Dental stress

Jo Bowen discusses ways to deal with modern-day dental stress and signs to show when it’s all getting too much.

Over the last 30 years a raft of stress research looking at all medical professionals finds those aged under 30 in these professions suffer the most. Young dentists are usually the ones on the steepest learning curves of professional development. They are likely to be at the frontline of any target pressurised service provision. Recent surveys looking at dentists’ health confirm well over half of them report detrimental levels of work-related stress including suicidal ideation and the syndrome of burnout (Br Dent J, 2019)

In this article I will look at commonly found negative stress factors that affect very many young dentists. I cover this from both an individual and wider system point of view. I then make suggestions as to what sort of help to get for stress including basic self help tools I find many overlook. My key message is that you should take action over any stress damage you experience. Your mental and physical health really does matter to you.

Causes of stress in dentists

I am often asked whether some dentists can’t cope with lots of stress. The false assumption here is that with a bit of ‘resilience training’ some weaker dentists can smile again and crack on with the job. This sort of viewpoint can be highly damaging. We need a more sophisticated understanding of the complexity of the contexts of stress at the outset of any understanding.

The reality is that all people – and that of course includes all young dentists – vary in their ability to deal with cumulative demands and life events for all sorts of reasons. Each person’s human life story and the demands on them develop differently over time. Examples will include physical and mental health problems, hormonal flux, ability to process strong emotions, trauma histories, access to healthy or supportive lifestyles, networks, communities and environments. Our ability to cope and adapt is made up of an interweave of social psychological and biological factors. Einstein’s famous quote comes to mind: ‘Life is like riding a bicycle. To keep your balance, you must keep moving.’

So let’s move on to consider what drives our stress at a whole system level that we work and live in. No doubt about it, the jobs young dentists do are significantly challenging for them all. New jobs away from friendship groups, onerous on calls, night shifts or covering for rota gaps can easily give rise to a sense of being out of control, tense or isolated. PG exams, regulatory demands and CV development (added value audits, research etc) also necessitate extra workload and angst.

‘Imposter syndrome’

Additional stresses come from the need to compete for jobs, sometimes against close peers. National recruitment (eg DCT) can mean moving around every year or ‘treading water’ until you land that coveted higher training place. Equally you may be facing a work culture where you don’t feel you can ever really do your very best – moral distress might be relevant here. Lots of complex cases in the community and practice management issues can also feel daunting. Dentists are frequently driven by self-critical demands, which then promote good surgical outcomes for their patients. However, this mindset has negative consequences if fired up by unrealistic targets and a lack of understanding from organisational systems. Some younger dentists – especially females I talk with – report the addition of the ‘imposter syndrome’.

Any time humans feel adversely judged they can feel shame and self-erosion. The growing healthcare complaints culture is increasingly unsettling. Being close to all sorts of physical or psychological pain is hard. Empathising with patient after patient can inevitably produce emotional overload and toxicity. If there is no reflective space built into the working day, and often no time for a decent lunch hour or coffee break, that is likely to be damaging. Clinicians can then easily tip into poor coping habits (addictions and poor eating habits for example) and drift into giving up protective immersion in hobbies, sports or socialising. A vicious cycle of stress and disempowerment begins to take its toll.

Then there’s the issues outside of work going wrong for us. When you are younger you may not be in a committed supporting relationship or you may be trying to start a family, you may be facing difficult break ups or first deaths or illness of family. You may be in debt. You may not yet be on the housing ladder like some of your peers or have lots of stressful commuting to do. Not all difficult stress at work is specifically due to work. Again, we need to see the whole picture to know how to counteract stress.

What to do about stress?

Dentists need to know about auditing their stress levels and self-help to try to catch stress effects early. We are talking about bad stress here because good stress – adequate challenge and new learning – is protective to any clinician. Develop a tool kit of things you find personally helpful. If you are in imminent danger of harming yourself get help very urgently through the emergency services, or see your GP urgently.

However when informal or self-care is insufficient, as it often may be, there are a large number of help resources available including from the BDA or the Practitioner Health Program. The GP, educational supervisor or OH may offer local help signposting. Remember with help ‘no one size fits all’. Importantly, you must be able to trust the counselling or other treatment mode you choose and develop more help for yourself as time moves on and you change.

There remains the question ‘how do I know I need more help?’ I recommend a period of regular tuning in once a week or so. Ask yourself: ‘So how am I feeling?’. Good advice may be to keep a check by rating overall wellness from 0-10 to track changes. Any rating of three or less should be a strong prompt to get urgent help.

What to look out for

What are the early signs to watch out for? Gauging feelings (either through our emotions or our bodies) can be a really important early signalling method for stress. Angry outbursts, frequent sighing, tiredness, tension headaches, GI irritability or startle responses are some of the signs, as is treating yourself or others badly and avoidance behaviours. Disrupted sleep habits. We are beginning to know much more about sleep as a deeply protective stress/trauma processing system now. So it is worth taking notice if you are sleeping poorly.

Others may have noted changes in you, try to listen to them too. Importantly, you can also help your peers who may be struggling. There’s a fashion for ‘deep listening’ now in medical education but all that really means is trying to use your whole self to perceive situations using your thinking, emotions and senses. Maybe allow people more than one chance to open up about a difficulty they have. Talking about distress does not promote the likelihood of self-harm and usually helps someone reduce their risk. Try always to be kind and compassionate. Consider the best ways to form trust in order to help both yourself and others.

Related to this, it is very important to understand the stigma of acknowledging weakness in dentistry. The fear of being seen as incompetent in any way leaves you in denial or very defensive. Look out for the #AndMe anti-stigma campaign. It is heartening how successful senior clinicians actively challenge stigmas, talking openly of their wellness journeys.

Getting the help you need

So, to recap, there’s lots of reasons you might feel stressed. You are not to blame yet you can play a strong part in looking out for what you feel and need. Check your stress regularly. Get help early. Don’t stay stuck and hurting. Remind yourself – this is for you, yourself and not only for your patients and career.

Top tips for stress self care

Seven-11 breathing (see Youtube for videos on method) – do this proactively and at first sign of stress
Creative visualisation safe place (rehearse a script to relax) – good for a 10-minute relaxation
Body muscular relaxation
Mindfulness
Good sleep – ‘beditation’ and sleep hygiene
Chat with friend/exercise/walk outside/hobby.

References

More than half of dentists say stress is affecting their practice. Br Dent J 226, 7 (2019)