Rethinking Anxiety in Dentistry

A significant percentage of dental and dental hygiene students already meet criteria for burnout before entering the workforce.¹ This suggests that the potential problem lies in the way of thinking they have adopted before they entered professional training.

Globally, approximately one in seven (14.3%) of 10 to 19-year-olds experience mental health conditions, yet these remain largely unrecognized and untreated.² Anxiety is one of the most common mental health issues. Some students entering dental training probably have a preexisting untreated condition and without baseline intervention, the mental health condition may intensify throughout their careers. If you add in the recognized demands of training and occupational stress, the dental workforce is experiencing higher rates of burnout, anxiety, and depression compared to many other professions.^3,4

Traditional approaches to managing stress in dentistry, while valuable, have not fully addressed the root of the problem.⁵ United States-based research shows elevated suicide mortality rates among dentists, with a steady increase over recent decades.⁶ This trend persists despite decades of research, awareness campaigns, and well-established coping strategies.⁷ 

This new perspective on anxiety emerged during The Philosophy Fridge experience⁸ and was presented in an earlier online exclusive. It challenges the way oral health professionals think about anxiety itself. Rather than viewing anxiety solely as a negative condition to suppress or eliminate, this approach considers it a natural and potentially useful function; an internal signal designed to guide perception, decision-making, and action.

Adapting to a New Perspective on Anxiety

Adapting to a new perspective is notoriously difficult, and traditional therapeutic approaches appear to underestimate the power of early life conditioning. Conditioning begins at birth and is wholly dependent on parents’ beliefs, ideologies, and their understanding of why nature put the instrument of anxiety in us and what nature intended its purpose to be. We learn how to process anxiety through our conditioning. Early experiences, whether supportive or adverse, shape how people respond to stress later in life. Overprotective environments, neglect, abuse, or chronic pressure can all contribute to maladaptive patterns.⁹

Dysfunction in the processing of anxiety usually manifests with the individual struggling to integrate into society and researchers have identified a cycle in which the very dysfunction that needs to be addressed also limits the ability to address it.¹⁰

In the context of dentistry, this conditioning may be reinforced by the demands of education and clinical training. In addition, the dental profession attracts certain personality types who do not cope well if training standards are poor.

If you work within your biology then anxiety becomes a positive, powerful, life-enhancing asset, whatever stage you are at in your life. The problem is so much about we are told about anxiety in our earlier life is wrong. We’re not meant to shrink, fade, or be sidelined. We’ve just never been shown an accurate picture of what is possible, or how we can take control.

Managing Emotions

Cognitive behavioral therapy (CBT) is the mainstay of therapy and emphasizes the relationship between thoughts, feelings, and behaviors.¹¹ It provides tools for reframing negative thinking and developing healthier responses. However, reports show success is highly variable. People often don’t realise that for therapy to be successful they have to first believe it’s going to be successful. The confusion is understandable as generally we are raised to not associate science with the art of belief.

One of the greatest challenges during therapy is unravelling the concepts of emotions, thoughts, feelings, and thinking. Another hurdle is separating the nature of these concepts from the origin of anxiety. It seems to become more difficult with age, and it appears that what is laid down in the formative years can be partly irreversible.

Practical Steps Toward Overcoming the Challenges of Readaptation

A more effective approach may involve redefining your relationship with therapy. This begins with a series of mindset shifts:

• Appreciate that for therapy to be successful you have to first believe it will be successful.
• Accept that professional mental health support, whether therapy or medication, often involves trial and adjustment rather than immediate solutions.
• Therapy requires an active will and active participation.
• The aim is to control negative thoughts, stop living in fear, and to reduce the number of things being worried about.
• Recognize that an emotion is a natural reflexive reaction to a sensation.
• Meaning was attached to the sensation during the formative years through conditioning.
• Some of those meanings aren’t suited to coping with the realities of humanity and the world.
• It takes an emotion (with its attached meaning) plus a thought to create a feeling.
• The thought is perceptual based on the desired outcome (ie, the thought can be controlled by what you want the outcome to be).
• Emotions can’t be changed but thoughts can.
• The feeling drives behavior and action.
• Action can result in change.
• The action is to accept all emotions, thoughts, feelings, and behaviors and to gently fade out the unhelpful ones without overly amplifying the desirable ones.

These shifts are not quick fixes. They require consistent effort and reinforcement over time. But they offer a pathway toward greater adaptability, balance, and resilience.

It can help to empower yourself by reading material on personal construct theory, theory of the mind, network theory, and CBT.
Over time, you realize that the key to happiness is balance, and balance requires a broad experience of a full spectrum of emotions: good and uplifting vs cruel and deflating. Avoiding the negative ones with sights set on only chasing positive ones is a perfect set up for emotional fragility and disaster.

References

1. Deeb RG, Braun S, Carrico C, Kinser P, Laskin D, Golob Deeb J. Burnout, depression and suicidal ideation in dental and dental hygiene students. Eur J Dent Educ. 2018;22:e70-e74
2. Institute for Health Metrics and Evaluation. 2021 Global Burden of Disease. Available at https://vizhub.healthdata.org/gbd-results/. Accessed May 13, 2026.
3. Kulkarni S, Dagli N, Duraiswamy P, Desai H, Vyas H, Baroudi K. Stress and professional burnout among newly graduated dentists. J Int Soc Prev Community Dent. 2016;6:535–541.
4. Durkin J, Mumford C. Burnout, stress, and wellbeing: the rising mental health crisis in UK dentistry in dental care professionals. A quantitative Perspective. Int J Dent Hyg. February 2025.
5. Plessas A, Paisi M, Bryce M, et al. Mental health and wellbeing interventions in the dental sector: a systematic review. Evid Based Dent. 2022;7:1–8.
6. Tomasi SE, Lipman R, Bloom F, Nett RJ, Cox-Ganser JM, Fechter-Leggett ED. Suicide deaths among dentists in the United States. J Am Dent Assoc. 2005;156:1024-1033.
7. Meyerson J, Gelkopf M, Eli I, Uziel N. Stress coping strategies, burnout, secondary traumatic stress, and compassion satisfaction amongst Israeli dentists: a cross-sectional study. Int Dent J. 2021;72:476–483.
8. Ahmed H. The Philosophy Fridge: Bad Apples, Soggy Gums, Rotting Teeth. Self-published, 2019.
9. Lieb R, Wittchen HU, Höfler M, Fuetsch M, Stein MB, Merikangas KR. Parental psychopathy, parenting styles, and the risk of social phobia in offspring. A prospective-longitudinal community study. Arch Gen Psychiatry. 2000;57:859-866.
10. Borsboom DA. A network theory of mental disorders. World Psychiatry. 2017;16:5-13.
11. Glenn D, Golinelli D, Rose RD, et al. Who gets the most out of cognitive behavioural therapy for anxiety disorders? The role of treatment dose and patient engagement. J Consult Clin Psychol. 2013;81:639-649.