The dental team shortage that began during the pandemic has not resolved. In April 2026, the American Dental Association’s Health Policy Institute (HPI) said only 60 percent of dentists have enough dental hygienists on staff. Its assessment was blunt: the shortage is real and “unlikely to go away soon.” The training pipeline is growing, but so far the extra graduates have not shown up as more staff in dental offices. HPI points to practice economics as part of the reason.
The size of the workforce
The U.S. Bureau of Labor Statistics (BLS) counts about 225,300 dental hygienist jobs and 388,600 dental assistant jobs in 2025. HPI counts 205,088 professionally active dentists, or 60.0 per 100,000 people.
- Dental hygienists: median pay of $98,100 a year ($47.16 an hour) as of May 2025. Entry typically requires an associate degree. BLS projects employment to grow 8 percent from 2025 to 2035, which it calls “much faster than average,” with about 15,000 openings a year.
- Dental assistants: median pay of $48,070 a year as of May 2025. Entry typically requires a postsecondary nondegree award. BLS projects 7 percent growth over the same decade, with about 53,000 openings a year.
Most of those projected openings come from people leaving the occupations rather than from new positions. For hygienists, BLS projects net employment growth of about 17,900 over the whole decade, against roughly 15,000 openings every year.
What dentists report
HPI’s April 2026 analysis found that 91 percent of dentists who had recently recruited hygienists described it as “very or extremely challenging.” Dentists named staffing, tied with dental insurance issues, as their top challenge heading into 2026. Shortages of assistants and administrative staff were reported less often, though HPI did not give exact figures for those roles.
HPI’s quarterly survey for the fourth quarter of 2025, as summarized by Oral Health Group, shows how common recruiting is. In the prior three months, 31.4 percent of dentists had recruited hygienists and 34.9 percent had recruited assistants. Hygienist recruiting difficulty had held essentially flat for three years. Assistant hiring had eased slightly. More than 40 percent of dentists said they planned to add staff in 2026.
Staffing worries are not limited to independent offices. In the same survey, 59.3 percent of dentists affiliated with dental support organizations (DSOs) named staffing as a top concern, compared with 53.8 percent of non-DSO dentists.
More graduates, same headcount
HPI reports that first-year enrollment in dental hygiene programs rose 16 percent from 2020 to 2025, and that 2025 produced the most hygiene graduates on record. Total dental office staffing, however, had been flat for at least a year and a half. HPI says it lacks good data on retirements and exits from the field, so it cannot yet say where the new graduates are going or why they are not adding to the total.
The fiscal squeeze
The usual response to a labor shortage is to raise pay. HPI’s analysis suggests that is harder in dentistry right now. After inflation, average wages for dental office staff, including hygienists, are lower than they were a few years ago, while wages for medical office staff and private-sector workers overall have risen. HPI’s explanation is margin compression: practice revenues are down, and costs for equipment, supplies and technology are rising faster than reimbursement. HPI calls this the “fiscal squeeze” and expects the shortage to track it.
Policy responses
HPI lists several levers: higher reimbursement, lower practice costs, technology adoption, larger practices, cheaper or shorter training, and expanded scope for hygienists and assistants. Some states are already experimenting:
- Missouri launched a pilot allowing trained dental assistants to perform supragingival scaling on patients who are periodontally healthy or have gingivitis.
- Florida, Connecticut, Vermont and Massachusetts allow foreign-trained dentists to practice as hygienists.
- Indiana and Virginia passed workforce bills that took effect in summer 2026, according to HPI.
Scope proposals are contested. A March 2026 UCSF Healthforce Center brief on California notes that dentists have called for easier training and broader duties for assistants. Hygienists have pushed back, calling it potentially harmful “scope-of-practice creep,” while also seeking a broader scope for their own profession.
The California picture
California has its own pressures and its own licensing structure. The UCSF brief counts 565 federally designated dental health professional shortage areas in the state at the close of 2025. Almost 3 million people live in them, and only 36.1 percent of the need there is being met. Most of those designations are facilities, usually federally qualified health centers serving Medi-Cal patients.
The brief also describes who makes up the auxiliary workforce. More than 93 percent of both registered dental assistants and registered dental hygienists are women. RDAs are 50.1 percent Hispanic, while RDHs are 51.1 percent white and 21.0 percent Hispanic. The California Dental Association reported that 95 percent of dentists it surveyed in April 2023 had trouble hiring hygienists.
California has tried to widen the assistant pipeline. Since July 1, 2025, under the Dental Board’s 2024 sunset bill, SB 1453, candidates have three additional routes to RDA licensure: a Certified Dental Assistant pathway, an alternative program pathway and a preceptorship pathway. It is too early for published data on how many new RDAs those routes have produced.
What it means for practices
The data point to a shortage that will ease slowly, if at all, on its own. Training capacity is rising, but real wages are falling and practice margins are tight. For practice owners, the main levers are the ones HPI names that a single office can control: compensation within the practice’s economics, scheduling and hours, technology that reduces administrative load, and training current assistants for the expanded duties state law allows. Scope-of-practice changes will be decided in state capitols, and they are worth watching.
Sources
- ADA Health Policy Institute, “We Have a Major Dental Hygienist Shortage. It’s Unlikely to Go Away Soon.” (HPI Perspectives, April 2026)
- ADA Health Policy Institute, The dentist workforce
- U.S. Bureau of Labor Statistics, Occupational Outlook Handbook: Dental Hygienists
- U.S. Bureau of Labor Statistics, Occupational Outlook Handbook: Dental Assistants
- Oral Health Group, “U.S. dental practices face a fiscal squeeze heading into 2026” (summary of HPI Q4 2025 data)
- Davis M, Mertz E. “The California Oral Health Workforce: Deficits and Opportunities.” Healthforce Center at UCSF, March 2026
- California Dental Association, California’s Dental Workforce
- Dental Board of California, Alert: New Application Requirements for Registered Dental Assistants (SB 1453)
