When the hospital dental residents at Mount Sinai Hospital in Toronto discussed the difficulties of dealing with the stress of dental school, Bruce Freeman, DDS, DOrtho, MSc, stepped in to offer them classes in yoga, meditation, and mindfulness. The Dental Department at Mount Sinai has welcomed and encouraged this initiative and it is now a core part of the program. And while he has seen his students respond well to these lessons, he believes that dental professionals at every stage of their careers would benefit from learning to breathe and relax.
“Do you ever feel like you have one foot on the gas, one foot on the brake? Do you think you’re alone? Yes! You feel you’re alone because people are embarrassed to discuss this. So my goal is to take away the stigma and say to people that we’re all stressed. Life is getting more complicated,” said Freeman, co-director of the TMD-Facial Pain Unit at Mount Sinai Hospital. “We’re bombarded. Our brains can’t handle it.”
The Road to Wellness
Freeman has had a busy career. He has owned his own practice in addition to his work at the pain clinic, and he acknowledges that the patients at the clinic present their own challenges. Managing their needs while running a business took a toll on his own life. Freeman noted that he is a member of a generation “that was told to suck it up” and not whine about their lot, despite the effects this attitude was having on his life and on the care he was providing.
“I was constantly worried about my patients, constantly worried about pleasing my patients to the point where I ignored myself,” said Freeman, who then decided to sell his practice, though he still works there and focuses on complex surgical cases where communication is even more important, due to the fears associated with them. “I decided to become a yoga teacher and learn how to manage my own stress because what I realized is self-care leads to the best patient care. And I also developed a lecture, a full-day lecture, on patient experience, helping people understand how our brain works.”
Freeman does yoga and stretches every morning, along with basic breathing exercises. While classes are helpful, he says these activities aren’t difficult to learn, with many instructional videos available for free online. Exercise is essential to managing stress, he said. Meditation during this activity is helpful as well, though many people may have misconceptions about how it works.
“It’s not about clearing your mind of thoughts. It’s about, ‘Okay, I’m having a thought. I’ll let it go.’ This is my time to just breathe, slow my heart rate, and get ready for the day, which can even be five, 10 minutes. You can even meditate on the subway to work or school. It’s not about sitting in stillness in a particular position. It’s about closing your eyes and just letting your mind come to peace. Let thoughts come, let them pass,” Freeman said.
Dentists can perform these exercises in their office as well. Freeman noted that dentists’ blood pressure goes up about 10 points every time they give an injection. Taking a few minutes to breathe and relax before and even while seeing a patient can improve both your health and the quality of care you provide. Freeman said one dentist who had heeded his advice told him about a case where he couldn’t get a root tip out. But by stepping out of the operatory and performing a breathing exercise, the dentist was able to calm down and get the job done.
Dentists also can coach patients through these techniques so they are calmer and more receptive to treatment too. For example, Freeman suggests breathing with patients, being sure to inhale and exhale deeply, with the exhalation taking twice as long as the inhalation. Also, simply trying to do a better job of talking with your patients can go a long way in reducing their stress and improving care.
“The biggest stress involved in patient care is patient communication,” Freeman said. “When people make a complaint against a healthcare practitioner, it has nothing to do with clinical care. It’s all about experience. Nobody calls and says ‘My filling was done poorly.’ They say ‘The doctor was rude. The receptionist was rude. She didn’t listen to my needs.’ It’s our failure to understand how our brains are working, why we feel stress, why the patient feels stress.”
Freeman also shares strategies with patients so they can continue to manage their stress once the appointment is over. He tells them how the blue light of smartphone and other screens can disrupt and reduce their melatonin levels, impacting the quality of their sleep. Bruxism and sleep apnea also impact oral health, sleep hygiene, and overall quality of life, and Freeman tackles these topics during his appointments too.
The Daily Grind
As for other practitioners, Freeman acknowledged that multiple sources of stress make it difficult to get through the day. The physical practice of dentistry, for instance, takes a toll on the body. Dentists, then, need to stretch their muscles before and during the day like an athlete preparing for a game or a workout. Good posture and ergonomics also are essential to pain-free practice and a long, healthy career.
“It takes a team of people to keep me upright—my acupuncturist, chiropractor, and physiotherapist,” Freeman said, noting how his acupuncturist especially emphasizes the connections between physical pain and emotional health. “She always says to me, ‘Things and people don’t aggravate you. You let them.’ Our ego gets in the way.”
Freeman admitted it isn’t easy, considering how many things can trigger stress, such as the excessive student debt that burdens many young dentists—and those who aren’t so young. Also, he said, some dentists are associating for 30% of their billing. Competition for these jobs is steep, too, especially with the growing number of graduates. These financial concerns often are among the greatest risks to mental health and to relationships, Freeman said.
Social media is another trap. There’s the fear that patients will go on local sites and leave scathing reviews that malign reputations and put practices in jeopardy. Or, dentists often see posts seemingly showcasing the glamorous lives that their friends and colleagues lead, leaving many of them to feel like they’re coming up short both professionally and personally themselves.
“Social media is very dangerous for younger dentists, because they go on and see these people, thinking they’re living these fabulous lives and doing amazing work. And they forget that it’s just Instagram or Facebook. It’s not real. But it does affect you psychologically. But they think it doesn’t,” Freeman said. “They think, ‘This person is having a great life. Why aren’t I living that great life?’”
Today’s students and young dentists haven’t been prepared well for these myriad stresses, Freeman said. Dental schools are challenged enough in providing them with the clinical skills they will need to practice, Freeman added. Non-clinical subjects like finances, practice management, and work-life balance get token coverage, if anything. Plus, many students seem to arrive at dental school ill prepared for stress in the first place.
“We see a lot of parents now, instead of teaching their kids to figure something out, they’re very much helicopter or snowplow parents. They’re always hovering or clearing the path,” Freeman said. “Kids today don’t have any tools in the toolbox to know how to deal with stress. There has to be a happy medium between sucking it up and asking for help.”
A Mindful Life
Regardless of their generation, then, mindfulness enables dentists to manage all of these different pain points and continue their work. Simply being aware of what you’re doing, what you’re saying, and how you’re breathing can have a huge effect on how much stress you feel, how you approach your work, and the quality of your care, Freeman said. It’s about being present in your day to day life and paying attention to purpose in the present moment.
“Somebody asked me why I would want to pay attention to my present moment when my present moment might be stressful, painful, or challenging. It’s because change only comes when we know what it is that gives us stress or pain. If you’re not sitting back and observing and going, ‘How does my body feel when this happens,’ then you’re never going to recognize what change needs to happen,” Freeman said.
Freeman encourages everyone who feels stress to reach out to him to learn more about the role of stress management in dentistry. He also advises students and practitioners alike to spread the word and engage with their faculties, associations, and colleagues to de-stigmatize concerns about mental health and emphasize the role that self-care plays in providing quality clinical care.
“I want schools to just be shaken up and wake up and say, ‘Hey, this problem exists. This is a big problem.’ And if you want to turn out the best clinicians who can deliver the best patient care, they have to manage their own self-care and be able to communicate effectively so their patients are happy and the best care is delivered,” Freeman said. “If you can’t look after yourselves, how can you look after anybody else?”