PTO and Paid Sick Leave Rules for Dental Offices

The federal floor for paid time off is zero.

Federal law does not require employers to pay for time not worked — vacations, sick leave and holidays are matters of agreement between you and your employees, according to the Department of Labor.

Whatever paid time your staff receive beyond a state mandate is there because your policy, offer letter or handbook promises it.

Paid sick leave is the same story federally: there is currently no federal legal requirement for paid sick leave.

The nearest federal rule is unpaid — employers covered by the Family and Medical Leave Act must provide up to 12 weeks of unpaid leave for certain medical situations.

One coverage test is head count: the FMLA covers private employers with 50 or more employees for each working day in 20 or more calendar workweeks in the current or preceding calendar year, so a practice below that head count falls outside it.

Zero required does not mean zero offered.

In March 2026, among private-industry workers at establishments with 1 to 49 workers, 75% had paid sick leave, 71% had paid vacation and 73% had paid holidays (BLS).

In the health care and social assistance industry group — broader than dental care — 87% had paid sick leave, 82% paid vacation and 84% paid holidays.

An offer with no paid time at all is in the minority on those numbers, and the state mandates below make zero impossible in the states they cover.

Paid sick leave is where state law starts to bind.

Each rule below was checked against statute text or official state guidance as of this guide's October 2026 check, and the accrual rates, annual caps, carryover rules and employer-size thresholds differ state by state.

If your state is not in the table, do not assume you are exempt — check with your state labor department before you finalize a policy.

Employer size changes the answer in New York, Massachusetts, Oregon, Arizona, Michigan and Nebraska —the difference between a paid floor, an unpaid floor and a lower cap can turn on whether you are at 4, 6, 10, 11 or 15 employees.

The laws also carry notice, records and usage rules of their own that this table does not reproduce, so read your state's official guidance or have employment counsel review your policy before you rely on it.

And re-check each year: Missouri's 2025 repeal shows how fast these mandates move.

Merging vacation and sick time into one PTO bank is tempting because it is simpler to run — no arguing over whether a day home with a sick child is sick or personal.

The structure has legal consequences that differ by state, and California is the clearest example in this guide's sources.

California's Labor Commissioner treats a combined PTO bank like vacation: it vests as earned, cannot be forfeited, can be capped, and must be paid out at separation.

That last item is the trap for practices that merge sick leave into PTO there.

Separately, California lets you cap paid sick leave accrual at 80 hours or 10 days — but a bank the policy calls PTO carries vacation's rules with it, so every unused hour in the merged bank becomes money owed when the employee leaves.

Outside California, this guide's sources do not settle how a merged bank is treated versus separate banks, state by state — confirm the question with your state labor department before you merge.

Whatever structure you pick, the state minimums in the table above are amounts of sick time employees must be able to take — confirm with your state labor department that the bank structure you choose delivers them.

Accrued vacation payout is the most expensive thing on this page, because in some jurisdictions the balance converts to wages on the way out the door.

California is explicit: there is no legal requirement to provide vacation at all, but if you do, earned vacation is wages that vest as worked and cannot be forfeited, and all earned, unused vacation must be paid at the employee's final rate of pay at separation (Labor Code 227.3).

Two California corollaries shape policy design there.

A use-it-or-lose-it vacation policy is illegal under California law, while a reasonable cap that stops further accrual is allowed.

And a combined PTO bank is treated like vacation, so it is owed at separation too — merging the banks in California converts what might have been a year-end reset into a payout on every exit.

Illinois reaches a similar result by statute: if a contract or policy provides paid vacation, all earned, unused vacation must be paid at the final rate of pay at separation, and no employment contract or policy may provide for forfeiture of earned vacation upon separation (820 ILCS 115/5).

Massachusetts counts holiday or vacation payments due under an oral or written agreement as wages, while its earned sick time law says employers need not pay out unused earned sick time at separation.

Outside these states, this guide's sources do not settle the question either way — check your state labor department before assuming an accrued vacation balance is forfeited or owed at exit.

Then mind the clock on the payment itself: federal law does not require you to give a former employee their final paycheck immediately, and per the Department of Labor some states may require immediate payment.

Know your state's final-pay timing before a separation happens, not after.

Deciding to close for a week between Christmas and New Year — or for a conference, or a slow summer stretch — raises two questions: who keeps pay, and what happens to their banks.

Federally, nothing forces holiday pay: federal law does not require payment for time not worked, including federal or other holidays.

Whether a closed day is paid, and whether it draws down PTO or sits unpaid, is whatever your policy says — subject to whatever your state adds on top.

The salary rule is the one that bites.

You cannot dock an exempt employee's salary because you closed the office or had no work available — deductions for absences occasioned by the employer or by the operating requirements of the business mean the employee is not paid on a salary basis.

For an exempt office manager, a closure day in a week they otherwise work cannot come out of that week's salary.

Whether you can require exempt staff to use accrued PTO to cover a closure was not settled by this guide's sources — put the question to employment counsel before you try it.

For hourly staff, a closure day is a decision, not a mandate: unpaid, or drawn from PTO if your policy says so and state law allows.

Decide it once, write it down, and apply it the same way every closure — the consistency is what makes the policy hold up.

A PTO policy is a short list of decisions, and your state's mandates decide a number of them for you.

Work them in this order:

• One bank or two. Separate vacation and sick banks, or a merged PTO bank? Re-read the California trap above before you merge.
• Accrual or front-load. Under Illinois' law, employers that front-load the full 40 hours need not carry over unused leave — front-loading ends the carryover question there; hour-based accrual tracks time actually worked, which matters for part-time staff.
• The rate. Match or beat your state's accrual floor from the table above — 1 hour per 30 hours worked in New York, Massachusetts, Oregon, Colorado, New Jersey, Minnesota, Michigan, Arizona and Nebraska; 1 hour per 40 in Washington and Illinois; California's floor is stated as at least 40 hours or 5 days a year.
• Caps. California lets you cap paid sick leave accrual at 80 hours or 10 days, and Minnesota lets you cap the total balance at 80 hours unless the employer agrees to more; in California, a reasonable vacation accrual cap is the allowed alternative to a use-it-or-lose-it policy, which is illegal.
• Carryover. State rules differ — Colorado allows up to 48 unused hours to carry over; Massachusetts allows up to 40 hours to carry over while use stays capped at 40 hours a year.
• Rehires. California requires restoring accrued, unused sick leave when an employee returns within 12 months of separation.
• Separation. Pay out whatever your state owes — in California and Illinois, earned unused vacation at the final rate of pay — and write the rule into the policy so payroll never improvises on exit day.

Then hold the line: apply the policy identically across hygienists, assistants and front-office staff, and re-check it against your state's current law every year — Missouri's 2025 repeal shows how fast this landscape moves.

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