How Stress and Mental Health Plays a Role in Physical Well-Being for Dental Professionals

Dentistry is known to be one of the most stressful professions in health care. According to a survey conducted by RDH E-Village, more than half of dental hygienists feel stressed by their job on a daily or weekly basis.¹ This survey suggests that the common causes of higher stress levels for dental professionals are musculoskeletal discomfort, personal strain, ambiguity in the office, and emotional exertion. Musculoskeletal disorders, also known as MSDs, are extremely common among dental professionals. Studies show that up to 97.9% of dental professionals experience physical pain from musculoskeletal disorders.² In an industry known for high stress and work-related pain, the question we must ask is: are they connected?

Some contributors to musculoskeletal disorders among dental professionals are awkward working posture, movement repetition, on-going vibration, and long-durations sitting. Many dental professionals complain that the pain eases when they’re not working and then it returns during work hours. There is a strong correlation between stress and pain. Moving forward in this article, I’ll examine the connection between the these.

Let’s start by talking about stress. Stress is our body's response to pressure; it is a feeling of emotional or physical tension. Stress can stem from a specific thought, situation, or event. It often occurs when we feel frustrated, angry, nervous, or lacking control. In addition, stress can come from the food we eat, the exercise we partake in or lack thereof, our lifestyle, relationships, and more. In small doses stress is a good thing. However, stress can become highly problematic when it’s ongoing and the body isn’t able to go through the full stress response and return to homeostasis.

Stress Reduction Strategies

There are many ways to address stress and improve our physical and mental wellbeing. One simple practice is to focus on your breathing. Our breath and the way we breathe have a direct correlation to our nervous system. When you feel stress coming on or lingering after an event, simply become aware of your breathing patterns. Often, the breath will be shallow and fast. Focus on slowing down the breath, and the exhale in particular. Exhalation is connected to our parasympathetic nervous system. Take 10 breaths and focus on long, slow, steady exhalations.

Another practice for reducing stress is called Box Breathing. Box Breath is a breathing practice that focuses on creating balance in the breath. To practice Box Breathing, start by inhaling for a count of 4, pause at the top for a count of 4, exhale for 4 counts, and pause at the bottom for 4 counts. You can adjust the counts as needed. Try this cycle of breathing for 8-10 rounds or until you feel more relaxed.

Another practice to help reduce stress is a body scan. A body scan is a simple way of becoming more aware of your body, and in turn, becoming more present. This one is taught in many mindfulness and yogic practices. Start at your head and work your way to your feet–or vice versa. Simply notice and relax each area as you go.

The last practice to help reduce stress and optimize our resilience to stress is therapeutic yoga. With gentle and mindful movements of the body linked with a steady breathing pattern, you create balance in the nervous system, reduce muscle tension, and become more present. With this, stress levels reduce, and the muscles relax.

How we cope with stress is extremely important. Everyone deals with stress differently and it depends on several things including early life events, genetics, and our personality. To understand stress and the relationship between our mental and physical well-being, we must look at the nervous system. The nervous system has 2 main divisions; the first is the autonomic nervous system. The autonomic nervous system is a branch of the peripheral division which encompasses 2 individual systems, both of which have unique functions: the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS).

These 2 systems work together throughout every day. When stress occurs, the SNS activates what is commonly known as the “fight or flight” response. When the stress response is triggered, our body produces stress hormones that allow us respond to dangerous situations quickly. This is the main function of the sympathetic nervous system. When this response is activated, the body shifts its energy and resources towards fighting off a threat, such as a medical emergency in the dental office. The SNS signals the release of specific hormones, and from there, a host of actions occur within the body including increased heart rate, blood vessel dilation, and digestive disruptions. The SNS response happens suddenly to prepare the body to respond to an emergency. This is known as acute stress.

Stress and the stress response can be extremely useful in certain situations. Working in clinical dentistry, it allows us to activate quickly as needed to help an anxious patient or a medical emergency. Once the crisis has passed, ideally the body returns to an unstressed state. The recovery from the stress response is facilitated by the parasympathetic nervous system, the second system within the autonomic nervous system. When the stressor passes and the PNS is prompted, our hormones go back to normal quickly, shifting the body into the “rest and digest” state. When our body is able to respond to stress and swiftly return to homeostasis, no long-term effects arise.

While stress can occur as a result of heavy traffic on the way to work, a rude comment from a co-worker or patient, or equipment not functioning properly, it can add up throughout the day, leading to chronic stress. We live in a busy society, constantly inundated with information from the news and social media which can cause a compounding effect whether we realize it or not. In addition, as dental professionals, we are receiving information all the time–feedback from our patients, messages from our team, our own thoughts and analytical processing, and so on. If we don’t find ways to manage our stress and our response to stress, we will remain in a state of constant arousal, leading to long-term health effects.

When we remain in a constant state of sympathetic arousal, many symptoms can occur including feelings of anxiousness, frustration, and irritability. Some may notice themselves snapping at co-workers or friends, being unable to make clear decisions, or having difficulty sleeping. Other symptoms include low energy, fatigue, digestive problems, headaches, shallow breathing, and aches & pain in the body. There are clear signs that long-term stress is directly correlated to our physical well-being.

Chronic stress occurs when the body experiences stressors with such high intensity and frequency that the autonomic nervous system cannot activate the relaxation response regularly. This leads to a continuous trigger of physical reactions in the body and affects every system in the body–directly or indirectly. Our bodies are designed to handle acute stress–such as the random medical emergency in the office–not a state of constant stress. To evaluate the correlation between stress and physical pain, we can look at how an overactive nervous system affects the entire body.

We know that stress affects all systems of the body including the musculoskeletal system. When our body experiences stress, our muscles become tense and breathing becomes shallow. Ideally under stress, the muscles tighten all at once, and once the stressor passes, the muscles relax. However, what happens when the trigger passes but we continue to feel stressed, as a result, the muscles remain tense.

Muscle tension is our body’s intelligent way of protecting itself against harm or threat, however, if we’re living in a state of chronic stress, it becomes difficult for our muscles to relax. When muscles are tight for long periods of time, other reactions in the body may be triggered, and may lead to pain. For an example, chronic muscle tension in the head, neck, and shoulders often leads to headaches for people.

Constant muscle tension can lead to many adverse effects including reduced blood flow and circulation, both of which are necessary for our body to heal. With an overproduction of cortisol released during chronic stress, inflammation in the body increases, leading to pain and fatigue. In addition, once you experience pain, it’s common for people to start worrying about that pain. In the study The Pain Catastrophizing Scale: Development and validation, they explain that, “Pain-related fear of movement can lead to hypervigilance, muscular reactivity, and avoidance.”³ Often time, we avoid exercise or movement thinking that it will lead to more pain. When in reality, our muscles need movement! When they are not being used, they become weak and lead to further discomfort.

Our body is interconnected and complex. When we experience stress, mentally, emotionally, or physically, it creates a ripple effect in the rest of our body. So, when we are experiencing chronic stress, it takes a toll on our entire system. While it’s important to reduce physical pain, which can lead to stress, it’s necessary to address stress itself.

Pain and stress are designed to alert the body on a short-term basis. The body is designed to deal with them for a short time. When the body is stuck in “fight or flight” mode for extended periods of time, this overworks the body and causes problems. We can minimize stress and pain by building better resilience to stress, minimizing stressors, and actively managing stress levels day-to-day.