Virginia has more dentists per capita than most states — but far fewer dental hygienists to support them.
That imbalance is widening across Hampton Roads, where many practices are struggling to keep up with demand for routine cleanings and preventative care, said Ryan Dunn, who leads the Virginia Dental Association.
Dentists perform advanced procedures and surgeries, while hygienists perform much of the preventive, day-to-day work that keeps patients healthy, from cleanings to screenings, under a dentist’s supervision.
Virginia allows one dentist to oversee up to four hygienists, but in many communities the ratio is flipped.
In Hampton, for example, Dunn noted there are 58 dentists and only 32 hygienists.
“If you showed up at the hospital and there were more doctors than there were nurses, you'd have a real problem as to getting quality care,” Dunn said.
Dani Howell works at Howell Dentistry in Suffolk, where the shortage has become increasingly visible.
At one of the practice’s two locations, there are only three hygienists — effectively two and a half, Howell said, given part-time schedules.
Before the pandemic, the clinic had about 10 full-time hygienists.
Howell said patients who once could reschedule a cleaning within weeks are now being booked nearly a year out.
“There are obstacles because most people just do need preventative care,” Howell said.
The shortage has also forced dentists to take on tasks typically handled by hygienists, such as cleanings and basic gum care, which limits their ability to perform more complex procedures.
“It's a teamwork approach that we need to do,” Howell said. “And when one of the team members isn't there, somebody’s got to pick it up.”
A poll by the American Dental Association’s Health Policy Institute found that nearly half of dentists have personally taken on duties previously assigned to other team members due to staffing challenges.
Dunn said the gap stems from a lack of training programs.
Only six community colleges in Virginia offer dental hygiene programs, graduating fewer than 150 hygienists a year when the market needs nearly 1,000, Dunn said.
Dunn said programs are costly to run and struggle to recruit instructors, who earn far less than in private practice - a dynamic that’s also plagued nursing schools and contributed to shortages in that workforce as well.
“Our student graduates usually have wonderful opportunities as soon as they graduate and become licensed. It's very difficult then to attract them back to the community colleges to teach, because we can't compete with those great salaries in the industry,” said Kerry Ragno, vice president for academic affairs at Virginia Peninsula Community College.
Ragno said the college once ran a dental hygiene program that graduated about 10 students a year, but paused admissions in 2023 after years of financial strain and faculty turnover.
Now, the college is seeking state funding and partnering with local universities and dental organizations to reopen its dental hygiene program.
Virginia Commonwealth University runs the state’s only university-based dental hygiene program. Despite a recent expansion in its class size, it can still enroll just 20 new students a year.
Marion Manski, director of the division of dental hygiene at VCU School of Dentistry, told WHRO in a statement that demand is increasing due to expanded Medicaid access at the same time the workforce is aging.
To address the shortage, the Virginia Dental Association has been pushing for more education and training opportunities across the state.
Dunn said the group has met with private and community colleges to explore ways to expand dental hygiene programs.
