Why they quit: the 2022 joint study of 9,377 dental assistants and hygienists on pay, culture and leaving

What it says#

The report opens with the practical cost of the shortage rather than the emotion of it. Vacant positions in dental assisting and dental hygiene had "reduced dental practice capacity by an estimated 10% nationally," a figure the body of the report puts at 11% from HPI's February 2022 poll, and one in three dentists who did not have full appointment schedules said trouble filling staff positions was part of the reason. In July 2022, four in ten practices were recruiting or had recently recruited assistants, nearly as many were recruiting hygienists, and among those dentists nine in ten called it extremely or very challenging. Staffing was the single biggest concern dentists named in January 2022 and still the biggest in July.

The report's contribution is that it asks the staff, not the dentists. A total of 4,255 dental assistants and 5,122 dental hygienists responded in 2022 to a survey distributed by ADAA, DANB and IgniteDA to about 133,000 assistants and by ADHA to about 124,000 hygienists.

What the staff said about their jobs: 60.0% of assistants and 54.5% of hygienists rated their satisfaction 8 to 10 on a 10-point scale, and only 7.2% and 7.7% rated it 1 to 3. Satisfaction was lowest among DSO employees in both groups, 45.3% of assistants and 45.9% of hygienists at the 8-to-10 level against averages of 60.0% and 54.5%, and highest in private solo practice for assistants and in public health for hygienists. More than half of each workforce had been in the field at least 11 years, but the majority had been in their current job five years or less, and roughly a third expected to retire within five years: 33.7% of assistants and 31.4% of hygienists.

What they said about pay: 49.2% of assistants and 45.5% of hygienists had received a raise within the past year, another 19.7% and 17.5% one to two years ago, and 22.2% and 25.8% had never received a raise at their current employer, though most of those had been there less than three years. Where a raise had happened it was usually small, 1 to 3% for 68.2% of assistants and 62.0% of hygienists. Set that against what dentists reported in June 2022, when 84.6% said they had raised assistant pay in the past year and 79.9% said they had raised hygienist pay. HPI names the gap rather than resolving it, noting that the cohorts are separate and that there may be "an inflated sense of generosity" on the employer side, a deflated one on the employee side, or both.

What they said about benefits: the majority of both groups receive dental benefits, paid holidays, paid vacation and retirement savings, while health insurance, paid sick time, paid leave and continuing education funds are rare overall. Those rarer benefits track the practice setting closely. Among hygienists, health insurance reaches 20.9% in private solo practice, 38.8% in group practice, 72.8% in DSOs and 86.1% in public health; paid leave reaches 6.4%, 11.6%, 29.3% and 64.6% across the same four settings. Dentists' most common reason for not offering paid leave was cost, at 68.6%, followed by "not the industry norm" at 30.9%.

Why they leave: 62.2% of assistants and 79.5% of hygienists had voluntarily quit a position. Among those who had left the field altogether, the most common reasons for hygienists were negative workplace culture, lack of growth opportunity and inadequate benefits; for assistants, insufficient pay, negative culture and overwork. Asked what would have kept them, "better pay" was the clear top answer, with management and communication close behind. The report distills all of it into six risks to retention that are the same six items for both roles in different order: insufficient pay, negative workplace culture, overwork, lack of growth opportunity, inadequate benefits and communication concerns. The three retention factors named by satisfied staff are work-life balance, positive workplace culture and the ability to help patients.

Who it applies to#

The respondents are dental assistants and clinical dental hygienists, current and former, anywhere in the United States. Samples skew as the professions do: 96.3% of assistants and 97.5% of hygienists were female, 79.0% and 86.8% White. Most were employed full time in the field, 63.6% of assistants and 53.7% of hygienists, and most worked in private solo practice, 39.4% and 50.4%, or group practice, 22.0% and 24.0%. Only 7.1% of assistants and 9.0% of hygienists worked in a DSO, so the DSO satisfaction finding rests on a small share of the sample.

Nothing here is state specific, and nothing here is a wage. The report tells you why people leave dental jobs and what benefits they have; it does not tell you what to pay, and it directs employers to BLS state-level employment and wage statistics for that.

What changed#

This is the first edition of this survey. What it changed was the diagnosis. Shortages had been treated as a pandemic effect; the report says that is "just part of the story," pointing to dental assisting enrollment trending down since 2015, a roughly 7% drop in first-year hygiene enrollment in 2020-21, fewer than half of the hygienists who left early in the pandemic returning by 2021, and an estimated 3.75% of hygienists voluntarily leaving the workforce in 2021. Its conclusion, written in 2022, was that shortages "are likely to remain an issue for years to come."

They have. HPI's April 2026 analysis, covered separately in this directory, finds only 60% of dentists with adequate hygiene staffing and 91% of recruiters still calling it very or extremely challenging, this time alongside record hygiene enrollment and graduates. ADHA's 2026 position statement leans on this 2022 report as the evidence that the drivers are retention, not supply. The 2022 report remains the primary source for why staff leave; the newer HPI work is the source for how many seats are empty.

Where the source is#

The report is a free 51-page PDF hosted on ADA.org, dated October 2022, written jointly by the ADA Health Policy Institute, the American Dental Assistants Association, the American Dental Hygienists' Association, the Dental Assisting National Board and IgniteDA. The methods section names the sample and recruitment, the appendices reproduce the full assistant and hygienist questionnaires and the dentist polling instrument, and a references section documents every outside figure, including the Surgeon General's 2022 burnout advisory, DentalPost's salary survey and DANB's own salary and satisfaction survey. The suggested citation is printed on the last page. It is copyright the contributing organizations and free to download without registration.