"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.
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
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
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
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
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
- Time pressures
- Patient demands
- Uncooperative patients (children, fearful, nervous or militant)
- High levels of concentration and focus
- Team issues
Question: How do dentists cope with their stress?
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
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
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
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
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:
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
- 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
Several studies looked at the level of stress
to such a degree that respondents showed signs
of burnout using the following indicators:11
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
- exhausted mentally or emotionally
- negative, indifferent or cynical attitude toward patients
and staff (depersonalization)
- feeling of dissatisfaction with personal accomplishments
- negative evaluation of self
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
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
There are two relevant barriers keeping dentists from managing
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.
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
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.
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
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.
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.
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.
- American Dental Association. 2003 Dentist Well-Being Survey. Chicago, 2005.
- Kay E, Lowe J. A survey of stress levels, self-perceived health and health-related behaviors of UK
dental practitioners. Br Dent J 2007:204;E19.
- George JM, Milone CL, Block MJ, Hollister WG. Stress Management for the Dental Team. Philadelphia: Lea & Febiger. 1986.
- 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.
- Ayers KMS, Thomson WM, Newton JT, Rich AM. Job stressors of New Zealand dentists and their coping strategies. Occupational Medicine 2008.
- Rada R, Leong C. Stress, burnout, anxiety and depression among dentists. JADA 2004;135:788-793.
- Edlin R. Avoiding the ill effects of stress. TheYoungDentist.com. 2011.
- Peterson MR, Burnett CA. The suicide mortality of working physicians and dentists. Occupational Medicine 2008;58:25-29.
- British Cohort. The Medical Research Council National Survey of Health and Development. 2005.
- Alexander R. Stress-related suicide by dentists and other health care workers. JADA 2001;132:786-794.
- World Health Organization International. International Classification of Diseases. 2010.
- Gorter R, Albrecht G, Hoogstraten J, Eijkman M. Professional burnout among Dutch dentists. Community Dentistry and Oral Epidemiology. 2007;27:2:109-116.