Levels of burnout in general dental practitioners in the south-east of England

Burnout, Stress, and Wellbeing: The Rising Mental Health Crisis in UK Dentistry in Dental Care Professionals. A Quantitative Perspective

RESEARCH AIM

To determine if dental care professionals working in National Health Service (NHS) practices are more at risk of stress, wellbeing concerns and burnout than their private practice counterparts.

INTRODUCTION

In dentistry, stress, anxiety, and wellbeing concerns have been apparent for many years with burnout and poor mental health in dental registrants being described as early as the 1980s.

METHODOLOGY

An online platform-based questionnaire was used to administer the chosen scales. Data from 201 participants were analysed (N = 201). The sample consisted of 31 dental nurses and 170 dental hygienists and dental therapists.

RESULTS AND CONCLUSIONS

A one-way multivariate analysis of variance (MANOVA) determined that there was no statistically significant difference between private and mixed practice dental professionals on the combined scales F (3, 190) = 0.76, p = 0.59, Wilks Lambda = 0.97, partial eta squared = 0.12. Dental hygienists, dental therapists and dental nurses working in mixed private and NHS dentistry are not more susceptible to stress, wellbeing issues and anxiety than their private counterparts according to the data set. This suggests that there are other factors associated in the mental health concerns of registered dental care professionals raised by the literature examined. The feelings and frustrations of dental registrants are likely to have lasting consequences for the provision of dentistry if working practices and hierarchical conditions do not improve patient access to both private and NHS dentistry. More research into the stress, wellbeing and burnout levels across dental registrants would be beneficial to explore the effects on the entire dental team, with a focus on solely working in NHS provision.

Sources of occupational stress amongst dentistry academics

BACKGROUND

Dentistry professionals may experience significantly higher occupational stress than other health professionals and dentistry academics may have specific work content and context sources of stress.

AIMS

The aim of this study is to identify common sources of occupational stress, and how these are associated with wellbeing, in dentistry academics.

MATERIALS & METHODS

A cross-sectional online survey with staff in Dentistry departments in Australia and New Zealand. Assessment included 23 items from five general domains of occupational stress from the NIOSH-Generic Job Stress Questionnaire, a 23-item list of sources of stress and the 22-item Psychological General Well-Being Index. Analyses used descriptive statistics and multiple linear regression.

RESULTS

A total of 107 respondents (average age 50 ± 11.7 years, 56.8% men) completed the survey. Leading sources of occupational stress were job future, time pressure at work, work overload, and administration demands. A multiple linear regression model significantly predicted wellbeing, F(8,77) = 13.141, p = .000, adj.R²  = .53, but there were no significant associations for any of the specific sources of stress.

CONCLUSION

The combination of time pressure, workload and responsibility, job dissatisfaction, low social support, and uncertain job future was inversely associated with wellbeing amongst these dentistry academics. Future studies should consider the development and evaluation of interventions to address these concerns.

Estimation of Factors Affecting Burnout in Greek Dentists before and during the COVID-19 Pandemic

This study is a comprehensive, cross-sectional survey in occupational burnout, career satisfaction, and quality of life conducted in March 2021 among dentists in the vast area of metropolitan Athens, Greece. Data were collected using a self-reported questionnaire based on the Copenhagen Questionnaire (CQ) for assessing work stress and the Maslach Burnout Inventory-Human Service Survey (MBI-HSS) for evaluating occupational burnout. Using the independent t-test, ANOVA, Pearson's correlation, and multiple linear regression, 804 valid questionnaires were analyzed. During the pandemic, personal exhaustion was affected by gender (b = 1.862, p = 0.0001), age (b = -0.598, p = 0.0001), number of children (b = -0.886, p = 0.020) and higher degree (b = -0.450, p = 0.012). Exhaustion due to working with patients was affected by gender (b = 0.662 p = 0.0001), age (b = -0.513, p = 0.0001), number of children (b = -0.701, p = 0.0001), higher degree (b = -0.207, p = 0.028) and years in practice (b = 0.408 p = 0.0001). Males were more prone to unhappiness, dissatisfaction, and professional physical and emotional exhaustion, but personal resources through higher education, beliefs, values, and hobbies can offer a preventive shield to all dental professionals. Economic management issues can also enhance dentists' satisfaction and feeling of safety in a rapidly changing environment.

The Risk of Burnout Syndrome and Determining Factors in Dentists from Mureș County

Introduction: In our modern society, burnout syndrome develops over a long period of time because of constant stress and increased emotional pressure. Dentistry is known as one of the most stressful professions. The aim of this study was to determine the incidence of burnout syndrome among dentists in Mureș County, Romania, and to assess the determining factors associated with burnout. Material and methods: We conducted an online survey regarding burn-out syndrome among dentists. Results: The most frequent complaint among respondents was the loss of personal accomplishment, followed by emotional exhaustion and depersonalization. Higher levels of emotional exhaustion and depersonalization were seen in non-married, male dentists between 51–60 years, who worked more than 8 hours a day without an assistant. Conclusions: Based on the presented data, the risk factors for burnout syndrome should be brought to the attention of dentists and various preventive programs should be implemented.

Psychological Distress among Undergraduate Dental Students in Saudi Arabia and Its Coping Strategies-A Systematic Review

The objective of this paper was to evaluate the studies that have reported on psychological issues among dental students in Saudi Arabia and to develop coping strategies to overcome these mental health-related issues. The present systematic review is in accordance with the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search for the articles was carried out in the electronic databases by four independent researchers. The data search was performed in the electronic search engines like PubMed, Google Scholar, Web of Science, Scopus, Medline, Embase, Cochrane and Saudi Digital Library for scientific research articles published from January 2000 until December 2020. STROBE guidelines were adopted for qualitative analysis of six articles which met the eligibility criteria. The analysis of the literature revealed that most of the studies included were conducted in the past 8 years in different regions of Saudi Arabia. Findings of this systematic review clearly state that dental students in Saudi Arabia experience higher levels of depression, stress and anxiety and stress during their education period, with a higher stress for female students compared to male students. There is an urgent need to introduce interventional programs and preventive strategies to overcome the long-term effects.

Barriers and facilitators to GP-patient communication about emotional concerns in UK primary care: a systematic review

BACKGROUND

In the UK, general practitioners (GPs) are the most commonly used providers of care for emotional concerns.

OBJECTIVE

To update and synthesize literature on barriers and facilitators to GP-patient communication about emotional concerns in UK primary care.

DESIGN

Systematic review and qualitative synthesis.

METHOD

We conducted a systematic search on MEDLINE (OvidSP), PsycInfo and EMBASE, supplemented by citation chasing. Eligible papers focused on how GPs and adult patients in the UK communicated about emotional concerns. Results were synthesized using thematic analysis.

RESULTS

Across 30 studies involving 342 GPs and 720 patients, four themes relating to barriers were: (i) emotional concerns are difficult to disclose; (ii) tension between understanding emotional concerns as a medical condition or arising from social stressors; (iii) unspoken assumptions about agency resulting in too little or too much involvement in decisions and (iv) providing limited care driven by little time. Three facilitative themes were: (v) a human connection improves identification of emotional concerns and is therapeutic; (vi) exploring, explaining and negotiating a shared understanding or guiding patients towards new understandings and (vii) upfront information provision and involvement manages expectations about recovery and improves engagement in treatment.

CONCLUSION

The findings suggest that treatment guidelines should acknowledge: the therapeutic value of a positive GP-patient relationship; that diagnosis is a two-way negotiated process rather than an activity strictly in the doctor's domain of expertise; and the value of exploring and shaping new understandings about patients' emotional concerns and their management.

Occupational burnout and depression among paediatric dentists in the United States

BACKGROUND

Paediatric dentists in the United States may be at greater risk for occupational burnout and/or depression because of chronic stress associated with provision of paediatric dental care and increasing prevalence of females in the workforce.

AIMS

To determine the prevalence of occupational burnout and/or depression among US paediatric dentists.

DESIGN

A self-administered online anonymous survey was sent to members of the American Academy of Pediatric Dentistry (n = 4735). The questionnaire consisted of seven demographic items, 22 items of Maslach Burnout Inventory (Three subscales: Emotional exhaustion, Depersonalization, and Personal accomplishment), and eight items of Patient Health Questionnaire-8.

RESULTS

The survey had a response rate of 11.4% (females = 53%). Twenty-three per cent of respondents had high emotional exhaustion while fewer respondents had high depersonalization (12%) or low personal accomplishment (10%). Nine per cent fulfilled the study's definition of occupational burnout (high emotional exhaustion + high depersonalization). Seven per cent of respondents had moderate-to-severe depression and showed significant correlations (P < .05) with high emotional exhaustion, high depersonalization and low personal accomplishment. Two out of five respondents with occupational burnout also had moderate-to-severe depression. There were no gender differences in prevalence of burnout or depression.

CONCLUSIONS

Few paediatric dentists had occupational burnout and/or depression.

[Mercury exposure and dentists' health status in two regions of centrall Morocco: descriptive cross-sectional survey]

INTRODUCTION

mercury exposure is recognized as a worldwide public health concern. However, the effect of long-term exposure to low-doses of this heavy metal is still subject to debate. Due to the use of mercury in dental amalgam, dental health care professionals are chronically exposed to low-doses of this metal. In this context, we have conducted a descriptive cross-sectional survey among liberal dentists in two regions of the center of Morocco. In parallel, the global health status of participants was investigated to assess the relevance of a subsequent etiological survey.

METHODS

data were collected through a self-reported questionnaire. Occupational exposure of dentists to mercury was evaluated based on their use of dental amalgam. Moreover, the other common factors increasing the background pollution or inducing exposure peaks were also investigated. On the other hand, smoking, vaccination, fish consumption, and the number of dental amalgam in mouth were considered as non-occupational exposure sources. Finally, the self-reported global health problems of participants were collected.

RESULTS

192 dentists were included in the present study. Seventy-six percent (76.04%) of them declared using dental amalgam in their practice. Moreover, the presence of dental amalgam in mouth was identified as the main non-occupational source of exposure to mercury (63.45% of participants). Finally, most of participants (46.35%) have expressed neuropsychological complaints.

CONCLUSION

altogether, our results revealed a real mercury exposure in the studied population. Thus, effective preventive measures should be promoted to minimize the mercury exposure in dental offices. Moreover, an etiological study will be of great interest to reveal the impact of mercury exposure in this population.

The evaluation of a continuing professional development package for primary care dentists designed to reduce stress, build resilience and improve clinical decision-making

Introduction Stress and burnout are widely accepted as a problem for primary care dental practitioners. Previous programmes to address this issue have met with some success. Burnout is associated with poor coping skills and emotion regulation, and increased rates of clinical errors. Anxiety is associated with poor decision-making and is thought to be associated with poor clinical decision-making. Attempts to improve decision-making use increasing meta-awareness and review of thinking processes. Bibliotherapy is an effective method of delivering cognitive behavioural therapy as self-help or guided self-help (with some therapist input) formats.Objective To evaluate the efficacy of a specially designed CPD package which was designed to improve coping skills, build resilience and reduce the impact of anxiety on dentists' clinical decision-making.Design A multi-centred quasi-experiment.Setting Lincolnshire and Nottinghamshire (England) 2014.Materials and methods Thirty-five volunteer primary care dentists used two versions (self-help [SH] and guided self-help [GSH], which included a 3 hour workshop) of a specially written cognitive behavioural therapy bibliotherapy programme designed to improve well-being and decision-making.Main Outcome Measures The main outcome measures were dentists' burnout, depression, anxiety, stress and decision-making style. Data were also collected on use and evaluation of the programme.Results At 6 weeks there was a clinically and statistically significant reduction in depression, anxiety and stress levels, a statistically significant reduction in burnout (emotional exhaustion) and hypervigilant decision-making, and an increase in personal achievement. The improvements in depression, stress, emotional exhaustion and hypervigilant decision-making were maintained at 6 months. Dentists were overwhelmingly positive in their evaluation of the project and used most of its contents.Conclusion With the caveat of small numbers and the lack of a no-treatment control, this project demonstrated that a self-help package can be highly acceptable to dentists and, in the short-to-medium term, improve dentists' well-being and decision-making with implications for patient safety.

A study to explore if dentists' anxiety affects their clinical decision-making

Aims To develop a measure of dentists' anxiety in clinical situations; to establish if dentists' anxiety in clinical situations affected their self-reported clinical decision-making; to establish if occupational stress, as demonstrated by burnout, is associated with anxiety in clinical situations and clinical decision-making; and to explore the relationship between decision-making style and the clinical decisions which are influenced by anxiety.Design Cross-sectional study.Setting Primary Dental Care.Subjects and methods A questionnaire battery [Maslach Burnout Inventory, measuring burnout; Melbourne Decision Making Questionnaire, measuring decision-making style; Dealing with Uncertainty Questionnaire (DUQ), measuring coping with diagnostic uncertainty; and a newly designed Dentists' Anxieties in Clinical Situations Scale, measuring dentists' anxiety (DACSS-R) and change of treatment (DACSS-C)] was distributed to dentists practicing in Nottinghamshire and Lincolnshire. Demographic data were collected and dentists gave examples of anxiety-provoking situations and their responses to them.Main outcome measure Respondents' self-reported anxiety in various clinical situations on a 11-point Likert Scale (DACSS-R) and self-reported changes in clinical procedures (Yes/No; DACSS-C). The DACSS was validated using multiple t-tests and a principal component analysis. Differences in DACSS-R ratings and burnout, decision-making and dealing with uncertainty were explored using Pearson correlations and multiple regression analysis. Qualitative data was subject to a thematic analysis.Results The DACSS-R revealed a four-factor structure and had high internal reliability (Cronbach's α = 0.94). Those with higher DACSS-R scores of anxiety were more likely to report changes in clinical procedures (DACSS-C scores). DACSS-R scores were associated with decision-making self-esteem and style as measured by the MDMQ and all burnout subscales, though not with scores on the DUQ scale.Conclusion Dentists' anxiety in clinical situations does affect the way that dentists work clinically, as assessed using the newly designed and validated DACSS. This anxiety is associated with measures of burnout and decision-making style with implications for training packages for dentists.

An observational analysis of recent female dental enrolment figures in the Republic of Ireland

PURPOSE/OBJECTIVE

This research investigates the participation and completion rates of Irish female undergraduate dental students from 2003 to 2014.

METHODS

The Higher Education Authority database was accessed and dental students enrolment and completion figures were extracted, compiled and analysed according to gender distribution.

RESULT

From 2003 to 2014, there has been a steady increase in the number of female students enrolled in and completing Ireland's undergraduate dentistry programmes.

CONCLUSIONS

The findings reveal that a distinct process of feminisation has occurred in Ireland since the early 2000s. The feminisation of dentistry in Ireland will impact on workforce projections for the Irish dental service. However, more research needs to be undertaken to explore why female students are motivated to pursue a career in dentistry. Due regard also needs to be given to ensuring these women progress in their dental career. Dental education can play an important role here.

Burnout and Work Engagement Among Dental Practitioners in Bangalore City: A Cross-Sectional Study

INTRODUCTION

Burnout is a job-related stress reaction; a potential hazard for personal, professional lives of dentists. Work Engagement (WE) is the antithesis of Burnout and they can co-exist.

AIM

This study was taken up to know the prevalence of Burnout and WE among dentists in Bangalore, India.

MATREIALS AND METHODS

In a cross-sectional study, all (n=116) dentists practicing in Bangalore East Zone were randomly selected. A structured, self-administered questionnaire revealing dentists' demographics, practice characteristics, Burnout level [6-item from Maslach Burnout Inventory] and WE [4-item from Utrecht Work Engagement Scale] was used. Ethical clearance and informed consent was obtained. The data was analyzed using SPSS version 15.0.

RESULTS

With a response rate of 58.6%, high burnout was seen in 5.15% dentists. Personal Accomplishment was significantly associated with dentists in older age-group (p=0.002), married (p=0.014), MDS qualified (p=0.038), having long working hours (p=0.009) with assistants (p=0.024), more years into practice (0.007), travelling more distance from residence (p=0.021). Significance was also seen for dedication among dentists with assistants (p=0.006), emotional exhaustion among dentist with long working hours (p=0.009), and driving own vehicle (p=0.028). Finally absorption was found significant in dentists practicing solo.

CONCLUSION

Higher WE were found but still burnout persisted. Thus, burnout and WE were found to co-exist.

Stress and professional burnout among newly graduated dentists

BACKGROUND

Dentists encounter numerous professional stressful situations, beginning from education to day-to-day practice. The resulting stress tends to have a negative impact on their personal as well as professional lives.

OBJECTIVES

To measure daily burnout, and to investigate the extent of expectations from dental career and the feeling of being unqualified new dental practitioner.

MATERIALS AND METHODS

A close-ended questionnaire, i.e., "the Copenhagen Burnout Inventory," was utilized for evaluation. A total of 121 dentists with an experience ranging between 6 months and 5 years were included. The period was considered initiating from graduation to dental practicing in urban or rural areas. Ninety-seven dentists replied with filled questionnaires (80.16%). The multivariant analysis was done using SPSS 11.0 ver. (Chicago, USA).

RESULTS

Using measures analysis, the mean scores for dentists on the basis of age and sex (n = 97) were calculated. The factors most commonly considered responsible for professional burnout were emotional exhaustion (39.27%), frustrations (47.83%), feeling worn out at the end of the day (35.05%), feeling worn out at the end of the working day (46.80%), exhaustion in the morning at the thought of another day at work (35.05%), feeling that every working hour is tiring (46.80%), less energy and less time for family and friends (47.83%). The most common cause for stress was professional burnout that was recorded commonly in females in the age range of 26-28 years.

CONCLUSIONS

Dentists are more prone for professional burnout, anxiety, and depression. The main reason for this is the nature of their practice and their personality traits, especially while pursuing dentistry as a carrier. Stress may lead to negative impact on dentists' personal as well as professional lives.

Burnout prevalence and correlates amongst Colombian dental students: the STRESSCODE study

INTRODUCTION

Accumulating evidence amongst dental students indicates an alarming prevalence of stress, which can precipitate the development of burnout--a state of mental or physical exhaustion and disengagement. Understanding individual and educational correlates of burnout is necessary for its prevention. The aims of this study were to determine the prevalence of burnout amongst a large sample of Colombian dental undergraduates and investigate its psychosocial and educational correlates.

MATERIALS AND METHODS

Survey data collected from 5647 students participating in the Stress in Colombian Dental Education study were used for this analysis. Burnout was measured using the Maslach Burnout Inventory-Student Survey (MBI-SS). Covariates included participants' socio-demographic characteristics and perceived stress, as well as educational environment factors. Descriptive, bivariate and multivariate methods based on multilevel mixed-effects logistic regression modelling were used for data analysis.

RESULTS

Seven per cent of the students surveyed met the criteria for burnout. The prevalence of burnout was higher amongst upper classes, older and married students, those who reported not having passed all required courses and not having dentistry as their first career choice, as well as students in public institutions and those with large class sizes. Moreover, students' perceived stress in the domains of workload and self-efficacy was significantly and positively associated with burnout.

CONCLUSIONS

Both personal and educational environment characteristics were found to be associated with burnout. Irrespective of these factors, students' perceived stress with regard to workload and self-efficacy was a strong influence on burnout and its alleviation may be a promising avenue to prevent psychological morbidity.

Low burnout risk and high engagement levels among oral and maxillofacial surgeons

Little is known about the well-being of oral and maxillofacial surgeons. The aim of this study was to measure the levels of burnout risk and the demanding work aspects of Dutch oral and maxillofacial surgeons, as well as the levels of positive work engagement and stimulating aspects of the work environment. The Maslach Burnout Inventory, Dutch version (UBOS), and inventories on positive engagement, work demands, and stimulating aspects of work, were sent to all 179 Dutch oral and maxillofacial surgeons currently in clinical practices. With a 70% response, UBOS mean scores on Emotional Exhaustion and Depersonalization appeared lower, and on Personal Accomplishment appeared higher, when compared with relevant reference scores. Engagement scores appeared to be relatively high. Mean scores on the work demands subscales were all well below the scale midpoint, whereas work resources were all well above. Dutch oral and maxillofacial surgeons showed relatively favorable burnout and engagement levels. The aspects of the work environment that best explain differences in burnout are 'Practice demands and organization' and 'Lack of variation and perspective in work'. Differences in engagement are best explained by 'Variety in work' and 'Positive effect upon patients'. It is remarkable that all work demands show relatively low levels and all stimulating work aspects show relatively high levels.

Stress and burnout in postgraduate dental education

INTRODUCTION

High levels of stress and burnout have been documented among dental students and practicing dentists, but evidence among dental residents and postgraduate students is lacking.

MATERIALS AND METHODS

Ninety-nine postgraduate students enrolled in clinical, non-clinical and PhD programmes in the Athens University School of Dentistry completed the Graduate Dental Environment Stress (GDES) questionnaire and the Maslach Burnout Inventory. Perceived stress was measured in two domains, academic (GDES-A) and clinical (GDES-C) and burnout was measured using the scales of emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA). Analyses relied on descriptive, univariate and multivariate methods based on ANOVA and generalised linear models.

RESULTS

Participants' mean age was 30 years; two-thirds were women and practised dentistry independently of their graduate studies. Residents in clinical programmes reported significantly higher levels of perceived stress compared to non-clinical and PhD students (P<0.05). There were no gender differences in perceived stress. Forty per cent of respondents were burnout 'cases' on the EE scale, while this proportion was 38% for reduced PA and smaller, 13% for DP. Perceived stress was positively correlated with all burnout dimensions, whereas independent dental practice and higher age had a protective effect.

CONCLUSIONS

High rates of burnout manifestations were detected among this sample of Greek postgraduate dental students. Perceived stress correlated with burnout and was more pronounced among those enrolled in clinical residency compared to non-clinical and PhD programmes.

The orthodontist burnout

OBJECTIVE

The aim of this study was to assess whether the Burnout Syndrome is clearly expressed in orthodontic practice and to identify its impact in both general dentistry and orthodontics.

MATERIALS AND METHODS

A questionnaire was administered to 366 operators in the dentistry-orthodontic field, hence a multi-factorial statistical analysis based on the multi-factorial method was carried out. Demographic data, the Maslach Burnout Inventory (MBI), divided into three subsets, Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA), and a specific questionnaire for orthodontists were analysed.

RESULTS

The analysis of the MBI showed that EE affects only 1/5 of the sample, DP significantly affects only 1/3 of the sample, while the RPA was reported to be low in 2/3 of the sample. General dentists were more affected from burnout as compared with orthodontists. The specific questionnaire highlighted that members of both categories had work-related stress, mostly due to management and financial issues related to the workplace.

CONCLUSIONS

The research suggested that Italian orthodontists were less prone to Burnout Syndrome compared to general dentists. As life-style has a major impact on the onset of the syndrome, preventive measures and solutions could be useful in order to prevent the symptoms of the Burnout Syndrome.

Dental practitioners and ill health retirement: a qualitative investigation into the causes and effects

INTRODUCTION

Data published in 1999 from the Government Actuary on the National Health Service Pension Scheme (1989-1994) have indicated that the frequency of ill health premature retirement (IHR) was four times more prevalent among dentists at age 42 years compared with doctors.Objective The aim of this project was to determine the factors that contributed to IHR in dental practitioners, and the effects of IHR on their lives.

METHOD

Semi-structured interviews were carried out during 2007. A topic list was developed, piloted and used to guide the interviewer. A purposive sampling technique was used to recruit the respondents from an insurance company database. A framework approach to data analysis was utilised.

RESULTS

Twenty-three respondents were interviewed, 19 male and 4 female, aged between 39-59 years. Depression, stress and anxiety were reported by respondents to be major causes of their retirement, followed by musculoskeletal disease and premature disability caused by trauma. This is illustrated by the following: '...just went straight into general practice but with some regrets. Practice was so depressing' (GDS/NHS); 'I withdraw, I don't engage ... I found it more and more difficult and one morning... I collapsed in tears at the practice' (GDS/NHS). Dentists reported both negative and positive comments in relation to support received from their health insurance company.

CONCLUSIONS

The main causes of IHR were depression, musculoskeletal disease and specific skin conditions. Respondents expressed concern regarding the level of support available to dentists in distress. Respondents to this study found that continuing to work had a positive impact on their health.

Burnout among the clinical dental students in the jordanian universities

Background

The study aimed to evaluate the level of burnout among the clinical dental students in two Jordanian universities.

Methods

A total of 307 students from the two schools were surveyed using Maslach Burnout Inventory survey. Scores for the inventory’s subscales were calculated and the mean values for the students’ groups were computed separately. Kruskal-Wallis and Mann-Whitney tests were carried out and the results were compared at 95% confidence level.

Results

The results showed that the dental students in both Jordanian universities suffered high levels of emotional exhaustion and depersonalization compared to reported levels for dental students in other countries. The dental students of the University of Jordan demonstrated a significantly higher (p < 0.05) level of emotional exhaustion than their counterparts in the Jordan University of Science and Technology.

Conclusions

The findings indicated that dental students in the Jordanian universities presented considerable degrees of burnout manifested by high levels of emotional exhaustion and depersonalization. Studies targeting students health and psychology should be carried out to determine the causes of burnout among dental students. The curricula of the dental schools in the two universities should be accordingly improved to minimize burnout among the students.

Keywords

Burnout; Emotional exhaustion; Depersonalization; Personal accomplishment; Maslach Burnout Inventory

Occupational burnout and work engagement: a national survey of dentists in the United Kingdom

OBJECTIVE

To determine the levels of burnout and work engagement among dentists in the United Kingdom.Study design Postal survey of 500 dentists selected at random from the General Dental Council register.

METHODS

Respondents completed a questionnaire pack comprising the Utrecht Work Engagement Scale (UWES-17) and the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), together with questions on demographic characteristics.

RESULTS

Approximately 8% of respondents had scores suggestive of burnout on all three scales of the MBI-HSS and a further 18.5% had high scores in two of the domains. Eighty-three percent of respondents had work engagement scores suggestive of moderate or high work engagement. Dentists with postgraduate qualifications and those who work in larger teams had lower burnout scores and more positive work engagement scores. Dentists who spend a greater proportion of their time in NHS practice showed lower work engagement and higher levels of burnout.

CONCLUSIONS

Burnout affects a small but significant proportion of dental practitioners in the United Kingdom. A larger proportion of practitioners show low work engagement, suggesting a negative attitude to their work. Higher burnout scores and lower work engagement scores were found in dentists without postgraduate qualifications, those in small teams and in those who spend a greater proportion of their time in NHS practice.

Positive engagement and job resources in dental practice

OBJECTIVES

The aim of this study is to determine the level of engagement among dentists, and subsequently, to investigate which dental job resources are positively correlated with engagement.

METHODS

By stratifying on gender, age, and region, a representative sample of 848 general dental practitioners was drawn at random, plus an extra group of 95 female dentists for gender comparison purposes. Engagement was assessed using the Utrecht Work Engagement Scale (UWES), consisting of three subscales: Vigor, Dedication; and Absorption. Job resources were measured using the Dentists' Experienced Job Resources Scale (DEJRS).

RESULTS

Six hundred and thirty two dentists (67%) responded, 76% male and 25% female. Mean age: 44.6 years (SD = 9.0). Engagement: Dedication and Absorption mean scores were higher among dentists when compared with manual norm scores, based upon a variety of professions, whereas Vigor mean scores were comparable to manual norm scores. Job resources:'Immediate results / Aesthetics' and '(Long term) Patient results' showed highest mean scores among all dentists. Gender differences were found on '(Long term) Patient results' and 'Patient care'. Engagement and job resources: All DEJRS subscales and the full scale showed statistically significant positive correlations (pmcc) with the UWES subscales.

CONCLUSION

Dentists showed relatively high mean scores on an engagement measure when compared with manual norm scores. No gender differences in mean scores were found. Job resources most valued were 'Immediate results / Aesthetics'. The job resources, 'Idealism/Pride' and 'Patient care', showed most predictive value with regard to engagement among dentists. In order to prevent burnout, it is recommended to raise dentists' awareness of the importance to create sufficient time and space for stimulating aspects in their work.

Factors related to job satisfaction among South Korean dentists

OBJECTIVES

The purposes of this study were to investigate the level and distribution of job satisfaction and to explore work environment factors associated with job satisfaction of South Korean dentists.

METHODS

A stratified systematic random sample of 1029 dentists was selected from the 10 357 registered dentists in the Korean Dental Association. They were surveyed via a self-administered mail questionnaire. Job satisfaction was measured by a modified version of the Dentist Satisfaction Survey.

RESULTS

The response rate was 62.2%. The mean score of overall job satisfaction among South Korean dentists was 3.2 out of 5. In terms of work environment factors, the most satisfying aspect was patient relations (3.7) and the least satisfying aspect was personal time (2.8). Multiple regression analysis identified a model including patient relations, perception of income, personal time, staff, and specialty training that accounted for 35% of variation in overall job satisfaction. The majority of the variance was explained by patient relations.

CONCLUSIONS

This study suggests that patient relations, perception of income, personal time, staff, and specialty training are important work environment factors for job satisfaction among South Korean dentists. The findings of this study will be helpful to policy makers to design plans to increase the level of job satisfaction among South Korean dentists.

How dentists cope with their job demands and stay engaged: the moderating role of job resources

This study focuses on job demands, job resources, and work engagement among 1,919 Finnish dentists employed in the public sector. Based on the Job Demands - Resources model, it was first predicted that the inverse relationship between job demands (e.g. workload, physical environment) and work engagement would be weaker when dentists had many resources (e.g. variability in the required professional skills, peer contacts). Second, using the Conservation of Resources theory it was hypothesized that job resources are most beneficial in maintaining work engagement under conditions of high job demands. The data were based on a postal questionnaire with a response rate of 71%. The dentists were split into two random groups in order to cross-validate the results. A set of hierarchical regression analyses resulted in 17 out of 40 significant interactions (40%). Four out of 20 possible interaction effects could be cross-validated showing, for example, that variability in professional skills mitigated the negative effect of qualitative workload on work engagement and, in addition, boosted work engagement when the qualitative workload was high. The main conclusion is that job resources are useful in coping with the high demands in dentistry and help dentists to stay engaged.

Specialty and sex as predictors of depression in dentists

BACKGROUND

Stress, burnout, substance abuse and suicide among dentists have been studied, yet no study in the United States has specifically addressed depression in e dentists. The objective of the authors' study was to determine if sex and dental specialty were correlated with depression in dentists.

METHODS

The authors conducted a survey of a sample of dentists chosen randomly from the American Dental Association's mailing list of member dentists. The survey, stratified by sex and specialty, resulted in 560 responses, for a 53 percent response rate. The authors used the Zung Self-Rating Depression Scale to measure depression. The authors examined the respondents' sex, age, number of children, marital status, specialty, practice type, location of practice, years in practice and hours worked per week.

RESULTS

The rate of depression in the overall sample was 9 percent. Sex was associated with depression (P < .001), but specialty was not. However, multiple regression analysis found that sex was significantly related to depression in only two specialties: periodontics and pediatric dentistry. Overall, the regression model explained an unimpressive 6 percent of the variance in depression scores. The most important finding of the study was that only 15 percent of depressed dentists were receiving treatment.

CONCLUSIONS

The survey results showed that only female pediatric dentists and periodontists were more depressed than their male counterparts. None of the other variables studied contributed significantly to the understanding of depression in dentists. Depressed dentists, like other depressed people, tend not to seek treatment.

CLINICAL IMPLICATIONS

Depression and serious depression occur among dentists, and much of it is untreated. Because depression is harmful to dentists and raises quality-of-care issues, they should be educated to help them recognize depression and encouraged to seek treatment.

Job satisfaction of registered dental practitioners

BACKGROUND

This study was designed to measure job satisfaction among registered clinical dentists so as to identify issues which may influence recruitment and retention of dentists in active clinical practice.

METHODS

A questionnaire measuring dimensions of job satisfaction was mailed to a stratified random sample of 80 private and 80 public sector dentists selected from the 1999 Victorian Dental Register.

RESULTS

An adjusted response rate of 60 per cent was achieved (n = 87). Analyses showed significant differences (ANOVA; p < 0.05) in levels of satisfaction for various dimensions of job satisfaction by gender, age group and practice type. Differences in job satisfaction between male and female dentists related to the personal time dimension. Differences in satisfaction between dentists of different age groups were attributable to six dimensions: relationships with colleagues, relationships with patients, relationships with staff, personal time, community and administrative responsibilities. Differences between levels of satisfaction among private and public dentists related to the autonomy, relationships with patients, pay and resources dimensions.

CONCLUSION

There are various dimensions of job satisfaction that may be pertinent to issues influencing recruitment and retention of dentists. Differences that exist between levels of job satisfaction among private and public sector dentists, between male and female dentists and dentists of different age groups need to be addressed in order to improve recruitment and retention rates of dentists in active clinical practice in different sectors of the dental care system.

[Professional burnout in dentists and stomatologists of the Galician Health Service]

AIM

To analyse the degree of professional burnout in primary care dentists of the Galician Health Service (GHS).

DESIGN

Descriptive, cross-sectional study.

SETTING

Dental care units of the GHS primary care network.

SUBJECTS

All primary care dentists of the new primary care model of the GHS (N=79). Response rate: 50% (N=35).

MEASUREMENTS

Anonymous self-applied questionnaire: the Maslach Burnout Inventory, that evaluates emotional exhaustion, depersonalization, and personal achievements; a social and personal questionnaire. Student's t test, ANOVA, 2 or Fisher's exact test were used.

MAIN RESULTS

Mean age: 46.58+/-9.47; sex: 74.3% males; temporary job: 82.9%; years in the GHS: 15.25+/-8.34. High values were detected in: emotional exhaustion 54.3%; depersonalization 55.6%; personal achievements 6.9%. No statistically significant differences were identified in terms of age, sex, marital status, type of contract, rural vs urban areas, number of patients treated, or years in the GHS, apart from the "personal achievements" subscale, that was rated, significantly higher (P=.046) by those who had shorter experience at for the GHS.

CONCLUSION

GHS dentists show a degree of professional burnout close to the one described for family doctors at the Spanish National Health System.

The role of occupational stress in the maladaptive use of alcohol by dentists: a study of South Australian general dental practitioners

BACKGROUND

It is well recognized that dentistry is a stressful profession. However, there are conflicting views about the extent to which such stress contributes to hazardous drinking among dentists. In addition, the relative contributions of stress and pre-existing vulnerability in predicting alcohol problems among dentists generally (and Australian dentists in particular) have yet to be determined.

METHODS

The levels of stress and alcohol consumption of 312 South Australian dentists were measured. Factors known to mediate vulnerability to alcohol disorders were also assessed with appropriate psychometric instruments.

RESULTS

High levels of stress/burnout, consistent with other studies of dentists' stress, were recorded. Hazardous levels of alcohol consumption, which were between two and four times higher than the normative South Australian population, were also reported, particularly among males and rural dentists.

CONCLUSIONS

To a significant extent, stress and hazardous alcohol consumption are both present among South Australian dentists. However, compared with work stress/burnout, existing personal vulnerability factors are much stronger predictors of such hazardous alcohol consumption. We suggest that professional dental bodies, and state Dental Boards, may play a role in ensuring stress inoculation and guidance on safe limits of alcohol consumption for dentists-in-training; and in creating appropriate mechanisms for assisting dentists who experience alcohol related difficulties.

The workforce of professionals complementary to dentistry in the general dental services: a survey of general dental practices in the South West

OBJECTIVE

To describe the working patterns, training experiences, estimated size, and future training needs of the workforce of professionals complementary to dentistry in the general dental service in an English region.

METHODS

Postal questionnaire of NHS dental practices in the South West of England.

RESULTS

The response rate was 65%. There was an average of two whole time equivalent (wte) dentists working per practice. Dentists work a mean 0.8 wte per practice. Sixty per cent of practice time is NHS. Vacancies existed for 120 dentists (98 wte) with reported difficulties in recruitment. There was an average of 1.25 wte dental nurses per dentist with 44% of nurses working part-time. A quarter of nurses' time is on non-clinical duties. The turnover rate for nurses was between 13% and 26%, with recruitment difficulties. Approximately 50% of nurses do not have a professional qualification. There is variation between health authorities in proportions of qualified nurses. Hygienists are employed in 72% of practices, but only 20% of their work is NHS. Dentists have favourable attitudes to an expansion in the employment and training of professionals complementary to dentistry.

CONCLUSIONS

There are problems with recruitment and retention of all categories of the dental workforce in the GDS, particularly in rural areas. There is a large unmet need for pre- and post-qualification training for professionals complementary to dentistry compounded by marked inequalities in access to training.

Dental services and perceived oral health: are patients better off going private?

OBJECTIVE

The aim of this study is to determine associations between method of payment for dental services and perceived oral health in the UK.

METHOD

A national UK study involving a random probability sample of 2718 adults. Respondents were interviewed in their homes about their method of payment for dental services (private or NHS), service use (time and reason for last dental visit), self-reported oral health status (number of teeth possessed and denture status) and the impact of their oral health on their quality of life (employing the 16-item OHQoL-UK( Copyright) measure).

RESULTS

The response rate was 68% (1838/2718). Thirty one percent (575/1838) claimed they paid privately for dental services the last occasion they visited their dentist. This was associated with self-reported number of teeth possessed (P<0.01), denture status (P<0.01), WHO goal of retaining 20 teeth with and without a prosthesis (P<0.05), impact of oral health on life quality (P<0.01), and number of positive oral health influences experienced (P<0.01). However, these associations did not remain apparent having accounted for socio-demographic factors (age, gender, and social class background) and reported dental attendance pattern.

CONCLUSION

Difference in perceived oral health exists between private and NHS dental service users. However, this is more likely to be attributed to socio-demographic factors and regular use of services rather than method of payment.

Preventive (evidence-based) approach to quality general dental care

Restorative and scaling treatments have not generally provided an effective method for managing dental caries and periodontal diseases. Rather, restorative treatment has often covered up the disease processes in the short term and created a new problem: that of maintenance and re-restoration of restored teeth. Thus, standard invasive dental treatments that are commonly provided fail to address the fundamental bacterial nature of the diseases. Indeed, these treatments rather readily generate and perpetuate a totally unacceptable chain of events. This chain embraces many shortcomings, which themselves nurture what may be described as the repeat restorative cycle. The time has come to correct this iniquity. Dental caries and periodontal diseases are dynamic conditions which need 'managing' with a focused cocktail of preventive and refined restoration care. Much more emphasis should be placed upon the assessment of each and every caries or periodontal lesion, with a view to implementing specific preventive measures and allowing the natural arrest of disease processes to occur. The universal adoption of a preventive (evidence-based) approach to making dental treatment decisions could be by far the most powerful factor in reducing the restorative burden of dental services. It is clear that dental education and practice need to rise proactively to the challenge, or changes will be forced upon them while they are in a defensive position. There is a need to move wholeheartedly and contentedly into the preventive era.

Burnout intervention among Dutch dentists: long-term effects

The aim of the present study was to determine the long-term effects of a burnout-intervention program among Dutch dentists using a longitudinal design. Using the Maslach Burnout Inventory (Dutch version: MBI-NL), at the initial measurement in 1997 a 'burnout risk group' (n = 171) was identified. This group received feedback on their scores and was invited to participate in an intervention program. Of the total group. 19 dentists participated in an intervention program. After the end of the intervention program, 92 dentists (the 19 participants and a control group) responded to a post-intervention survey in 1998. These dentists were approached once more 1 yr later, and this time 78 dentists (84.8%) returned a questionnaire. While demonstrating an improvement on all subscales of the MBI-NL at the first post-test, results show that the program participants showed a relapse at the second post-test. Controls who took action on their own initiative, on the other hand, reported a beneficial effect in the long run. Finally, controls that did not take any preventive action showed little or no progress. Possible causes for these findings are discussed, including the influence of coping style. perceived control, confounding factors, demand characteristics, and the necessity of post-intervention follow-up.

A career counseling program for dentists: effects on burnout

The effects on burnout of a career counseling program were measured among general dental practitioners. Out of a group of 171 dentists, identified with unfavorable scores on the Maslach Burnout Inventory - Dutch version (MBI-NL), nineteen chose to participate in the program. It consisted of individual counseling and group sessions, using cognitive and behavioral intervention techniques, over a 6-month period. One month after the last session, both program participants (N=17) and invited, but not participating, dentists (N=66) again filled in the MBI-NL. Comparison of participants' pre- and post-test scores showed significant statistical improvement on the MBI-NL scales emotional exhaustion (EE), and personal accomplishment (PA). Among the control group, a distinction was made between dentists who had self-initiated preventive measures (N=35) and those who had not (N=31). Self-prevention also appeared to have an effect on EE and PA. Among dentists who reported not to have undertaken preventive action, no change in burnout levels was found. With reservations, it can be concluded that the prevention program does have a positive effect on burnout scores among dentists, while different forms of self-initiated prevention activities also appeared to be effective.

Going private? Exploring the drift away from the NHS

The perception that dentistry is being privatised is widespread. A two-phase study was undertaken to investigate the factors influencing dentists' decisions to practise in the public and or private sectors. In phase I a national postal survey of general dental practitioners (n = 1011) explored differences in working practices and experience of NHS and non-NHS work. Survey data were supplemented in phase II by in-depth interviews with four subsamples of dentists in two regions. The survey found that although the majority of dentists continued to treat the majority of their patients within the NHS since the introduction of the 1990 contract patterns of practice have changed. Where private dentistry was increasing, it was regionally variable and arose mainly from concerns with financial security, maintaining quality of work and autonomy. Ideological differences were apparent in relation to differences in practice mix. Those who continued to work in the NHS, because of insufficient demand for private dentistry, did so in order to provide access to treatment and to maintain a reliable source of income and pension rights. Dentists interviewed expressed reluctance in withdrawing from NHS practice. Disillusionment with government policy and recognition of the marginal nature of dental health issues suggests that current trends will continue.

Relating personality to interview results and performance in the first year of the dental course

The aim of this paper is to relate personality measures of Year 1 undergraduate dental students to their performance at admissions interview and during the first year of their course. The personality profiles of 58 first year dental students, were statistically related to results of the first year examinations and to the results of 54 of the students' structured admissions interviews. A relationship was found to exist which related personality to interview results and performance in the first year of their dental course.

Professional burnout among Dutch dentists

Professional burnout, a long-term consequence of occupational stress, is considered to be a factor that explains a substantial proportion of incapacity for work. Burnout is defined as emotional exhaustion, depersonalization, and diminished personal accomplishment.

AIMS

To investigate levels of burnout among Dutch practising dentists, to compare dentists' scores with norm scores, and to determine the percentage of dentists "at risk".

METHODS

The instrument used was the Dutch version of the Maslach Burnout Inventory (MBI-NL), a 20-item modified version of the original MBI. A highly representative group of Dutch dentists participated (n = 709, 75% response rate).

RESULTS

Mean levels (and standard deviations) of burnout were: emotional exhaustion 13.7 (8.6); depersonalization 5.9 (3.9); personal accomplishment 30.8 (5.9). Dentists had more favourable means compared with standard scores, although in the 95th percentile dentists showed more emotional exhaustion than standards indicate. While no overall sex differences were found, male middle-aged dentists tended to show more burnout. Of the working Dutch dentists, 21% had a certain risk, 13% had high overall levels of burnout, and 2.5% were highly burned out.

CONCLUSION

It is concluded that Dutch dentists have relatively favourable mean levels of burnout, but those who are exhausted are extremely exhausted. The male dentist in his forties appears to be most vulnerable to burnout.

Perceived control systems, work conditions, and efficiency among Swedish dentists: interaction between two sides of human resource management

Two aspects of Human Resource Management (HRM), a main trend in modern personnel management, are considered in this study: A 'hard' version stressing performance monitoring and competition, and a 'soft' version stressing communication with employees. The aim of the investigation was to examine whether these two aspects of modern management are reflected in dentists' perceptions of differences in work conditions compared with other professionals. A questionnaire was answered by 312 publicly employed dentists and 3,600 other professionals in Sweden. The response rate was 66-77%. Effects from HRM on work, conditions and perceived efficiency were confirmed. The interaction effects, reflecting the duality of HRM, resulted in poorer work conditions, e.g. worse balance between effort and reward and worse opportunities for developing competence and collaboration in the workplace. This pertains especially in the case of dentists, where the positive effects of 'soft' HRM did not compensate for the negative effects of 'hard' HRM. Dentists in Sweden's Public Dental Health Service appear as a vulnerable group among Swedish professionals.