This study focuses on job demands, job resources, and work engagement among 1,919 Finnish dentists employed in the public sector. Based on the Job Demands - Resources model, it was first predicted that the inverse relationship between job demands (e.g. workload, physical environment) and work engagement would be weaker when dentists had many resources (e.g. variability in the required professional skills, peer contacts). Second, using the Conservation of Resources theory it was hypothesized that job resources are most beneficial in maintaining work engagement under conditions of high job demands. The data were based on a postal questionnaire with a response rate of 71%. The dentists were split into two random groups in order to cross-validate the results. A set of hierarchical regression analyses resulted in 17 out of 40 significant interactions (40%). Four out of 20 possible interaction effects could be cross-validated showing, for example, that variability in professional skills mitigated the negative effect of qualitative workload on work engagement and, in addition, boosted work engagement when the qualitative workload was high. The main conclusion is that job resources are useful in coping with the high demands in dentistry and help dentists to stay engaged.

How dentists cope with their job demands and stay engaged: the moderating role of job resources

Burnout, viewed as the exhaustion of physical or emotional strength as a result of prolonged stress or frustration, was added to the mental health lexicon in the 1970s, and has been detected in a wide variety of health care providers. A study of 600 American workers indicated that burnout resulted in lowered production, and increases in absenteeism, health care costs, and personnel turnover. Many employees are vulnerable, particularly as the American job scene changes through industrial downsizing, corporate buyouts and mergers, and lengthened work time. Burnout produces both physical and behavioural changes, in some instances leading to chemical abuse. The health professionals at risk include physicians, nurses, social workers, dentists, care providers in oncology and AIDS-patient care personnel, emergency service staff members, mental health workers, and speech and language pathologists, among others. Early identification of this emotional slippage is needed to prevent the depersonalization of the provider-patient relationship. Prevention and treatment are essentially parallel efforts, including greater job control by the individual worker, group meetings, better up-and-down communication, more recognition of individual worth, job redesign, flexible work hours, full orientation to job requirements, available employee assistance programmes, and adjuvant activity. Burnout is a health care professional's occupational disease which must be recognized early and treated.

Burnout as a clinical entity—its importance in health care workers

Introduction: Dental students have to face the additional stress of their studies in addition to the stresses related to dentistry as a profession. Furthermore, increasing stress may result in declining student performance. The aim of the present study was to assess perceived sources of stress amongst dental undergraduate students at a private dental institution in India.



Materials and methods:  A modified dental environment stress (DES) questionnaire which consisted of 38 questions was used to assess the levels of stress.



Results:  The first major stressor for all the students was examination and grades with a mean score of 2.86 (SD 1.06) followed by full working day, receiving criticism from supervisors about academic or clinical work, amount of cheating in dental faculty, rules and regulations of the faculty and fear of unemployment after graduation. Amongst the six highest stressors in each year, at least three were dental faculty related. There was a significant difference in stress perception between genders with a predilection for males. Twelve of the 38 questionnaire items had significant differences across the year groups including clinical DES items.



Conclusion:  The primary sources of stress as perceived by nearly 275 students at one private dental school in India were examinations and grades followed by full working day and receiving criticism from supervisors about academic or clinical work. It appears there is a need for the establishment of student advisors and counsellors combined with a faculty advising system in addition to student-oriented programmes.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1600-0579.2008.00535.x

Perceived sources of stress amongst Indian dental students

In this study, it was hypothesised that dentists with a high burnout risk would experience more health complaints and show more unhealthy behaviour when compared with dentists with a low burnout risk. With a response rate of 75%, a representative group of 709 actively practising dentists responded to a questionnaire containing the Dutch version of the Maslach Burnout Inventory (MBI-NL), a health complaints measure (VOEG), and items on health behaviour. Results showed that dentists with a high burnout risk reported health complaints to a greater extent than dentists with a low burnout risk. They also reported more unhealthy behaviour in some aspects (physical exercise/sporting, increase in alcohol consumption, unhealthy diet), but not in others. It also appeared that one out of ten dentists reported having poor general health, and that three out of ten reported to have poor physical condition. In general, dentists' self-reports appeared favourable in comparison with the Dutch population. It is concluded from this study that among dentists burnout and poor health are strongly related. It is discussed that in order to deal preventively with burnout in dentistry, attention to physical health, including ergonomics, is essential.

Burnout and health among Dutch dentists

Many dental health workers suffer from musculoskeletal disorders in the upper extremities. In addition to ergonomic factors, psychosocial work characteristics have been linked to musculoskeletal disorders. The present cross-sectional study aimed at investigating how musculoskeletal disorders in the upper extremities (UED) and occupational position are related to work characteristics and general health problems in female dental health workers. Questionnaire data from dentists, dental hygienists and dental nurses (N=945) showed that 81% reported UED. Multivariate analysis of variance showed that dentists reported the highest levels of physical load and fatigue whereas dental nurses reported the lowest levels of influence at work. Irrespective of position, those with UED considered their physical and psychosocial work environment and their own health to be significantly poorer than did those without UED. A hierarchical multiple regression showed that the physical load of dentistry was most strongly related to UED. Despite improvements to the ergonomics and physical work environment of dentistry, it is concluded that female dental health workers are still at high risk of developing UED.

Work Characteristics and Upper Extremity Disorders in Female Dental Health Workers

In the spring of 1986 burnout and its relation to social and physical environments and the nature of work were studied using a questionnaire sent to a sample of 232 dentists aged under 62 living in the province of Uusimaa, Finland. Most male and female dentists (71 and 67%, respectively) were working in group practices and most (88%) employed an assistant. Professional problems were generally (71%) solved by consulting colleagues. Half of those responding were very satisfied with their relationship to other dental staff. All but 9% of dentists experienced problems in their physical working environments and 22% felt that their uncomfortable working posture interfered significantly with job satisfaction. Women reported chronic work-related conditions diagnosed by a physician more often than men (21 vs. 10%, respectively). At the time of the study, most dentists were experiencing pain in connection with work on patients and 41% of women and 59% of men were experiencing occupational stress. Most dentists experienced at least temporary psychological fatigue as a result of their work and almost half were exhausted at the end of each day. Despite this, most enjoyed working with patients and were enthusiastic about their work. Three aspects of burnout emerged on factor analysis: psychological fatigue, loss of enjoyment of work, and hardening. One third of dentists experienced some hardening and ceased to care greatly what happened to some of their patients. Of the factors associated with working environments, only dissatisfaction with relationships with patients, problems relating to the physical environment and poor working posture significantly increased burnout. Dissatisfaction with patient relationships increased disinterest and hardening. Unhappy marriages were highly significant predictors of psychological fatigue in men. The results suggest that hardening can be prevented by improving physical working environments, and fatigue and disinterest by improving working posture. Burnout can be regarded as posing a significant threat to good dental care.

Irja Kandolin

Papers

Burnout and its causes in Finnish dentists.