If you’re a dental hygienist, you’ve probably felt it—the pressure to sell, the ethical dilemmas, and the constant tug-of-war between patient care and profitability. You got into this profession to help people, not push unnecessary treatments. But lately, it feels like the industry is shifting in a way that makes staying in the field harder than ever.
You’re not alone. Here are 20 brutally honest reasons why dental hygienists are quitting or even opening their clinics to escape the growing sales-driven culture in dentistry.
1. The Salesperson Dilemma: Are You a Hygienist or a Sales Rep?
Many offices expect hygienists to “educate” (aka sell) additional services like fluoride applications and deep cleanings—sometimes even when they’re not medically necessary. This puts hygienists in an uncomfortable position, torn between patient care and practice revenue.
2. The 3.5x Rule: Justifying Your Existence
Most practices expect hygienists to generate at least 3.5 times their hourly wage in production. If they don’t, they’re seen as “not profitable.” The result? A never-ending cycle of upselling.
3. Pushing Treatments That Aren’t Always Necessary
You’ve probably been told to recommend expensive mouth rinses, electric toothbrushes, or additional cleanings—even to patients who don’t truly need them. Many hygienists struggle with this because it feels more like a sales pitch than honest patient care.
4. The Periodontal Diagnosis Gap
Research shows about 20 – 50% of the global population is affected with periodontal disease, yet many offices diagnose only 6%. Why? Because it’s faster and more profitable to keep things simple with prophy (basic cleaning) appointments instead of longer, more thorough perio treatments.
5. The Death of the “Hygiene Prophy Palace”
Traditional 40-minute prophy appointments are being replaced by high-production models that push scaling and root planning (SRP), laser treatments, and expensive fluoride applications.
6. The Time Crunch: Ethics vs. Efficiency
Spending an extra five minutes with a patient? Many practices frown upon it because time is money. However, rushing appointments often leads to lower-quality care and patient dissatisfaction. Hygienists are stuck between doing the job right and keeping up with unrealistic schedules.
7. PPO Insurance Is Killing the Industry
Many offices accept PPO(preferred provider organization) insurance, but the low reimbursement rates mean they need to find other ways to stay profitable. That often translates into hygienists being pressured to “educate” (sell) additional billable services.
8. Some Procedures Are Regional Cash Grabs
Selling extra services like irrigation treatments can feel appropriate in some areas but wildly out of touch in others.
9. Balancing Patient Care with Profitability
You’re stuck between what’s best for the patient and what’s best for the office’s bottom line. The stress of this balancing act is pushing many out of the profession.
10. Questionable Treatment Efficacy
Is a quick in-office irrigation treatment better than a take-home solution? Many hygienists wonder if certain treatments are pushed because they’re truly effective—or just because they bring in more money.
11. Ethical Ways to Increase Production Exist—But They’re Ignored
Proper period diagnosis, fluoride recommendations, and laser training can boost production without compromising ethics, but many offices take the shortcut of upselling instead.
12. Wages Aren’t Keeping Up with Inflation
The cost of living is rising, but hygienists’ wages haven’t kept pace. Meanwhile, insurance reimbursements keep dropping, making it harder for practices to justify paying higher wages. The financial squeeze is real.
13. “Selling” Is Just Rebranded as “Educating”
Management often tells hygienists, “You’re not selling; you’re educating.” But when there are daily production targets, the line gets blurry.
14. Conflicting Philosophies: Why Some Are Walking Away
Not every dentist and hygienist see eye to eye on patient care. If an office prioritizes production over ethics, many hygienists find themselves frustrated and looking for a new job—or even leaving the industry altogether.
15. Tech Investments Mean Higher Production Targets
New dental technology, like lasers and digital scanning tools, can improve patient care. But they also come with an expectation: use them often enough to justify the investment. This means more pressure to push procedures.
16. The Growing List of Billable Services
Practices push treatments like SRP, Arrestin applications, laser therapy, and adult sealants. Not all are unnecessary, but are they always needed for every patient?
17. The Fluoride Treatment Debate
In-office fluoride (45,000 ppm) is much stronger than take-home versions (1,500 ppm), but the push for in-office treatments often feels more financial than medical.
18. “Lower Overhead” Often Means Lower Staff Wages
Some dentists suggest cutting overhead costs instead of pushing production. But in reality, this often translates to lower hygienist wages.
19. Tracking Your Stats Is Yet Another Burden
Hygienists are often encouraged to track their perio diagnosis rates, fluoride acceptance, and treatment acceptance. While this data can be helpful, it also adds extra work and stress on top of an already demanding job.
20. The Bigger Problem: Dentistry Is a Business First
At the end of the day, dental practices are businesses, and businesses need to make money. Until the industry finds a way to balance profitability with ethical patient care, more hygienists will continue to walk away.
Why Dental Hygienists Are Quitting—or Opening Their Clinics
For some, the stress is too much. Others are taking matters into their own hands, launching a hygiene-focused clinic where they can prioritize ethical patient care.
At the end of the day, hygienists want to help people, not sell to them. Until the industry changes, dental hygienists will continue to quit.
Do you feel the pressure, too? Share your experience in the comments!
