Australian Dental Journal 2008; 53: 61–66

SCIENTIFIC ARTICLE
doi:10.1111/j.1834-7819.2007.00011.x

Working practices and job satisfaction of Victorian dental

hygienists
M Hopcraft,* C McNally,  C Ng,à L Pek,à TA Pham,à WL Phoon,à P Poursoltan,à W Yuà
*Cooperative Research Centre for Oral Health Sciences, School of Dental Science, The University of Melbourne, Victoria.
 Lecturer, Faculty of Dentistry, The University of Sydney, New South Wales.
àSchool of Dental Science, The University of Melbourne, Victoria.

ABSTRACT
Background: Increasing demand for dental services and a projected shortage in the oral health workforce in Victoria has
focused attention on dental hygienists as one mechanism for increasing the supply of dental services. Understanding the
dental hygienist workforce is essential in order to plan effectively for the future delivery of dental services in Victoria.
Methods: A postal survey of a random sample of Victorian dental hygienists was undertaken in 2006. Data on hygienistsÕ
demographic characteristics, current dental practice, history of career breaks, aspects of clinical practice and job satisfaction
were collected.
Results: A response rate of 77 per cent was achieved. A total of 94.0 per cent of hygienists were currently working as a
dental hygienist, working an average of 28.7 hours per week. Younger hygienists worked longer hours than their older
colleagues. Career breaks were common, with 44.8 per cent reporting a career break of greater than one month,
predominantly for child rearing, with a mean career break of 20.1 months. Hygienists reported a high level of satisfaction
with most aspects of their employment.
Conclusions: Victorian hygienists worked predominantly in private practices in metropolitan Melbourne, providing a range
of preventive and periodontal services. Understanding the working patterns of dental hygienists is critical as hygienist
numbers expand in the future, in order to undertake thorough evidence-based workforce planning.
Key words: Dental hygienist, employment, career satisfaction, workforce.
(Accepted for publication 27 June 2007.)

for dental services and the ability of the current oral

INTRODUCTION
The dental hygiene profession was introduced in
Australia in 1975, coinciding with an increasing
recognition of the importance of prevention in the
management of dental diseases.1 Australian hygienists
have traditionally focused on the management of
periodontal disease as well as the prevention of dental
diseases, and their scope of practice has been tightly
regulated, with prescription and supervision as key
elements of hygiene practice. Recently, dental hygiene
education has moved from two-year diploma courses to
three-year baccalaureate degrees in many Australian
universities, and is now often combined with dental
therapy education to produce graduates with qualifica-
tions and skills in both of these fields.
There has been an unprecedented demand for the
employment of dental hygienists in recent times in
Australia,1 and there is an expanding body of research
highlighting a growing disparity between the demand
ª 2008 Australian Dental Association
health workforce to meet this demand.2–4 This has led
to predictions of a shortage of approximately 1500
dental providers by 2010. Four new training pro-
grammes for dental hygienists have been established
since 2004. Equitable access to dental hygiene services
has also been a concern in Australia, particularly in
regional and rural areas and also for patients eligible for
subsidized public dental services.1
Whilst there were only 107 dental hygienists com-
prising just 3.9 per cent of the Victorian oral health
workforce in 2000, this had nearly doubled to 194
hygienists (5.6 per cent of the oral health workforce) by
2006.5 By 2010 there will be up to 60 dental hygienists
graduating annually in Victoria. Dental hygienists are
now the fastest growing category of the oral health
workforce in Australia, with hygienist numbers pro-
jected to increase 28.9 per cent between 2000 and 2010
compared with only a 13.9 per cent increase for
dentists.3 In Victoria, the ratio of dental hygienists to
61
M Hopcraft et al.
general dentists was 1:13 in 2005, considerably lower
than a ratio of 1:1 reported for the United States,
Canada and Japan.6
Internationally, females dominate the profession of
dental hygiene, and this is also true of Australian
hygienists.7–9 In Australia, the majority of practising
hygienists work part-time (71.0 per cent) and in the
private sector (71.5 per cent).3 Furthermore, more than
one in five hygienists work in specialist dental practices
and only 3.4 per cent work in public hospitals or public
community dental clinics. In the United Kingdom, half
of the dental hygienists worked part-time, and career
breaks were common, predominantly for child rearing.8
Job satisfaction was high with a strong work focus on
provision of preventive services and dental health
education. Several studies have also shown that a small
percentage of dental hygienists occasionally undertook
clinical duties outside their legally permitted scope of
practice.8,10 Although one-third of British dental
hygienists believed that they were regarded as an easy
way of improving practice revenue for their employer,
most felt that their employer appreciated their skills.11
Indeed, 73 per cent of dentists thought dental hygienists
had important roles to play in preventive dentistry.
Recent research in Australia has highlighted a growing
disparity between the demand for dental services and the
ability of the oral health workforce to supply these
services.2 One of the options that has been considered
both in Australia and in New Zealand to improve access
to dental services is expanding the scope of practice of
dental hygienists and dental therapists.12 Expanding the
scope of practice is advocated by hygienists in Canada,
but there is strong opposition from dentists who believe
that hygienists are not adequately trained to practise
independently.13 Australian regulations for dental
hygienists are more restrictive than in other countries,
and in Victoria dental hygienists are required to work
within the context of an overall treatment plan under-
taken by a dentist. Hygienists are able to practise
independently in Denmark, Sweden, the Netherlands
and some parts of the United States.14 Models of care
allowing direct access to dental hygienists for disadvan-
taged populations are also common in the United States.
Understanding the current dental hygienist workforce
is essential in order to plan effectively for the future
delivery of dental services in Victoria. The aim of this
study was to investigate the working patterns, employ-
ment characteristics, job satisfaction and scope of
practice of dental hygienists currently registered in
Victoria.
METHODS
There were 179 dental hygienists registered with the
Dental Practice Board of Victoria (DPBV) on 30 June
2005. A list of practice addresses was obtained from the
62
DPBV. Practitioners with an interstate or overseas
address were excluded from the sample. A random
sample of 100 dental hygienists was selected for the
study. A questionnaire was mailed out to subjects, with
a plain language statement and self-addressed reply
paid envelope to return the questionnaire. A second
mail-out to non-responders was undertaken approxi-
mately six weeks after the initial mail-out.15
The questionnaire asked for basic socio-demographic
data, dental practice demographics, attitudes towards
the employment and scope of practice of hygienists,
clinical duties performed and employment conditions,
and was based on similar studies conducted by other
researchers.7–11
The data from the surveys was entered into a
spreadsheet, and transferred to SPSS v.14.0 for analysis.
The University of Melbourne Human Research Ethics
Committee approved the study, and participation
was voluntary. The project was supported by the
Dental HygienistsÕ Association of Australia (Victorian
Branch) Inc.
RESULTS
A total of 67 questionnaires were returned completed
and 13 questionnaires were returned as being undeliv-
erable (incorrect address, practitioner no longer at that
address or on holiday), giving an overall response rate
of 77 per cent. The dental hygiene profession was
predominantly female, and the average age of respon-
dents was 36.7 years (Table 1). Ninety-four per cent of
the respondents were currently working as a dental
hygienist. Nearly two-thirds of hygienists worked at a
single practice location only, and most respondents
worked in private general dental practice. Only three
hygienists reported working in the public sector (two as
sessional clinical demonstrators at university). Most
hygienists worked in metropolitan Melbourne, while
only 12.1 per cent in rural areas. Hygienists who were
working in regional and rural areas were predomi-
nantly working in private dental practices, with only
three hygienists working in specialist practices in
regional and rural locations.
Dental hygienists worked an average of 28.7 hours
per week, with hygienists aged 20–29 years working
significantly more hours per week than hygienists aged
over 30 years (t = 2.11, p = 0.039). Twenty per cent of
hygienists worked less than 16 hours per week, and
only 42.1 per cent worked more than 33 hours per
week. Hygienists who had children reported working
only 25.0 hours per week, significantly fewer hours
than hygienists without children who worked
32.0 hours per week (ANOVA F = 8.415, p = 0.005).
Just over one-third of hygienists reported that they
work with a dental assistant for all patients, while
28.3 per cent never work with a dental assistant.
ª 2008 Australian Dental Association
 Working practices and job satisfaction of hygienists

Table 1. Demographic profile of respondents

Age group

20–29 yrs 30–39 yrs 40–49 yrs 50+ yrs Total

(n = 19) (n = 26) (n = 17) (n = 5) (n = 67)

Male (%) 5.3 7.7 0.0 0.0 4.5

Have children (%)(a) 0.0 65.4 82.4 80.0 53.0
Currently working as a dental hygienist (%) 94.7 92.3 94.1 100.0 94.0
Number of practice locations
One 72.2 57.9 52.9 60.0 61.0
Two or more 27.8 42.1 47.1 40.0 39.0
Current employer(b)
Private dental practice 83.3 94.7 94.1 100.0 91.5
Periodontist 11.1 10.5 17.6 0.0 11.9
Orthodontist 22.2 15.8 17.6 0.0 16.9
Public practice ⁄ teaching 11.1 0.0 5.9 0.0 8.5
Location of main dental practice
Melbourne 82.4 55.0 81.3 80.0 72.4
Regional Victoria 11.8 20.0 12.5 20.0 15.5
Rural Victoria 5.9 25.0 6.3 0.0 12.1
Hours worked per week
Mean (SD) 32.8 (9.3) 28.1 (10.6) 26.3 (9.3) 25.2 (7.8) 28.7 (9.8)
Work with a dental assistant at main practice
Never 16.7 35.0 35.3 20.0 28.3
Sometimes 27.8 40.0 29.4 40.0 33.3
All patients 55.6 25.0 35.3 40.0 38.3
(a) 2
v = 28.50, p < 0.001.
(b)
Some hygienists had more than one employer.

Hygienists who worked in orthodontic practices were (Table 3). Illness and financial problems were not
more likely to work with a dental assistant for all reported as frequent reasons for taking an extended
patients (80.0 per cent), compared with hygienists in career break.
general practice (32.8 per cent), while 57.1 per cent of Hygienists were generally very satisfied with various
hygienists in periodontal practice never work with a aspects of their employment when rating satisfaction on
dental assistant (v2 = 11.47, p = 0.022). a 10-point scale (1 – minimum satisfaction and 10 –
Hygienists were generally well remunerated, with maximum satisfaction) as shown in Table 4. Only
62.5 per cent earning more than $50 000 per year 3.0 per cent of hygienists reported a satisfaction score
(Table 2). Annual remuneration increased with increas- of 5 or less. Hygienists were least satisfied with their
ing hours worked per week. The method of remuner- remuneration and most satisfied with the location of
ation varied, with 79.3 per cent of hygienists paid an their practice. Hygienists who worked 17–32 hours per
hourly rate (mean $43 per hour, range $32–60 per week had the highest level of overall job satisfaction
hour), 13.8 per cent paid an annual salary and 6.9 per (9.00), significantly higher than hygienists who worked
cent paid on a commission basis (range 40–50 per cent). less than 16 hours per week (7.82) (ANOVA F = 3.54,
Career breaks of more than one month were p = 0.036). Younger hygienists aged 20–29 years were
common particularly for child rearing, with older more dissatisfied with their role and scope of clini-
hygienists having had significantly longer career breaks cal practice (7.32) than older hygienists (9.50), and
this difference was statistically significant (ANOVA
F = 2.95, p = 0.040). Older hygienists were also more
Table 2. Dental hygienist annual remuneration by satisfied with their working hours compared to the
average hours worked per week younger hygienists (ANOVA F = 2.76, p = 0.050).
The most commonly performed clinical procedures
Hours per week
undertaken by dental hygienists were oral hygiene
<16 17–32 >33 Total instruction, scaling and root planing and periodontal
Annual remuneration (a) charting (Table 5). A small but significant number of
<$40 000 9 3 0 12 hygienists indicated performing clinical procedures not
$40–60 000 2 12 5 19 currently permitted in Victoria, such as tooth whitening
$60–80 000 0 6 11 17
$80 000+ 0 1 8 9
and emergency treatment, although these procedures
are allowed in some other states in Australia. Some
Total 11 22 24 57
hygienists were undertaking dental hygiene treatment
(a) 2
v = 43.341, p < 0.001. planning which was also not permitted by the DPBV.
ª 2008 Australian Dental Association 63
M Hopcraft et al.

Table 3. Reasons and lengths of time for a career break for hygienists (%)
Age group

20–29 yrs 30–39 yrs 40–49 yrs 50+ yrs Total

(n = 19) (n = 26) (n = 17) (n = 5) (n = 67)

Taken an extended career break (%) 36.8 65.4 52.9 80.0 55.2
Mean total career break time – months(a) 3.1 13.7 34.2 45.0 20.1
Reasons for extended break (%)
Child rearing 0.0 53.8 35.3 60.0 34.3
Travelling 31.6 23.1 5.9 40.0 22.4
Another career 0.0 3.8 17.6 20.0 7.5
(a)
p = 0.027 (ANOVA, F = 3.48).

Table 4. Mean satisfaction with aspects of employment of hygienist (1 – minimum satisfaction and 10 – maximum
satisfaction)
N Employment Remuneration Scope of Working Workload Location of Overall job
conditions practice hours practice satisfaction

Age
20–29 yrs 19 8.00 7.89 7.32 7.47 7.32 8.11 8.26
30–39 yrs 25 8.00 7.84 7.96 8.84 8.32 8.88 8.68
40–49 yrs 17 8.29 7.82 8.35 8.41 8.59 8.47 8.35
50+ yrs 4 8.25 7.00 9.50 9.50 8.00 8.75 9.00
Total 65 8.09 7.80 7.97 8.37 8.08 8.54 8.49
Hours worked per week
<16 hours 11 8.18 7.55 7.73 8.82 8.73 9.45 7.82
17–32 hours 22 8.36 7.91 8.55 8.59 8.36 8.41 9.00
33+ hours 25 8.12 8.04 7.84 7.96 7.92 8.16 8.56
Total 58 8.22 7.90 8.09 8.36 8.24 8.50 8.59
Annual remuneration
<$40,000 15 8.00 7.67 8.07 8.80 8.60 9.07 8.53
$40–60,000 21 8.33 7.48 8.33 8.52 8.29 8.33 8.52
$60–80,000 18 7.83 7.67 7.72 7.83 7.06 8.39 8.56
$80,000+ 9 8.56 8.89 8.00 8.22 8.33 8.11 8.67
Total 63 8.14 7.78 8.05 8.35 8.02 8.49 8.56

Table 5. Type and frequency of dental services initially sampled. Not all of the respondents supplied
provided by hygienists (%) answers to all of the questions. Based on a comparison
Regularly Occasionally Never
of age and gender characteristics of dental hygienists
(%) (%) (%) registered with the DPBV, this sample appears to
be representative of dental hygienists registered in
Fissure sealants 20.3 43.8 35.9
Fluoride application 52.3 38.5 9.2 Victoria.
Oral hygiene education 100.0 0.0 0.0 The Victorian dental hygienist workforce is predom-
Polishing restorations 7.7 70.8 21.5 inantly female, and this gender profile mirrors the
Taking radiographs 62.1 22.7 15.2
Suture ⁄ pack removal 6.1 28.8 65.2 workforce in both the United Kingdom and New
Scaling and root planning 97.0 3.0 0.0 Zealand.8,12 The mean age of Victorian hygienists
Removing orthodontic wires ⁄ bands 21.2 10.6 68.2 was 36.7 years, compared with 37.7 years in New
Taking impressions 56.1 36.4 7.6
Local anaesthesia 44.0 28.8 27.3 Zealand and 38 years in the United Kingdom.8,12
Community periodontal index 38.5 21.5 40.0 Victorian hygienists had a similar pattern of career
Dietary counselling 53.7 42.3 0.0 breaks as New Zealand dental hygienists, although the
Clinical photography 22.7 25.8 51.5
Emergency treatment 1.5 19.7 78.8 mean total career break time in New Zealand was
without dentistsÕ prescription 42.7 months, compared with only 20.1 months in
Initial oral examination 6.1 28.8 65.2 Victoria.12
Consult with dentist 71.2 25.8 3.0
regarding patient management More than half of the hygienists worked less than
Complete periodontal charting 80.6 14.9 4.5 32 hours per week, although younger hygienists
worked longer hours than older hygienists. This part-
time participation in the workforce is consistent with
DISCUSSION
the findings from other studies of dental hygienists
The response rate for the survey was acceptable when internationally.8,10,12,16 Victorian hygienists worked on
adjusted for the number of uncontactable hygienists average fewer hours per week (28.7) than their New
64 ª 2008 Australian Dental Association

Zealand counterparts (30.4),12 but more than South
Australian hygienists (25.8).17 Child rearing had sig-
nificant impact on the mean hours worked, and this is
also consistent with findings from other studies.8,12 The
predominantly part-time nature of dental hygiene
practice, particularly as it relates to child rearing, has
important implications for workforce planning and
the supply of dental services by the dental hygiene
workforce.
The majority of hygienists reported working in
general practices in Melbourne, with less than one-
third working in specialist periodontal and orthodontic
practices, and even fewer working in regional and rural
Victoria. This is consistent with national data for
Australia, which shows a practising rate of hygienists
per 100 000 population of 3.8 for major cities, 1.2 for
inner regional areas and 0.9 for outer regional areas.7
There was an extremely low participation rate of
Victorian dental hygienists in the public sector. Reasons
for this lack of engagement with public dental hygiene
practice were not investigated in this study, however
the low participation rate is a major concern for the
equitable provision of dental hygiene services. It is
important to understand why hygienists are predomi-
nantly employed in private practice, and what barriers
exist for the employment of dental hygienists in the
public sector. In Australia, dental therapists have
traditionally been the preferred option for the public
sector since they are able to provide restorative dental
services, and this has previously met the perceived needs
of the community. Conversely, private practitioners
have embraced the preventive services provided by
dental hygienists, and incorporated this into their
practices. This model of care should be further inves-
tigated for the public sector. Given that nearly one-third
of the Victorian population is eligible for public dental
services,4 with a high prevalence of periodontal disease
and a requirement for preventive services in this
group,18,19 there is clearly a need for the greater
provision of periodontal and preventive services in the
public sector, a role perfectly suited to the dental
hygienist. The high remuneration reported by many
hygienists may be a contributing factor in the low
participation rate in the public sector, where salaries
are generally lower than those in the private sector.
The majority of hygienists expressed a high level of
job satisfaction compared to their counterparts in the
United Kingdom.8 Victorian hygienists were generally
satisfied with their location of practice, working hours
and workload, while employment conditions, remuner-
ation and scope of practice were ranked lower in their
satisfaction scale. Older hygienists were more satisfied
with their working hours and clinical scope of practice
than their younger counterparts. This may be a
reflection of selection bias, since hygienists who are
dissatisfied are more likely to cease employment as a
ª 2008 Australian Dental Association
Working practices and job satisfaction of hygienists
hygienist.8,12 Younger hygienists may also be more
interested in increasing their scope of practice and
gaining greater professional recognition than their older
colleagues.
A small but significant number of hygienists were
performing clinical procedures not currently permitted
in Victoria, such as tooth whitening and emergency
treatment. This may indicate a lack of understanding
of the scope of practice by the employing dentists or
the hygienists, a factor that was not fully explor-
ed. These findings may suggest a demand for an
expansion of scope of practice into these areas of
dental practice.
CONCLUSIONS
There has been no previous research investigating
dental hygienists in Victoria, and this study has
provided a valuable insight into their practice. This
research highlights the strong contribution hygienists
make to the provision of dental care in Victoria,
providing primarily periodontal and preventive dental
services. Dental hygienists are predominantly engaged
in part-time employment in private practices located
in metropolitan Melbourne. In coming years, dental
workforce shortages will require dental hygienists to
play a bigger role in the provision of dental services.
The increased utilization of dental hygienists as part of
the dental team has been clearly recognized as an
approach to improve both dental service delivery and
access to appropriate dental care, and the disparity
between supply and demand will intensify pressure to
expand the scope of practice for dental hygienists. The
increase in the number of dental hygienists currently
being educated in Victoria and across Australia will
also influence the contribution of dental hygienists to
the provision of dental services.
ACKNOWLEDGEMENTS
The authors wish to acknowledge the Dental Hygien-
istsÕ Association of Australia (Victorian Branch) Inc for
its financial support of this research. The work
described in this paper was supported by the Cooper-
ative Research Centre for Oral Health Sciences (CRC-
OHS). The CRC-OHSs activities are funded by the
Australian GovernmentÕs Cooperative Research Centres
program.
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Address for correspondence:
Dr Matthew Hopcraft
Senior Lecturer
School of Dental Science
The University of Melbourne
Melbourne, Victoria 3010
Email: m.hopcraft@unimelb.edu.au
ª 2008 Australian Dental Association