Stress in orthodontic dentistry

Are you suffering? Helena Alder explains how to identify the stressors and what you can do to combat it

In this article I want to talk about stress and how it relates to orthodontic dentistry, and even more importantly what you can do about it. It is a well-known fact that there is a lot of stress in dentistry. A BDA survey from 2014 uncovered that almost half of GDPs in the UK (47%) reported high levels of stress compared to an average of around 15% of all British workers [1], and while there is little research done on the actual levels of stress and life satisfaction for orthodontists, a survey out of Canada in 2003 [2] looked at the main stressors and contributing stress factors orthodontists experience on a regular basis.

Hans Selye defined stress in the 1930s as all that is unpleasant, noxious, or excessively demanding [3]. The identified top stressors or excessively demanding tasks that orthodontists are dealing with on a regular basis are; patients that show dissatisfaction with care received, performing difficult tasks on a difficult or uncooperative patient, falling behind schedule, constant time pressures, motivating patients with poor OH and/or decalcification as well as patients with broken appliances. Time pressures and motivating patients with poor OH and/or decalcification came out especially high in the rankings.

Identifiers and threats

A big key in dealing with stress is hence to identify the stressors that are particularly relevant to you in your daily practice or everyday life. However, more recent research in neuroscience and mindfulness also flesh out what actually happens in our brains and bodies in those moments of increased pressure and stress, and this gives us another exciting opportunity to deal with your daily stressors even more skilfully.

Enter the amygdala highjack. The amygdala is a tiny part of the brain which is responsible for detecting and responding to threats. It sets in motion a primal response in moments of perceived threat and stress where the body goes into fight or flight to stave off that threat. While it is attempting to move us away from danger, when it is activated it also highjacks our higher brain structure the middle prefrontal cortex which is responsible for helping us make rational decisions and maintaining emotional balance. Hence the term amygdala highjack.

Worry and ruminating can also contribute to an ongoing low-grade amygdala highjack, so as long as you ruminate and worry you remain in a state of distress. You are basically in a chronic sympathetic nervous system arousal, which is not a good state. The sympathetic nervous system is designed to stave off the threat in short powerful bursts before returning you to a normal resting state. Now with your daily worries in dealing with patient expectations, time management and broken appliances this can inadvertently lead to a state of chronic sympathetic arousal. This means that stress hormones keep getting pumped into your body which will have all sorts of negative consequences on your health and well-being [4].

Practical tips on how to interrupt your stress response?
– Have a lunch break everyday. Make sure you take a good break and don’t get tempted to work through lunch. You need regular recovery to maintain balance and not get caught in your stress response.
– Identify your main stressors. What are the key stressors that you experience regularly – clinically or personally? What are some things you can do to eliminate or minimise these?
– Time management. Running late and keeping to schedule is identified as a main stressor for orthodontists. How can you step back and take the overview? Think through your day and plan ahead. Good time management is critical, and don’t beat yourself up when you fail.
– Take three deep breaths before each patient. This can feel like it adds to your time pressures, but it is well worth the investment. You will start your next appointment with a calm mind and the parasympathetic nervous system on-line.
– Take some time out of each day to ‘do nothing’. Even five minutes can have a great impact. Set the intention to do nothing, and see what happens.
– Take a mindfulness course. If you don’t want to invest in the full eight week MBSR course, find a course on-line or get in touch with myself to get some support to try mindfulness.

Support your body

So how do we counteract the amygdala highjack? The antidote is to support your body to regularly get into the opposite state; the parasympathetic state. Parasympathetic arousal occurs when we are relaxed, and it is associated with restoration and recovery. This in turn lights up the left prefrontal cortex where we find emotional balance, increased ability for problem solving, clarity of thinking, happiness and productivity.

To be clear, you don’t want to be in parasympathetic states all the time, but rather you want to cultivate a balance between the two. You need the energy of the sympathetic nervous system to get things done, however, the problem occurs when it highjacks your system or is switched on chronically. A balance between sympathetic and parasympathetic modes promotes peak performance and flow states.

And you might have guessed by now my main suggestion for shifting this balance of chronic sympathetic arousal to more parasympathetic arousal – yes, you are quite right; namely mindfulness. Developing your ability to simply observe your experience in a non-judgemental way, seeing whatever thoughts and feelings arise in your mind as ‘just thoughts and feelings’ as they don’t always accurately reflect what is actually going on – especially if they are triggered by the amygdala highjack, can have profound effects. This is the beauty of mindfulness that it’s just about training the mind, and it’s completely secular. It only requires that you are willing to be present, being here and now and not judging what is going on. Mindfulness is incredibly effective for getting the left prefrontal cortex back on-line in order to access your rational decision making processes and emotional well-being.


So the key to learn how to free yourself in those moments when there is a perceived stressor in your daily clinical work is awareness. Becoming aware of your habitual reactions to your triggers, and then with the help of mindfulness choosing a different way to act5.

The most widely used method for working with mindfulness and stress is Jon Kabat-Zinn’s Mindfulness Based Stress Reduction (MBSR). This is an eight-week course that supports participants to gain control over their chronic stress and promote their emotional well-being. Participants have reported more enthusiasm, energy and joy returning in their work [5].

Hopefully this article gives you a taste of the potential role mindfulness can play in helping you deal with your daily stress as an orthodontist, and as always, please get in touch if you would like to explore this further.


1. BDA, The Psychosocial Working Conditions and Work-related stress among Community Dentists in the UK 2014
2. Stephen F. Roth, Giseon Heo, Connie Varnhagen, Kenneth E. Glover, and Paul W. Major (2003) Occupational Stress Among Canadian Orthodontists. The Angle Orthodontist: February 2003, Vol. 73, No. 1, pp. 43-50.
3. Selye, H. A syndrome produced by diverse nocuous agents. Nature. 1936;32.
5. Jon Kabat Zinn – Full Catastrophe Living, p-306-334

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