By Kathleen O’Loughlin, D.M.D.,
Executive Director and Chief Operating Officer, American Dental Association
Imagine you have been granted a
do-over. Instead of being a 55-year-old experienced practice owner, you are 20 years
old again, bright-eyed and eager to work with your hands and to care for other
human beings by applying yourself in the realm of health care. You are smart—always
at the top of your class. You are certain—almost—that you will be offered a spot
in the dental school that your dad attended. You will, right?
But this second time around, you are
wiser because you have traveled this road before. You know that dental school
will be the hardest years of your life so far—especially that second year. You
know that after you graduate, there is a high likelihood that you will pay
down your $247,000 of dental school debt over what seems like a lifetime. You
will experience feelings of insecurity, like one out of three of your
colleagues who doubt their own competence. There is a one-in-five chance you will
face moderate levels of depression, which may be due to stress at work. You may
even feel the need to self-medicate feelings of sadness with alcohol or
Knowing all this, would you still want
to become a dentist?
In 2015, the American Dental
Association (ADA) conducted a
national survey of America’s dentists, asking them questions about their
general health and well-being. Dentists reported on their levels of stress,
sleep habits, satisfaction with their personal relationships, alcohol and drug
use and other wellness indicators.
The survey also asked: “If you re-lived
your life, would you still want to become a dentist?”
Some respondents expressed doubts, but most
Are you surprised? I’m not.
Dentistry is an extremely rewarding and
fulfilling career. Nine out of 10 dentists in private practice report feeling satisfied.
At the same time, dentists experience
high levels of stress often associated with the unique demands of working in
this field. Dentists treat anxious human beings who demand perfection, and they
do it all day, hunched over in tiny
environments. They are surgeons, but patients are never sleeping; patients are
always awake, so dentists talk them through each procedure, explaining every
step to make them feel comfortable. Most of the time it is exciting, but
sometimes it is exhausting.
High levels of stress in dentistry
disproportionately affect younger dentists. In the survey, dentists under the
age of 40 were less likely to feel in control of their work environments,
scored higher on a depression scale and were at a higher risk of alcoholism
compared with older dentists. This data led me to believe that either a dentist’s
career becomes easier as time goes on as a result of experience, or the dentist
learns to better cope with and manage stress as he or she grows older.
The true answer is probably somewhere
in the middle. But since we are aware of dentistry-related stressors, we may be
able to teach students to cope with them so that they can feel reduced levels
of stress throughout their careers, not just in the later years.
This is not to say that dental schools
should place a higher value on student well-being than they do on training
highly competent dentists. I taught dental students for many years and believe
that the rigor, competitiveness and high standards of the dental school curriculum
are not merely stressors; they are also tools that help teach students to
manage the stress they will face throughout their careers.
I am an advocate of meditation, of
focusing on the moment, observing the mind and body and accepting what is
observed. Self-compassion is important, especially in a stressful profession
like dentistry. In the field of psychiatry, research has shown that mindfulness
training can help patients manage stress through focused thoughts, self-awareness
and acceptance of feelings that exist. It has also shown that self-care or self-soothing
(without alcohol or drugs) enables the body and mind to achieve a quiet
peacefulness that mitigates the harmful effects of chronic “fight or flight”
adrenalin biochemistry. Many dental schools have added mindfulness training and
wellness to their curricula.
The practice of dentistry and its
outcomes are improved when a dentist is properly equipped to handle the
emotional stressors that accompany a career in dentistry, and the entire
profession is enriched by professionals who operate at their highest potential.
That potential is reached when we possess an optimistic mindset that includes
not only mindfulness but also sufficient physical exercise, healthy relationships,
a balanced diet and, most importantly, a sense of purpose and compassion for
Stress impairs a person’s ability to
operate at her or his highest potential, and individuals do not always seek out
the help they need, even if they know they need it. In the survey we conducted,
about half of dentists said it would be difficult for them to seek professional
help because they think they should be able to solve problems on their own. That
perfectionist, get-your-hands-dirty problem-solving attitude that drew many of
us to dentistry, also prevents us from asking for help when we need it.
My anecdotal experience teaching dental
students reflects this data; as a teacher, you often are not aware there is an
issue until a student appears in tears at your office door or simply, silently,
stops coming to class or clinic.
Programs like the ADA’s Dentist Health and Well-Being Program aim to support dentists with the nonclinical aspects
of dentistry, like prescription opioid abuse prevention, substance use and
mental health support and dental practice ergonomics. The ADA’s research and
support resources are available to faculty members and students.
Dentist wellness is a passion for me
personally. My dad, a dentist, took his own life due to untreated depression
when I was a third-year dental student. He never asked for help, and my family,
including me, was in denial. When I was in my last year of dental school, I was
pregnant. I was so stressed thinking that I wouldn’t graduate on time that my
blood pressure was sky-high, and I wasn’t eating or sleeping well. My
obstetrician asked me, “What the heck are you doing?” She said my stress level
and how I was handling it could negatively affect my baby. What a wakeup call.
I feel for dental students to this day because I still remember the feelings they
experience of being overwhelmed—of helplessness, and of hopelessness—and the
toll those feelings can take on the heart and mind. I am lucky I learned my
lesson early. We cannot avoid stress and emotional distress, but we can learn
to manage it in a way that benefits our families, our patients, our profession
Knowing all this, if I could re-live my
life, would I still want to become a dentist?