Stress in the dental fraternity - Identification and solution in present scenario
In the current scenario of working life, the pursuit of money and success at the expense of one's own health has become the accepted norm. As a result, life has become very busy and stressful for most individuals. Health professionals including dentists are most common victims of this spreading devil of ill-health. Studies have reported that, dentists are subjected to a variety of stress-related physical and emotional problems. These problems include growing incidence of lower back pain, cervical spondylitis, fatigued and strained eyes, cardiovascular diseases, nervous breakdown and in worst cases commission of suicide. [1-3]

Causes of stress
Stress has become an integral part of any profession that deals with human interaction, especially in the health care sector. Most patients desire quick relief from suffering at a lower cost, which puts the doctor under tremendous stress in order to meet the increasing demands. Some of the identified causes which generate the stress are; [4-6]

Unemployment
After obtaining graduation every individual wants to start a career either as a private practitioner or pursue post-graduation in dental specialty. Due to strong competition, very few dedicated candidates get into post graduate courses and will get master’s degree after 3 years. Only candidates with post graduate degree are eligible for academic career as a teacher. The scenario of present job as an academician and number of post graduate candidates is very obscure and non-comparable, as candidates are much more than number of vacancies available. Candidates with graduate degree who want to start their career as private practitioners have to face the competition of over-crowding of dental practitioners in urban area. Rural areas are relatively less invaded by a number of dentist. Ultimately, after passing B.D.S. or M.D.S. dentists have to face unemployment leading to frustration.

Workplace environment
Usually the private dental professionals work for most of their clinical time in a small place with limited ventilation and natural light. The dental treatment is recognized as amalgam of art and science as it requires skill and knowledge to work in the oral cavity. The treatment procedures are both physically tiring and mentally taxing. Due to continuous bending work posture body strain, back pain and body fatigue have become a routine. Over a period of time, it becomes both physically and emotionally disturbing.

Feeling of loneliness
Most of the private dental professionals work single handed and do have limited opportunity to share and solve the problems with their fellow dentists. This feeling of loneliness is more complicated by the fact that dentists have to be competitive with other fellow colleagues due to human nature of insecurities. To maintain the best in the practice and financial security, every dentist wants to settle in urban sectors of our community which results in development of nuclear nature as a human being.

Work perfection desire
The desire to be perfect and to deliver their best to the patients is a major cause of emotional stress among the dentists. The art and want of perfection is inculcated in dental school as a need of time. However, the dentist should realize that certain factors are beyond their control such as the oral hygiene status and oral health care motivation of patient or oral tissue condition etc., which play a vital role in treatment outcome.

Economic restraints
Finance is a well-known and the major cause of stress among the budding dentists. During the start of their practice, usually every dentist is repaying loans to cover the cost of dental school and the cost of setting up a private practice. After certain period of practice, the dentist realises that the expenses are rising and sometimes surpasses the clinic income. The first six months is always a waiting or window period in case of private practice, where there is less or no income but an expenditure on maintenance of the setup. Work and financial burden lead to stress in the practitioner, which may affect adequate nourishment as well as rest. This inevitably leaves the dentist tired and exhausted at the end of each day.

On the othe side, financial burden often causes disturbances in mood and family relations. The dentists often get a mental block and think that they can’t take vacations or holidays due to financial loss in their absence. When a dentist is absent from his office the income totally stops; but the regular expenses continue. The dentists who worked all the time and never take leave from duty might earn some more money, but pay high price i.e. STRESS. They become emotionally, mentally exhausted, unstable and develop an enemic, frustrated attitude towards everyone including their patients, staff and family.

Frustration of not being renowned
A dentist learns perfection and updates his knowledge for providing ideal treatment for their patients. But in reality private practice is totally different from dental school learning. In private practice many patients due to fear, stubborn attitude, economic restraints, dental neglect or no appreciation towards dentist’s work; will not accept the treatment readily suggested by the dentist. They try to overcome and impose their treatment plan on the dentist. Thus, the dentist against his wish may be forced to do compromised treatment and get frustrated for not providing planned treatment.

Patient's anxiety and fear
Treating a live human being is a challenging task and it becomes more difficult when working on a fearful patient. It not only increases the mental stress but also becomes devastating to the dental practitioner. Dentist’s responses to stress run parallel with patient’s anxiety and fear about the dental procedures. This ultimately could lead to a chance to an early hypertension, cardiovascular diseases and heart attack in dentists.

Lack of exercise or hobby
Usually it was observed that when dentists were not exercising enough to prevent deterioration of musculo-skeletal tissues, organs, vessels and circulation in general they get much stressed. Regular exercise not only keep their muscles in good health but also prevent them from spine and neck pain.

Symptoms of stress
A stressed person usually has one of the various symptoms either physical or mental such as irritable bowel syndrome, acidity, headache or high blood pressure. In clinic, repeated work of similar nature may led to burnout which is a a loss of interest or ability to perform the job due to long-term high stress levels. [7]

How to manage stress in routine dental practice?
It is a fact, that stress could never be totally eliminated from dental practice. However, it can be minimized as much as possible in order to avoid many stress-related physical and emotional problems. The key to manage stress successfully is to first recognize and understand its causes. Once the causes have been identified and understood, preventive steps could be taken promptly.

Some of the preventive measures that could minimize the stress in dental practice are [8].

1. Good clinic staff rapport: Soft communication and good rapport with staff ultimately improves the working environment at the dental office.
2. Good peer rapport: Friendly get-togethers with professional colleagues and friends resolve the isolative condition and improve the knowledge by sharing experience.
3. Scheduling working hours: Fixing clinical hours for patients resolve the physical as well as mental stress on the dentist and the clinical staff. As working schedule is fixed; time for lunch break and relaxation could be well managed.
4. Regular family vacations and social gathering: Taking holidays on regular intervals not only relaxes the body but freshen up the minds of clinicians. Attending the regular social events could also act as stress busters.
5. Manage to keep some hobby: Keep your hobby as a integral part of your life. Hobby not only relieves the stress but also refreshes the mood.
6. Attending stress and behavioral management program: Learning how to handle patient’s anxiety, negativity and fear towards dental treatment in a better way by practice and behaviour management programmes. Stress management courses, lectures should be arranged for dentists and should also be included as a part of behaviour management in the dental curriculum.
7. Regular exercise: Adopting a habit of physical exercise, such as regular walking, jogging, swimming or any other physical sport activity or gym would definitely help to improve physical and mental well-being of the clinician.
8. Self and family care: Caring and loving oneself is as important as caring for patients. Unless a doctor cares for himself, he can not satisfy a patient's never ending demands.
9. Alternative treatment: Alternative therapies are usually recommended to relax the mind and to make it free of stress. These include aromatherapy, dance therapy, music therapy, inculcation of a favourite hobby, accu-pressure, acupuncture, panchakarma therapy in ayurveda and herbal medicine.

Dentist as an oral health care provider becomes a victim of various stresses, which may be physical, mental and financial or any social problem. It is high time now to think regarding the stress in dental fraternity otherwise this everlasting stress could make the dentist either to opt for new profession or mandate to live under the continuous stress and deteriorate their health and mind.