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We sought to characterize the work environment and identify factors that influence the occupational health of dental hygienists.We conducted a qualitative analysis of dental hygiene work based on five national focus groups.We found that musculoskeletal symptoms are common, particularly after 10 years; common ergonomic problems included instruments and chairs. Important nonphysical workplace problems include role ambiguity (eg, employee vs. independent practitioner), inadequate recognition, role identity (eg, distinction from dental assistants), role conflict (eg, with dentists and spousal office managers), and social isolation.Work organizational factors (eg, frequent part-time work, inadequate breaks, perception as a “second team” distinct from the dentist and dental-assistant team) impede the remediation of ergonomics and other problems. Job flexibility encourages hygienists to change work hours or location rather than deal with work conditions. Occupational health interventions should address social environment and work organization.