Let's talk about mental health

The pandemic has led to a rise in mental health issues among medical professionals across the board, but as we’ve seen, caring for our own mental health is essential in providing exceptional care to patients.

By Michael Silverman DMD

In dentistry, discussions around mental health predominantly focus on the patient. Yet, even before the COVID-19 pandemic, the dental profession was cited as having a high suicide rate compared to other medical professions. While suicide cannot be attributed to any one factor such as career choice, the pandemic has exacerbated this issue, with health care workers at the forefront of a national crisis, shouldering an insurmountable obligation of care.

The pandemic has led to a rise in mental health issues among doctors and nurses, and dentists are no exception. Turning the discussion inward, we look at the impact the pandemic has had on the mental well-being of dentists and examine ways to care for our psychological wellness as caregivers during such a remarkable time of uncertainty.

Inherent Stress

Dentistry can be an inherently stressful career. Burnout, exhaustion, heart attacks, and suicide can be the result of the pressure, schedules, patient demands, financial and legal issues, regulations, and focus required of dentists.

In a 2007 article written by orthodontist Dr. Randy Lang, he states dentists suffer from psycho-neurotic disorders 2.5 times greater than physicians, indicating that dental professionals are at high risk of stress-related illnesses.

In the 2017 Vice News article, “Are Dentists Really More Prone to Suicide?” by Elizabeth Brown, she states a query of the CDC's National Occupational Mortality Surveillance over the years 1999-2010, “showed that dentists were 2.5 times as likely to die by suicide as members of the general population,” linked to pressure in the form of “money trouble, physical and emotional stress, isolation, and the unfavorable public perception of dentists in general.”

That’s enough to make everyone appreciate the value of mental health breaks and wellness retreats.

COVID-19 Created More Space to Talk About Mental Health

In addition to the stressors already found on the job, dentistry is particularly burdened by the airborne nature of COVID-19. While dentistry is an occupation at high risk of “infection potential,” dentists have shown a lower rate of actual infection when compared to other healthcare workers. A study by the University of Connecticut attributes this to “a high level of adherence to enhanced infection control procedures and strict protocols.”

These strict protocols, along with closures during lockdowns and the limiting of scheduling patients and staff throughout the pandemic, have added to the financial pressure and staffing issues that many dental practices are now experiencing.

Researchers from Israel and India indicate that fear of infection and financial anxiety are the top psychological stressors elevating a sense of distress internationally among dental professionals.

Given this breaking point, there has been a growing "call-to-action" movement within the dental community to expand awareness and encourage prevention.

Organizations such as the American Dental Association, the Dental Mental Network, and Mental Health Wellness in Dentistry have set up support and resources for dental professionals to feel more comfortable discussing mental health and implementing procedures to aid in the mental wellness of dentists and their entire dental staff. 

The British Dental Association has given members 24-hour access to counseling and emotional support via a professionally staffed medical helpline in the U.K.

In March of this year, the ADA partnered with Hope for the Day, a Chicago-based nonprofit focusing on mental health. Together, they're collaborating on a series of mental wellness resources to raise awareness and dispel mental health stigma.

Ways You Can Better Manage Stress

Stress developed out of an evolutionary process for survival, activating what we know as the “fight or flight” response. Stress acts as an indicator in the brain, causing the hypothalamus and higher cognitive centers to shut down. In our current environment, more and more people are finding themselves in a constant state of heightened alert due to overwhelming stress.

But our overall well-being isn't just the absence of stress, it's a healthy social, physical, and mental state. Experts in psychology recommend ways to manage self-care as staying active and setting aside time for leisure activities; having compassion for others and yourself is essential. Try to limit the internal negative "self-talk" by focusing on positives. Get into a routine that allows for quality sleeping, eating, drinking, and routine exercise. Some ways to do this include:

  • Staying Active: It's well understood that routine physical activity positively impacts our physical and mental health, including its effect on the immune system, which controls the probability of infection. Take time daily, if even in small increments throughout the day, to move and be active. 
  • Social Connections: Additional stress can come from prolonged isolation, which negatively affects mental well-being. Staying in touch with family and friends, even via social media, can provide an essential source of joy and connection. 
  • Practice Positive Thinking: By drawing attention to the present, we can break negative thought patterns that become overwhelming. Mindfulness is a skill used to draw the mind away from negative thought patterns, focusing on the senses and breathing to achieve a state of calm, homeostasis. Left unchecked, our minds are drawn to thoughts based on fear, anxiety, and past or future events. Through the practice of mindfulness, one aims to fully enjoy living in the present and release accumulated stress from over-thinking.
  • Connect with Colleagues: Social support systems are a vital resource for healthcare providers. Finding the support of peers who can empathize and understand one another leads to a reduced feeling of isolation and stress. Look for professional member organizations to join, such as local, state, and national dental societies.
  • Utilize Industry-Specific Resources: With mental health resources designed for dentists, seeking help is private and specific to your needs as a healthcare provider. There are even therapists who specialize in problems unique to dentistry.

In Conclusion

The COVID-19 pandemic has had a crushing effect on the mental health of medical providers globally. More than ever, we need to recognize the signs of distress and shatter the silence around our mental well-being. The stigma of asking for help can only diminish when we talk openly about mental health. We all get that “gut feeling” when we know something isn’t right– be it ourselves, loved ones, or colleagues.

As dentists, physical and mental suffering should never be part of our profession. If COVID-19 has taught us anything, it’s that caring for our well-being is the first step in providing a high level of care to patients.

Author: Dr. Michael Silverman is a globally recognized lecturer, educator, author, and patient's rights advocate, and the founder and President of DOCS Education. He has appeared in front of 28 dental boards to advocate for the right of dentists to provide sedation in an environment of safe and reasonable regulations. A graduate of the University of Pennsylvania School of Dental Medicine and believer in lifelong continuing education, Dr. Silverman continues to champion safe and effective minimal and moderate dental sedation.

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