September 1, 2007
by Randy Lang. DDS, D.Ortho
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.
RELATED VIDEO: Dr. Preety Desai Talks Stress [And What It’s Doing To You]
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.
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.”
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.
RELATED ARTICLE: Dentistry’s Suicide Dilemma
* 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.
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;
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?
* 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.
NOT ONE MENTION OF MERCURY!
Super political-correct article.
But informative also.
Luís Jervell, Porto, Portugal
So it’s the dental school that is responsible for unaffordable dental care and not the dentist. I will go the rest of my life with bad teeth. I haven’t smiled in 20 years. I smile in the mirror and I’m disgusted at what I see. I’ll probably be single the rest of my life because of my teeth and I wonder of anyone has committed suicide because of the certainty of of knowing they will never be able to afford nice teeth. I wonder if that also bothers dentists. Something should be done.
It amazes me that after reading this, you still feel no empathy towards the dental care providers. You completely missed the point of the article. Why is it that some patients feel so entitled for free dental work. It’s not the dentist fault that you have chosen to neglect your teeth all your life and don’t have a decent job to afford the care you need. Understand that dentists work extremely hard, spend ridiculous amount of money and energy to be able to provide the best possible care for their patient. So to answer you, no it doesn’t bother the dentist when an entitled, lazy, useless asshole is ashamed of his smile. Get a job and pay for the care u need
To be honest running a dental clinic is really hard beyond what people thinks since running the clinic would require great knowledgeable dentists plus a team and staff to support the management and patients
Currently, we are running a dental clinic in Orlean, ON, Canada and this article has been passed to the entire team to be aware of points that you have mentioned about stress
As a private practitioner for 27 years, I have never had so much stress as nowadays. besides the above mentioned stressful things, we are also in an industry that facing threats constantly: namely, malpractice litigation, hefty and redundant government regulations, insurance companies bullying, social media reviews ⋯⋯literally, you have to be vigilant to be “perfect ” for everything at any moment , or if any thing happens from one of these, it will stain your reputation, credential, or may ruined your entire career! Health professionals are walking on a thin line everyday, it will take a toll one day for sure.
We should not assume that it is the practice of dentistry that can kill you! Perhaps it is not dentistry that causes so much stress that one would contemplate suicide. Could it be that there are other causes – other causes of stress – that may help shape the minds of people as they are growing up and this type of person is attracted to dentistry because of the way it is practiced. Not saying that dentistry is not stressful – it is. But it can also be very rewarding. It is important to highlight the importance of psychological therapy when needed. Perhaps it should be mandatory for anyone treating patients who are fearful and in pain. With a much deserved increased awareness of mental illness, all people should do a lot more talking about any pain or discomfort they feel.
This article is very spot on…although it covers in good detail about 15-20 reasons why dentistry is stressful it leaves out literally another 200-500 reasons. I think it’s a horrible choice for a profession.
Good article. I’ve been practicing since 1994. Have good standing, never sued, and I’ve helped a lot of people. Pts have also taken advantage more often that I’ll admit. But I’m leaving the profession at age 57. Not going to list reasons why except blew out L4L5 disc. (I’m tall, and ergo in dental is hard for tall people). I seriously cannot wait to say “I’m finished”. Moving to another state, will not mention it going fwd in whatever I do.
27 years as a dental assistant.
I’m ready to buy an RV and leave town!
I’ve been in the field sense I was 16-17 yrs old. I was a patient of the doctor. I’ve noticed that every time I would come in the office would have a new front office. The time I was hired was because a front office just walked out on the doc. The phone lines were blowing up so he asked if I could answer them. I had experience answering phones so he asked if I was interested in working and I said yes and he hired me on the spot. We would always get yelled at when he was having a bad day. I also walked out on him twice but he called and Apologize. I knew he was having a bad day due to his profession or to some picky patients that expected perfection with their procedures (which I understand). In my 20+ yrs of experience I have worked with different providers and I’ve seen the same situations repeat all the time. Dentistry is not for everybody. I have done everything in the field from assisting to billing and everybody goes through the same stress. I have to agree with this article and now I understand why I have a bad lower back lol!!!!
Nice job! This article is absolutely 100% dead on. With the recession, my take home income went down by 1/3 and has never recovered. I practiced as a private practice dentist for 25 years and now practice for the corporation I sold to last year. Stress is quite a bit, but still the work is not rewarding for all of the reasons listed in the article. I am overjoyed that none of my children have chosen dentistry as a career. That goes for my brother’s children as well (he is a prosthodontist). My sister’s husband killed himself (he was a general dentist). None of her kids are going into the field either. We are the last of the dentists in the family. We have had practicing dentists in my family continuously since 1926. For me, it was increasing costs of practice and my own income decreasing over the last 10 years, as well as absolutely oppressive government regulations and continuous threats of more regulation from our regulatory body and countless arms of the everpresent provincial government that made me seek a way out. I practice in Ontario. The other dentists in my family practice in the USA. Their situation is about the same financially as mine but their harassment from the government and regulatory bodies where they practice does not even hold a candle to what we have to endure in Ontario. My opinion is that there is absolutely no reason at all that a person should even consider practicing in Ontario. My heart goes out to new grads.
Mercury poisoning from drilling and handling amalgam fillings is the reason why Dentists get depressed and back pain and vision loss. I know because I had all three symptoms and fixed them all following this heavy metal detox protocol. Please Dentists do some research!!!! Stop using amalgam fillings and get certified to take them out safely. IAOMT.org is an organization that will teach you how to deal with safe removal of amalgam fillings. Please learn this info so you can stop poisoning your patients and yourselves. See this for more info. https://www.youtube.com/watch?v=W0UPr4K9nlk
Well thank GOD someone finally nailed it!!!!! That’s the ticket!! Pure genius. HAHAHAHA
I have not used amalgam since, oh, 2004 or thereabouts. What’s your point? My stress level is going through the roof, I am hating this profession more than I ever did, and at 50 I’m desperate to get out….. because of amalgam restorations (and not many of those) I did fifteen years ago? Amazing!
I’ve been a dentist for 28 years and I’ve been miserable the whole time. Working hard to find another career and escape the most unsatisfying career in the world.
Been practicing for 33 years and just
recently sold my two practices in northern Ontario to a corporation.
I felt strongly for the last ten years that I had to be more concerned with increased regulation and governess of the profession than the actual practice of dentistry.
Since the year 2006 my salary slowly declined over the years as overhead increased . My colleagues actually used the word “hate ” to describe being a dentist as well as comments ” nobody hates it more than me”.
The general consensus regarding the colledge was it created an overhanging unwholesomeness ,I felt it was just the unhealthy cost of doing business as a dentist in Ontario.
The profession was good to me financially, and I’m grateful but I worked in rural areas and did not have the urban issues of saturation ,competition and higher overhead.
I was two weeks late for first year of dental school because I had reservations about being a dentist and of course I was coach on what a great profession it was at that time .
Do it again, not a chance .
Boy does misery love company. I found this article because I am tired of hating my career choice and feeling anxious and stressed all the time so I thought I’d do some research. My brother is also a dentist and we are constanly comparing notes and trying to see who hates it more. So far it has been a dead heat. This career is literally going to kill me if I continue the same way. I do exercise but I am always having anxiery attacks which no doubt raise my blood pressure and stress my heart. This career is not worth dying for. Like many others I have financial responsibilities that keep me from just not showing up (a recurrent pleasant dream of mine). Unfortunately this is a career path that requires a ton of advanced training but offers absolutely zero lateral moves. I have been a dentist for 27 years and have no training to do anything else. If I left this career, what would I do? (Scott-I’d love to know what you are doing now, Dave-any luck?). One of my children is in college and his roommate just got accepted to a very expensive dental school. He was so happy and all I could think was to plaster a smile on my face and tell him congradulations when what I really wanted to do was shake him senseless and yell at him. I just kept thinking that another sucker was born. I feel sorry for this kid. Like Mark (5-20-18), I finished my first year of dental school and had serious reservations way back then. At the time I continued because I was already a dental school year in debt but stupidly, I continued. Biggest mistake of my life.
I feel the exact same way u do. 22 years for me and it’s worse than its ever been. Both of my sons, 17 and 19, want to do this as a career and I am doing everything I can to discourage them. I’m looking to sell my practice before this career kills me. Would love to talk with you
That’s an absolutely true factor. peoples nowadays not aware of dental health.
Good article.I’m practicing in Nigeria for almost 10 years and have not heard of any dentists committing suicide but stress and back pain can be excruciating especially when you’re almost 2metres tall. I am doing a MSc in Public Health and planning to move from looking into the oral cavity.
oh! just read some comments. and kind a scary. but pretty sure being a dentist is promising.
This article is very informative. This will help to dentist how to handle stress
it’s Good. This is a very important and uncovered topic. Everyone knows the stress in Dentistry
I have been in practice for over 20 years now and I can simply no longer take the stress. I have decided to leave dentistry, even though at the age of 50 it isn’t easy or perhaps even practicable to retrain for another career, because I am convinced that I won’t survive another 20 months, let alone years, in this profession. I can no longer sleep, I have constant back pain and headaches, I can’t afford holidays, a recent sickness kept me away from work for ten days and my practice is yet to recover, and I can see no prospect of things getting better. So while I still can I’m getting out. And all I have to say to any young person even contemplating dentistry today is, do anything, absolutely anything, else. Your life is worth more than this, take it from me.
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