Are your patients stressed? Here's how to find out.

Time magazine’s June 6, 1983 cover story called stress “The Epidemic of the Eighties,” and referred to it as our leading health problem. There can be little doubt that the situation has grown progressively worse since then.

Numerous surveys confirm that adult Americans perceive they are under much more stress today, than a decade or two ago.

Stress is one of the most talked about topics these days, with people of all ages discussing it, and more importantly, showing it. Relationship demands, health problems, traffic congestion, work deadlines-from 3 year olds to 83 year olds, there is no escaping it.

In each of our worlds, stress plays a major factor in our lives, and as dental hygienists, we are merely on the cusp of innovation, continually finding ways to help our patients deal with it and the oral manifestations resulting from it.

“Dental offices today need to recognize and address the issue of stress with their patients.”
-Dawn Kasper, RDH

Difficult to Pinpoint

Stress is difficult for scientists to define, because it is a highly subjective phenomenon that differs for each of us. Things that are stressful for some individuals can be pleasurable for others.1

Stress can be described as the body’s physical, emotional and mental response to a change that calls for some kind of adjustment. When you are stressed, your body responds as though you are in danger. It makes hormones that speed up your heart, make you breathe faster, and give you a burst of energy. This is called the flight or fight response. Continuous stress manifests itself in the form of:

• hypertension

• chest pain

• abdominal pain

• respiratory problems

• anxiety or depression

• heart attacks or stroke

• immune system disturbances resulting in increased susceptibility to infection

• a host of viral linked disorders, from the common cold and herpes to AIDS and certain cancers

• autoimmune diseases like rheumatoid arthritis and multiple sclerosis

In addition, stress can have direct effects on the skin (rashes, hives, atopic dermatitis), the gastrointestinal system (GERD, peptic ulcer, irritable bowel syndrome, ulcerative colitis) and can contribute to insomnia and degenerative neurological disorders like Parkinson’s disease.

In fact, it’s hard to think of any disease in which stress cannot play an aggravating role or any part of the body that is not affected. This list will undoubtedly grow as the extensive ramifications of stress are increasingly being appreciated.

Work-related stress

Job stress can be defined as the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources or needs of the worker. The concept of job stress often is confused with challenge, but they are not the same.

Challenge energizes us psychologically and physically, and it motivates us to learn new skills and master our jobs. When a challenge is met, we feel relaxed and satisfied. However, when the challenge has turned into job demands that cannot be met, relaxation has turned into exhaustion, and a sense of satisfaction has turned into feelings of stress, the stage is set for illness, injury and job failure.

Unlike stress in general, work-related stress affects men and women equally, with common causes including:

• Unreasonable performance demands

• Changes in technology

• Lack of interpersonal communication between employer and employees

• Lack of interpersonal employee relationships

• Fear of job loss or demotion

• Long working hours or less family time

• Under utilization of skills

• Underpaid or cuts in pay or benefits

• Verbal or sexual abuse on the job

Dental offices today need to recognize and address the issues of stress with their patients. As dental hygienists, we have the opportunity to positively affect our patients by establishing trust, showing sensitivity, being approachable, communicating and listening to their needs. In some cases, using sedation and anesthesia might be necessary for patients with extreme anxiety. Has your office become trained to deal with patients’ stress?

Stress and Oral Health

Too much stress may not only spoil your mood, it may also spoil your smile. The effects of stress can easily be seen in mouths, ranging from problems with TMJ, grinding, clenching, periodontal disease, dry mouth, caries, and cracked teeth, to name just a few (see ”Stress and Oral Health” for details).

It is very important to educate yourself and your patients on the effects of stress in their mouth and provide them with the appropriate home care tools to address those stress-related issues. There is mounting evidence that there is a strong link between stress and gum disease.

Although it is difficult to pinpoint the negative effects of stress on your gums, researchers say the studies suggest that elevated levels of the stress hormone cortisal may be involved in periodontal disease. In addition, stress may make people more lax about their oral health habits, and they may increase the use of nicotine, alcohol or drugs.4

The importance of educating each patient on the effects of stress in their mouth and providing them with the appropriate home care tools to help prevent it, will go a long way toward alleviating their oral health problems, thereby also helping to reduce their stress. By individualizing each patient’s appointment, and stressing the importance of designing a home care treatment plan they can agree to, they are much more likely to be compliant, leading to good overall oral/systemic health. Good health will result in less stress, thereby helping to break the vicious cycle.

Help Patients Live Healthy

According to a study by the National Institute for Occupational Safety and Health, 40 percent of American employees feel their job is very stressful, and 80 percent feel stress while on the job.

In a perfect world, we all need to learn stress management skills and seek healthy ways to relieve stress through exercise, balanced eating, plenty of sleep, good dental habits, meditating, breathing exercises, maintaining a positive attitude, limiting caffeine and alcohol, recognizing spiritual needs and developing alternative activities such as relaxing hobbies. That requires recognition of stress in our daily lives, its’ effects on our bodies, and the desire to take action to help relieve it.

It is our genetics that load the cannon, but our lifestyle is what lights the fuse. There are many ways to make positive changes in our lives that will help us to minimize stress. Remember: It is not what happens to us, it is what we choose to do about it that makes the difference in how our lives turn out. 

Dawn Kasper, RDH, EC, has practiced clinical dental hygiene for 28 years. She is the owner and president of Trusted Success, a Practice Management consulting business providing dental offices with team consulting and coaching, to compliance and success. Dawn is a published author, recognized speaker, and consultant.

She has been an active member of the American Dental Hygiene Association, The American Dental Education Association, the Illinois Dental Hygiene Association and the North Suburban Dental Hygiene Association.

References available upon request. E-mail mh@advanstar.com.