Boreout: the lesser known counterpart to burnout in dental care professionals

You’ve heard of burnout, but another phenomenon is becoming equally as prevalent in the oral health profession – Benjamin Tighe explains how underutilisation is leading to an epidemic of boreout in dental care professionals.

The wellbeing of the dental hygiene and therapy workforce has never been more worthy of attention. For years, occupational discourse has centred on burnout as the predominant threat to clinician mental health. Yet a growing body of organisational psychology literature points to an equally insidious but conceptually distinct phenomenon: boreout. These two syndromes occupy opposite ends of the same spectrum of occupational distress. Understanding their differences, and crucially their shared professional consequences, is essential if healthcare organisations, commissioners, and practitioners are to develop effective responses.

There is extensive evidence for burnout as it applies to dental hygienists and therapists in the UK context, while boreout can be used as a framework for understanding the occupational consequences of professional underutilisation. Both phenomena are present in the structural reality of NHS dental practice in England – here’s how that manifests and what a meaningful response might look like.

Burnout: definition and origins

Burnout is formally classified as an occupational phenomenon. In May 2019, the World Health Organization (WHO) included it in the 11th Revision of the International Classification of Diseases (ICD-11), defining it as ‘a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed’ (World Health Organization, 2019).

The ICD-11 characterises burnout along three dimensions: feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism; and reduced professional efficacy (World Health Organization, 2019). Importantly, the WHO notes that burnout ‘refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life’.

The academic foundations of burnout research were established in the 1970s, principally through the work of Herbert Freudenberger, who first described the phenomenon among care workers, and Christina Maslach, whose subsequent research produced the Maslach Burnout Inventory (MBI) – still the most widely used validated instrument for its measurement (Barbosa et al, 2024). The MBI operationalises burnout across three subscales: emotional exhaustion (EE), depersonalisation (DP), and personal accomplishment (PA).

Burnout in dental professionals

Burnout among dental professionals is well-documented and worsening. A systematic review following PRISMA guidelines found significant burnout prevalence across dental professionals globally, with the COVID-19 pandemic exerting a measurable additive effect on emotional exhaustion and depersonalisation scores (Barbosa et al, 2024). In the UK specifically, a 2025 study examining burnout, stress, and wellbeing among dental care professionals found that levels of occupational stress are rising, with structural and organisational workplace factors identified as primary contributors (Durkin et al, 2025).

The NHS dental workforce as a whole is under considerable pressure. The British Dental Journal has described the dental recruitment and retention crisis in stark terms: in 2021, 58% of NHS general dental practitioners reported an intention to leave or reduce their NHS commitment within five years, with stress and burnout cited as key drivers (Bhatti and Kelleher, 2023). A 2022 survey of 2,204 dentists found that 45% had reduced their NHS commitment since the onset of the pandemic, with two-thirds of practices reporting unfilled vacancies (Bhatti and Kelleher, 2023). Critically, attrition affects the entire dental workforce: 39% of dental nurses have indicated wanting to leave dentistry within the next two years (Bhatti and Kelleher, 2023).

Burnout among dental hygienists and therapists in the UK

UK-specific evidence for dental hygienists and therapists is now emerging. A survey of dental hygienists and therapists (DHTs) in south west England conducted by Hallett, Witton, and Mills found that reported wellbeing among DHTs was consistently lower than general population norms (Hallett et al, 2023). Significantly, 45% of respondents reported high anxiety levels, and 37.2% reported high stress levels on a validated single-item measure. Younger respondents reported lower levels of life satisfaction, and those performing no dental therapy reported statistically significantly lower happiness levels than those working to their full scope.

The study concluded that low mental wellbeing is likely to impact negatively on workforce morale and motivation, leading to increased absenteeism and, ultimately, loss of colleagues from the dental workforce.

A mixed-methods study involving British Society of Dental Hygiene and Therapy (BSDHT) members, published in the International Journal of Dental Hygiene in 2025, confirmed that both dental hygienists and dental therapists are frequently underutilised across both NHS and mixed practice settings in the UK, with implications for job satisfaction and professional wellbeing (Rochford, 2025).

Drivers of burnout in dental hygiene and therapy

The literature identifies several consistent drivers of burnout in this professional group:

Physical demands

The repetitive musculoskeletal strain inherent in clinical dental hygiene practice is a well-established occupational stressor (Gorter, 2005). Musculoskeletal pain has been identified as one of the factors most significantly associated with work stress among dental hygienists, alongside working without an assistant and long working hours.

Emotional labour

Sustained management of patient anxiety, maintaining professional composure, and navigating complex interpersonal dynamics in the clinical environment generate significant emotional demand (Hallett et al, 2023).

Workplace and systemic pressures

Lack of support from practice management and doubts about one’s own capabilities have been identified in the international dental hygiene burnout literature as significant risk factors (Gorter, 2005). In the UK context, NHS contractual pressures and financial constraints on practices compound these individual-level factors (NHS Alliance, 2026).

Workforce instability

The NHS Long Term Workforce Plan acknowledged that workforce challenges in dentistry increased during the COVID-19 pandemic, with practitioners offering fewer NHS services and making them harder for the public to access, creating additional pressure on those remaining in the system (NHS England, 2023).

Boreout: definition and origins

Boreout is considerably less established in the clinical literature than burnout, yet its relevance to healthcare professionals is increasingly recognised. The term was first introduced by Swiss management consultants Philippe Rothlin and Peter Werder in their 2008 English-language publication Boreout! Overcoming Workplace Demotivation, in which they described a state of chronic under-stimulation, boredom, and professional meaninglessness arising from insufficient or insufficiently challenging work (Rothlin and Werder, 2008).

Boreout is, in this sense, the structural inverse of burnout. Where burnout arises from too many demands placed on a professional, boreout arises from too few – or from demands so far beneath the professional’s capacity that they generate chronic under-engagement (Chodyka et al, 2025). It is important to note that boreout has not yet been formally classified in the ICD-11 or equivalent diagnostic frameworks. It remains a psychological and organisational construct rather than a clinical diagnosis. Its empirical base, while growing, is less extensive than that of burnout.

Symptoms and consequences of boreout

One of the most clinically relevant features of boreout is how closely it mirrors the symptoms of burnout, despite arising from entirely opposite causes. This phenomenological overlap makes it prone to misidentification by both affected individuals and their managers. Affected employees may experience (Rothlin and Werder, 2008):

• Psychological symptoms: low self-esteem, shame, anxiety, crisis of professional identity, social withdrawal, and a sense of professional uselessness
• Physical symptoms: sleep disturbance, somatic complaints, and fatigue
• Behavioural manifestations: disengagement, presenteeism, and the deliberate performance of busyness to mask under-stimulation
• Career consequences: increased intention to leave the profession, deskilling, and loss of clinical confidence.

Crucially, boreout is frequently misattributed to individual character deficiencies – perceived as laziness or poor performance – when it in fact reflects a structural mismatch between a professional’s capabilities and the role they are being asked to perform (Chodyka et al, 2025). Employees suffering from boreout may actively feign busyness to avoid negative attention, creating a performance of engagement that masks genuine and chronic distress (Rothlin and Werder, 2008).

Boreout and the underutilisation of dental hygienists and therapists

The concept of boreout acquires particular salience when considered alongside the well-documented underutilisation of dental hygienists and therapists in the UK. Since the GDC’s 2013 direct access ruling, dental therapists have been authorised to see patients independently and to perform restorative work, paediatric care, and primary tooth extractions within their GDC registration scope (General Dental Council, 2013). Legislative changes in 2024 further extended the autonomy of dental hygienists and therapists to supply and administer certain medications directly (Preshaw et al, 2025). Yet evidence consistently demonstrates that these provisions remain unrealised in the majority of clinical practice settings.

A survey of practices in south west England employing dental therapists found that 89% of those practices estimated that much of their therapist’s time was spent undertaking work traditionally within the scope of practice of a dental hygienist, rather than their broader therapy scope (Gallagher et al, 2020). The same regional survey found that none of the activities within the DCP scope of practice were performed by the relevant DCP group in all responding practices, indicating widespread and consistent underutilisation of the full DCP skill set across the region.

A BSDHT member survey published in 2025 found that a significant proportion of dental hygienists and therapists wished to work to a fuller scope than currently permitted by their employing practice (Rochford, 2025). Of those wishing to expand their practice, dental hygienists in private settings were more likely to be utilising elements of their scope than NHS counterparts, suggesting that contractual and commissioning structures are a key barrier (Rochford, 2025).

The British Association of Dental Therapists (BADT) found that over 60% of dental therapists were unable to work to their full scope, demonstrating what Stanfield (2025) describes as the ‘systemic failure to integrate them properly into the workforce’ (Stanfield, 2025). Stanfield draws an explicit link between underutilisation and professional dissatisfaction: ‘Many therapists find themselves underutilised. The lack of dedicated therapist positions forces them to accept hygienist roles, leading to skill attrition and dissatisfaction within the profession.’

How can boreout be avoided?

The British Dental Journal has characterised the situation starkly: a study found that 73% of clinical time in NHS primary dental care was spent on tasks that could be delegated to dental care professionals, yet most dental therapists are not enabled to work to their full scope (Preshaw et al, 2025).

Critically, the UK survey of south west DHTs provided direct empirical evidence linking restricted scope to reduced psychological wellbeing: those dental therapists who were performing only hygiene treatments – that is, not working to their therapy scope – reported statistically significantly lower happiness levels than those working to their full scope (Hallett et al, 2023). This is, to this author’s knowledge, the closest the UK dental hygiene literature has come to quantifying what the boreout literature would recognise as the measurable psychological consequences of chronic professional underutilisation.

NHS England’s Long Term Workforce Plan acknowledged the problem at a national level, identifying the need to ‘give the NHS workforce fulfilling career paths with potential to use their full scope of practice’ and noting the ambition to deliver 15% of dental activity through dental therapists and dental hygienists – compared to a significantly lower proportion at the time of publication (NHS England, 2023).

Burnout versus boreout: comparative analysis

Implications for practice, workforce policy and professional bodies

Both burnout and boreout carry consequences extending beyond the individual clinician. Burnout has been linked to reduced patient safety, increased clinical error rates, and accelerated workforce attrition (Chodyka et al, 2025). Boreout drives progressive deskilling, disengagement, and the waste of clinical capacity at a time when an estimated 13 million people in England are unable to access an NHS dentist (NHS Alliance, 2026).

Individual level

Clinicians experiencing disengagement, emptiness, or a persistent sense of professional stasis should be aware that these experiences may not reflect personal failing but a structural mismatch between their training and their current role. Engagement with direct access provisions, CPD, and peer support networks may provide partial remedies; professional bodies including the BSDHT offer relevant resources and advocacy.

Practice level

Practice owners and principal dentists should audit the deployment of dental hygienists and therapists against their full GDC scope of practice. Restricting a dually registered hygienist-therapist to hygiene maintenance alone is not a neutral operational decision: it carries documented psychological consequences for the professional concerned (Hallett et al, 2023) and represents a missed opportunity for patient care. NHS dental teams that empower therapists to practise at full scope can contribute meaningfully to reducing waiting times and widening access (Preshaw et al, 2025).

Commissioner and policy level

Reform of NHS contracting frameworks is required to make it financially viable for practices to deploy therapists within their full scope on an NHS basis. The 2013 direct access provisions must be given practical and financial effect within NHS general dental practice, consistent with the ambitions set out in the NHS Long Term Workforce Plan). The GDC’s scope of practice review process and the 2024 prescribing legislation changes are necessary but insufficient steps without commensurate commissioning reform.

Distinct but equally damaging

Burnout and boreout are not opposites that cancel each other out. They are two distinct but equally damaging expressions of a professional environment that is not functioning as it should. Both lead to the same endpoint: skilled clinicians who feel disconnected from their work, a profession struggling to retain its workforce, and patients who receive less than they deserve.

The dental hygiene and therapy workforce in the United Kingdom is highly trained, vocationally motivated, and capable of far greater clinical contribution than current practice models in many settings permit. Addressing burnout demands action on workload, culture, and institutional support systems. Addressing boreout demands the professional and political courage to dismantle the structural restrictions that prevent clinicians from practising to the full extent of their training and GDC registration. Both are necessary. Neither is optional.

References

• Barbosa, P. et al. (2024) ‘Prevalence and management of burnout among dental professionals before, during, and after the COVID-19 pandemic: a systematic review’, Healthcare (MDPI), 12(23), p. 2366. DOI: 10.3390/healthcare12232366.
• Bhatti, A. and Kelleher, M. (2023) ‘The dental workforce recruitment and retention crisis in the UK’, British Dental Journal, 234(12). DOI: 10.1038/s41415-023-5737-5.
• Chodyka, M., Grudniewski, T., Chrząszcz, A., Krawczyńska, S. and Ciekanowski, Z. (2025) ‘The impact of burnout and professional rust on organisational safety and the effectiveness of human resource management’, European Research Studies Journal, 28(2). Available at: https://ersj.eu/journal/4074 (Accessed: 6 July 2026).
• Durkin, J. et al. (2025) ‘Burnout, stress, and wellbeing: the rising mental health crisis in UK dentistry’, International Journal of Dental Hygiene. DOI: 10.1111/idh.12911.
• Gallagher, J.E. et al. (2020) ‘Development and retention of the dental workforce: findings from a regional workforce survey and symposium in England’, BMC Health Services Research, 20(1). DOI: 10.1186/s12913-020-4980-6.
• General Dental Council (GDC) (2013) Scope of Practice. London: GDC. Available at: https://www.gdc-uk.org/standards-guidance/standards-and-guidance/scope-of-practice (Accessed: 6 July 2026).
• Gorter, R.C. (2005) ‘Work stress and burnout among dental hygienists’, International Journal of Dental Hygiene, 3(2), pp. 88–92. DOI: 10.1111/j.1601-5037.2005.00108.x.
• Hallett, G., Witton, R. and Mills, I. (2023) ‘A survey of mental wellbeing and stress among dental therapists and hygienists in South West England’, BDJ Open, PMC10120495. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10120495 (Accessed: 6 July 2026).
• NHS Alliance (2026) Exploring the future model of dentistry and oral health provision. Available at: https://thenhsalliance.org/resources/exploring-the-future-model-of-dentistry-and-oral-health-provision (Accessed: 6 July 2026).
• NHS England (2023) NHS Long Term Workforce Plan. London: NHS England. Available at: https://www.england.nhs.uk/wp-content/uploads/2023/06/nhs-long-term-workforce-plan-v1.2.pdf (Accessed: 6 July 2026).
• Preshaw, P.M. et al. (2025) ‘Expanding the role of dental therapists’, British Dental Journal. DOI: 10.1038/s41415-025-8776-2.
• Rochford, D. (2025) ‘Working to a full scope of practice in general dental practice: a mixed methods study presenting the results of a British Society of Dental Hygiene and Therapy member survey’, International Journal of Dental Hygiene. DOI: 10.1111/idh.12911.
• Rothlin, P. and Werder, P.R. (2008) Boreout! Overcoming workplace demotivation. London: Kogan Page.
• Stanfield, J. (2025) ‘The overproduction of dental therapists in the UK: a workforce mismatch and potential solutions’, Dental Health, 64(4), pp. 38–42. Available at: https://www.bsdht.org.uk/wp-content/uploads/2025/07/by-John-Stanfield.pdf (Accessed: 6 July 2026).
• World Health Organization (WHO) (2019) ‘Burn-out an “occupational phenomenon”: International Classification of Diseases’, WHO Departmental Update, 28 May. Available at: https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases (Accessed: 6 July 2026).

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