Perceived sources of occupational stress in general dental practitioners

The Role of Staff-Assessed Care Quality in the Relationship between Job Demands and Stress in Human Service Work: The Example of Dentistry

The aim of this study was to investigate staff-assessed care quality at the clinic as a predictor of stress and as a moderator between job demands (quantitative demands and role conflict) and stress among dental professionals as an example of human service workers. Cross-sectional questionnaire data from 1012 dental professionals (i.e., dentists, dental hygienists and dental nurses) working at 99 clinics were analysed by confirmatory factor analysis and a two-level hierarchical linear model. Stress, quantitative demands and role conflict were measured by the Swedish standard version of COPSOQ III and care quality was measured by three proprietary items. The results showed that staff-assessed care quality at the clinic was of importance for the individual workers' experiences of stress. Furthermore, the staff's joint assessment of the care quality at the clinic mitigated the negative effect of role conflict on stress among dental nurses. These results indicate that a high level of staff-assessed care quality at the clinic can contribute to reduced stress in dental professionals.

Level of anxiety and depression among undergraduate dental students of University of Hail, Saudi Arabia

BACKGROUND

Dental students have been identified as having a high level of stress.

OBJECTIVE

This study aimed to assess the prevalence of anxiety and depression among undergraduate dental students of university of Hail and to determine the association of anxiety and depression in terms of gender and respective year of study.

METHODS

This was an observational cross-sectional study. Nonprobability sampling technique was used to assess the prevalence and association of anxiety and depression among male and female dental students of preclinical and clinical years of College of Dentistry, University of Hail, Saudi Arabia. Students were contacted personally, explained the purpose of the study and asked to participate in the study. Students were asked to complete both Beck's depression inventory and Beck's anxiety inventory to assess the level of their respective status.

RESULTS

The results of the survey revealed that a greater number of females suffered from 'moderate' level of anxiety (12.3%) as compared to males (3.2%). Additionally, the percentage for females to experience 'borderline' (11.6%) and 'moderate' (9.7%) level of depression was higher than their male counterparts -'borderline' (7.7%) and 'moderate' (2.6%). The level of anxiety and depression compared with genders was found to be statistically significant. It was noted that final year students (8.4%) experienced 'moderate' level of anxiety and there was a peak rise in level of depression among 4th year (6.5%) and 6th year (5.8%) students as compared with other years.

CONCLUSION

The finding of the study emphasizes that the overall percentage of level of depression is comparatively higher than level of anxiety among dental students.

Supporting dentists' health and wellbeing - a qualitative study of coping strategies in 'normal times'

Background Research has highlighted multiple determinants of dentists' health and wellbeing, and has raised concerns over workforce morale and retention. Limited research has been undertaken on possible solutions. Thus, the aim was to explore the coping strategies used or advocated by dentists to protect and support their health and wellbeing.Methods This qualitative study involved a purposive sample of dentists working in England taking account of age, gender, career stage, work sector, geographical area, position and route of entry to registration. Dentists were approached via gatekeepers across England to participate in semi-structured interviews. A topic guide, informed by past research, was used to guide the discourse. Informants' views were audio-recorded and field notes were made. Data were transcribed and analysed using an interpretative phenomenological approach to generate theory with the support of the framework methodology.Results Twenty dentists were interviewed from a range of backgrounds. Self-reported coping strategies included a range of strategies for 'taking control', including 'embracing self-care' and 'seeking professional support', while drawing on 'supportive personal and social networks'. Managing professional careers included diversifying through greater 'mixing' of NHS with private work, privatising, specialising, or combining dentistry with another role. Strengthening job security and facilitating diversity of experience remain important for supporting the health and wellbeing of dentists. Selling practices or, in the extreme, completely leaving the profession were considered practical options. At organisational level, building sustainable teams and transforming culture were advocated as important; while at systems level, reforming the NHS and bridging the gap between the profession and regulatory body were considered vital. Additionally, the need for strong professional leadership and wider societal debate was advocated as part of a whole systems approach to enable job satisfaction in delivering high-quality, patient-centred, evidence-based care in future.Conclusion While dentists demonstrated a range of coping mechanisms, multi-level action was advocated to enhance the health, wellbeing and retention of dentists. Systems reform at macro- and meso-levels is urgently advocated to enable fulfilling careers within dentistry, particularly for those at the front line of primary dental care in the public sector. Personal resilience alone will not suffice and recommendations for action are explored to avert a public health catastrophe. This is a time for reflection, debate and action.

Supporting dentists' health and wellbeing - workforce assets under stress: a qualitative study in England

Background Multiple determinants influence dentists' health and wellbeing. In light of recent concerns, the aim of this research was to explore contemporary influences on dentists' health and wellbeing in England, drawing on their lived experience.Methods Semi-structured interviews were conducted with a purposive sample of dentists working in England, taking into account age, gender, career stage, work sector, geographical area, position and route of entry to registration. A topic guide, informed by the literature, was used to guide the discourse. Dentists were approached via gatekeepers, supported by snowball sampling. Interviews were recorded and transcribed for analysis. Framework analysis was used, taking an interpretative phenomenological approach to develop theory.Results Twenty dentists, from a range of backgrounds, participated in this research. While health and wellbeing was reported to be more positive among dentists in their later career, those in their early career and/or with high NHS work commitments shared concerns about their physical, psychological and emotional health. Influences ranged from macro-level issues relating to professional regulation and health systems, through meso-level, notably their workplace and job specification, to micro-level issues relating to their professional careers, relationships and personal life. Dentists highlighted ethical concerns and feeling driven to deliver, together with being demoralised by a survival culture, all leading to perceived lack of control and reduced professional fulfilment. In contrast, being able to deliver quality care, innovate and effect change, as well as being valued for their delivery, were perceived to positively contribute to general health and wellbeing.Conclusion Dentists have a vital role in providing care for patients, so there are serious public health implications if urgent action is not taken to improve and sustain their health and wellbeing. This study confirms that dentists are affected by multiple contemporary influences, and although greater support is needed for individuals, organisational, system and policy changes may be required to fully address the challenges they face.

Occupational Stress among Dental Professionals

Stress at the work place was declared by the World Health Organization as a worldwide epidemic. The stress caused by work appears when the balance between one’s own possibilities and the environment demands is disturbed, which leads to a poor mental state. The fact is that the majority of dentists find they are under constant stress, which is caused by the nature of dental work. Literature describes dentistry as an extremely stressful profession. The main stressors include the tendency toward technical perfection, the causation of pain in patients, the lack of patient cooperation during dental treatment, the failure to maintain the given appointments. Adequate education and preparation, even during dental studies, non-neglect of symptoms and difficulties at the work place, adequate and timely response to the identification of the cause and its elimination or balancing, have a key role in solving this great problem in modern dentistry.

Dentist Job Satisfaction: A Systematic Review and Meta-analysis

Objectives

Because of the heterogeneous nature of the evidence regarding dentists’ job satisfaction, an overview was necessary to examine dentists’ level of job satisfaction and to determine related work environmental factors.

Materials and methods

A literature search was conducted using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Electronic database searches of PubMed/MEDLINE, EMBASE, and Web of Science were performed until March 1, 2020. Two independent authors collected data and assessed the methodological quality of primary studies using the Newcastle Ottawa Scale.

Results

Nine studies were included from the 1987 initially retrieved. Among the included studies, 5 exhibited a neutral level of satisfaction and originated from China, South Korea, Egypt, and the United States, and 3 studies from Canada, Lithuania, and the United States showed a high level of satisfaction. Only 1 study did not report the mean job satisfaction score. According to bias evaluation, 9 studies were considered low risk.

Conclusion

The findings showed that dentists were satisfied with their jobs at a moderate to high level, and specialists were more satisfied than general dentists. Regarding work environmental factors, the 6 most satisfied factors were patient relationships, respect, delivery of care, staff, professional relationship, and professional environment. Five of the least satisfied factors were personal time, stress, income, practice management, and professional time. However, longitudinal studies would be required to identify changes in these factors. Further studies should be performed in middle- and low-income countries using the Dentist Satisfaction Survey, including stress evaluation.

Key determinants of health and wellbeing of dentists within the UK: a rapid review of over two decades of research

Aim To review the key determinants of health and wellbeing among dentists working in the UK.Methods Rapid review of the literature (1996-2018) across seven health and social science databases through OVID and the Cochrane Library, professional and health system sources. Records were screened according to agreed inclusion and exclusion criteria by title, abstract and full text. Data extraction and qualitative synthesis of the included studies were performed. Quality assessments for risk of bias were made using a mixed methods appraisal tool.Results Thirty-eight studies met the criteria for inclusion. Fourteen were assessed as high, 22 as medium and two of low quality, most involving cross-sectional research in the form of questionnaire surveys. Whereas overall, the health and wellbeing of dentists within the UK is reported as 'good', recently published evidence suggests a less positive view may be emerging. The health and wellbeing of dentists is associated with a wide range of factors: personal, professional career, relationships, job specification, workplace and system. Emerging evidence suggests additional concerns about the regulation of dentistry. Workplace characteristics were most often explored among researchers and reported as being a key issue.Conclusion Evidence highlights multiple determinants of health and wellbeing, most notably related to workplace characteristics; however, while there is a relative lack of well-founded prospective research investigating the nature and direction of the relationships and comparison across UK health systems, there is increasing evidence of health and wellbeing concerns that require further investigation.

Job Satisfaction of U.A.E. Dental Practitioners

Objective  The study aims to analyze job satisfaction among registered clinical dentists in the United Arab Emirates (UAE), and also to explore satisfaction with different work environmental factors and relate them to overall job satisfaction.

Materials and Methods  A survey modified from the American Dental Association version of job satisfaction published in 2013 to 2014, was given to 197 licensed dentists in Dubai and Sharjah cities in the UAE. The questionnaire included four main sections, in addition to the demographic factors questions. All questions were answered using the 5-point Likert scale. The only exception was the comfortability in the working environment which was answered using a 3-point Likert scale.

Statistical Analysis  Categorical data were presented as frequencies and percentages, and data were analyzed using means and standard deviations. Regression analysis was performed with overall job satisfaction as the dependent variable and seven aspects of satisfaction with work and individual characteristics as the independent variables. An α level of 0.05 was used for tests of statistical significance.

Results  The overall job satisfaction of dentists working in the UAE is high compared with other countries. Highest satisfaction was related to the relationship with patients, colleagues, and staff. On the other hand, the least satisfaction was linked to the opportunity for part-time work and benefits package. There were no significant differences between male and female participants regarding all work-related factors apart from autonomy. However, private sector dentists had a higher level of satisfaction compared with the public sector in many work-related factors.

Conclusion  There are various dimensions that collectively influence the level of overall job satisfaction. Difference existing between the levels of job satisfaction among private and public sector dentists and between male and female dentists need to be addressed to increase the level of job satisfaction among UAE dentists and thus improve all dental care system.

Moving the four habits model into dentistry. Development of a dental consultation model: Do dentists need an additional habit?

A consultation model for dentistry is presented, with communication skills in a didactic and structural format, applicable for most types of visits, patients and problems. A characteristic of the dental visit is its division into dialogue phases and clinical phases, which makes verbal exchange especially challenging. The original Four Habits Model (4H) has been adapted from medicine to the specific structure and content of a dental visit, and a modified model is proposed. The dental model consists of a structural core framework relevant for all dental consultations, and additional extensions applicable to commonly occurring issues. Facilitate Perceived Control has been added to the model, due to its crucial importance in dental visits, and we suggest naming the model "The Four + One Habits Model for Dental Visits (4 + 1HD)." The proposed model should have clinical relevance for improving patient care and patient experience, as well as easing the busy everyday life for dentists in a variety of clinical settings. It is also likely to be a flexible framework for communication skills training at all levels of dental education. More research is needed to validate and test the model in various clinical and educational settings.

Impact of time pressure on dentists' diagnostic performance

OBJECTIVES

Although stress is prevalent amongst dentists, there is a paucity of data on the impact of stressors on dentists' clinical performance. To address this gap in the literature, the aim of the present study was to explore the role of time pressure, representing one common stressor, on dentists' radiographic diagnostic performance.

METHODS

Forty dentists were randomised to examine and provide a radiographic report on two sets of radiographs (six bitewings in each set) under two conditions on a cross-over basis: time-pressure vs. no-time-pressure. The radiographic report of an experienced consultant was considered the gold standard against which participants diagnostic decisions were compared to calculate sensitivity and specificity. Participants rated their stress after each experimental condition using a 100 mm visual analogue scale (VAS).

RESULTS

The VAS scores for stress were significantly higher in the time pressure condition vs. no time pressure condition (mean: 55.78 versus 10.73, p < 0.0001), indicating that the time pressure acted as a source of stress. Dentists' diagnostic performance was affected; the sensitivity was significantly lower under time pressure (median: 0.50 versus 0.80, p < 0.0001), but by contrast, the median diagnostic specificity was 1.00 under both conditions.

CONCLUSIONS

Time pressure negatively impacts one aspect of dentists' diagnostic performance, namely sensitivity (increased diagnostic errors and omissions of pathology), which can potentially affect patient safety and the quality of care delivered. However, time pressure was found to have less influence on diagnostic specificity.

CLINICAL SIGNIFICANCE

The present study demonstrated a significant deterioration of dentists' diagnostic performance (sensitivity) under time-pressure when examining bitewing radiographs. Diagnostic errors may put patient safety at risk, with patients potentially being harmed if pathology is missed. Such errors can have medicolegal implications on the dentists' practice.

Comparing Practice Management Courses in Canadian Dental Schools

Practice management has become an increasingly important aspect of dental education over the years in order to better prepare students for the reality of practice. The aim of this study was to quantify and describe practice management courses taught at the ten Canadian dental schools in order to identify common approaches, compare hours, determine types of instructors, and assess the relationship between courses' learning objectives and the Association of Canadian Faculties of Dentistry (ACFD) competencies and Bloom's cognitive levels. The academic deans at these ten schools were surveyed in 2016; all ten schools responded for a 100% response rate. The authors also gathered syllabi and descriptions of the courses and analyzed them for themes. The results showed a total of 22 practice management courses in the ten Canadian dental schools. The courses provided 27 to 109 hours of teaching and were mostly taught in the third and fourth years and by dentists on three main topics: ethics, human resource management, and running a private practice. The courses were correlated to the ACFD competencies related to ethics, professionalism, application of basic principles of business practices, and effective interpersonal communication. Most of the courses' learning objectives addressed comprehension and knowledge in Bloom's cognitive levels of learning. These results can help to guide discussions on how practice management courses can be developed, improved, and refined to meet the challenges of preparing students for dental practice.

Understanding emotionally relevant situations in primary dental practice. 3. Emerging narratives

BACKGROUND AND AIMS

Dentists experience considerable occupational stress. Stressful clinical situations can provoke high levels of negative emotions, and situations which are associated with positive emotions tend to be overlooked by practitioners. Reflection regarding difficult situations is encouraged to facilitate learning. Cognitive behavioural therapy (CBT) formulations may be applied to situations appraised both positively and negatively. Analysis and interpretation of the dentist's coping behaviour and the consequent outcomes facilitate learning and reflection upon individual interactions with patients.

METHOD

Twenty primary care dental practitioners in the greater Lincoln area participated in a semi-structured interview which explored their stressful and positive clinical experiences. Some of the episodes were analysed to create CBT formulations.

RESULTS AND DISCUSSION

CBT formulations are presented and the learning points highlighted by this structured presentation are discussed. In particular, it is suggested that this structured reconstruction of events, which highlights dentists' emotions, responses and the transactional effects of coping responses, might well facilitate objective reflective learning either individually or as part of peer to peer support. It should facilitate dentists' emotional processing of events and may thus contribute to stress reduction.

CONCLUSION

CBT formulations of positive and negative dental scenarios may be constructed. It is proposed that this is a useful technique to foster reflection and learning in clinical situations and should lead to improved communication skills and shared decision-making, resulting in fewer complaints and thereby reduced stress. It should also improve dentists' emotional processing.

Occupational Stress and Coping Behaviours Among Dentists in Kerman, Iran

OBJECTIVES

Recognising causes of stress can help prevent associated adverse effects. This study aimed to investigate causes of occupational stress and coping behaviours among general dentists in Iran.

METHODS

This cross-sectional study was carried out from April to December 2014. A modified version of the Occupational Stress Indicator questionnaire was used to assess causes of stress and coping behaviours among 142 general dentists in Kerman, Iran.

RESULTS

A total of 93 dentists participated in the study (response rate: 65.5%). Of these, 58.9% reported often being stressed. The mean general stress score was 63.33 ± 19.99. The most common causes of stress were maintaining high levels of concentration while working (65.6%), time pressures (64.5%), concern over their ability to deliver dental services in future (60.2%) and rising costs (59.1%). No significant relationships between stress and gender, age, workplace or working hours per week were noted (P >0.05). However, there was a significant correlation between general stress scores and years of job experience (P = 0.05) and number of patients treated daily (P = 0.03). The most common methods for coping with stress were resting (71.0%), sports (45.2%) and entertainment (43.0%). Most dentists felt that stress management courses could help to reduce stress (89.7%).

CONCLUSION

General dentists in Kerman were subject to many sources of stress in their workplaces, with significant relationships between stress scores and years of work experience and number of patients treated daily. Dentists should be encouraged to participate in stress management courses to help alleviate stress.

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.

An investigation of the attitudes and fears of vocational dental practitioners in England and wales in 2007

AIM

The aim of this study was to investigate whether recent changes in the National Health Service (NHS) dental contract may have caused increased anxiety and concern among vocational dental practitioners (VDPs).

METHOD

A total of 606 questionnaires, which had previously been piloted, were distributed to VDPs across England and Wales at the end of the vocational training (VT) year in 2007. The questionnaires contained a range of questions about VDPs' attitudes and fears, the influence that they perceived the new dental contract for the General Dental Services of the NHS had on their VT training experience, and their expectations for the future.

RESULTS

A 71% response rate was achieved. The results reflected changes in opinion about the dental profession among VDPs between when they applied for university and six years later on their completion of VT. During this period, they reported that their feelings of job security had declined from 93.1% (n=390) to 34.1% (n=145) and financial security from 94.8% (n=405) to 51.5% (n=219). Anxiety about the potential lack of funding in the NHS was felt by 77.6% (n=330). The effect of increasing numbers of dental graduates on employment prospects produced anxiety in 72.5% (n=305) of VDPs. On completion of VT, 19.4% (n=83) of VDPs did not have employment for the following year.

CONCLUSION

At present, the future is more uncertain for new dental graduates than in the past. The dental profession needs to become more aware of the pressures that graduates are facing and further research is needed to investigate them and the effects that they are having on the future of dentistry.

Mentoring. A Quality Assurance Tool for Dentists Part 1: The Need for Mentoring in Dental Practice

This paper introduces the concept of mentoring and its use in dental practice. It explains how there has been a drive for quality in all areas of healthcare in the United Kingdom (UK), and that clinical audit and clinical governance are two of the quality assurance tools that have been developed. It suggests that the most important factor in the provision of quality care is the dentist and that it is therefore essential that dentists are given support and encouragement by their peers, together with recognition of good performance. The next section of the paper considers factors that hinder a dentist's quality of performance. It explains that there are multiple stresses in dental practice and, if they are not managed and controlled, that they can lead to professional burnout, anxiety and depression. One of the most important stressors that can impact on the quality of patient care is the constraint of time, which can frequently result from pressure from third parties such as managers and administrators. Dentists often feel isolated. The final section of the paper describes how dentists may be supported. Techniques include developing special interests within oral healthcare, career development, good human resource management, peer review and study groups, and coaching and mentoring. The nature of these last two techniques is discussed and the authors conclude that the best tool for supporting the quality of performance of dentists is mentoring.

Morale of vocational dental practitioners in the United Kingdom

OBJECTIVE

This study was undertaken to devise a suitable survey instrument to measure morale, and to undertake an assessment of morale amongst vocational dental practitioners (VDPs) in the UK.

DESIGN

Postal questionnaire survey.

SETTING

Dental vocational training schemes in the UK.

SUBJECTS

Vocational dental practitioners.

METHOD

A confidential postal questionnaire was used to measure levels of morale among all VDPs in the UK in 2007.

RESULTS

A response rate of 76.7% was achieved. The mean morale score for Scottish VDPs was significantly higher than that of the Northern Irish VDPs, which in turn was significantly higher than those of the VDPs in England or Wales. In England and Wales females recorded higher morale scores than males. Lowest morale scores were associated with statements referring to concerns about future changes to NHS dentistry, and the limits on treatment within the NHS system. The highest scores were associated with good working relationships.

CONCLUSION

The use of an appropriately tested questionnaire has provided a convenient objective measure of morale. The morale of VDPs in the United Kingdom was lower than expected. Scottish VDPs recorded higher morale scores than other VDPs and responded more positively in the survey instrument. The most negative responses from all VDPs were regarding the effect of the NHS system on treatment and concerns about future changes to the NHS.

Psychological stress and health in undergraduate dental students: fifth year outcomes compared with first year baseline results from five European dental schools

Psychological stress in undergraduate dental students: fifth year outcomes compared with first year baseline results from five European dental schools.

OBJECTIVE

To compare the levels of a series of health-related indicators from a cohort of fifth year dental students from five European schools with their first year scores, and to investigate the relationship between these follow-up measures.

METHODS

Burnout was measured using the Maslach Burnout Inventory (MBI), consisting of three scales: Emotional Exhaustion (EE, alpha = 0.90), Depersonalisation (alpha = 0.80) and Personal Accomplishment (alpha = 0.72). Physical health was measured by the Physical Symptoms Questionnaire (alpha = 0.82), psychological distress was measured using the General Health Questionnaire (GHQ, alpha = 0.89) and student stress was captured using seven subscales of the Dental Environment Stress questionnaire (DES, alpha = 0.92). A total of 132 fifth year students responded from five dental schools (Manchester, Belfast, Cork, Helsinki and Amsterdam), a 51% response.

RESULTS

Fifth year students showed relatively high mean MBI scores when compared with first year results, especially on EE; 39% could be labelled 'high scorers'; 44% of the students met the criteria for 'cases' on the GHQ. Highest mean scores on the DES were obtained on the subscales: Study Obligations, Patient-Related Aspects and Study Pressure respectively. Between schools interesting differences were detected on all variables. As hypothesised, a clear direct effect of stress on both burnout and physical symptoms was shown. An indirect effect of stress on mental health via burnout was shown.

CONCLUSIONS

Dental students showed a negative development through the years from first to fifth year with regard to EE and psychological distress. Both burnout constructs related to physical and mental health. It is recommended that dental faculty focus on the importance of prevention and intervention of stress amongst undergraduates.

Atraumatic restorative treatment and dental anxiety in outpatients attending public oral health clinics in South Africa

OBJECTIVES

This study was undertaken to test the hypotheses that using the atraumatic restorative treatment (ART) approach results in lower patient anxiety and that lower anxiety leads to higher restoration/extraction ratios.

METHODS

The test group of dental operators (n = 9) was trained in ART The control group (n = 11) was not, and did not apply ART The Short Form of the Dental Subscale of the Children's Fear Survey Schedule (CFSS-SF) and Corah's Dental Anxiety Scale (DAS) were used to assess patient anxiety after ART (test group) and after traditional restorations (control group). The restoration/extraction ratio calculated for primary (children) and permanent dentitions (adults) per operator was based on 12-month treatment statistics. Dental anxiety assessments were analysed using ANOVA. Differences were compared using the t-test and corrected for confounding factors (ANCOVA). The Pearson correlation coefficient was used to measure the correlation between dental anxiety levels and restoration/extraction ratios.

RESULTS

The mean CFSS-SF score for test-group children was statistically significantly lower than for the control-group children. The mean DAS score for test-group adults was statistically significant lower than the control. No significant correlation was observed between dental anxiety level and restoration/extraction ratio per operator for both dentitions in both groups.

CONCLUSION

The first hypothesis was accepted; the second, rejected. Although dental anxiety scores were lower both in child and in adult patients treated by ART than in those who received traditional restorative treatments, this positive effect had not resulted in higher restoration/extraction ratios.

Factors inhibiting the implementation of the Atraumatic Restorative Treatment approach in public oral health services in Gauteng Province, South Africa

OBJECTIVE

To investigate potential barriers to the utilisation of the ART approach in a South African public oral health service.

METHOD

7 barriers were identified: patient load/work load, operator opinion, patient opinion, service management, material supply, clinical ART skill, chair-side assistance. Operators were asked to answer a questionnaire one year after completing the ART training. Responses ranged from 1 = no barrier to 5 = highest barrier. Treatment data per operator were collected during 1 year after training, for both dentitions, including: number of extracted teeth, placed traditional restorations, ART restorations. The restoration/extraction (REX) ratio and the proportion of ART restorations (ART%) of the total number of restorations were calculated and correlated with the barrier variables. Pearson correlation, ANOVA and 2-tailed t-tests were used in the statistical analyses.

RESULTS

Patient load/work load (mean = 2.80: SE = 0.16) was the strongest barrier (p<0.001) and clinical ART skill was the weakest barrier (p<0.001). A significant correlation between material supply and mean REX score was observed in both dentitions. In primary teeth, the ART% correlated significantly with clinical ART skill (r= -0.63; p<0.01). In permanent teeth, statistically significant correlations were observed between ART% and patient load/work load (r = -0.54; p<0.05), patient opinion (r = -0.76; p<0.01), operator opinion (r = -0.53; p<0.05), chair-side assistance (r = -0.57; p<0.05), oral health service management (r = -0.46; p<0.05).

CONCLUSIONS

1 year after ART training completion high patient load/work load, followed by insufficient provision of materials/instruments, were the two most inhibiting barriers to the use of ART in the public oral health services. Dentists' perceptions of low clinical skill levels in performing ART confidently inhibited the use of ART in primary teeth in children.

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 to reduce the stress of general dental practice: the need for research into the effectiveness of multifaceted interventions

While the practice of dentistry has been demonstrated to be significantly stressful, there have been few published studies describing interventions to reduce the stress of dental practitioners. This article describes research into the prevention and alleviation of stress amongst a variety of healthcare professionals, including dental practitioners, and describes the findings from a small scale study of an intervention aimed at general dental practitioners who reported high levels of work related stress. It is argued that to be effective, interventions should be tailored to the individual needs of the practitioner, within a structured intervention framework. Further research into the effectiveness and cost-effectiveness of stress management for dental practitioners is required.

Perceived sources of stress in Nigerian dental students

The objective of this study was to identify sources of stress among dental students at the University of Lagos, Lagos, Nigeria. A modified Dental Environment Stress (DES) questionnaire was used to study the 137 students in years 3-6, of which 105 (76.6%) responded. Results show that the year 5 students indicated the highest level of stress overall on items relating to pre-clinical training with 21 (70%) recording aggregate DES score over the cut-off point for high stress. For clinical items, nearly all the students - 27(90%) of year 5 and 24 (100%) of year 6 recorded aggregates over the cut-off point. The most important stressors were those related to the lack of provision of a well-supported system of dental education in Nigeria in terms of availability of materials for clinical training and study materials. There were no significant differences in stress perception between genders. However, students who chose Medicine as their first choice for admission with Dentistry as an alternative experienced significantly higher overall mean and higher mean scores for most items. In conclusion, it appears there is a need to improve support for dental education in Nigeria.

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.

Potential occupational health problems for dentists in Flanders, Belgium

The aim of this study was to gather data on occupational health effects among Flemish dentists. A questionnaire on various potential health effects was sent out to randomly selected Flemish dentists. Pilot experimental studies were performed on hearing and sensory function of the fingers on small groups of dentists. Audiometric data of both ears, gathered with an interval of 10 years, were analysed. Sensory tests of the fingers were performed for dominant and non-dominant hands in relation to exposure time to (ultra)sonic equipment. Positive responses for the questionnaire were as follows: low back pain, 54% (stress-correlated); vision problems, 52.3% (age-correlated); infections, 9%; allergies, 22.5% (mainly latex); stress level was scored 7 on a scale from 0 to 10; diminished sensitivity of the fingertips, 6% and auditory disorders, 19.6%. Pilot audiometric data showed a hearing loss at 4,000 Hz for the left ear, presumably indicative of occupational noise trauma. The two-point discrimination ability of the dominant hand tended to diminish in line with the number of years of practice. Dentists in Flanders were found to suffer from various health-related problems. More elaborate studies are required to provide more details on the risks for occupational hearing impairment and vibration hand neuropathy and to determine whether the problems described were related to the practice of dentistry.

An assessment of career satisfaction among a group of general dental practitioners in Staffordshire

OBJECTIVES

To assess the level of job satisfaction among general dental practitioners from one area of England, and to assess the association of various personal and work related factors with job satisfaction.

DESIGN

Postal questionnaire survey.

SETTING

General dental practices in South Staffordshire, Wolverhampton and Dudley, England.

METHOD

An anonymous questionnaire posted to all 396 registered dentists in the above areas.

RESULTS

A 75% response rate was achieved. Data were analysed using non-parametric statistics for any significant differences in the scores for stress, respect, overall professional satisfaction, quality of life and overall job satisfaction according to the different demographic groupings of the dentists (alpha =0.05). Dentists with an area of special interest had higher scores in all categories except quality of life. Overall job satisfaction was higher among private dentists, and those in group practices and in non-rural locations. The highest bi-variate correlation occurred between overall job satisfaction and overall professional satisfaction, delivery of care, income, respect and professional time.

CONCLUSIONS

Job satisfaction was judged to be good among this group. Stress was the factor associated with the greatest dissatisfaction. This survey produced similar results to preceding US studies, and suggests ways of improving job satisfaction.

Psychological well-being and perceptions of stress amongst Japanese dental students

The purpose of this study was to investigate the relationship between Psychological General Well Being (PGWB) and perceived sources of stress amongst dental students in Japan. Second to sixth year dental students of Tokyo Medical and Dental University were invited to participate in the questionnaire survey. The questionnaire collected information on demographic and social background, lifestyle behaviours, the PGWB index and the Dental Environment Stress (DES) questionnaire. A total of 320 students (56% male) participated, with a response rate of 91%. Male students had significantly higher PGWB scores and lower DES scores than female students (P < 0.05). There were no significant differences in the year of study for DES mean score and PGWB total score. Students whose first choice of admission was dentistry experienced less stress than those whose first choice was another discipline (P < 0.05). Students who regularly exercised showed significantly lower stress levels and higher well-being status than those students who did not exercise (P < 0.01). Correlational analysis showed an inverse relationship between PGWB and DES scores (r = -0.544, P < 0.001). Multiple regression analysis revealed that DES mean score was significantly related to gender, first choice of admission and PGWB total score. It is suggested that perception of stress amongst Japanese dental students is influenced by gender, dentistry as first choice for admission and students' general well-being.

Stress, burnout, anxiety and depression among dentists

BACKGROUND

Dentists encounter numerous sources of professional stress, beginning in dental school. This stress can have a negative impact on their personal and professional lives.

CONCLUSIONS

Dentists are prone to professional burnout, anxiety disorders and clinical depression, owing to the nature of clinical practice and the personality traits common among those who decide to pursue careers in dentistry. Fortunately, treatment modalities and prevention strategies can help dentists conquer and avoid these disorders.

PRACTICE IMPLICATIONS

To enjoy satisfying professional and personal lives, dentists must be aware of the importance of maintaining good physical and mental health. A large part of effective practice management is understanding the implications of stress.

Working conditions and dentists' attitude towards proprioceptive derivation

Proprioceptive derivation (Pd), a new method of organising a dentist workstation as well as a working procedure, was introduced to Thailand. The aim of this study was to assess the working conditions and the attitude to Pd among experienced users. Questionnaires were distributed among 12 dentists. The results showed that all dentists chose to work in a sitting posture and mostly worked without breaks between patients. They spent less time on dental examination and crown and bridge therapy tasks. Solving problems in patients with physical limitations resulted in a low stress level. Seven dentists (58.3%) always used Pd and liked it. Five dentists (41.7%) sometimes used Pd, with 3 of them liking it. Only 2 dentists, who sometimes used Pd, did not like it because it could not cover all dental tasks and treatment, and it was difficult and complex.

Job satisfaction among Canadian orthodontists

Job satisfaction has been well researched for many professions, including general dentistry. The job satisfaction of orthodontists has not been adequately studied. The aims of this study were to describe job satisfaction among orthodontists and to determine characteristics associated with job satisfaction in the profession. A self-administered, anonymous survey was mailed to Canadian orthodontists. It included a modified version of the Dentist Satisfaction Survey, an overall occupational stress score, and items addressing various characteristics of the respondents. Of 654 mailed surveys, 335 were returned, for a response rate of 51.2%. Most orthodontists (79.3%) were classified as satisfied according to the overall job satisfaction scale of the Dentist Satisfaction Survey; however, some (2.5%) were classified as dissatisfied. The facets of orthodontics with the highest degree of satisfaction were patient relations (93%), delivery of care (86%), respect (84%), professional relations (80%), and staff (76%). The most dissatisfaction was associated with personal time (26%) and practice management (15%). Stepwise multiple regression analysis resulted in a model including overall occupational stress, membership in the Canadian Association of Orthodontists, total number of staff, and age to account for 27.1% of the variation in the overall job satisfaction scale. Based on accountable sources of variance, the overall job satisfaction scale seems to be more affected by other variables than the characteristics evaluated by this survey.

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.

The technologically well-equipped dental office

BACKGROUND

Information technology, or IT, applications for dental practice continue to develop rapidly. More than 85 percent of all dentists use computers in their offices, and the number of clinical uses for the computer is on the rise. This article discusses the state of the art of several technologies, provides an integrative view of a technologically well-equipped office and offers several guidelines for technology purchasing decisions.

CONCLUSIONS

Most administrative applications are relatively mature and are required for the smooth functioning of today's dental offices. Clinical applications--such as dental and medical health histories, charting, digital imaging, diagnostic and treatment applications, and decision support--vary in their degree of maturity. Most Internet applications-such as Internet-based scheduling and e-mail communication with patients--still are an optional adjunct for dental practices.

PRACTICE IMPLICATIONS

Practitioners should develop a comprehensive plan for implementing or updating the IT infrastructure in their offices. Issues to be considered in technology purchasing decisions include usability, integration, work flow support, cost-benefit analysis and compliance with standards.

Dentists in general and community practice: a Scottish survey

OBJECTIVES

To identify the available workforce in general dental practice and to describe the job satisfaction, career and retirement plans of dentists in general and community practice.

DESIGN

A postal cross-sectional survey.

SETTING

Primary care dentists practising in Scotland in 2000.

MATERIALS AND METHODS

Semi-structured questionnaires were sent to all primary care dentists identified from the Scottish Dental Practice Division as being in practice in Scotland.

RESULTS

The response rate was 70% (1,335 GDPs and 187 CDPs). Although most dentists in both the GDS and CDS stated that they enjoyed their work, 35% of GDPs would not now choose dentistry as a career. Eighty-three per cent of the GDPs' time was spent on clinical work, of which 5% was not NHS-funded. Daily demotivation was reported by 70%, most commonly citing the job itself and the NHS 'treadmill'. Two-thirds of CDPs were women, as were half of GDPs aged less than 30. Only 35% of CDPs planned early retirement but 80% of them felt underused. Two-thirds of GDPs planned to retire in their mid-50s, and a further quarter planned to work part-time. Of the former, only a quarter agreed that nothing would induce them to work beyond this time.

CONCLUSION

Conditions of work within primary care dentistry require modification to retain the current workforce and accommodate the increasing proportion of women. Part-time employment packages may encourage older practitioners to work for longer, and allow younger practitioners to fulfil family or personal commitments.

Stress in dental specialists: a comparison of six clinical dental specialties

OBJECTIVE

To describe and compare the levels of stress reported by dental practitioners working within clinical dental specialties.

METHOD

Questionnaire survey of 220 dental practitioners identified from the General Dental Council lists of specialist practitioners in the following clinical specialties: orthodontics, paediatric dentistry, restorative dentistry, endodontics, periodontology, prosthetic dentistry.

FINDINGS

The clinical specialties did not differ in their reported levels of stress. Practitioners working in the field of paediatric dentistry reported the highest median levels of reported stress for three of the four scales, though this trend was not significant.

CONCLUSIONS

The practitioners surveyed from six clinical specialties did not experience significantly different sources of stress.

General dental practitioners' beliefs on the perceived effects of and their preferences for remuneration mechanisms

OBJECTIVE

To identify GDPs preferences for differing remuneration mechanisms and their beliefs on the effect of the mechanisms in care provision.

DESIGN

Postal questionnaire survey of 300 GDPs holding an NHS contract with a London Health Authority.

RESULTS

GDPs perceive that remuneration mechanisms are important in determining the provision of care but not overall disease levels. There were differences in the preferred remuneration mechanisms when working under the NHS compared with the non-NHS sector. When providing care under the NHS, either the current remuneration system or a salaried plus bonus would be the preferred choice, while for non-NHS care a fee-per-item mechanism is preferred. Fee-per-item arrangement was the preferred choice of younger general practitioners compared with older practitioners. Females showed a greater preference for a salaried with bonus arrangement compared with males.

CONCLUSIONS

If policy makers are to use remuneration mechanisms to influence the provision of care effectively, the beliefs that care providers hold about various mechanisms are important to understand how they would respond to changes in the system.

Measuring work stress among Dutch dentists

Individual differences among dentists determine to a large degree what is experienced as work stress, but assessment of specific areas is necessary to be able to act preventively. The aim of this study was to develop an instrument to be used to monitor the experience of work stress in detail, to measure its levels, and to relate those levels to job (dis-) satisfaction. A questionnaire was developed, the Dentists' Experienced Work Stress Scale (DEWSS), covering widespread aspects of dental work, which was completed by 709 dentists, forming a highly representative sample of Dutch general dental practitioners. Factorial, correlational, and reliability analyses were conducted, after which seven areas of stress emerged: Work Pressure, Financial Aspects, Patient Contacts, Work Contents, Career Aspects, Team Aspects, and Professional and Private Life. Of these, Patient Contacts and Work Contents showed highest mean scores, as did the specific items: 'defaulters', 'governmental instructions', and 'unreasonable or demanding patients'. A strong inverse relationship was found between work stress, in particular lack of career perspective, and job satisfaction. The questionnaire is a valuable instrument to monitor pressure at work as felt by Dutch general dental practitioners. Patient contacts, work pressure, and career perspective clearly need preventive attention in the Dutch situation.

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.

Young dentists--work, wealth, health and happiness

OBJECTIVE

To determine the relationships between working conditions for new dental graduates and their mental and physical health.

DESIGN

A cross-sectional postal survey.

SUBJECTS

Graduates from the years 1991 and 1994 were selected to provide cohorts before and after the introduction of mandatory vocational training. A total of 232 graduates were sent questionnaires and 183 replied (77%): 90 men (49%) and 93 women (51%).

SETTING

The cohorts came from all Scottish dental schools. When surveyed in 1996/1997, 66% were working in Scotland and 28% were in England. The rest were elsewhere in the UK or abroad.

MEASURES

Measures included a wide range of conditions at work: number of patients seen, pace of work, hours worked, attitudes to work, financial arrangements, alcohol consumption, sickness-absence, physical and mental health.

RESULTS

There were significant differences between those working in general practice and those in hospital in terms of the hours, numbers of patients seen, feelings of competence and senior support. Methods of payment for treatment in general practice also revealed differences in perception of work: most pressure at work was associated with part NHS and part private funding. Mental health and alcohol consumption were equivalent to age-matched junior doctors, but increased psychological symptoms in female dentists were significantly associated with the number of units of alcohol consumed.

CONCLUSION

Selected working conditions are associated with reported competence, stress and health among young dentists.