Recent Studies reported in dental literature confirm that dentists are subject to a variety of stress-related physical and emotional problems.
These problems included an alarmingly high incidence of cardiovascular disease, ulcers, colitis, hypertension, lower back pain, eye strain, marital disharmony, alcoholism, drug addiction, mental depression and suicide.
STUDIES AND STATISTICS
* The suicide rate of dentists is more than twice the rate of the general population and almost three times higher than that of other white collar workers.
* Emotional illness ranks third in order of frequency of health problems amongst dentists, while in the general population it ranks tenth.
* Coronary disease and high blood pressure are over 25% more prevalent among dentists than in the general population.
* Dentists suffer psycho-neurotic disorders at a rate of 2 1/2 times greater than physicians.
* The #1 killer of dentists is stress-related cardiovascular disease.
* The dental profession in North America loses the numerical equivalent of one large dental school class each year.
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CAUSES OF STRESS
Why is our profession so prone to stress-related physical, mental and social problems? Since it is unfortunately too late for most of us to switch into law or engineering, at least we can examine some of the causes of stress in dental practice and then see if we can find some solutions to them and hopefully live a little longer and happier.
* Confinement
The average dentist spends most of his or her life confined to a small, sometimes windowless, 7ft. by 9ft. operatory, which is smaller than the cells in our penal institutions. The work is intricate and meticulous and is performed in a small, restricted oral space. The procedures are both physically and mentally taxing and as a result, strain, back troubles, circulatory disorders and fatigue are common. It is relatively easy, over a period of time, for a dentist to become both physically and emotionally “burned-out.”
* Isolation
Most dentists practice alone. Consequently they do not have the opportunity to share and solve problems with their colleagues the way other professional groups do through peer support.
The problem of isolation is compounded by the fact that dentists tend to be competitive with one another. This trait is unfortunately a bi-product of our competitive dental school training. It is then reinforced after graduation by the intense competition created by the surplus of dentists that now exists in many cities and large metropolitan areas.
* Stress of perfection
The relentless pursuit of perfection and permanence in an inhospitable oral environment is a major cause of stress and frustration for dentists. The stress of perfection is instilled in dental school. However, it must be tempered with the realization that the most perfect restoration will ultimately be rendered imperfect by time and patient neglect, despite the efforts of the dentist.
* Economic pressure
During the early part of his or her career, the typical dentist is paying off huge loans to cover the cost of dental school and the cost of setting up a private practice . These two figures can easily exceed $250,000. Once in practice, the dentist soon learns that office overhead rises to meet income. It often then surpasses it.
Economic pressure forces many dentists to work through their lunch — an hour that is the single most important period of the work day. Instead of using the time to get proper nourishment and much needed rest, he or she will often accommodate an additional patient or two. This inevitably leaves the dentist tired and exhausted by the end of the day.
Another result of the economic pressure of practice is that dentists often feel that they literally cannot afford to be sick or take holidays. When a dentist is absent from the office, the income totally stops, but the high overhead expenses continue to grow relentlessly.
The dentist who works all the time and never takes time off might make a few dollars more, but there is a high price to pay — BURNOUT! And when dentists burnout, they become emotionally and mentally exhausted, develop a negative, indifferent or cynical attitude towards both their patients and their staff, and evaluate themselves negatively.
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* Time pressures
Attempting to stay on schedule in a busy dental practice is a chronic source of stress. Dentistry, unfortunately, seems to be governed by Murphy’s Law — “If any thing can go wrong, it will go wrong and usually at the worst possible time.” Also, dentists often find that the first 90% of a complicated dental procedure takes 90% of the allotted time and the last 10% takes another 90%. And as we all know, once we are behind schedule there is no way to catch up.
* Compromise treatment frustration
A dentist spends four years in dental school learning perfection and “ideal” treatment for his or her future patients. Yet the realities of private practice are that many patients, due to financial restraints, poor insurance plans or low appreciation of quality dental care, will not accept “ideal” treatment plans. The result is that the dentist is continually forced to compromise treatment and is frustrated in not being able to reach his or her ideal treatment goals.
Consequently, the dentist is often forced to operate a “fix-and-repair” business, providing compromised treatment for patients who refuse the full spectrum of dental care. The dentist then ends up emotionally carrying the responsibility for less than ideal results while the patient continues to express unrealistic expectations.
* Patient anxiety
The psychological stress of working with apprehensive and fearful patients can be devastating to the dental practitioner. There is now considerable evidence that dentists experience patterns of physiological stress responses (increased heart rate, high blood pressure, sweating, etc.) that parallel the patient’s responses when performing dental procedures that evoke patient fear and anxiety. This in turn can lead to an early heart attack for the dentist.
* Dentist’s personality
Researchers are finding that many personality traits that characterize a good dentist are also traits that predispose to depression in mid-life, drug and alcohol abuse and the attendant risk of suicide. Among such traits are:
(1) compulsive attention to details;
(2) extreme conscientiousness;
(3) careful control of emotions;
(4) unrealistic expectations of himself or herself and others (i.e. employees and patients);
(5) a marked dependence on individual performance and prestige.
* Lack of exercise
The Pankey Institute in Miami evaluated the health of 2,400 dentists. It found that the dentist’s life was characterized by Dormancy, Degeneration and Stress (i.e. DDS). Also, dentists do not exercise enough to prevent progressive deterioration of connective tissue, small blood vessels, muscles and circulation in general.
MANAGING STRESS
Stress can never be totally eliminated from dental practice. However, it must be minimized as much as possible in order to avoid the many stress-related physical and emotional problems that it causes.
The key to managing stress successfully is to first recognize and understand its causes. Once the causes have been identified and understood, preventive steps can be taken.
Some of the preventive measures that could minimize the stress of dental practice are as follows:
* Improving the working environment at the office;
* Becoming less isolated and sharing problems with fellow practitioners;
* Wor
king more sensible hours and taking time each day for a leisurely lunch break;
* Taking holidays whenever the pressures of practice start to build;
* Learning how to better handle patient anxiety and hostility;
* Adopting a program of physical exercise, such as regular walking or working out at a local health club;
* Most important, being kinder to yourself and less critical and demanding of your efforts.
Courses on managing stress should be made available to all dentists and should also be included in the dental curriculum at our dental schools. If 99% of dental courses are now devoted to the patient’s health, couldn’t just 1% be devoted to the future health of the dentist?
REFERENCES
* ADA Bureau of Public Information News Release. Temple University School of Dentistry Study of dentist suicide rates, Jan. 31, 1997.
* Alexander RE. Stress-related suicide by dentists and other health care workers: fact or folklore? JADA 2001; 132:786-94.
* American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV). Washington: American Psychiatric Press; 1994.
* Atkinson JM, Millar K, Kay EJ, Blinkhorn AS. Stress in dental practice. Dent Update 1991; 18 (2):60-4
* Bourassa M, Baylard JF. Stress situations in dental practice. J Can Dent Assn 1994; 60:65-71.
* Blikhorn AS. Stress and the dental team: a qualitative investigation of the causes of stress in general dental practice. Dent Update 1992; 19:385-7.
* Bureau of Economic Research and Statistics. Mortality of dentists, 1968 to 1972. J.A.D.A., 90:195-198, 1975.
* Cooper, K.H., and Christen, A.G. Dentist, “Heal thysef”: Modification of life style. D.C.N.A., Vol 22, No.3, July 1978.
* Cooper C, Watts J, Kelly M. Job satisfaction, mental health, and job stressors among general dental practitioners in the UK. Br Dent J 1987; 162:77-81.
* Forrest, W. R. Stress and self-destructive behaviors of dentists. D.C.N.A., Vol 22, No 3, July 1978.
* Gale EN. Stress in dentistry. N Y State Dent J 1998; 64(8):30-4.
* Godwin W, Starks D, Green T, Koran A. Identification of sources of stress in practice by recent dental graduates. J Dent Educ 1981; 45:220-1.
* Humphris G. A review of burnout in dentists. Dent Update 1998; 25:392-6.
* Moore R, Brodsgaard I. Dentists’ perceived stress and its relation to perceptions about anxious patients. Community Dent Oral Epidemiol 2001;29:73-80.
* Newbury-Birch D, Lowry RJ, Kamali F. The changing patterns of drinking, illicit drug use, stress, anxiety and deptression in dental students in UK dental school: a longitudinal study. BR Dent J 2002; 192:646-9.
* Neilsen, N., and Polakoff, P. It hurts the dentist too. Job Safety and Health, 3:21-25, 1975.
* Occupational hazards of dentistry: speculations on dentists, stress and suicide. Dental Currents, Vol 8, Issue 2, Jan. 1977.
* Schaufeli W. Burnout. In: Firth-Cozens J, Payne RL, eds. Stress in health professionals: Psychological and oranisational causes and interviews. New York: Wiley; 1999:16-32.
* Simpson, J.C. Dentists grow richer but feel the pressure: suicide rate is high. Wll Street Journal, Dec. 17, 1976.
* Sword, R.O. Stress and suicide among dentists (two-part series). Dent. Surv., Mar.1977, pp.12-18, and Apr. 1977, pp.10-16.
* Wilson, RF, Coward PY, Capewell J, Laidler TL, Rigby AC, Shaw TJ. Perceived sources of occupational stress in general dental practitioners. BR Dent J 1998; 184:499-502.
Dr. Lang is an orthodontic lecturer at the University of Toronto and past president of the Ontario Association of Orthodontists. He maintains an orthodontic practice in Mississauga and Etobicoke, ON. Dr. Lang is co-chair of Oral Health’s editorial board.