Unmasking Burnout: A Dentist’s Guide to Recognition and Recovery

As dentists, we have the most incredible job in the world. Every day we impact our patients’ ability to live and experience their world with confidence and free of pain. Beyond improving mastication, we give patients permission to express themselves and to smile. We are literally putting smiles on children’s faces, daily. So why are so many dentists experiencing burnout?¹

In 2021, the American Dental Association distributed the Dentist Well-Being Survey to 20,000 dentists across the United States. This report revealed that the percentage of dentists diagnosed with anxiety in 2021 had more than tripled since 2003. In addition, dentists scored higher on a depression scale than any previous survey.¹

A systematic review and meta-analysis published in 2022 aimed at assessing the prevalence of burnout in dentists showed the notable impact of emotional exhaustion, depersonalization, and decreased personal accomplishment. Of the 13% of dentists reporting significant burnout symptoms, 25% presented with high levels of emotional exhaustion, 18% had high levels of depersonalization, and 32% noted reduced personal accomplishment.²

Post-COVID depression and anxiety have forced many brilliant clinicians to leave dentistry altogether in what has been identified as the impact of “The Great Resignation.” Burnout and increased stress levels not only diminish reported happiness and fulfillment in the profession, but directly impair our ability to practice dentistry with competence and excellence — leaving many professionals feeling ashamed and isolated.³

As a practicing orthodontist and business owner, I experienced the same symptoms of overwhelm only 5 years into my career. Crippled by shame, I told no one. I was chronically exhausted and depressed, and felt trapped in a profession that was once my dream. I started to feel like I had no value in my work and fantasized about how I was going to exit the profession.

It turns out that my feelings of inadequacy and overwhelm were characteristic of burnout symptoms originally described by an American psychologist Herbert Freudenburger, PhD, in 1974.⁴ Freudenburger initially outlined 12 stages of burnout that were later simplified into five.³

Stage 1. Honeymoon Stage

The honeymoon stage is characterized by enthusiasm and excitement, and is often accompanied with passionate engagement. It is defined as feeling productive and inspired, even particularly creative and optimistic about the future.

A key component of stage 1 is proving your capability with a high emphasis on achievement.³ This stage is evidenced by rapid growth within the profession and high levels of productivity accompanied by seemingly endless energy, often working 7 days a week.

Stage 2. Onset of Stress

Stage 2 is the start of feeling stagnate. During this stage, you start to notice that your work is taking more time than you’d like. You start looking for “work-life balance.”

Some days feel more stressful than others and you notice that you have less time and energy for the people you love and the activities that you enjoy and value outside of work. Physically, this stage can be accompanied by headaches, anxiety, irritability, and changes in appetite and sleep pattern. Objectively this stage also shows a dip in production and quality of work.³

Stage 3. Chronic Stress

Many dentists who reach this stage of burnout will recognize a rise in frustration levels and an increased number of hours of the day experiencing frustration. Problem-solving skills and performance start to decrease significantly.

Associated feelings in stage 3 include an overwhelming sense of powerlessness and victimization. You start to blame people and events outside of yourself. In dentistry, this could look like blaming the economy, insurance companies, staff, patients, and even loved ones.

This stage also commonly includes feelings of resentment, cynicism, and apathy. These habituated feelings lead to persistent fatigue, even exhaustion. Your job starts to feel like a burden that undermines your ability to adequately take care of your overall well-being.³ It is during this stage that increases in alcohol and drug use begin as compensation to calm an overactive sympathetic nervous system.

Stage 4. Burnout

Stage 4 is recognized as the official burnout stage. Increasing feelings of apathy and stress now reach a critical level of exhaustion that can be paralyzing. In this stage, meeting the demands you and others place on you can be challenging. Moreover, this stage is additionally burdened with feelings of inadequacy, failure, pervasive pessimism, and an obsession with escape.

Stage 4 can feel very alienating within dentistry and can negatively impact feelings of self-worth. People in this stage may begin to neglect their personal needs and health due to persistent obsession with work issues and their disempowering emotions.³

Stage 5. Habitual Burnout

Unless there is a dramatic life change or sudden awareness that initiates recovery, burnout can become chronic and habitual. Burnout becomes a way of life. During this advanced stage, not only do you recognize mental and physical fatigue, but you may identify chronic sadness and depression.³

Awareness of burnout symptoms is the first step to combating it. But awareness is not the solution. Once you recognize the symptoms of burnout, intentional changes must be made in your relationship with work to prevent further progression. What follows is five steps to address the symptoms of burnout within dentistry to cultivate a healthier mental and emotional relationship with yourself within this great profession.

 

Managing stress and burnout in dentistry

1. Detach from work.

One of the most effective ways to address burnout is to distance yourself literally and mentally from what is causing it. For the detachment to be effective, both physical and mental distancing are necessary.³ This may be the most challenging task, especially for dentists who are business owners or still have outstanding student loans.

In the latter stages of burnout and stress, we experience an inability to fully access our executive function. Increased and persistent stress directly impairs working memory and cognitive flexibility.⁵ Distortion of urgency and inability to consider alternative solutions are characteristic of chronic sympathetic nervous system activation.

As burnout is exacerbated, so is the fear of stepping away and the inability to fathom another option. Detaching from work can feel unsafe, dangerous, or irresponsible. These disempowering emotions have the opposite effect and increase stress and overwhelm.³

Alternatively, you may consider microdetachments on a regular basis. These may mean working for a few weeks in the month, fewer days in the week, or fewer hours in the day. The key component is to fully separate for the remaining time mentally as well as physically.³

2. Prioritize nervous system regulation.

Nervous system regulation refers to a cascade of physiological responses secondary to intentional mind-body techniques to decrease a heightened stress state.⁶ In a dysregulated nervous system state, the sympathetic and parasympathetic nervous systems are imbalanced.

Dysregulated states, including chronic stress, impact the ability to access key executive functions.⁵ Executive functions that suffer most from a dysregulated nervous system include the ability to problem solve effectively, task initiation, time management, and accessing compassion and positive engagement with others. Symptoms can be physical, mental, and emotional, including chronic pain, migraines, difficulty concentrating, irritation, insomnia, and anxiety.⁷ Regulation of the nervous system requires intentional activation of the parasympathetic nervous system cascade to bring calm.⁶

Paying attention to the body’s queues and slowing down intentionally or taking a break become lifesaving skills. Breathing techniques, somatic body work, meditation, and exercise all help to support a quick recovery from sympathetic nervous system stress to parasympathetic nervous system calm.⁶

3. Embrace what is in your control.

One of the characteristics of latter stage burnout includes the persistent feeling of being out of control.³ Researchers suggest focusing on the aspects of your life that you can control and actively change.⁸ Patient outbursts, economic fluctuations, drama among team members, and last minute patient cancellations are all frequently out of our control and attribute to the majority of stress experienced. Although you can’t control your patient’s flat tire, you can control your response to it.

Mindset work and mindfulness practices strengthen your ability to choose a new perspective or a new thought.⁹ Where do you have control in your work? You always have control over your attitude, mindset, effort, free time, and breath. Maintaining awareness of how each of these impacts your workday can be enormously empowering.²

4. Actively engage in activities that increase appreciation of your own value and productivity.

Stages 4 and 5 of burnout are characterized by feelings of inadequacy and decreased self-value.³ Engaging in activities that are not only enjoyable but that you are good at helps to rebuild self-confidence and self-worth. This is a key component of restoring emotional well-being.⁸

Participation in activities outside of work that help remind you that life is more abundant than the confines of your office, elevates your emotions and establishes perspective. The richness of your life can be cultivated by exploring and making time for things you love outside of work and is possibly the best way to prevent burnout.

5. Cultivate meaningful relationships

Most people who experience burnout find themselves socially isolating and experience feelings of ostracization and loneliness.³ This can be particularly true if you have been focusing too much on work at the detriment of time with loved ones and not making time to nurture critical social connections.

In the longest running study on happiness within the Harvard Study of Adult Development, results have supported the benefits of embracing community.¹⁰ This 85-year-long longitudinal study found that relationships are the key component to happiness. Close relationships have a greater impact on physical and emotional health and well-being than money or material success. Close relationships are, in fact, better predictors of long and happy lives than social class, IQ, or genetics.¹⁰

As a combatant to burnout, placing special emphasis on the relationships in your life that are the most important and fulfilling not only adds value but offers great perspective when work feels overwhelming. Choosing to intentionally make time for meaningful relationships is a strategic business decision.

Conclusion

In my experience, dentists pride themselves on excellence and on being the hardest working people in the room. But there is no badge of honor for burnout. Everyone loses when we push ourselves beyond our limits. Let this article be an opportunity for you to recognize your own habituated patterns that may influence long-term stress.

Give yourself permission to take radical personal responsibility for your own mental and emotional well-being. Most important, know that you are not alone. In the same way you would never expect your patients to treat their own dental pain, it is important to give yourself permission to seek support. It might save more than your career.

References

1. American Dental Association. Dentist Well-Being Survey Report. Available at: https:/​/​ebusiness.ada.org/​Assets/​docs/暧.pdf. Accessed June 4, 2024.
2. Moro JDS, Soares JP, Massignan C, et al. Burnout syndrome among dentists: a systematic review and meta-analysis. J Evid Based Dent Pract. 2022;22:101724.
3. De Hert S. Burnout in healthcare workers: prevalence, impact and preventative strategies. Local Reg Anesth. 2020;13:171-183.
4. Freudenberger HJ. The staff burn-out syndrome in alternative institutions. Psychotherapy: Theory, Research & Practice. 1975;12:73-82.
5. Shields GS, Sazma MA, Yonelinas AP. The effects of acute stress on core executive functions: a meta-analysis and comparison with cortisol. Neurosci Biobehav Rev. 2016;68:651-668.
6. Beer J. Nervous system regulation and why is it important? Available at: https:/​/​positivepsychology.com/​nervous-system-regulation. Accessed June 4, 2024.
7. Elbers J, Jaradeh S, Yeh AM, Golianu B. Wired for threat: clinical features of nervous system dysregulation in 80 children. Pediatr Neurol. 2018;89:39-48.
8. Ginoux C, Isoard-Gautheur S, Sarrazin P. “What did you do this weekend?” Relationships between weekend activities, recovery experiences, and changes in work-related well-being. Appl Psychol Health Well Being. 2021;13:798–816.
9. InsideOut Mastery. 5 Strategies to Focus on What You Can Control – and How to Ignore the Rest. Available at: insideoutmastery./​om/​focus-on-what-you-can-control. Accessed June 4, 2024.
10. Waldinger RJ, Schulz MS. The Good Life: Lessons From the World’s Longest Study of Happiness. New York: Simon & Schuster; 2023.

From Decisions in Dentistry. June/July 2024; 10(4):8-10, 13