I lecture to dentists, I ask them how much dentistry has changed in the last 25 years and they say it’s night and day. The business side is the same way. There was no social media or smart phones 25 years ago. The business of dentistry has changed, and if you don’t adjust with the times it can be to your detriment, just like it would be clinically.”

Dental team members are choosing to leave practices for various reasons. For some, it’s about compensation and benefits like health care and paid time off. Others want to feel appreciated and know they have the opportunity for growth. The point is, if you want to keep your team intact, you have to find out what motivates each employee and be willing to offer it.

“You have to be able to compete,” Somekhian says. “Practice owners need to realize they have competition out there that’s more real now than ever before, and you might have to pay more or offer more benefits to make your practice more attractive.”

Health care is on top of that list of benefits. Many hygienists don’t work enough hours to qualify for health insurance under the Affordable Care Act, Fogg says—which leaves health care providers without coverage of their own. This became even more of an issue during the pandemic, when dental workers had to risk exposure to COVID-19 every time they came into the office. Many left the industry all together or walked away from smaller offices to work for DSOs. (Unlike private practices, many DSOs do provide health insurance.)

Paid vacation time is also a sore point, Fogg says. Many dentists don’t offer paid time off (PTO) and only allow team members to take unpaid vacation when they’re out of the office. Otherwise, they’ll lose production while the hygienist or assistant is away.

“This is the way it’s been done for 3 or 4 decades, but now we’re at this intersection where hygienists and dental assistants are graduating and they’re not on their parent’s health care insurance. They’re also not working enough hours to qualify for mandatory insurance, and that creates a gap,” Fogg says. “Employers can close that gap by offering tangible benefits like co-paid, co-sponsored health insurance, or allowing professionals to take vacation time when it’s best for their schedules, families and well-being. Doing more to enable the happiness and health of your team, in turn, leads to better care and better business. ”

For dentists and owners to successfully navigate a challenging staffing shortage, it also helps to organize a consistent and complementary team of employees who can “fill in” for core employees when they deal with the usual interruptions of life—whether that’s a child’s recital or a family emergency, Fogg says. It’s why many dentists use onDiem to build a complementary team of consistent and flexible workers who can provide that all-important continuity of care—because they grow familiar with your office and your patients. Having this team also allows employers to treat more patients and get patients on the schedule faster, boosting productivity and giving some relief to your permanent part-time team.

Dental employees not only want more paid time off, they want more flexibility in their schedule (and that’s why so many of them have opted to go part time). Let’s say you’ve found a hygienist you know is a great fit for your team and who your patients will love. The problem is, she wants to work 3 days a week but you only planned to offer 2, and she doesn’t want to work evenings or weekends because she has young children at home. Instead of walking away, figure out how to make it work, Massotto says. You’ll be in a much better position than if you hire someone who isn’t the right fit but who is willing to work the exact hours you had in mind.

“Investing in your team members is also vital to retaining them,” Somekhian says. “Consider giving them a CE allotment of, say, $500 to take courses that will allow them to grow as clinicians. Professional development is essential; team members want to improve their skills and make a difference in the practice. They also look to you as a mentor, so demonstrating that you’re a leader they can learn from will help foster loyalty.”

Then, of course, there’s money. You have to pay them a competitive wage, Massotto says, or they’ll jump ship as soon as they can. While money isn’t the top motivator, it is important, and it’s worth an extra dollar or 2 an hour to get a really great person on board who will help your practice grow. The cost of not paying a little extra is much greater.

To understand the earnings left on the table with an unfilled position, think about it this way, Fogg suggests. A hygienist can, as an example, bring in $1,500 per day in production and another $4,000 in diagnosed treatment, for $5,500 per day. Multiply that by the number of days you have an open and unfilled position. That’s a ton left behind, and it adds up quickly. It’s simply a smart strategy for employers to provide the benefits, protections and flexibility our limited labor market demands—because the cost of leaving empty seats unfilled is much greater than the cost of providing PTO and a health care plan.

“At the end of the day, your employees want to feel like they’re part of a team,” Fogg says. “In the midst of a serious staffing shortage, providing benefits and protections that are common in every other industry is no longer a ‘nice-to-have.’ It’s a critical and indispensable part of hiring and retaining happy employees, maintaining a stellar quality of care, and ensuring a sustainable and successful business growth strategy.”

To retain quality employees, you need to create an environment they can thrive in, Massotto says. That means developing detailed job descriptions, preparing employee agreements and offering training. If the team members you hire aren’t working out, remember they may not be to blame. You have to set them up to win, and that means giving them access to all the tools they need.

“There are hundreds of jobs available and not enough people to fill them, so employees will pick what’s best for them,” he says. “And the good ones will interview you as much as you interview them to see if this is a place they want to be, if it’s a job they can make a career out of and if there’s opportunity for growth. Is there an incentive for them to make more money, or are they going to be stuck with the same wage with no chance for bigger opportunities.”

Remember, your staff is an extension of you, Massotto says, and you need to create a positive, supportive culture of growth. If team members are dealing with gossip and drama every day, at some point they’re going to move on.

The doctor has to set the example, Massotto says. In all great practices, team members love their doctor and are happy to tell patients about how great his or her work is and to promote the practice’s services. But your team members will only feel that way if you take care of them, and that means offering them training and benefits—basically all the things that show you value them.

“It behooves you to be a better leader and manager in your practice,” Massotto says. “It’s not enough to show up and be a good dentist. You should have that down by now. If they’re not happy with you, it doesn’t matter what you pay them. The 3 things team members want are appreciation, acknowledgment and security in their jobs. When you don’t give them those things, it goes to, ‘Give me more money.’ But it will get to the point it doesn’t matter what you pay them, they just won’t want to work there anymore.”

If their schedule is chaotic and their days full of drama and uncertainty about their jobs and their future, your employees will start looking for another position. That means they won’t be focused on your patients and providing the best experience possible. You really have to offer stability and a positive working environment if you want to keep quality employees on your payroll.

Effective communication is also key, Massotto says. Everything breaks down if communication is poor. It’s important to focus on creating strong communication in your practice. You have to communicate your expectations, goals and practice vision or team members will feel lost and systems won’t run properly—and that, of course, will lead to frustration that could send employees out the door.

Employees also seek out a culture that allows for flexibility in their schedule, and adding teledentistry to the mix can certainly help with that, MouthWatch CEO Brant Herman says. Providers can work 1 day a week at home to provide virtual consults, for example, helping to give them that work/life balance they’re after. They can take on cosmetic, ortho and new patient consults for 1 or multiple locations, present treatment and conduct a range of follow-up appointments. This opens up new opportunities for existing team members and boosts practice efficiency as well. It also helps shorten the wait time, as some patients can go right from the call center into a virtual appointment for an immediate consult.

How to overcome a challenging dental labor market and retain employees. 