Addressing Mental Health Challenges in Dentistry

According to the ADA's 2021 Dentist Health and Well-Being Survey Report, 46% of the surveyed dentists were struggling with anxiety. The percentage of dentists diagnosed with anxiety more than tripled from 2003 to 2021.

The ADA Council on Dental Practice became alarmed and piloted a confidential, easy-to-use risk assessment tool designed with Mayo Clinic and the ADA Wellness Ambassador Program to measure clinical distress and well-being. In February 2023, the ADA announced that the mental health risk assessment tool, The Well-Being Index (WBI), is now available free of charge to ADA members. 

“Having access to a tool such as the WBI is an important commitment to safeguarding the health and well-being of dentists,” said Kami Dornfeld, D.D.S., ADA Dental Team Wellness Advisory Committee chair. “Mental health is health. Our patients’ health depends on our being able to prioritize our own health and well-being.”

Common stressors

Common stressors that have been noted among dentists include:

• Practice Demands—Dentists often face prolonged hours of rigorous work, which, combined with the intricacy and precision required in dental procedures significantly contributes to stress levels. They must stay focused. They feel highly accountable to their patients to deliver outstanding results. They risk litigation. On top of that, practice owners have a business to manage. They feel pressure to generate a profit and to expand their business to survive long-term.
  
  They have team members and patients to satisfy and retain, or turnover becomes costly. They are often caught between striving to make care affordable for patients and raising the wages of their team members, while the costs of providing oral healthcare are rising.

• Early Career Vulnerabilities—Particularly in the first five years, dental professionals report high levels of stress due to inexperience with advanced dental cases and business management. They are at more risk of making costly mistakes when hiring, managing team members, and making purchases.
  
  
• Attracting new patients to build a young practice is challenging, and the cost of marketing can be out of line with the return on investment. When patients decline treatment, cancel or no-show appointments, or express dissatisfaction with treatment, confidence suffers and anxiety grows--especially as they are worried about paying down debt.

Whether they are in private practice as an owner or an associate, or if they are employed as part of a corporate group, during the first five to ten years dentists are growing in confidence and competence to do more advanced dentistry, and many of the behavioral and clinical skills they must acquire are learned by experience. They are simultaneously educating their patients to appreciate more comprehensive dental care and accept the restorative procedures that will be in the patient’s best interest. 

• Team Retention and Hiring Concerns—Nearly every dentist has been affected by the labor shortage, either through staff turnover or pay expectations that are out of balance with the business's financial health. Job boards’ surveys of providers have identified team retention and hiring as dentists’ top concerns in 2024. With hygienists and dental assistants in short supply, dentists are losing sleep and thinking through possible scenarios to cope.
  
  
• Pandemic-Induced Strain: We aren’t so far beyond the pandemic years that we have forgotten the disruptions COVID-19 caused dental teams, patient care, and earnings. The pandemic not only impacted financial security but also intensified mental health challenges for providers, team members, and the people they serve. Coping mechanisms have been operationalized, and the pandemic has passed, but fatigue lingers.
  
  

High susceptibility to anxiety and chronic stress impact professional performance.

Negative emotions make it more challenging to concentrate and process information effectively. This can lead to errors in diagnosis and treatment. 

People sense when their provider is depressed or lacks focus. This reduces their confidence and limits their conversations, negatively impacting relationships essential for team productivity and patient retention. 

And let’s never forget that chronic stress is emotionally and physically painful for those experiencing it.

Some of the symptoms of mental health decline that you might see in yourself and others include:

• Constant worry
• Mood swings
• Irritability
• Depression
• Changes in sleep and eating
• Lingering emotional and physical fatigue
• Chronic lack of enthusiasm for and engagement with your work
• Social withdrawal
• Serious thoughts about changing careers
• The onset of stress-related disorders such as loss of appetite, headaches, and digestive problems
• Increased reliance on substances like alcohol and tobacco for relaxation
• Thoughts of suicide--alarmingly, a significant fraction of dental professionals have contemplated suicide, underscoring the severity of mental health issues in this field.
  
  

To address the mental health challenges of clinical providers and their teams, mental health experts stress the importance of being aware and in a community of support.

The leadership at Smile Source would like to praise our members for supporting and encouraging each other through the many challenges of dental practice today. The collegiality of the Smile Source community improves the mental health and well-being of not only our members but the thousands of team members and millions of patients they serve. This is one of the primary reasons your Smile Source membership is so valuable—to not only you and your colleagues but the entire world. 

Even if you feel stressed and that you have a long way to go to achieve your vision of practice, you can take pride as you build your independent dental practices to provide the highest level of personalized clinical care. Take every opportunity to converse with fellow Smile Source members because their insights WILL give you the boosts you need to better manage your challenges and maintain a healthy perspective and resilience.

Here are some examples of shared stress management techniques.

Make Small Gestures. Incorporating small positive gestures can significantly de-escalate stressful situations. For example, if your dental assistant used a new camera to take extraoral and intraoral photos of a patient for case workup and some of them are not up to your standard, you can reduce tension by saying, “We haven’t worked with that camera before, so I’m not surprised there are a few images that have to be retaken. You know, I think we shouldn’t hurry into using the new camera until we’ve scheduled a couple of hours to practice with it. Please review the schedule and find two to three hours we might work together soon. In the meantime, we’ll use the old camera and you should retake these three images. Let me see them when you are done.”

How easy was that? Rather than letting yourself feel frustrated, a gesture of understanding empowers your assistant and takes you both one step forward toward mastering the new camera system. Speaking of “one step forward...”

Take Small Steps. Breaking down large tasks into smaller, manageable parts can alleviate overwhelming feelings. Think of small steps to reach your goals as stepping stones. 

The thing about stepping stones is that each one takes you farther in the direction you want to go. For example, if you are worried about team retention, what are some small steps you could take to reduce the stress you feel? Perhaps, you could intentionally, and regularly pose a question to your team members and actively listen and affirm their feedback. Perhaps, you could pause your day to express gratitude to your team. Surveys indicate that feelings of being unheard and unappreciated are top factors motivating dental workers’ search for a new job.

Don’t Ignore a Small Problem. Solve it. If you ignore multiple small problems, they add to your stress and might lead to the proverbial “death by a thousand cuts.” Take steps daily to see and solve problems as you see them. 

Schedule Your Day the Best Way for You. What makes you tick and enables you to get “in the zone” of flow to do your best work? It’s not the same for every person. Some people must complete their mounting list of small projects before they can comfortably settle into doing a big one.

Are you more like this first dentist or the second one?

1. Dr. Smith likes to schedule two to three hours each afternoon to focus on a new patient consult and exam or to execute an advanced treatment. First thing in the morning, she likes to “put on her skates” as she comes out of the morning huddle and then rolls from one operatory to another for brief follow-up appointments and checking on maintenance patients in Hygiene.
2. Dr. Wood is more productive doing a big work-up or delivering a big restorative case first thing in the day, so he blocks out his mornings to focus on these. 

Take a Tip from Stephen Covey. When it comes to working on the business aspects of your practice, schedule time each week to list the aspects of practice administration you need to understand and control better. Then, prioritize this list and begin sub-listing some stepping stones. 

Schedule time to work on the highest priority goal first and give yourself the grace to “get to the others” after reaching your priority goal. Covey admonishes that big rocks won’t fit in the container if the small rocks and sand go in first. Each big goal you achieve will release endorphins and take one big item off of your stress list.

Go Home and Play. Love people and activities outside of dentistry. Go home before you are too tired, and throw yourself into something that interests you and drives your creativity in new ways. A sport, music, gardening, carpentry, art, family outings, cooking, volunteering, conversations with friends…your special pastimes outside of dentistry are likely to rejuvenate you plus change your perspective. If you find that your special interests no longer elevate your mood, you may have become clinically depressed and need professional help—or you might just need a new challenge that excites you more. 

Don’t Compare Yourself to Others. Social media has a way of highlighting all the wonderful achievements of others, and if you currently feel you are not achieving as much as your colleagues, you might feel sad. People are not the same. Dentists don’t all succeed in the same way or advance their skills and businesses at the same speed. Remember the story of The Tortoise and the Hare and the value of persistence and resilience. Protect your resilience to stay mentally healthy so you and your practice can evolve.

Be Part of the Solution: Prioritizing mental health means being aware of more than your own emotions. You are attentive to the emotions of those around you. You intentionally observe the effect you are having on others and want to have a positive impact. You are purposeful in what you do to create a caring environment in which you and others can thrive. 

Effectively dealing with mental health in the workplace starts with you, the employer. Be supportive and understanding when employees are struggling. Recognizing and accepting their state of mental health is a step toward healing and can help diminish the stigma associated with needing help.

Resources and Support Systems

It’s likely that all dentists feel stress and burnout at various times in their lives. Many dentists endure mental health challenges in silence, often due to fear of professional repercussions or judgment by peers. Although there is a stigma surrounding mental health within the dental profession, it is lessening, and Smile Source is one community in which you can safely discuss your worries. We encourage you to reach out, stay in communication, and lean on Smile Source leaders and members for the advice, mentorship, and support you need. 

Organizations like the American Dental Association (ADA) provide valuable resources to support the mental health of dental professionals. Initiatives such as the Dr. Lorna Breen Health Care Provider Protection Act aim to reduce burnout and provide mental health assistance to healthcare providers. Additionally, ADA's Dentist Health and Wellness Program offers tailored resources to address stress, depression, or burnout.

The Dental Mental Network (DMN) and Dental Practitioner Support offer 24/7 resources and confidential help for dental professionals. These support systems are crucial for maintaining mental health and quality of life for those in the dental field.

The ADA’s Council on Dental Practice aligned its wellness priorities with those outlined by the National Academy of Medicine’s National Plan for Health Workforce Well-Being. These priorities include investing in assessment, measurement, and resource strategies. The Well-Being Index, promoted by the ADA and mentioned at the beginning of this article, is an example of this investment. The link to this index is at the top of the following list.

• ADA: Well-being index available to all ADA members to support mental health
• ADA: Association tackles mental health with sense of urgency
• ADA: Wellness resources
• ADA: Protect your mental health
• Smile Source helps dentists thrive together
• Mental health in dentistry: Has the profession opened up through the years?
• Mental health and wellbeing interventions in the dental sector: A systematic review
• An individual-level approach to stress management in dentistry
• Mental health in dentistry: An unspoken concern