Dental practitioners are facing increasing risks of stress related illness. Dentolegal Consultant Dr Annalene Weston looks at how to recognise the signs and manage your stress levels

Stress related illnesses take many familiar forms, with dental practitioners not only demonstrating a higher-than-normal risk for back issues but also gastrointestinal disorders, cardiovascular issues and often demonstrate higher levels of drug and alcohol dependency, mood disorders and even suicide.

Causes of stress

In order to better manage our stress and protect our health, we first need to consider the contributing factors which compound to make dental practitioners so very prone to its effects.

Isolation – While group practices and hospital settings have decreased the isolation of dental practice, this is still a recognised contributory factor to stress. Especially for those practitioners who have experienced an adverse outcome or received a complaint.

Many of us are lucky to work in supportive practices, or have a supportive network outside of our practice, but not all of us have this luxury. When stress attacks, and the walls start closing in, those who cannot reach out to their support network will suffer greatly. We need to find ways to talk it out and manage our stressors in a healthier and more effective way.

Confinement – We don’t get out much. Some of us don’t even have windows in our treatment rooms. Understandably, this can flow on to a diminished sense of wellbeing and happiness. This lack of ability to move around can impact on our wellness in other ways, as we can become unfit and sedentary, further increasing our risk for ill health.

Patient factors – Patient stress and anxiety is born from their fear of us, the treatment we are going to perform, and the news we are going to break to them about their dental health and needs. It is often compounded by the fact that patients are commonly attending under duress, making a ‘distress purchase’ due to pain or another problem. It is only natural that they will let this stress out on the person they feel most appropriate – that person is probably you.

Through no ill intent or malice, patients can devalue our treatment, our service, and even our self-worth when they choose to shop around for a better price or trust the advice of Google over the clinical advice we are giving.

Internal stress – We strive to provide our best work, at all times, and can become frustrated with ourselves if things don’t go to plan. This constant drive for perfection can only lead to bitter disappointment as there are many factors outside of our control that can negatively impact on the appearance, success and longevity of the work we do.

External stress – There are many factors impinging on our lives which will load more stress on to us. Money is certainly at the crux of much practitioner stress as we struggle to support ourselves and our loved ones whilst simultaneously paying off hefty HECS and other debts. We are often at the stage of our most rapid career development, while at the same time building a family of our own which no doubt comes with financial and emotional burdens. The burdens do not outweigh the joys of family life, but financial and familial issues have been responsible for many sleepless nights for generations of dental practitioners. Moreover, those who choose to open their own practice will feel these stresses to a greater extent.

Other people’s ‘bottom line’ may also begin to impact your practising life, if the business owner finds you to be “underperforming” and begins to apply insidious pressure on you to “produce just a little more”. We are not working in a factory. Simply put, you cannot make people need more treatment.

Running late – This could easily have sat under any of the headings above, but such a significant stressor deserves a heading of its own. We run late because things go wrong. We run late because patients are late. We run late because emergencies are squeezed in to enable patient care. We run late because it is more convenient for our patients to have that done now so they don’t have to come back. And we run late because we are chasing a dollar, for ourselves and for the business owner. We do not run late because we want to, or because we enjoy it, and no matter how you look at it, running late causes us stress.

A knock-on effect of running late can mean missing lunch, or being late for personal commitments, or simply not getting home in time to put the kids to bed. It sucks and it hurts us. And finally, we do not do our best treatment when we are under this much pressure.

Personality traits – Every strength can be a weakness. The very personality traits which make us truly great dental practitioners, our attention to detail and critical eye, our conscientiousness and our caring nature, can turn around and bite us where it hurts. These traits predispose us as a profession to reach out for a crutch to get us through the disappointments of our daily life. Regretfully, these crutches can take the form of drugs and alcohol, and dependency on any form of medication, whether prescribed or self-administered is a recipe for disaster.

Facebook fibbing – The societal tendency to hide our flaws and failures and promote only our strengths is played out daily in a narcissistic fashion in the public arena of social media. Not only does this skew one’s view of what is good and what is right, but it can cause many practitioners to reflect on their own work with shame for not being ‘good enough’. Read the posts with interest, take the key learning points and do not dwell. Comparison is the killer of all joy. You are on your own journey, embrace this and do not worry about the journey of others – each comes with successes and failures, joys and fears; and remember, truly great practitioners share their failures as well as their successes with others to help them grow.

Solutions for managing stress

Networking for a better ‘everything’ – There can be no doubt that dental practitioners who have networks of support are ‘better’ in so many ways. Mentors and study groups help us to talk through the challenges of practice and exchange ideas about treatment modalities. Collective treatment planning and timely constructive feedback will enable us to grow confidently as practitioners, through every stage of our career, and naturally this flows on to providing much better treatments to patients.

Networking outside of the surgery will also reap rewards. Having a solid group of people you can trust to talk through your failures with is incredibly empowering, as a problem shared is truly a problem halved. Closing the surgery door and engaging in some hobbies and relaxation will make a more balanced you and give you groups of friends who don’t want to talk about teeth. Get moving for health and wellbeing. Get some fresh air. Your emotional and physical health will thank you for it.

Don’t sweat the small stuff – Regretfully, the very nature of dental practice means that things can and will go wrong. It’s OK.

A calm approach in the face of adversity will lead to a better outcome for both you and the patient. And once the crisis is over, talk about it. There is no shame in struggling with an extraction, or a root canal treatment, or any dental procedure. Talking about what went wrong will help you to recognise the warning signs in the future and avoid adverse outcomes of a similar nature.

Also, talk to your staff. If you are struggling because of time pressures, they need to give you a bit more time. If they are not prepared to do that, then this may well not be the best practice for you.

HALT – Dental Protection review the complaints and adverse outcomes reported to us, and one thing we have identified, is that you (and the patient) are more at risk of something going wrong if you are Hungry, Angry, Late or Tired (HALT). Sometimes, time spent having a quick break will save heartache for all. Don’t be scared to take a break between patients to clear your head if needed.

Patient factors – Accept that you don’t see the best side of people when they come to you frightened and in pain. Accept that people say silly things, that they come to you because they DO like and trust you, and don’t take the silly comments personally.

Try to work with patients, within their time and financial constraints to provide the best treatment you can. If you are unable to produce quality treatment with the constraints they place on you, then consider referring the patient to another practitioner who may be a better fit for them.

Recognise dependency – The path to dependency is short and easily followed, but the road to recovery takes a lifetime. Be honest with yourself about what you drink and consume. There is no place for drugs of dependency for those who choose to become a dental practitioner, and use of both legal drugs and illicit drugs can lead to the loss of your registration. Alcohol may be legal, but it too is open to abuse.  Please reach out if this section has in any way made you feel uncomfortable because it is relevant to your life, right now.

Bringing it all together

The key to health is multifaceted and complex, but we can start on the right path by caring for ourselves, mentally, physically and emotionally, by stepping away from the surgery to develop some perspective. It’s important to be kind to ourselves when things don’t go to plan and reach out to our support network for support.

Eating right, exercising, finding some fresh air and work-life balance all feed into this, but we can start by being kinder, to ourselves and others to set the tone for a less stressful life.