Top Dental Worker Questions Answered Part 2: Getting Compensated Fairly, Independent Hygiene Work, And Commission-based Hygiene

Happy woman with money in her hands

Click here to see part 1 of the series.

Welcome to Part 2 of our hygienist FAQ series. Over the past year, we’ve sat down with thousands of dental hygienists, dental assistants, and dental office staff. We collected your most frequently asked questions.

To answer them, we talked with dental offices, dental associations, and former hygienists. Get ready.

In part 2, we’ll discuss:

  • How to determine if a job offer is fair according to the market?
  • How can I be an independent dental hygienist?
  • Is commission-based hygiene work better than wage-based?

Let’s jump in!


How to determine if a job offer is fair according to the market?

You’ve got the job. But you can’t tell whether the money and benefits are fair. It happens all the time, and it’s not an easy landscape to navigate. Between trying to decipher half-legible Glassdoor interviews and struggling to find the average salary in your area, simply knowing if a salary is fair market rate can feel impossible — much less negotiating that salary to include experience and expertise.

We’ve got your back. Let’s look at the types of factors we help our temp assistants who want to go full-time look for, and why they’re important:

  • Salary: There’s a big difference between a liveable salary and a fair salary. Hygienists make good money, but don’t fall into the trap of thinking “good” is good enough. You want a salary + benefits package that fairly reflects your value. So… how do you know what your value is? We recommend using a combination of salary-data websites (think: Indeed, Monster, Glassdoor, etc.), data from sources within and around the dental industry (we’re dropping some salary figures next week!), and data from headhunters and staffing agents. In fact, the latter is probably the most valuable. No one has insights quite as accurate as staffing agencies or headhunters. They’re boots on the ground. Call one and simply ask. You don’t need to sign up for anything; most will be happy to help. 
  • Culture: With burnout at record-high rates and hygienists dealing with more anxiety and depression than ever, a good work culture is worth its weight in gold. Here’s an important question: will you be happy working there? Seems simple. But it’s probably the single most important component of your entire offer. Obviously, it’s not always easy to tell what the real culture of a practice is until you’re there. That’s why we always recommend temping at a few offices until you find the right one. But you can always ask other hygienists and assistants who work there. Invite them out for dinner. Ask them honest questions about the culture and “vibe” of the office. Work somewhere that makes you happy — not just somewhere that makes you money.
  • Flexibility: Don’t underestimate the power of flexibility. Vacation days, hour-setting, schedule-picking, and extra paid time off are HUGE. There is direct, undeniable link between workplace flexibility and your happiness, health, and quality of life. This goes far beyond your work hours. Flexibility can literally transform your entire life. So, we always recommend that hygienists and assistants ask about flexibility upfront, and discuss adding extra vacation days or flexible schedules to the offer. Obviously, the best way to create flexibility is to temp, and we would recommend that everyone at least try it out. But even non-temps can also create flexibility. You just need to discuss it. Often, this puzzle piece is ignored in negotiations. Don’t ignore it. You’ll be happy you didn’t.
  • Market conditions: Right now, dental hygienists are in high demand. Well, that’s actually an understatement. You’re the highest in demand you have ever been. Dental offices are literally battling for your signature. Use that to your advantage. Hygienists can get over market value right now. Better yet, you have an intense amount of negotiating power when it comes to flexibility and benefits. Do not settle for a paycheck. Find an office that’s truly wonderful.
  • Work conditions: Culture is one thing; work conditions are another. What do the hours look like in the office? How long are the appointment slots? What types of patients are you working with? And what kinds of equipment do they have, and what is the quality of that equipment? These are all important considerations. We’ll say it again: temp before you full-time. It really helps you uncover these conditions firsthand. But if you don’t temp, you can always ask to have a look around the office. Better, talk to the hygienists and assistants and ask them these questions. You can even reach out to former employees (find them via social media) to ask about their experiences (hint: they left for a reason). Your goal is to understand as much as possible about the office before you accept the job. The last thing you want is to be staring at a room of worn-down tools, super-short appointment slots, and cranky dentists.

How can I be an independent dental hygienist?

First off, we need to define what “independent dental hygienist” means. Temp workers are independent by nature (they get to choose their own shifts and do their own thing), but dental hygienists that work for us only have to worry about a single tax form (we handle deductions), and get near-unlimited support. So, they aren’t fully independent. While there are truly independent dental hygienists, most aren\’t actually aware of how this works, and most practices are just skirting the law and giving temps headaches in this space. So, we\’ll make the fair assumption no one would want to work that way.

For this question, we mean going 100 percent independent and starting your own practice — a common question (and dream) for many hygienists. Truthfully, it’s more achievable than you think. But it is a little costly. Expect to spend at least $250,000 on the building if you’re in Canada. For the United States, you may be able to half that cost. Don’t worry! You can still go independent without the building — though it will hinder your income capabilities. We’ve seen a few of our hygienists start with an investment in a mobile hygienist van and eventually move to a brick-and-mortar practice (here’s a story of one!)

We do know this: you want to join the Canadian Dental Hygienists Association’s Independent Practice Network. The CDHA is an amazing hygienist-centric organization that helps hygienists across Canada create independent practices and fight for better wages and working conditions. We’re huge supporters. They spell out everything you need to know about starting your own independent practice. We would drop a huge how-to list, but, well… they say it and know it better than we do. So, we won’t be redundant.

Here’s some good news: we’re seeing dental hygienists open practices at a good rate — despite the pandemic setback. Even 3 years ago, hygienists were rushing toward independence. Unfortunately, COVID-19 shattered some of those dreams. Luckily, the post-pandemic atmosphere seems favorable to independent practices. So, don’t be afraid to chase those dreams.

Is commission-based hygiene work better than wage based?

This is a complicated question. From our discussions, it seems that dentists prefer commission-based work as a whole. And for good reason, they get to pay you based on your performance. So, they have tighter control over their ROI.

That said, commission-based hygiene work doesn’t always work out in your favor. In fact, there are plenty of hygienists that earn significantly less money under a commission-based system. And it might not be the best for your mental health (more on this below).

First, let’s talk about the 4 main ways hygienists are paid:

  1. Straight salary: You get a specific amount each money, no matter how many patients you take care of or how much (or little) you do.
  2. Straight commission: You get paid a commission for every patient you see (usually 30 to 50 percent). That’s your pay. The more you earn the office, the higher your pay. Most often, straight commission includes prophy bonuses (once insurance pays).
  3. Mixed: This is probably the favorite of most full-time hygienists. You get a flat salary + commission percentage. It has a few cons and pros of both types. Importantly, you want to make sure your base salary covers living expenses. That’s important. Most mixed contracts have small commission-based components, but they can add up fast when you deal with a high patient volume. In general, this type of contract really only works in high-volume practices.
  4. Daily/hourly: This is probably the second most popular. While it doesn’t have the earning potential of a straight commission in a high-volume practice or the benefits associated with a straight salary, it has one secret advantage: it’s insanely flexible. Under this system, you set your hours, you pick your days, and you control your entire life and schedule. This is becoming increasingly popular as burnout picks up steam. Some hygienists want to build their work around their life — not the other way around.

How do you know which type of payment method will earn you the most money?

Great question! This is actually sort of complicated. All of them can earn the most money in certain situations. So, you need to pay attention to some factors.

  • Your average daily production: Figure out how much money you produce for your practice each day. In this example, let’s say it’s $550 on average.
  • Your average salary (down to the day): Take your salary (plus paid days off), and divide it by 260. That’s roughly your average daily pay. In this example, let’s say it’s $180.
  • Your hourly pay: If you get paid hourly, multiply that number by 8. In this example, let’s say your daily pay is $280.

With an average production of $550, you would make between $181 (33 percent commission) and $275 (50 percent commission) per day. This means you would earn more than straight salary and slightly less than hourly.

Obviously, any of these could be swapped around. You may find salary nets you the most money. It just depends on your unique situation.

Let’s pro-con this:

Wage-based hygiene work pros:

  • You have a predictable income that makes it easy to budget your money and predict expenditures week-to-week.
  • You can focus on the quality of care without fear of losing out on money due to a slower pace.

Wage-based hygiene work cons:

  • Your earnings are static, no matter how good you are at your craft or how many patients you help.
  • Hygienists often earn a little less under this model as a whole, though results definitely vary.

Commission-based hygiene work pros:

  • You can earn more money if you’re accurate, fast, and skilled. It’s a meritocracy of sorts. Your skill translates into additional income.

Commission-based hygiene work cons:

  • Honestly, it can be stressful. You can get stuck in a trap of constantly trying to do more patients and keep a specific pace — even when it impacts the quality of care. Worse, you can fall into a spending trap, where you need to constantly think about speed to keep up with payments.

Mixed-based hygiene work pros:

  • You get some of the benefits of straight commission without all the added stress.

Mixed-based hygiene work cons:

  • You will get paid a lower base salary than straight commission (or have fewer benefits). You have to earn the rest via commission.
  • This only works in high-volume practices.

Hourly/daily hygiene work pros:

  • You get unlimited flexibility. You choose your hours and days.
  • You can sometimes earn more than both a straight salary and a straight commission.

Hourly/daily hygiene work cons:

  • You don’t have the simple routine of salary-based positions.
  • You will have fewer benefits compared to salary-based positions.

Want to Take Control of Your Career?

WORKFORCE gives you the flexibility to take control of your life and your career. Ready to reduce burnout and live your best life? Sign up as a dental hygienist, dental assistant, or dental receptionist today!

Subscribe to our newsletter

Get in-depth, data-drenched guides to help you navigate the dental ecosystem with ease.

Share this post with your friends

Scroll to Top