Purpose: As life expectancy increases and interest in oral health increases, the opportunity to visit the dentist increases. To provide safe dental care for elderly patients and accurately identify their needs. We aim to understand the impact of knowledge, image, and empathy for the elderly on communication skills. Research design, data, and methodology: This study conducted an online survey using a convenience sample of 201 dental hygienists working in dental hospitals and clinics from October 4 to October 6, 2023. The purpose of the survey was explained and consent was obtained in the research consent form before being conducted. Results: Differences in knowledge, image, empathy, and communication skills among the elderly include age, clinical experience, need for elderly-related education, and confidence in oral care in elderly patients with systemic diseases (p<0.05, p<0.01, p<0.001). The factor affecting communication skills toward the elderly was empathy (t=15.416(0.000<sup>***</sup>)). Conclusions: Through this study, the communication skills with the elderly is a basic quality and attitude that dental hygienists must have. Therefore, it is essential to develop and implement empathy and communication skills training programs for dental hygienists, which can significantly contribute to fostering a positive trust-based relationship between elderly patients and dental professionals. This proactive measure is crucial in preparing for the upcoming era of an increasingly aged society.