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In Your Face: Facing the Realities of Stress in Dentistry by Jen Butler, MEd, BCC

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"You can't change what you don't acknowledge." Dr. Phil McGraw totes this principle to millions of viewers weekly. Regardless of how you feel about the psychologist/doctor/ weight loss expert/entertainer, those words ring very true in the area of stress management.

Most stress management experts, resiliency coaches and clinical researchers agree that the first step in changing the level of stress in your life is to figure out exactly where the stress is coming from. Until you fully complete that first step, managing your stress is as effective as throwing darts at a dart board, blindfolded, with your non-dominant hand while spinning.

Within this article we face the realities and answer some of the most common questions around stress in dentistry. The purpose is to acknowledge how vast and deep this issue goes, what problems it causes for dentists, and, ultimately, what we can do about it.

Question: How stressed are dentists?

There are a number of studies that have been conducted which look at the stress levels of dentists. Their methodologies are in the form of questionnaires and surveys so as to illicit the personal perspective of each dentist. The researchers' questions and surveys were dissimilar, which gives us an opportunity to acknowledge the issues from a variety of viewpoints. The findings, however, are very much the same.

Dentists experience moderate to severe stress levels at work consistently in each study. One study claims 82.7 percent of dentists experience moderate/severe stress and another study found the number to be closer to 86 percent.1, 2 There was no statistical difference between the number of female and male dentists and their perception of stress levels.

Question: What influences stress levels?

Through this literary review, it was evident there were some compelling influencers on the stress levels of respondents.

Position

There was a significant difference in the way sole, private practitioners felt about their job satisfaction as it related to stress and dentists self-identifying as employees. Of sole proprietors, 57.2 percent were very satisfied, while only 35.8 percent of employee dentists reported the same. When looking at responses of somewhat satisfied to unsatisfied, the proportion of dentists changed: 42.9 percent of sole proprietors marked these answers, and an overwhelming 64.2 percent of employee dentists.1

Sleep

Respondents who slept less than seven hours a night reported having more than twice as much severe stress levels at work than those getting more than seven hours of sleep (19.5 percent, 8.1 percent respectfully).1 Moderate stress levels were comparable between the two groups with 64.9 and 68.5 percent. Those who perceived their jobs the least stressful was with the group sleeping more than seven hours a night with 23.4 percent claiming light stress versus that of their tired counterparts at 15.6 percent.1,2,6 Of the dentists with moderate/severe stress levels, 21.4 percent of them also had difficulty sleeping or staying asleep.7

Hours Worked per Week

There was a correlation between the number of hours dentists worked and their stress levels. Dentists who reported a severe stress level worked on average 39.7 hours per week. Those claiming moderate stress levels worked an average of 36.2 hours per week and light stress was 31.9 hours.1

Feeling of Control

Feeling in control of their work environment was an influencer of perceived stressed levels and job satisfaction.1,7 Dentists who felt they usually had control over their work environment were either somewhat satisfied (50.5 percent) or unsatisfied (9.1 percent). Those responding with sometimes or rarely having control had higher perceived stress and lower job satisfaction with 54.4 percent somewhat satisfied and 29.6 percent unsatisfied.7

Question: What are the common stressors dentists experience?

Each dentist has his or her own stress triggers depending on the ability to resolve a situation and the number of tools and resources he or she can mobilize to create solutions. Keeping that in mind, there are several stress triggers that were common throughout each of the literary works. Here are the top five in order of stress level.1,7
  1. Time pressures
  2. Patient demands
  3. Uncooperative patients (children, fearful, nervous or militant)
  4. High levels of concentration and focus
  5. Team issues
On average, dentists experienced five to seven stress triggers each day.1,5 Those with moderate to severe stress had been affected by their stress to the point it interfered with their usual, daily activities five days a month.1 That is 60 days out of every year dentists are so impacted by their stress they disengage, cancel work days, don't have energy to lead their teams, miss opportunity for case acceptance and further isolate themselves in their offices.5,7

Question: How do dentists cope with their stress?

Exercise/Sports

As much as 53 percent of dentists said they were almost completely inactive during the day, after work 57 percent get some form of exercise or physical activity.1,2,5 More male (68 percent) than female dentists (51 percent) use exercise and sports as a means of coping with stress.5 Dentists who did exercise were significantly more likely to be owner doctors or sole proprietors with only 15 percent of employee dentists turning to exercise as a means of coping with stress.1 Just over 49 percent believe their level of physical activity is very likely to cause health problems in the future and 58 percent of respondents planned to make a change in their level of exercise over the next 12 months.2

Avoidance

The concept of putting your head in the sand or forgetting about work is a common coping method reported by dentists in each of the studies reviewed for this piece. One study found as much as 59 percent of dentists leave the office and forget about the day's events with 60 percent of males and 57 percent of females taking the passive approach.3-5,10 Going so far as to change the work environment (firing staff, moving offices, dismissing patients, etc.), instead of facing stress triggers head on, was a method used by more male dentists (26 percent) than female (16 percent).5

Medicine/Drugs

There were similar responses from dentists when reporting on their doctor-prescribed and self-prescribed medications. Slightly over 39 percent say they take over-the-counter anal gesics regularly,2 nine percent take allergy/cold medications,1 and 5.4 percent take doctor-prescribed anti-depressants. Similar percentages of dentists smoke, around four percent, in each of the studies while only one percent claimed using illicit or recreational drugs to reduce stress.1,2,4,7

Alcohol

Each study reported alcohol as a popular coping method and relaxation tool for dentists. Self-reports in one study found 28 percent of dentists turning to alcohol as a means to cope with stress5 while in another study one percent of dentists were already in treatment for alcohol abuse. Two studies used the CAGE Questionnaire to determine alcohol tendencies and found 11.5 percent and 11.1 percent of dentists showed alcoholic tendencies.1,8 Another study using the Short Michigan Alcohol Screening Test gathered information to show six percent of dentists had a drinking problem with nine percent having alcoholic tendencies.2 This same study also found 35 percent of female and 38 percent of male dentists participated in binge drinking at least once a month. Further studies went on to conclude many of the drinking habits of dentists were established early in dental school and continued as a way to deal with stress.3, 4, 6, 10 In the end, 19.8 percent stated they should cut back on their drinking1 and 18 percent planned to drink less as a means to improve health and reduce stress.2

Question: What are the stress-related issues dentists develop?

Depression

In each of the studies reviewed, there were questions about the stress-related issues and illnesses experienced as a consequence of moderate and severe stress levels. The ADA discovered that of dentists:
  • 79.4 percent feel low in energy
  • 55.8 percent blame themselves for things gone wrong
  • 34.9 percent feel hopeless about the future
  • 29.1 percent have no interest in things
  • 23.5 percent have feelings of worthlessness
  • 41.9 percent have difficulty concentrating and making decisions
Of these respondents, 22.6 percent indicated moderate to severe depression. Other studies found similar responses: 34 percent frequently or always felt physically or emotionally exhausted6 and 47 percent were somewhat happy to unhappy with little interest in life.2

Burnout

Several studies looked at the level of stress to such a degree that respondents showed signs of burnout using the following indicators:11
  • exhausted mentally or emotionally
  • negative, indifferent or cynical attitude toward patients and staff (depersonalization)
  • feeling of dissatisfaction with personal accomplishments
  • negative evaluation of self
Three studies found 10.6 percent,5 13.7 percent6 and 14.6 percent1 of dentists show signs of professional burnout. Another study using the well-established Maslach Burnout Inventory reports 13 percent had high overall levels and another 21 percent had certain risk of burnout.12

Suicide

There is equal number of studies on either side of the debate around the issue of dentists having a high suicide rate. Of the research studies reviewed, 12 percent of dentists thought about suicide with 18 considering it within the last year.2 Another study found 6.1 percent thought about suicide1 and still another found 15.1 percent being so overwhelmed by stress they considered taking their life.10

The challenge with conclusively answering this question is the significant underreporting of suicide from family members as well as medical examiners.6,10 Also, there are significant deficiencies in the collection of data around suicidal deaths.6,9,10

Physical Pains

Dentists report significant medical conditions as a result of their stress, which often is a cause for early retirement.1,2,4,6 More than 58 percent of dentists experience physical pains with lower back pain being the predominate claim. Headaches, migraines and intestinal problems were also common diagnosed medical conditions dentists reported as a result of their stress.

Question: What keeps dentists from addressing their stress?

There are two relevant barriers keeping dentists from managing their stress.

Lack of Knowledge

When asked about resources available to them to reduce stress, a high proportion of dentists felt their network of services was limited.3,4,6 Respondents didn't know the steps to reduce their stress, were unaware of stress management programs geared for the dental professionals, could not identify books or websites as tools/resources, and felt their primary care physician was not the appropriate resource to help them reduce stress.

Self-regard

Several studies asked respondents questions of self-regard to measure the role the dentist's mindset plays in perpetuating stress. On a scale of strongly agree to strongly disagree, one study measured, "It would be difficult for me to seek help because I think I should be able to solve my own problems." Of dentists, 43.9 percent agreed or strongly agreed with the statement and only 25.3 percent strongly disagreed.1 More than half of dentists reported having doubts around their competence and ability to reduce stress1,2,4 and were often embarrassed by their current state of business to share with colleagues or seek professional help.3,6

Question: What can we do about it?

Time Management Training

Learning the skills necessary to have effective time management is crucial to reducing stress in the practice. Time management training includes learning and mastering the art of delegation, prioritization, decision making and assertiveness. It does not necessarily require a change in processes or systems, staff or business model to yield improvement of perceived stress.

Sleep More

The correlation between the amount of sleep each dentist reported and perceived level of stress is significant enough to note. Ensuring you get at least seven hours of restful, uninterrupted sleep each night might not eliminate the stressors you experience during the day but it does prepare your body and give you the mental energy necessary to navigate through them successfully.

Move More

To see an impact of stress levels you don't need to exercise for hours and hours. There are significant benefits to health with increased movement as opposed to structured exercise. Parking farther away in parking lots, taking the dog for a walk, using stairs when possible and walking the halls of your practice more often are easy ways to increase movement and impact your stress levels.

Drink Less

Studies concluded that the use of alcohol as a coping method for stress among dentists is on the rise.1,2,4,6,7 Using alcohol to mask, reduce or avoid stress in your work and life is a maladaptive coping method that extends the life of the stress trigger and often magnifies its intensity. Drinking less makes room for you to choose adaptive coping methods to reduce stress in a way that is healthy and permanent.

Seek Help

There are numerous tools and resources available to you in the form of books, websites, organizations and professionals that can guide you in reducing your stress. Depending on your unique needs, style of learning, preference of communication, and commitment, you can permanently reduce your stress. It takes action, often courage, and sometimes just one phone call to start the process. The only barrier you have is your willingness to take care of yourself.

References
  1. American Dental Association. 2003 Dentist Well-Being Survey. Chicago, 2005.
  2. Kay E, Lowe J. A survey of stress levels, self-perceived health and health-related behaviors of UK
    3. dental practitioners. Br Dent J 2007:204;E19.
  3. George JM, Milone CL, Block MJ, Hollister WG. Stress Management for the Dental Team. Philadelphia: Lea & Febiger. 1986.
  4. Newton JT, Allen CD, Turner A, Prior J. How to reduce the stress of general dental practice: The need for research into the effectiveness of multifaceted interventions. Br Dent J 2006;200:437-440.
  5. Ayers KMS, Thomson WM, Newton JT, Rich AM. Job stressors of New Zealand dentists and their coping strategies. Occupational Medicine 2008.
  6. Rada R, Leong C. Stress, burnout, anxiety and depression among dentists. JADA 2004;135:788-793.
  7. Edlin R. Avoiding the ill effects of stress. TheYoungDentist.com. 2011.
  8. Peterson MR, Burnett CA. The suicide mortality of working physicians and dentists. Occupational Medicine 2008;58:25-29.
  9. British Cohort. The Medical Research Council National Survey of Health and Development. 2005.
  10. Alexander R. Stress-related suicide by dentists and other health care workers. JADA 2001;132:786-794.
  11. World Health Organization International. International Classification of Diseases. 2010.
  12. Gorter R, Albrecht G, Hoogstraten J, Eijkman M. Professional burnout among Dutch dentists. Community Dentistry and Oral Epidemiology. 2007;27:2:109-116.
Author's Bio
Jen Butler, M.Ed., CPC, BCC has been working in the area of stress management and resiliency coaching for more than 20 years. As a national speaker and certified trainer, Ms. Butler has presented to thousands of business owners on how to reduce stress, increase engagement, and earn higher profits. Currently Ms. Butler works exclusively with dental professionals as a Master and Board Certified Executive Coach and Stress Management Consultant through 1:1 sessions, in-office consulting, and small or large group trainings.

Jen Butler is available as a coach, consultant, speaker and writer. To learn more about her services and sign up for her monthly StressLESS newsletter go to www.jenbutlercoaching.com. Take the Dental Stress Self-Assessment at www.jenbutlercoaching.com/quiz/ to find out your stress levels. Contact Jen Butler directly at 623-776-6715.
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