96 AUSTRALASIAN DENTIST PARTNERING WITH PATIENTS Dentistry has long been recognised as a high-pressure profession. Yet much of the conversation around dentists’ stress remains superficial: work harder, be more resilient, practise better self-care, power through. These suggestions, while well intentioned, often miss the core issue. Most dentists are not failing to cope because they lack resilience. Most dentists are struggling because they are operating in a chronically dysregulated state; physiologically, cognitively, and emotionally. Yet they are still being expected to perform at the highest clinical level. Understanding this distinction matters. Because when stress becomes chronic, then regulation becomes the limiting factor. Why dentistry is uniquely stressful Dentistry combines multiple high-risk stressors rarely found together in one profession: u High cognitive load: continuous decision-making under time pressure u Fine motor precision: sustained attention and physical control u Emotional labour: managing anxious, distressed, or dissatisfied patients u Business pressure: production targets, overheads, staff management u Isolation: limited peer support during clinical decision-making u Perfectionism culture: low tolerance for error, high self-criticism Numerous studies confirm that dentists experience higher rates of stress, burnout, anxiety, and depressive symptoms as compared with many other healthcare professionals (Gorter et al., 2000; Rada & Johnson-Leong, 2004). Importantly, this stress does not come in bursts. It is cumulative, often subtle, and frequently normalised. The cost of chronic stress in dentists Stress becomes problematic not because it exists, but because it persists without adequate recovery or regulation. Chronic occupational stress in dentistry has been linked to: Beyond Coping The Role of Regulation in Clinical Excellence By Dr Shahana Abed u Emotional exhaustion u Reduced empathy and patient connection u Impaired decision-making u Increased clinical errors u Musculoskeletal pain u Burnout and early career exit Dentists often remain “functional” for years; still producing, still treating patients while internally operating in a state of constant physiological tension.This is not a failure of strength of character. It is a predictable human response to sustained demands without sufficient regulation. Regulation Vs resilience: A critical distinction Resilience is often framed as the ability to “bounce back.” Regulation is the ability to remain stable while under load. In regulated states: u attention is flexible u emotional responses are proportionate u cognitive processing is clear u decision-making is deliberate In dysregulated states: u the nervous system prioritises threat detection u cognitive resources narrow u emotional reactivity increases u executive functioning declines Dentists are often encouraged to be resilient without being taught how to regulate the systems that underpin performance. What does “dysregulation” actually mean? Dysregulation is not pathology. It is a state shift. When stress is prolonged, the body adapts by maintaining an elevated state of arousal: u heightened alertness u increased muscle tension u faster heart rate u reduced cognitive flexibility Over time, this becomes the baseline. Dentists may describe this as: u feeling restless yet tired u difficulty switching off after work u irritability or emotional detachment u reduced tolerance for uncertainty u constant mental rehearsal or rumination These are not signs of weakness. They are signs of a nervous system doing exactly what it was designed to do; PROTECT. But without enough opportunity to reset. Why more knowledge doesn’t fix this Dentistry is saturated with education. Courses, CPD, webinars, protocols. Yet more dental knowledge does not automatically restore regulation. Why? Because regulation is not a cognitive process alone. It is a physiological and behavioural one. Under stress: u the brain prioritises speed over nuance u threat processing overrides reflective thinking u previously learned skills may become harder to access This explains why highly trained clinicians may: u doubt themselves during complex cases u feel less confident than their competence warrants u avoid attempting certain cases even if they intellectually understand them completely The issue is not lack of knowledge. It is reduced access to that knowledge under pressure. The principles of regulation in clinical practice While regulation is often discussed abstractly, its principles are practical and applicable to daily dental work. 1. Physiological stability precedes cognitive clarity Cognitive control depends on physiological state. When arousal is too high: u working memory capacity decreases u error monitoring increases u attention becomes rigid Dr Shahana Abed
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