Hiring and retaining hygienists has become one of the biggest challenges for dental practices. With increasing salary expectations, workforce shortages, and varying levels of experience among candidates, many offices struggle to remain competitive while maintaining profitability. In this guide, we’ll break down practical strategies to attract top hygienists, structure fair compensation models, and ensure a thriving dental practice.

Why Hygiene Compensation Needs a New Approach

The post-pandemic landscape has shifted drastically. Hygiene salaries have skyrocketed, making it harder for dental practices to offer competitive pay while keeping their overhead in check. Additionally, new hygiene graduates are entering the field with high salary expectations—sometimes surpassing what senior hygienists currently earn.

At the same time, practices that cannot afford these increasing rates may start considering alternative models, such as assisted hygiene or even doctor-driven hygiene services. If hygienists price themselves out of the market, dentists may begin replacing them with other solutions. So, how can we ensure fairness while making hygiene financially viable for the practice?

Step 1: Set Compensation Based on Skills, Not Just Experience

Instead of basing hygiene pay solely on years of experience, a performance-based tier system is a more sustainable approach. Compensation should reflect skill level, case acceptance, production efficiency, and contributions to the practice’s overall success.

Basic Skill Level (Entry-Level to Mid-Level Hygienist)

Runs on time consistently
Charts perio accurately
Completes all diagnostics and case documentation
Effectively participates in morning huddles
Produces at least $1,200–$1,500 per day

Mid-Level Hygienist (Growing into Advanced Role)

Effectively discusses perio treatment with patients
Improves perio case acceptance rate
Sets up the doctor’s treatment recommendations seamlessly
Demonstrates strong teamwork and initiative
Produces $1,500–$2,000 per day

Advanced Hygienist (Leadership and High Performance)

Leads case presentations and maximizes treatment acceptance
Utilizes adjunct services such as laser therapy, PRP/PRF, and fluoride treatments
Fully integrates digital scanning (e.g., for ortho or implants)
Supports practice growth through raving fan referrals
Produces $2,000+ per day

By tying compensation to skill level and production, practices can ensure that salary increases align with measurable contributions rather than just tenure.

Step 2: Implement a Base + Commission Model

To avoid inflating hygiene wages beyond sustainability, practices can offer a lower base salary with performance-based incentives. This model rewards hygienists for strong case acceptance, efficiency, and productivity while giving them an opportunity to earn more.

Example Hygiene Compensation Structure

Base Pay: Competitive hourly wage (but not inflated beyond what the practice can afford)
Commission: 25–30% of collections above a production threshold
Perks: Additional bonuses for perio case acceptance, fluoride treatments, or adjunct services

This structure ensures that hygienists who perform at a higher level earn more, while those who are still developing their skills have room to grow.

Step 3: Improve Hygiene Profitability Without Raising Salaries

If your practice struggles to pay top-dollar wages, consider optimizing revenue streams within the hygiene department. Rather than cutting salaries, look at ways to increase profitability.

Strategies to Increase Hygiene Revenue

Optimize Fee Schedules: Negotiate PPO rates and ensure that fees are competitive.
Expand Adjunct Services: Incorporate laser therapy, PRP/PRF, fluoride, and sealants to boost production.
Ensure Proper Coding: Many practices under-bill for hygiene services; make sure all codes are captured correctly.
Reassess Appointment Times: Can hygiene appointments be shortened without reducing quality? 50-minute and even 45-minute models are being tested successfully in some offices.
Incorporate Assisted Hygiene: Using an assistant for hygiene services can increase efficiency while keeping compensation fair.

By maximizing production within hygiene, higher wages become more sustainable without increasing costs for the practice.

Step 4: Retain Hygienists by Creating a Competitive Work Environment

Hygienists are constantly being recruited by other offices, often with offers that may seem too good to be true. However, salary isn’t the only factor that matters. Many hygienists choose to stay in offices where they feel valued, appreciated, and supported.

How to Retain Hygienists Without Breaking the Bank

Offer Growth Opportunities: Provide CE courses and leadership roles.
Create a Positive Work Culture: A well-run office with strong systems and efficient scheduling makes a huge difference in job satisfaction.
Check Market Rates Regularly: Stay competitive without overextending the budget.
Offer Perks Beyond Salary: PTO, wellness programs, and flexibility can be just as attractive as higher wages.
Keep a Pulse on Team Morale: Conduct monthly check-ins with hygienists to ensure they’re engaged and happy.

Step 5: Hire Strategically to Avoid Salary Inflation

When hiring new hygienists, many offices feel pressure to match or exceed market rates. However, blindly increasing wages can put a strain on the entire practice. Instead, follow these hiring best practices:

Know Your Market Rates: Stay informed about what hygienists in your area are actually earning, not just what job postings advertise.
Sell Your Practice Culture: Hygienists want more than just a paycheck; highlight what makes your practice a great place to work.
Set Clear Compensation Expectations: If offering a base + commission model, provide realistic earnings examples using actual practice data.
Don’t Overcommit: If a candidate demands an unsustainable salary, it’s okay to walk away.

Balance Fair Hygiene Pay with Business Sustainability

Hiring great hygienists requires a balanced approach to compensation, profitability, and team culture. By structuring pay around performance, optimizing revenue, and creating a great work environment, dental practices can stay competitive without compromising their financial health.

If you need personalized guidance on hiring hygienists, structuring compensation, or improving profitability, reach out! The Dental A Team is here to help.

Schedule a free Practice Assessment with our team. Let’s make 2025 your best year yet!

For more tips, check out our latest episode!

Hiring Hygienists In Today’s Economy