Illustration by Carson McNamara
Given the number of people who say they either fear or loathe a visit to a dentist, it’s no surprise that mental health issues are common among dental professionals. The American Dental Association reported in 2021 that the percentage of dentists with a diagnosis of anxiety more than tripled as compared to numbers from 2003. Although statistics after COVID-19 restrictions were largely lifted are not readily available, the ADA also reported that in 2019, 11% of dentists were diagnosed with depression, and 6% of dentists surveyed had an anxiety disorder, while only 3.1% of the general population did. Four percent of dentists reported having panic disorders, while only 2.7% of the general population reported the same. These numbers may have risen even further since the added pressures placed on the industry by the COVID-19 pandemic.
COVID-19 certainly didn’t help, but there are other reasons why dental professionals often contend with mental health issues, along with physical health challenges.
Dentophobia — it’s a thing.
Let’s face it — most people just dislike going to the dentist. The drills, the noise, the needles. A study from the Netherlands published in 2009 in the European Journal of Oral Sciences reported that dental phobia (an uncontrollable, irrational, lasting fear) was the most common type of phobia, affecting 3.7% of adults in the study population. And of those surveyed, 24.3% reported a general fear of going to the dentist. By comparison, 34.8% reported a fear of snakes.
Such patients may be vocal about how unhappy they are to be at a dental office — even though their procedure is clearly necessary to maintain oral health and head off even worse problems in the future. As a business owner, it is difficult to hear some of your patients — your customers, in fact — tell you how much they hate being there.
Fearful patients may be more common in hospital settings than in private practices, says Dr. Graham Forbes of Capital Dental Design, who worked two years in hospital dentistry. “I found a lot more fear there,” he says. “They get their care there, and they had no other choices (and) you seem to find that kind of phobia.”
The best way to alleviate fears and phobias, he says, is to be a “super-empathetic” and to take time and make the first injections and get to the needed level of sedation.
Small Errors — Big Consequences
Dr. Justin Scott of Baicy Dental in Henrico County shares some insight about other stressors in the industry: “Dentistry is both diagnostic and procedure-based, so you have to correctly diagnose the problem and effectively fix it,” he says, adding that unlike some medical professionals, dentists get only one chance to correctly perform a procedure, since teeth do not heal or grow back like soft tissue. In addition, dental procedures call for miniscule incisions — often just millimeters — under magnification and viewed in a small mirror, inside a dark, moist space, and often upside down or at odd angles. The results of dentistry can be major for a patient’s overall aesthetic, since our smile is part of how we interact and communicate with others, and patients expect their dentist to maintain or correct their teeth to their aesthetic norm and to restore or maintain function.
Paying the Bills
Many dentists are often small business owners, responsible for the salaries of their practice’s employees, insurance and overhead. To make this happen, they must meet a certain level of income per day. It’s not just about providing quality care, it’s about doing it while keeping a roof overhead and the lights on. Because a dental office team is often small, the dentist who owns the business is also responsible for the care of this tight-knit work family, including workplace satisfaction, providing health insurance and other benefits. This turns the title of “dentist” in the smaller practices into a business administrator, human resources manager, accountant, clinician and more.
COVID-19 has of course put a damper on the dental industry, Scott says. Although he feels more comfortable now that adequate PPE (personal protective equipment) and proper sterilization generally keep staff and patients safe, there is still fear from many patients over perceived potential risk.
Drs. Justin Scott and Sarah Ann Baicy of Baicy Dental in Henrico County (Photo courtesy Baicy Dental)
It’s a hard-knock life.
If you've never thought of dentistry as physically demanding work, think again. Because dentists and hygienists can only minimally adjust a patient’s positioning, their own bodies are often held in painful positions, for prolonged periods. Today’s dental chairs and operatory stools have undoubtedly improved positioning and ergonomics, but there can still be significant physical stress to the body for dental professionals. In 2021, the ADA surveyed 20,000 American dentists, finding that 84% of dentists reported pain while working — usually in the neck, shoulders and back. Another 14% reported that the pain was significant enough to interfere with their work.
Forbes cites the use of loupes that force you to sit up and not hunch as much. But the loupes are heavy, sit on your face all day and can stress the neck. He’s now using a microscope alleviating the neck stress, and providing a more accurate view.
And there’s more …
Angela Smith, an instructor with Fortis College, has been a dental assistant educator for 14 years. She says that during her 10 years as a clinical dental assistant before shifting to education, she often saw the frustration of dealing with patients with negative ideas about dentistry. “In addition to patients with phobias or who view dentistry simply as elective medicine, there are those who come only for emergency procedures and refuse to maintain routine oral health,” she says. “Even more frustrating were patients who would request cosmetic procedures such as tooth whitening but decline treatment for more urgent needs such as gum disease.” And the list of challenges goes on. Burnout is common, but after sinking many years of education into the field, it’s not always feasible to change — especially for those still paying off student loans.
Mental Health Solutions
Certain aspects of the dental industry will not change. Whether you’re a dentist or a hygienist, dental work often takes place in confined spaces that are usually windowless, and your area of focus is literally about the size of a tennis ball.
William “Leigh” Smith Jr., a service technician in the dental industry for 25 years, has seen it all. “Doing dentistry is in a way just like working in a coal mine. Regardless of advancements in technology — instruments, lighting, digital charting and imaging — you can’t change the fact that miners, much like dentists, still descend into a dark shaft and do what they do.”
What can be done to alleviate this stress?
Scott says that in his experience, creating stress relief starts by maintaining a good work-life balance and doing things that bring you joy outside of the office. “It’s easy to turn work into a personal stress prison,” he says. “You have to bring positive energy to the office and have team members that bring that same energy and enthusiasm.” This is important, he explains, as he spends as many hours with his staff as he does with his children during the workweek.
It’s even more crucial for him, as his wife, Dr. Sarah Ann Baicy, is also a dentist and co-owner of their practice.
“You have to bring positive energy to the office and have team members that bring that same energy and enthusiasm.” —Dr. Justin Scott
The work/life balance too often tips toward work, especially in a small or solo practice.
“As a solo doctor, it’s hard to take a vacation,” says Forbes. There are resources, such as books and podcasts, that can help, says Forbes, along with consulting firms.
He says it’s something that should be addressed in dental schools, but time is limited.
It’s good to be the boss, but there are some downsides, like spending long hours with a spreadsheet, Forbes says.
It helps to surround yourself with an efficient, top-notch team. “Every day is not sunshine and rainbows," Forbes says, “but it’s fun to be there, and on the rainy days, we support each other.”
The American Dental Association recognizes that awareness of mental health resources for dentists is an issue. According to their 2021 survey of 20,000 dentists, less than half of those surveyed were aware of dentist well-being programs. The ADA offers resources online, including videos, podcasts, articles, handbooks and guides that broach topics such as COVID-19, mental health resources, healthy work/life balance, coping with stress and how to avoid burnout.
Resources are available, but often go underutilized. “In educating dental professionals, from dental school to dental hygiene school to dental assisting school,” Fortis College’s Smith says, “we need to do a better job at offering seminars and lecture segments addressing mental health.”
