Women in Dentistry - Blog

I am not an expert in stress research, however, as a 25-year seasoned dentist, I am very experienced in managing stress and adversity in the dental practice.

If you are like me, stress is a daily occurrence: heavy workloads, unpredictable patient schedules and a perfectionist’s mindset often managing uncertain and complex situations. Now more recently we can tack on the post pandemic storm of rising costs, employee shortages, lack of employee engagement and escalating absenteeism.

Do you know what our greatest daily stressors are? Our own negative thoughts and stress perspectives/beliefs! Unfortunately, our cells are eves dropping on every thought that we have, particularly on those revolving around uncertainty and lack of control. "I can’t believe that my gutta percha fill was 1mm short - I am such a failure! My dental assistant is going to think that I am incompetent! I should not be doing anymore endo!" Sound familiar?

What are the leading institutions and stress researchers like Elisa Epel PHD and Harvard Medical School saying about our escalating modern stressors and their subsequent health outcomes?

To start, stress is an inflammatory disease (just like periodontal disease) that affects multiple organ systems within the body including your brain. Stress is an invisible force that seeps into every cell of the body and it changes hundreds of very important biological processes. Chronic stress is toxic causing premature cellular wear, increases biological aging, and promotes early disease development.

The biological chemical culprits of stress include cortisol, inflammation and cellular oxidative stress which increase our vulnerability to hundreds of conditions like early aging, obesity, cardiovascular disease, diabetes, cancers, and the neuropsychiatric disorders of anxiety, depression, and dementia. Ugh!

Our DNA is hardwired to survive, adapt and to win, but our present-day stressors are hijacking our evolutionary survival circuits and keeping us in a constant state of vigilance, anxiety, worry, and perseverance. The toxicity from chronic stress is harshly affecting the structure and function of our brain, particularly the youngest and weakest area of the brain the prefrontal cortex (executive functions). Unfortunately, in just 8 weeks, stress can prune back important neurological connections causing dysregulation of emotional circuits leading to more primitive thinking, behaving, and functioning. This can lead to burnout and reduced sense of well-being for dentists.

While there are many strategies available to manage stress, how do you think most dentists tackle the symptoms? Typically, the first thing that we do for the first 2-3 years is attempt to ignore or self medicate the problems. I know of dentists who have ignored a stressor for over ten years! When that doesn’t work and the symptoms get worse, we will then seek help from a primary care physician for medications (up to 25% success rate) or a psychologist to talk our symptoms away (CBT has up to 50% success rate).

But I am here to tell you that we now have another option in mind-body medicine to help manage our stress related conditions. Mind-body medicine is the recognition that our beliefs, thoughts, behaviours, emotions, and relationships have a profound affect to our physiology and vise versa. Science shows that you can decrease your stress response and build your resilience to stress by using mind-body techniques such as: mindfulness meditation, Relaxation Response breathing exercises, moderate exercise, mindful exercise like yoga or tai chi, balanced nutrition and healthy eating, good sleep hygiene, social support, positive psychology, and cognitive skills development. Today I am going to talk about mindfulness meditation as a pathway to promote health, happiness, and an increase in well-being. Mindfulness (or mindful awareness) is commonly defined as the state of attentiveness to the present moment. (Park ER et al 2021)

A study by Harvard in 2010 showed that we get caught up in mind wandering for about 50% of our waking lives, and mindful awareness helps to reduce the amount of time we spend in this autopilot. (Brewer J 2021)

Ultimately mindfulness practice allows one to shift away from dwelling on memories or anxiety-provoking thoughts and move toward being more present in our everyday lives. Mindfulness also involves paying attention to the present by bringing an open, non-judgemental, and curious attitude toward whatever is happening in the moment. This way of noticing experiences is often very different from how we usually notice our experiences, as we often habitually make judgments and comparisons about events when we do not need to. Learning to bring mindfulness to our present moments can help enrich our experiences, find more pleasure in positive events, struggle less with negative occurrences, and help dissolve the pesky habits that often run our lives. (Park ER et al 2021)

In my experience, mindful attention takes practice to cultivate as our minds are programmed to run wild and wander (like wild horses). As I said earlier, our DNA is evolutionarily programed to survive, adapt, and to win. It was a major survival advantage for the minds of our Forefathers to be able to analyze the past and predict the future to survive. Today this type of mental processing still serves us every day in the dental office if we need to formulate a treatment plan or remember similar circumstances in the past that could lend to current positive patient outcomes. Unfortunately, sometimes the brain’s analyzing and predicting processing systems are difficult to shut off. This often occurs with the negative thought loops that arise with chronic psychological stressors and analyzing the past leads to constant regret and shame and predicting the future leads to habitual anxiety, worry and rumination. We end up thinking our way to "dis ease"! It is therefore very advantageous for our health and wellbeing to be able to learn to turn OFF our wandering monkey mind, and mindfulness is a solution.

Mindfulness is simply the practice of learning to notice when the mind has wandered, and gently bringing it back to the present moment. If the mind wanders ten times (which is normal), we simply bring it back to the present moment ten times. There are many different practices one can try to build more mindfulness like: mindful eating and moving, belly breathing, journaling, active listening and practicing gratitude, but the training that will give you the most bang for your buck is to cultivate a daily formal meditation practice. "Meditation is like a gym for your brain, allowing you to build and strengthen your mindfulness muscle". (Brewer J 2021)

Can mindfulness meditation alleviate stress and increase our health and wellness?

The answer is a BIG YES!

A variety of meditative approaches can reverse the stress-associated physiologic changes that confer illness vulnerability. They reduce sympathetic nervous system drive and increase parasympathetic tone resulting in lowering of blood pressure, heart rate, respiratory rate, and oxygen consumption. Research now shows that the gene expression in your white blood cells changes to a healthier pattern reflective of reduced oxidative stress and reduced chronic inflammatory response leading to decreases adverse health outcomes and cellular aging. (Fricchione G.L et al 2016)

Thankfully, due to neuroplasticity, regular meditation can regrow and rewire crucial circuits for improved integrated brain processing for more optimal cognitive, emotional, and behavioural regulation. Here’s just one example on how we can start to rewire our brain to help us stay healthy:

The process of mindfulness meditation can begin with a focused awareness on our breath. When the mind decides to wander (which it always will), notice, and bring your awareness back to the object of focus which is the breath. Do this again and again until one day (usually in about 8 weeks) the attentional networks in the brain show signs of growth by creating more stability of mind and space between thoughts. You can then proceed to an open monitoring style of meditation where you open your awareness to other experiences instead of just your breath.

Sensations: Notice subtle sensations such as an itch or tingling without judgment and let them pass. Notice each part of your body in succession from head to toe.

Sights and sounds: Notice sights, sounds, smells, tastes, and touches. Name them "sight," "sound," "smell," "taste," or "touch" without judgment and let them go.

Emotions: Allow emotions to be present without judging them. Practice a steady and relaxed naming of emotions: "joy," "anger," "frustration."

Urges: When you feel a craving or an urge (to eat excess food, use an addictive substance, or practice an unwanted behavior), acknowledge the urge and understand that it will pass. Notice how your body feels as the craving enters. Replace the wish for the craving to go away with the certain knowledge that it will subside.

In each case, should your attention be hijacked by a chain of thought, gently and lovingly return it to your chosen object of awareness. In all, there is a reversal of stress and a return to a relaxed sense of wellness.

Mindfulness is NOT about stopping, emptying, or ridding ourselves of anything. Thoughts, emotions, and physical sensations are what makes up are human experience. Mindfulness is about changing our relationship to experience itself – including our stressors. So, the next time you find yourself anxious and stressed out: "Don’t just do something, SIT THERE"! (Brewer J 2021)

References

Brewer J. Unwinding Anxiety 2021
Fricchione G.L., Ivkovic A., Yeung, A.S. The Science of Stress: Living Under Pressure 2016
Park ER, Baim P, Kagen L. SMART Stress Management and Resiliency Training. The Relaxation Response Resiliency Program 2023