Employment Law Issues for Dental Practice Owners

Employment Structure in Dental Practices

Dental practices face distinctive employment challenges due to their unique workforce composition, which typically includes dentists (who may be associates, partners, or independent contractors), dental hygienists, dental assistants, office managers, and front desk staff. The practice structure—sole proprietorship, partnership, or corporate entity—affects employment obligations and liability.

One of the most common issues is the classification of associate dentists. While many practices structure associate relationships as independent contractor arrangements, this classification must withstand scrutiny under IRS guidelines and state law. The degree of control the practice exercises over the associate's schedule, patients, fees, and methods of treatment often points toward an employment relationship.

Dental Hygienist Classification

The classification of dental hygienists varies by state. Most states require hygienists to work under the supervision of a licensed dentist, which strongly suggests employee status. Some states have expanded scope-of-practice laws allowing hygienists to practice more independently, but the classification analysis remains fact-specific.

Dental practice owners should ensure that hygienists are properly classified as W-2 employees when the practice controls the manner and means of their work. Misclassifying hygienists as independent contractors can result in liability for unpaid employment taxes, wage and hour violations, and penalties from the IRS and state agencies.

OSHA Compliance for Dental Offices

Dental practices must comply with OSHA's Bloodborne Pathogens Standard (29 CFR 1910.1030), which requires a written Exposure Control Plan, universal precautions, engineering and work practice controls, personal protective equipment, hepatitis B vaccinations for exposed employees, and post-exposure evaluation and follow-up.

OSHA's Hazard Communication Standard also applies, requiring dental practices to maintain Safety Data Sheets for chemicals used in the practice, such as dental materials, sterilization chemicals, and cleaning agents. Annual training on these standards is required for all employees with potential exposure.

Wage and Hour Considerations

Dental practices often employ a mix of salaried and hourly workers. Front desk staff and dental assistants are typically non-exempt employees entitled to minimum wage and overtime pay. Office managers may qualify for the administrative exemption if they exercise discretion and independent judgment on significant matters and meet the salary threshold.

Paying dental hygienists on a daily rate or per-patient basis can create overtime compliance issues if the arrangement does not properly account for hours exceeding 40 in a workweek. Practices should ensure that all compensation arrangements comply with FLSA and applicable state wage and hour laws.

Associate Dentist Agreements

Whether structured as employment or independent contractor agreements, associate dentist arrangements should address compensation structure, restrictive covenants, patient record ownership, malpractice insurance obligations, scheduling, and termination provisions. Non-compete clauses for associate dentists are subject to the same state law restrictions that apply to other employment relationships and must be reasonable in scope, duration, and geographic area to be enforceable.