How To · 6 min read
Hygiene should generate 30% to 40% of your net production. It is a revenue number, and reading it as a cost number is how owners end up cutting the wrong thing.
Hygiene should generate 30% to 40% of your practice's net production. That is the benchmark, and it answers a different question than the one most owners ask about hygiene.
Most owners see their hygiene department as a cost. It shows up as the largest hourly wages in the building, and the instinct when it feels heavy is to look at the schedule and the pay. But hygiene is a revenue department, and this is the number that says whether it is carrying its share. Here is what a healthy share looks like, how to calculate it without picking a fight with your own report, and what it means when it slips.
Hygiene should produce 30% to 40% of total net production. That range comes from the practice benchmarking published by the Academy of Dental CPAs and the National Society of Certified Healthcare Business Consultants.
You will see other ranges published, and most of them are not disagreements. Writing in Dental Economics, Dianne Glasscoe Watterson puts hygiene at 25% to 35% of gross practice production. Gross production is a bigger denominator than net, because net has already had contractual adjustments and write-offs taken out of it. A share quoted against gross reads low against a share quoted against net. Same department, same dollars, different base.
That is worth internalizing beyond this one figure. Before you conclude that a benchmark you read somewhere contradicts the one you use, check what it is divided by. Most of the disagreement in published dental benchmarks is denominator disagreement wearing a costume.
We use net production here, because that is the base every other line on your profit and loss uses. You can check this share alongside your staffing and overhead ratios in our free Dental Practice Benchmark Scorecard, which takes about two minutes.
The formula is short:
Hygiene net production ÷ TOTAL net production, for the same period.
Take the practice from our hygiene labor percentage post. One month, two hygienists, nothing unusual.
| Total net production for the practice | $150,000 |
| Of which, hygiene produced | $48,000 |
$48,000 ÷ $150,000 = 32%. Inside the band, toward the lower half.
This is the part that quietly decides your answer, and almost nobody makes the decision on purpose.
There are two defensible ways to attribute production to hygiene, and your practice management software will happily give you both.
They do not agree. A periodic exam performed by the doctor inside a hygiene appointment lands on the doctor under the provider axis and inside hygiene under the procedure axis. Radiographs, fluoride and sealants move the same way depending on who is holding the handpiece that day. Two practices with identical schedules can report hygiene shares four or five points apart on this choice alone.
Neither axis is wrong. They answer different questions. The provider axis asks whether your hygienists are generating enough, which is the question you want when you are assessing the department as a business unit. The procedure axis asks how much of your revenue is preventive, which is the question you want when you are assessing the practice's revenue mix.
A department that appears to improve four points between the first quarter and the second because somebody ran a different report has not improved at all, and you will spend a management meeting congratulating a change that did not happen.
A single month is noisy. Hygiene runs on a fixed weekly rhythm and the doctor's schedule does not, so one heavy crown and bridge month pushes hygiene's share down without anything happening in hygiene at all. Read it on a trailing three month and trailing twelve month basis, against the band and against your own history.
Hygiene share is a fraction, and a fraction can move for reasons that have nothing to do with the thing you are measuring. Before you take the number to your hygiene team, work out which half moved.
If the denominator grew, your hygiene share fell because the doctor produced more. That is a good month wearing a bad number. Say your doctor's production climbs $30,000 while hygiene holds flat at $48,000. Total goes to $180,000, hygiene share drops from 32% to 27%, and the department that just got flagged did nothing at all. This is the single most common false alarm on this metric, and it is why the figure never gets read alone.
If the numerator shrank, hygiene genuinely produced less, and there are only a few reasons why:
Those four causes reduce to three levers, and they are not equally hard to pull.
Scheduling is the fastest. Filling existing open columns costs nothing but attention and moves the number in one cycle. Before you consider adding a hygiene day, look at what percentage of your current hygiene hours actually got used last month. Most practices with a hygiene share problem have unused capacity they are already paying for.
Case acceptance is the highest ceiling. This is the hygienist's role in doctor production, and it does not show up in hygiene's own column at all. A hygiene department that consistently hands off diagnosed treatment is generating doctor production it never gets credit for, which is one more reason not to judge the department on this figure alone.
The periodontal program is the most durable. It changes the mix of what hygiene does rather than how many hours it works, so it lifts production per hour instead of adding cost. It is also the slowest, because it requires consistent diagnosis and a team that believes in it.
Reprice before you restructure. If your hygiene fees are below market, everything above is being measured against a base that is too low, and no amount of scheduling discipline will fix arithmetic.
Hygiene sits on the practice KPI scorecard as three lines, not one, and this is the middle one.
Read together they usually make the diagnosis obvious in about a minute. Share low and productivity low is an empty column, and that is a scheduling problem. Share low and productivity healthy is usually a doctor-side story, not a hygiene one. Share healthy and staffing cost high is a wage and fee conversation. Any one of the three read alone will eventually point you at the wrong lever.
P.S. Reciprocity Accounting reports hygiene production the same way every month, so a change in the number means a change in the department and not a change in the report. See how we can help your practice.
30% to 40% of total net production. Ranges published against gross production run lower, commonly 25% to 35%, because gross is a larger denominator. Confirm the base before treating the two as a disagreement.
Either, as long as you never switch. The provider axis credits whoever performed the work and is the better read on the department as a business unit. The procedure axis credits the code regardless of who performed it and is the better read on your revenue mix. The two can differ by four or five points in the same practice on the same month.
Your doctor production grew. Hygiene share is a fraction, and a bigger denominator lowers it without anything happening in hygiene. Check the raw hygiene dollars against the prior period before treating a falling share as a hygiene problem.
Not automatically, and it is usually worth looking at. A share well above 40% most often means doctor production is soft rather than that hygiene is exceptional. Check whether the doctor's schedule has open time or whether diagnosed treatment is sitting unscheduled.
No, and this is the fairness problem with the metric. Treatment a hygienist diagnoses and hands off is recorded as doctor production. A hygiene department that is excellent at handoff can look average on its own share while lifting the practice significantly, which is why the department is never judged on this one figure.