Under Pressure: Dealing with Stress and Anxiety

by Akhil Chawla, BSc; Lesia Waschuk, DDS. MEd

Dental school, like any professional educational program, is challenging. Students are expected to develop their manual dexterity skills and maintain a heavy course load, which makes it difficult to maintain the balanced and healthy lifestyle that they know is important. It should, therefore, come as no surprise that a high occurrence of depression, anxiety and stress have been identified in dental students.1 Several predictors have been identified to indicate how likely students are to face these mental health struggles including gender, whether dentistry was the first choice for their field of study and their satisfaction with their relationships with faculty and peers.2 Within dental school, the incidence of depression is not uniformly distributed. In a traditional four-year program, students are most likely to report major depressive symptoms in their first and third years.3

To help them cope with stress, the students in one study reported engaging in activities such as reading, watching television and seeking emotional support from others to help them cope with stress. The authors conclude that this study “highlights the importance of providing support programs and implementing preventive measures to help students, particularly those who are most susceptible to higher levels of these psychological conditions.”4 In extreme cases, a prolonged battle with mental illness during dental school has caused students to consider exiting the program. Students in another study who report experiencing anxiety, depression or burnout were significantly more likely to report the intention to leave than those not reporting mental health problems. In that study, all the participants reporting that the COVID-19 pandemic impacted their mental health expressed intention to leave.5

The fact that many post-secondary students arrive on campus suffering from mental illness and other medical conditions that require treatment – or may develop symptoms of mental illness during their programs of study that are severe enough to cause them to consider withdrawing – has led university administrations to fund online and in-person mental health services that are provided through student health centres. At some universities, special wellness support programs, including mental health services, have been developed for students who are enrolled in professional faculties, for example the newly renamed Learner Experience for students at the Schulich School of Medicine and Dentistry at Western University (schulich.uwo.ca/learner_experience/). The University of Toronto provides embedded counselling at professional faculties including the Faculty of Dentistry. Where embedded counselling is available and utilized, benefits in improving function have been noted even for students who entered counselling experiencing high psychological distress.7

The use of mindfulness practices to promote psychological health has been well-established in scientific literature.8 Structured mindfulness programs such as Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) have been shown to be useful adjunctive tools in helping patients manage medical conditions and mental health disorders.9,10,11

Dr. Jessica Metcalfe is a general dentist who is also a certified life coach. She helps high-achieving individuals, including dentists, deal with imposter syndrome, perfectionism, and burnout in her coaching practice, The Alchemist Dentist (drjessicametcalfe.com/). The Internet enables professionals, such as Dr. Metcalfe, who are concerned about the wellness of their colleagues to share their practical knowledge on wellness-related topics and coping advice widely. The pandemic has seen a virtual explosion of free wellness-based content on all social media; one of the newest is Clubhouse, where Dr. Metcalfe co-hosts Self-Care Saturdays with an American “recovering” dentist called Dr. Laura Brenner who is now a career coach. Dr. Brenner also hosts the Dentists’ Side Gig Clubs on Clubhouse for those dentists who want to pursue non-dental interests professionally and practise dentistry part-time (https://clubhousedb.com/user/drlolabees).

One of the most important strategies that Dr. Metcalfe recommends to her clients is building a self-care plan. There are several self-care plans for different aspects of one’s life including mental, physical, professional and personal. When forming a self-care plan, Dr. Metcalfe says it is vital to “create strategies and practices that are both preventive and sustaining as well as interventional.”12 Preventive and sustaining activities include healthy hobbies and carving out free time for oneself. Interventional practices on the other hand are strategies that can be employed during times of stress.

Learning new breathing techniques can be an effective interventional strategy. An awareness of the breath is also one of the mindfulness practices that is taught in MBSR and MBCT programs. “By changing the way that you breathe, you can ultimately change the way your body is reacting in that moment,” says Dr. Metcalfe.13 There are two main strategies she recommends to clients in moments of stress. The first is known as Box Breathing; this involves inhaling for four seconds, holding the breath for four seconds, exhaling for four seconds and holding once again for four seconds. The other technique focuses on exhaling for longer periods compared to inhaling. To use this technique, breathe in for five seconds, hold the breath for two seconds and exhale for seven seconds. Both these techniques can be done during dental procedures or other work that is causing stress. Dr. Metcalfe reminds us that “there is nothing wrong with taking a moment to gather your breath and then [coming] back into the environment.”14

If you find dental school or clinical practice stressful, know that you are not alone. Canadian dental associations have ensured that there are supports and resources available to you now as a dental student, and these will continue to be available to you (and also your staff) when you are a practising dentist (see sidebar). When you are experiencing stress, there is nothing wrong with taking a break from your cubicle in the teaching clinic, your desk when you’re studying for finals or board exams, or your operatory when you’re in practice to gather your breath and then returning to the environment with a fresh perspective on the situation.


  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5457790/
  2. ibid
  3. https://www.dentistrytoday.com/news/industrynews/item/6721-dental-students-face-greater-rates-of-depression
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5457790/
  5. https://www.sciencedirect.com/science/article/abs/pii/S000281772100132X
  6. https://pubmed.ncbi.nlm.nih.gov/28049675/
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6580712/
  8. https://pubmed.ncbi.nlm.nih.gov/21802619/
  9. https://pubmed.ncbi.nlm.nih.gov/24745774/
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876939/
  11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876939/
  12. https://www.linkedin.com/posts/dr-jessica-metcalfe-873b671b5_itsoktonotbeok-mentalhealthawareness-mentalhealthmatters-activity-6826890882411839488-cVRq
  13. https://www.linkedin.com/posts/dr-jessica-metcalfe-873b671b5_dentallife-stresseddentist-anxiousdentist-activity-6829058684040028161-3Ctk
  14. ibid

About the Authors

Akhil Chawla, BSc is a second-year dental student at the Faculty of Dentistry at the University of Toronto and a former management consultant at KPMG, specializing in healthcare and life sciences advisory. Akhil hosts a podcast where he interviews individuals with atypical professional backgrounds, ranking in the top 35 career podcasts in Canada.


Lesia Waschuk, DDS, MEd is the Compliance and Education Specialist at Prep Doctors and an independent regulatory consultant. She has taught students in oral healthcare professional educational programs at two universities, three community colleges, and two private institutes. Questions about this article can be addressed to Dr. Waschuk at lesia.waschuk@prepdoctors.ca.

This is the latest in an occasional series of articles by the author(s) on mental health and wellness-related topics for oral healthcare professionals and students.