Dear Editor,

My IQ doesn't exactly break the bank but having racked my brains for far longer than most people would bother I still couldn't work it out. I mean there had to be a reasonable explanation, right? A perfectly logical answer?

Then I woke up in my dental chair (lunchtime snooze) and realised I was in a dental practice working with dentists. Cursing myself with the most penetrating expletive for even considering a reasonable explanation, I quickly reached the more realistic conclusion. It was pure greed.

I spoke to several dental hygienists to ask them if I was just being a bit stupid (as is usually the case). Was I missing something obvious and acting on hubris? According to them I was indeed a bit stupid but I hadn't actually missed anything. So many dental hygienists get paid such a low percentage of their earnings simply because the practice sets extortionate rates. The principals are apparently just greedy.

This answer conveniently tempered my initial confusion. After all, associate dentists understandably cost the practice a lot more in expensive materials, X-rays, laboratory bills, a nurse (they apparently don't cost very much judging by their wages) etc. But a hygienist has none of those costs, save for a few suction tubes and the little tablets that turn the rinse green. Some even bring their own instruments. So why should so much of their generated income be pillaged from them?

Speaking as a dentist (and I use the term loosely) who has happily covered for absent hygienists on many occasions I can testify to how impressive their work ethic is. To debride the average mouth, clean and disinfect the room, write up their notes and be ready for the next victim – er – patient, within the allocated time slot is quite a feat.

So many patients go in anxious and reluctant, and emerge happy and refreshed. The smiles they beam at reception clearly advertise the value that hygienists bring to the business. Stark contrast to the blood soaked screamer that I had to release after ripping their eyeball out through their sinus after extracting (and I use the term loosely) an upper wisdom tooth. So many patients now volunteer to see the hygienist. They volunteer to pay for the service. And yet somehow that means your hygienist is worth even less. Hmmm … confused.com.

Now, I realise that the practice is a business and the principal can set whatever rate they choose. It's a (relatively) free market. And the market is flooded with more hygienists and therapists than ever before, and they can always choose not to accept the practice's rate. There are plenty of hygienists working hard and making a decent income. More power to them.

A dentist would argue that if a hygienist wanted to earn more they should have studied to become a dentist or a periodontist or tried a different line of work entirely. Yeah, that's a dentist's answer, which means it's not so much an intelligent remark as an excuse. And it doesn't remotely speak to my point.

Are hygienists paid such a low percentage of their earnings because they are actually lesser mortals than dentists or specialists? Do they lack the requisite number of letters after their name? Is there some established professional prejudice against them akin to that against technicians and nurses?

I thought it was bad enough being an associate dentist but now I feel positively regal compared to hygienists. Whereas I once admired and helped anyone trying to advance onwards to become a hygienist, now I wonder what kind of slavery they'll find on the other side.

Not for me to tell practices what they should pay their associates or hygienists, but fair for someone to call them on their apparent greed. Yes, you live in a more materialistic time with ever more self-serving narcissism and insecurity fuelling your need to fund your golf club membership and other such vanity projects. I'm certainly not advocating that a plague of socialism infests dentistry. If that happens I'll be voting for Donald Trump faster than you can say ‘I. Don't. Care.’ Even with a name like mine.

This isn't going to change anything or make dentists value hygienists any more. But the creepy undercurrent of avarice so endemic to this profession leaves a taste in the mouth more bitter than lignocaine.

Paying people a fair percentage these days seems to be heresy and it's probably only going to get worse with time. Today's crop of dental graduates knows far less about dentistry than they do about money. The nation's teeth and wallets will probably both be in deficient state. We'll have little choice but to borrow a little of Gabriel Oak's stoicism and accept our fate.

And while we do that, let's talk about our dental nurses' pay….

Reader panel member Shaun Howe RDH responds to Sharif's letter: I read Sharif's letter with a wry smile and actually find his take on how dental hygienists are paid really quite refreshing. Sadly, the only reason it is refreshing is because it comes from a dentist. Many dental hygienists have told the same story for as long as hygienists have been working in general dental practice. Is it the principal dentists that are to blame or is it the profession of dental hygiene or indeed, is there a third party that is implicated?

For me, it has been a long term problem that has yet to be addressed and may well be in the near future as further empowerment of dental hygienists continues. We have direct access, we are allowed (now) to diagnose including using radiographs to assist this and I see that the BSDHT and others are engaging with the Department of Health regarding prescribing rights for dental hygienists.

As for poor pay and even poorer working conditions, well, I have been public and vocal about this in the past and feel that when a dental practice chooses to engage the services of a business coach well, there can be only one answer: someone has to lose out to increase margins and let's look to see who has the target on their back.

Lo! The dental hygienist is an easy target. Self-employed (usually), works alone with little or no support (despite this being contrary to GDC Standards) yet still delivers care to the practice patients (and this is not used loosely) and unbelievable value to the practice but, as Sharif correctly observes, in his lunchtime postprandial snooze, there really is only one winner.

Dental hygienists know exactly how much they are worth to a practice. It is not rocket science to count how many patients you saw in a given time period and then multiply it by the fee and hey presto, the income to the practice (not taking into account the goodwill generated by the dental hygienist because patients ‘emerge happy and refreshed’ from the smallest surgery in the practice).

Practice principals certainly can set their own levels, but I simply ask they learn to not be blinkered by business or indeed by those that tell them they can increase their own margins by forcing lower percentages on great, undervalued assets.

Well done Sharif, sadly stating the obvious, but well done.

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