Increased hygienist autonomy could be the key to alleviating dental accessibility issues, but many dental professionals agree that the industry must go about it the correct way in order for this effort to succeed.
As part of its 2026-28 Strategic Plan, the American Dental Hygienists’ Association plans to promote the hygiene profession as one capable of operating independently across a wider range of settings.
ADHA President Lancette VanGuilder said the new mission recognizes hygienists as the “driving force” of preventive care within healthcare settings.
The initiative comes as several states weigh new hygiene legislation aimed at improving accessibility. New York and Utah recently passed legislation that expands hygienists’ ability to practice without dentist oversight.
Several other states allow hygienists to fully practice independently, including Colorado, Maine and California. In other states, such as Alaska, Florida and Kentucky, hygienist autonomy is limited under various stipulations, like care setting and collaborative agreements. Several states do not permit independent hygienist practice and require direct or general supervision by a licensed dentist, according to Teero, a dental staffing company.
Five dental professionals recently spoke with Becker’s to discuss the benefits and challenges that could come with enhanced hygienist autonomy.
Note: Responses were lightly edited for clarity and length.
Benjamin Golik, DDS, Co-founder of URBN Dental (Houston): Thoughtfully increasing hygienist autonomy, within appropriate training, certification and state guidelines, is a natural evolution that can expand access to care while improving efficiency across dental practices.
From an operational standpoint, it allows dentists to focus on more complex procedures while hygienists play a greater role in preventive and periodontal care. This is especially important given ongoing hygiene workforce constraints, and at scale, it can improve patient flow, reduce wait times and expand overall capacity. Hygienists are often the most consistent and trusted point of contact for patients, and many individuals are more proactive with hygiene visits. Expanding their role helps bring more patients into the broader care continuum, leading to earlier diagnosis and more comprehensive treatment when needed. Importantly, this strengthens, not replaces, the role of the dentist by creating more consistent touchpoints that support overall patient health.
Clinically, hygienists are essential in managing gum and bone health, delivering periodontal therapies, guiding enamel remineralization for early, non-cavitated lesions, and reinforcing oral hygiene education. Providing them with the proper time and bandwidth to educate patients is critical to improving long-term outcomes.Technology is also accelerating this shift. AI platforms like Overjet, Pearl and VideaHealth are helping standardize how conditions are identified and communicated while enhancing patient understanding. These tools support clinical decision making, but do not replace the need for dentist oversight, particularly in complex cases.
There are also thoughtful opportunities to expand responsibilities, such as allowing properly trained and certified hygienists to administer local anesthetic within state guidelines, which can improve patient comfort and streamline care delivery. As this model evolves, hygienists may also expand their impact across broader preventive and community-based settings, while maintaining strong collaboration with dentists to ensure continuity and quality of care.
Ultimately, the future of dentistry is not about independence, it is about integration. Practices that align empowered hygienists, engaged dentists and supportive technology will be better positioned to deliver consistent, high quality, patient-centered care.
Doug Gray. Owner of Dental Business Solutions: I support the ADHA’s initiative to expand hygienist autonomy and promote more independent practice models. With the right infrastructure in place, this shift could significantly improve access to preventive dental care. However, several key factors will determine its long‑term success.
Coordination of care will be critical: As hygienists take on more independent roles, they must prioritize seamless communication [with] dentists, particularly around referrals, documentation and follow‑up treatment. While today’s technology — EMRs, HIPAA‑compliant messaging platforms and interoperable data systems — is more than capable of supporting this model, many care providers will require training to use these tools effectively and maintain consistent standards of communication.
Reimbursement structures must evolve: Current preventive care reimbursement rates from dental benefit providers are often too low to sustain a profitable standalone hygiene practice. Without adjustments from insurers, both patients and employers may increasingly question the value of traditional dental plans and turn instead to alternatives such as in‑house membership plans or direct‑pay models.
Economic realities will shape who enters this space: The overhead associated with operating independently — equipment, supplies, risk management and general administrative costs — means profit margins may be thin for solo hygienists. That said, market forces have a way of creating solutions. DSOs, with their capital resources and operational infrastructure, are likely to seize this opportunity and invest heavily in expanding hygienist‑led services.
Ultimately, increased hygienist autonomy has the potential to enhance patient access and modernize care delivery — if the profession addresses these challenges proactively. I’m excited about the possibilities and eager to support entrepreneurial hygienists as they explore these new practice models.
David Nguyen, DMD. CEO of URBN Dental (Houston): Hygienist autonomy is not a clinical debate. It is a capacity unlock for the entire dental industry.
The biggest constraint in dentistry today is not demand. It is access. We simply do not have enough provider bandwidth to meet the need for preventive care. Expanding hygienist autonomy allows the industry to scale the front door of dentistry without waiting on more dentists to enter the workforce. At scale, this changes everything. Hygiene becomes the primary engine for patient acquisition, early diagnosis and lifetime value creation. The practices that understand this will grow faster, operate more efficiently and build more durable models. But autonomy without structure will fail.
Dentistry only works when it is coordinated. Diagnosis, treatment planning and execution must operate as one system. If hygienists operate independently without alignment, you create fragmentation. Fragmentation leads to missed diagnoses, lower case acceptance and inconsistent patient experiences.
The future is not independent hygiene. The future is integrated autonomy. The winning model is a tightly coordinated platform where hygienists operate at the top of their license within standardized protocols, shared data systems and clear clinical accountability. That is where you get both access and quality at the same time. The organizations that get this right will expand access faster, remove bottlenecks and build stronger patient pipelines. The ones that do not will remain constrained by provider capacity and outdated workflows.
This shift will not disrupt dentistry. It will reveal who is built to scale.
Robert Trager, DDS. Dentist at JFK Airport (New York City): We all know there is a big shortage of dental hygienists in our profession. Seeking independent operation will not be perceived by all dentists as a non-starter. In today’s environment the profession of dentistry is being marginalized, disrespected and politicized by all vendors we deal with. I am sure many state and government agencies will approve hygienists practicing independently. In today’s environment, many health professionals are seeking to work independently. We as dentists must be prepared to accept this reality and maneuver around it and have a positive outcome.
These independence-seeking hygienists will no doubt be receiving a higher remuneration and higher benefits. We as a dental profession may not be able to compete with some of these scenarios, but [can] capitalize on seeking referrals from these institutions where they are being employed. I emphasize that we seek out the locations that these independent hygienists are employed at and if they are in our zip code area or are close by, to introduce ourselves with whatever marketing tools we may possess in order to receive possible referrals. These hygienists will be a great source of referrals because of their astute abilities to diagnose many dental disciplines. This effort should be perceived with an ethical and professional scenario. No bribes, kickbacks or referral payment should be considered because one will be discovered and [face] possible loss of licenses and fines. Accept the outcome and be prepared to make it work to our advantage.
Thomas von Sydow. CEO of Cornerstone Dental Specialties (Irvine, Calif.): This is indeed a grey area and there are no easy solutions. Hygienists are licensed by state dental boards as a clinician. If we look at medical, the analogy would be nurse practitioners and physician assistants. In most states, nurse practitioners operate independently, and physician assistants are under the direct supervision of a licensed medical physician. In practice, I see many dental offices still using hygienists as super DA’s, mostly doing cleanings, and they are viewed as kind of a lost leader and case identifier for the dentist. Many offices and groups see them as clinicians, and they mostly do scaling and root planing with perio maintenance.
Having worked with thousands of hygienists, most prefer the latter … I really don’t think the majority care if they are under indirect supervision or not. What they want is to work to their maximum allowable scope of practice. I think changing laws in general would not have a major impact, as the dentist/hygienist relationship is highly valuable to both if done right. How they are recognized by their organization is more important. If there is independence, optimally, independence and scope of practice should have requirements of who can do what.
At the Becker's 5th Annual Future of Dentistry Roundtable, taking place September 14-15 in Chicago, dental leaders and executives will gain insights into emerging technologies, practice growth strategies and the evolving landscape of dental care delivery, with a focus on innovation, patient experience and operational excellence. Apply for complimentary registration now.
