A nationwide survey of dental professionals in the United Kingdom reported high levels of stress, burnout, and concerns about workforce wellbeing. Specifically, six primary stressors were identified: heavy workload, pressures within the National Health Service, regulatory compliance and fear of complaints or litigation, financial strain, leadership and management challenges, and lack of self-worth.
The researchers analyzed 1,507 responses, including 287 detailed accounts from dentists, dental care professionals, practice managers, and reception staff. They based the study on a nonprobability convenience sample and analyzed free-text survey responses, which may limit generalizability. However, the anonymous format may have encouraged participants to report their concerns more candidly.
Respondents described rising patient demand and longer waiting times as persistent stressors. Many noted that patient volumes had increased compared with prepandemic levels, especially with waiting lists that extend to months in advance. Staff shortages, particularly within the National Health Service (NHS), compounded these pressures: "We are massively short-staffed (50% of normal staffing currently at my own clinic) but the volume of work remains the same, so the pressure on staff increases," one dentist said. "It's affecting all levels of staff, from reception to surgery," a General Dental Service (GDS) independent dental care professional (DCP) added.
Further, NHS contracts were viewed as difficult and target-driven. Dentists cited challenges linked to Units of Dental Activity (UDA) and reported frustration with delays in contract reform and limited funding. Many described NHS dentistry as a stressful and dissatisfying environment: "The greatest stress frustration comes from high volumes of patients seen at an NHS practice and providing work to a quality I would like while working towards NHS UDA [units of dental activity] targets." A third said they "feel under constant pressure and stress from NHS unachievable targets…[the] Government [is] not bothered or committed to funding so [it] seems [there is] no positive future for NHS dentistry." Many dentists said stress associated with NHS targets prompted them to move from mixed practices to salaried positions or private practice.
Financial pressures were also common. Dental care professionals reported low pay relative to workload and responsibilities. A GDS independent dentist said they would leave if they could, but it's not financially possible for them. After leaving a self-employed mixed practice for a salaried position, a Public/Community Dental Service dentist said they "don't have to worry about how much money [they are] going to bring home each month. [They] also don't have to feel like [they] have to rush patients and cut corners." A DCP summed it up: "[Our] wages [are] poor and do not reflect amount of hard work and commitment of staff."
Patient complaints were reported to have increased markedly since the COVID-19 pandemic. A practice manager described the environment: "We have verbal complaints daily about [appointment] waiting times and written complaints have increased 200%! Prior to COVID we could go years without a written complaint." Another echoed this sentiment: "It is practice managers and reception staff that are taking the brunt from patients' dissatisfaction, frustration and fear." A dentist added, "I have always enjoyed my job but I feel patients are more angry, frustrated and worried than before and we seem to get much more moaning and complaints directed at us. We have worked tirelessly to try and catch up (while being short of staff and a dentist) but can't meet all patient expectations within an NHS system that is not fit for purpose now."
Many dental professionals expressed concern about litigation or referral to the General Dental Council. One dentist described "the atmosphere from regulatory bodies, constant fear of disciplinaries, constant litigation fear and the feeling of being held to ransom by patients with axes to grind," while others were critical of regulations and "the fear of the reprisals that could come as a result of us not meeting what are essentially unrealistic expectations placed on us by the state and the patients."
Poor leadership and management were identified as another contributor to burnout. Respondents described a lack of support, guidance, and recognition, which further reduced morale: "The right things are said but never put into practice and I can say this with certainty as I have worked in post for many years," a DCP said. Many participants reported feeling undervalued, such as this dentist who said: "I was a mixed NHS/private, high-grossing associate, people pleaser, did everything in practice, but felt unappreciated by principal." Another hospital DCP added: "There has to be a hierarchy of leadership overseeing services, with tasks delegated appropriately according to scope of practice and experience."
Dental nurses were identified as especially vulnerable due to their central role in daily operations but comparatively low pay. One DCP described, "Without the dental nurses, the whole practice could not function and I believe the dental nurses need the most support for their mental health, as they are the least paid but do most of the essential day-to-day jobs needed to run the practice."
Some respondents described isolation or questioned their professional worth, while others reported serious distress, including suicidal thoughts. "I go home knowing that I have failed my patients," one dentist responded, while among other quotes from respondents that illustrate the "depth of despair," as the authors describe, are several DCPs and dentists who said they would not encourage anyone to join the profession.
“A significant proportion of the dental workforce are unhappy and unfulfilled in their role, with concerning levels of despair among some respondents who appear to be suffering serious mental health issues, including suicidal ideation,” wrote Ian Mills, BDS, PhD, of the University of Plymouth Peninsula Dental School in the UK, and colleagues in the report. Quantitative results showed that 61% of respondents reported high levels of emotional exhaustion that were consistent with burnout. These findings were consistent with international studies that have documented high burnout rates among dental practitioners, the authors noted.
"[The 'me', 'we', 'they'] description provides a helpful tool for reflecting on the role we each play in reducing stress through self-care, teamwork and influencing change at a systems level," the authors wrote. They reviewed the programs and resources that are in place with the NHS, British Dental Association, Dental Professional Alliance, GDC, and others to help individual providers build resilience, but, they wrote, "simply focusing on the resilience of the individual or the team is misguided and unsustainable. The main stressors identified within our study can be largely attributed to macro-level factors. This suggests that the major stressors to UK dental teams sit predominantly outside of their locus of control and require prioritization of policy and system-wide interventions over individual and team-based solutions." They concluded, "If the underlying issues are ignored, high levels of stress and burnout in dentistry will continue, particularly within the NHS, with serious consequences."
The authors reported no conflicts of interest.
Source: British Dental Journal
