MPS Foundation
Estimated read time: 5 mins
Poor mental health and wellbeing within dentistry is an issue of concern. It is a risk to personal safety and wellbeing, patient safety, and can negatively impact other areas of one’s life. However, despite the plethora of literature on stress in dentistry, and how it can negatively impact patient care, there is a dearth in knowledge around resilience.
Rightly so, the personal and professional wellbeing and development of healthcare professionals and their teams remains a priority for indemnity providers. Particularly within the stressful field of dentistry, there is need for more understanding of the factors which may erode or enhance resilience to dental environment stress for different members of the dental team, and how resilience is operationalised by these team members.
It is also important to clarify some of the different or similar sources of stress associated with particular roles within the team. In the field of aviation safety, passengers are instructed to put on their own oxygen mask before helping others. This rationale applies equally to dental professionals who firstly need to look after their own self-care to ensure they can protect the safety of their patients.
The MPS Foundation funded a study recently published in the British Dental Journal which explored dental professionals’ perceptions of resilience to dental environment stress. The full publication is open access and can be found here:
The study, carried out by the University of Portsmouth, analysed data from 22 interviews conducted with participants who were dentists, dental therapists, dental hygienists, dental nurses, dental technicians, and clinical dental technicians. The following discusses some of the key findings.
Participants spoke about the issues related to working within the restrictions of the NHS, which were primarily stressors associated with time pressures and patient expectations. However, even for specialists at the ‘top of their field’ in private practice, patient expectations were also a source of stress. Patient-led stressors have been a constant theme within the literature over the last two decades with fear of litigation reported as an emerging source of stress within dentistry. Interestingly though, this was not a theme which emerged from participants in this study, which is an encouraging finding in relation to participants’ perception that they perceived themselves as working safely and effectively.
It was not expectations from patients which were the source of stress for dental technicians (DT), but unrealistic expectations from other members of the team. The lack of insight into the skill and expertise of the DT, along with poor communication, seemed to be the major contributing factors for DTs sometimes feeling a lack of belongingness in the dental team. They concluded that better integration and collaboration at dental undergraduate level could be a solution to this issue.
In its investigation into the public and the profession’s understanding of ‘professionalism’, the General Dental Council (GDC) found that the tension between patient interest and financial interests could affect how treatment is provided in some cases. This study found one example of uneasiness in feeling compelled to advocate treatment a participant did not feel was necessary. This may be a dilemma for some groups of registrants who are not in a position to find work elsewhere and may well increase the risk of medico-legal issues further down the line
Lack of autonomy over how their day was planned and their ‘perceived position’ within the hierarchy of the dental team was echoed by all of the dental nurse (DN) participants. It was also a high source of stress for the dentists working in the corporate setting, as generally they had been used to having full control and now found themselves being ‘told’ what they could and could not do. On the other hand, good organisation was strongly linked to participants’ perception of having autonomy, and control over one’s day was a key component which participants felt improved their resilience.
Supportive networks as a tool for resilience is a major contributor to our coping mechanism. The participants used a range of networks which were all very similar. However, there was a reluctance from participants to use ‘in-house’ support and preferred other avenues. This also aligns with research which suggests that self-efficacy and self-worth can be undermined if the social support which has been given is perceived as having been given disingenuously. This is an important observation which may suggest a training and development need for those practices whose support schemes are not used by the very people for whom they are there to serve.
It was apparent from all the participants with experience, that whatever their role was in the dental team, it brought aspects of ‘meaningfulness’ which they perceived as mitigators to the stressors. These participants interpreted their experiences in terms of a meaningful life story, such as work which gave them a sense of purpose. At a biological level, purpose in life has been shown to predict both lower levels of allostatic overload and better emotional recovery from negative stimuli, and therefore increase resiliency to stress and depression. At a psychological level, it has been shown to be a strong predictor of an individual’s perception of autonomy, and likewise may also increase resiliency to stress and depression. The participants also believed that their work made a difference.
The study provided further understanding of how resilience to dental environment stressors is operationalised in the every-day work experiences of the dental team. The authors believe it is the first study to purposefully include representation from all registrants of the dental team, so their voices were heard. Although there were many similar experiences among the dental team, the findings also highlighted disparities with experiences which need to be addressed to further enhance dental professionals’ wellbeing. On the other hand, despite the disparities among participants in this study, they were all able to discuss attitudes towards their work which portrayed the characteristics of being positively-functioning individuals.
Learning about coping or preventive strategies that dental team members are using on a day-to-day basis to get through their working day has a fundamental influence on how we can interpret personal wellbeing, and the safety of patients. This philosophy underpins recent initiatives for mental health frameworks within the profession both nationally and globally. Such knowledge can only be seen as huge benefit to the profession as a whole, and needs to be disseminated to inform stakeholders in multiple arenas who have an interest in the wellbeing of a group of healthcare providers who make a vital contribution to the oral and holistic health of our population. A follow-up national survey is planned, with its questions informed by the results of this study.