Mental health in the dental profession during the COVID-19 pandemic
LEIPZIG, Germany: Even though millions of people suffer from anxiety and depression, according to the World Health Organization, psychiatric disorders often remain under-recognised and underdiagnosed. The persisting stigma around mental health issues exacerbates the problem, since those suffering feel shame and guilt on top of their existing condition and may therefore fail to seek the appropriate help. Because of the chronic stress associated with their profession, dentists are especially prone to occupational burn-out and depression, as studies have shown. Now, with the spread of SARS-CoV-2, there is an even greater physical and psychological burden among dental professionals.
The profession of dentistry has long been claimed to have a high suicide rate owing to a range of physical and mental stressors. A feature article by orthodontist Dr Randy Lang from 2007 sums up statistics which he collected from several studies that indicate that dental professionals are indeed at higher risk of stress-related mental and physical illnesses. For example, Lang stated that “dentists suffer psycho-neurotic disorders at a rate of 2.5 times greater than physicians” and “coronary disease and high blood pressure are over 25% more prevalent among dentists than in the general population”.
In a more recent investigation, a feature article by Vice Media reported on the significant occupationally linked pressure in the form of “money trouble, physical and emotional stress, isolation, and the unfavourable public perception of dentists in general”.
Consequences of the coronavirus pandemic
In addition to the pre-existing stressors of their jobs, dental professionals have been particularly burdened by the challenges arising from SARS-CoV-2. Dentistry has been reported to be one of the most high-risk occupations regarding infection potential, since the virus is airborne and dentists work in very close proximity to their patients. Furthermore, practices have been forced to close during lockdowns in many countries, adding immense financial pressure and leading to the retrenchment of staff in some cases.
In a recently published paper, Dr Andrea Vergara Buenaventura and her research team from the Universidad Cientifica del Sur in Lima in Peru have provided a comprehensive review of the consequences of past epidemics for mental health and have assessed possible aspects that might be associated with mental implications for dentists owing to the COVID-19 pandemic.
“Dentists must be prepared to play a more critical role and to fight against emerging life-threatening diseases”– Dr Andrea Vergara Buenaventura
In an interview with Dental Tribune International, Vergara Buenaventura shared that the idea for the article came up during a video call with colleagues who all shared similar worries and fears. “In the beginning, when we started with the literature review, we only had few references on COVID-19 and mental health and much less about mental health in dentists. We just found data about past epidemics, but it was precisely the same; the same feelings were reported,” she explained. Surveys conducted in India and Israel, for example, confirm the psychological distress being experienced by dental professionals in response to the COVID-19 pandemic.
Despite the challenges, Vergara Buenaventura is hopeful that this pandemic “will strengthen us as individuals and as a system”. “In my country, Peru, this pandemic has brought out the weaknesses of the Peruvian health system and has shown that dentists have to be part of the healthcare system. Dentists must be prepared to play a more critical role and to fight against emerging life-threatening diseases,” she concluded.
The challenges so far
Dr Sujata Basawaraj runs a private practice in Lewisville in Texas in the US and has first-hand experience of the challenges posed by SARS-CoV-2. “Mentally, working during a pandemic has been very stressful and tiring owing to the number of additional tasks that go into creating a safe environment for myself, employees and patients in my practice. We have to treat every patient with the possibility that he or she may have contracted SARS-CoV-2,” she explained to Dental Tribune International. She continued: “I feel like a level of communication that was imperative for dentists has been removed owing to the new gear we need to wear. It isn’t as easy to talk to patients, but at the end of the day, I believe that everyone’s safety should come first.”
Basawaraj went on to say that, as medical professionals, she and her colleagues are responsible for taking care of their patients’ health, which is something they have always been accountable for. She added: “I hope that people will continue to, or start to if they do not already, follow safety and social distancing guidelines as well as be patient with us doctors as we work to provide care during the pandemic.”
Despite the difficulties she has encountered, Basawaraj remains positive and takes care of her mental health as well as possible: “At the moment, spending time with my family, cooking, going on walks in the park while wearing a mask and social distancing […] have been my way of relieving some of the stress that comes from working during this pandemic. […] All we can do at this point is hope for the best.”
Creating a healthier work environment
A study by researchers from London has investigated mental healthcare for medical staff and affiliated healthcare workers during the COVID-19 pandemic and how they can be supported. The authors report that “rapid access to counselling, psychiatry and contingency for time off work” is important, but “prevention and mitigation is far more important than cure”.
Experts from several universities across the US have published a review paper in which they report that psychological flexibility and self-care are fundamental aspects of psychological health in general. Also, exercising regularly has a positive influence on overall well-being, according to researchers from Italy who specifically looked at how activity levels among the population changed during the pandemic. Owing to physical isolation and distancing, feelings of loneliness and anxiety may arise, and these should be addressed. It is key to reach out to family and friends in a safe manner, for example by keeping in touch via the phone or video calls.
In the pursuit of psychological health, it should be realised that the COVID-19 pandemic is unprecedented and each individual experiences and responds very differently. For these reasons, going at one’s own pace and taking care of oneself as well as possible are absolutely crucial.
Many dental associations offer resources, support and advice for dental professionals who are affected by work and personal stress. For instance, the British Dental Association gives its members access to 24-hour counselling and emotional support via Health Assured’s helpline, and the American Dental Association offers COVID-19 mental health resources on its website. Another helpful tool is a platform called Confidental, which aims to provide emotional first aid for UK dentists in distress.