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Journal of Chemical Health Risks
www.jchr.org
JCHR (2024) 14(2), 3220-3235 | ISSN:2251-6727
3220
Burnout in Orthodontists: A Comprehensive Review of Existing
Literature
1Dr. Prasad Mandava, M.D.S., 2Dr. Ramachandra Prabhakar, 3Dr. Ramachandran Saravanan 4Dr.
Edeinton Arumugam, 5Dr Mandava Sai Snigdha
1PhD Scholar, Department of Orthodontics, Dr. MGR Educational and Research Institute, Periyar E.V.R. High
Road, Vishwas Nagar, Maduravoyal, Chennai, Tamil Nadu, India.
2Supervisor, Department of Orthodontics ,Dr. M.G.R. Educational and Research Institute , Periyar E.V.R. High
Road, Vishwas Nagar, Maduravoyal,
Chennai, India
3Professor, Department of Orthodontics, University Faculty, Dr. M.G.R. Educational and Research Institute ,
Periyar E.V.R. High Road, Vishwas Nagar, Maduravoyal,
Chennai, India
4Professor, Department of Orthodontics, Expert Member, Dr. M.G.R. Educational and Research Institute
,Chennai, India.
Corresponding Author
Dr. Prasad Mandava, M.D.S.,
PhD Scholar, Department of Orthodontics, Dr. MGR Educational and Research Institute, Periyar E.V.R. High
Road, Vishwas Nagar, Maduravoyal, Chennai, Tamil Nadu, India.
(Received:07 January 2024 Revised: 12 February 2024 Accepted:06 March 2024)
KEYWORDS
Burnout,
Dentist,
Emotional
exhaustion,
Orthodontists,
Stress
ABSTRACT:
Background: Burnout is a concerning issue in the dental profession, and allied dental specialties,
including orthodontics, which is particularly prevalent in developing countries, where dentists
encounter significant stress due to the demanding nature of their work and interactions with anxious
patients. This narrative review aims to explore burnout in orthodontics, investigating its causes,
impact, and preventive measures.
Methodology: A comprehensive search was conducted in databases, including PubMed, Web of
Science, Scopus, and Google Scholar, to identify relevant literature published in English from 1980
to 2023. Articles focused on burnout in medical and dental practices, with specific emphasis on
Orthodontics, were subjected to analysis.
Results: The narrative review underscores the significant impact of burnout on orthodontic
practitioners, negatively affecting their well-being, job satisfaction, and productivity. Contributing
factors such as long working hours and administrative burden emphasize the importance of
implementing preventive measures and support systems to mitigate the adverse effects of burnout.
Conclusion: Regular assessments, employee assistance programs, and peer support networks are
crucial. Recommended treatment options include counselling, cognitive-behavioural therapy, and
mindfulness interventions. Continued research is needed to understand burnout's impact in
orthodontic practice. Collaboration among professional organizations and healthcare providers will
foster a healthier work environment, ensuring the well-being and effectiveness of orthodontic
practitioners.
Junior Resident, Department of Microbiology, Narayana Medical College
Journal of Chemical Health Risks
www.jchr.org
JCHR (2024) 14(2), 3220-3235 | ISSN:2251-6727
3221
Introduction
Burnout is a significant issue in the dental
profession, especially in developing countries.
Dentists experience high levels of stress due to the
demanding nature of their work, long working
hours, and dealing with anxious patients. This
emotional, mental, and physical exhaustion
negatively impacts their well-being, job
satisfaction, and productivity. Burnout also poses
risks to dentists' mental health, potentially leading
to conditions like anxiety and depression [1].
Furthermore, it can compromise the quality of
patient care, affecting the reputation of dental
practises and patient outcomes. Recognising
burnout as a public health concern is essential to
addressing its implications for dentists and patients
alike. Implementing support systems, promoting
work-life balance, and providing access to mental
health resources can help mitigate burnout's
negative effects [2,3]. Increased research and
awareness are crucial to developing effective
strategies for preventing and managing burnout
among dentists, leading to a healthier work
environment in the dental profession [1].
Most orthodontic studies primarily focus on
enhancing practitioners' understanding of
orthodontics and treatment planning. However, it is
now essential to shift attention to the mindset of
orthodontic postgraduates. The question arises:
How resilient are today's orthodontists? Can they
effectively handle the stresses and pressures of
patient care, or are they experiencing emotional
exhaustion, depersonalization, and burnout? Stress
is defined as the biological response to adverse
internal or external stimuli that disrupt the
organism's equilibrium [4]. It can either motivate
students to excel or render them ineffective. In
dental practise, unchecked stress can lead to mental
anguish and depression. Different stressors have
been identified across various regions, such as fear
of parents in India, financial situations in Western
countries, and resource constraints in developing
countries in Africa [5]. Occupational stress among
dentists has been a prominent subject of research in
recent years. Burnout, on the other hand, is a
distinct psychological condition that differs from
occupational stress. It requires sustained pressure
on an individual, leading to emotional, physical,
and mental exhaustion due to work conditions.
Understanding the levels of stress and burnout
among orthodontic postgraduates is crucial for
supporting their well-being and ensuring quality
patient care [6].
Concept Of Burnout
The term "burnout" was first coined by
Freudenberger in the 1970s, based on his
observations of volunteers working for aid
organizations in New York who experienced
emotional depletion and loss of motivation. He
defined burnout as a state of mental and physical
exhaustion caused by one's professional life,
leading to a decline in motivation and dedication to
work. During the same period, Maslach and
colleagues interviewed human-services workers in
California, who also used the term "burnout." They
described experiencing exhaustion, negative
attitudes towards clients, and a sense of lacking
professional competence. Maslach and Jackson
further defined burnout as a syndrome
characterised by emotional exhaustion,
depersonalization (a negative or detached response
towards others), and reduced personal
accomplishment (feelings of declining competence
and achievement). Originally thought to be specific
to the human services sector, research revealed that
burnout can affect workers in various occupations.
Scholars have adapted the concept of burnout to
apply it to different professions. For example, the
Maslach Burnout Inventory-General Survey
replaced depersonalization with cynicism and
reduced personal accomplishment with reduced
professional efficacy. History and Concept of
Burnout (Table 1) Other researchers have
developed alternative measures to assess burnout,
such as the Oldenburg Burnout Inventory, which
assesses exhaustion and disengagement, and the
Shirom-Melamed Burnout Measure, which assesses
physical fatigue and cognitive weariness. These
measures help identify and understand burnout in
various work settings beyond the human services
sector [6].
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Table 1: History and Concept of Burnout [7]
Burnout Origins
Coined by Freudenberger in the 1970s based on
observations of volunteers in aid organizations
Maslach and colleagues also used the term "burnout"
while studying human-services workers.
Burnout is a state of mental and physical exhaustion
caused by one's professional life[8].
Burnout Components
Emotional exhaustion: Feeling emotionally drained
due to contact with others.
Negative or detached response towards recipients of
one's service or care.
A decline in feelings of competence and achievement
at work.
Later adaptations replaced depersonalization with
cynicism and reduced personal accomplishment with
reduced professional efficacy[8].
Burnout Universality
Originally associated with human-services sector but
found applicable to various occupations.
Burnout Measures
Maslach Burnout Inventory–General Survey (MBI-
GS): Assesses exhaustion, disengagement, and
reduced efficacy[8,9].
Oldenburg Burnout Inventory: Measures exhaustion
and disengagement [10].
Shirom-Melamed Burnout Measure: Assesses
physical fatigue and cognitive weariness[7].
Methodology
Search terms including “Burnout,”
“ORTHODONTISTS,” “healthcare workers,”
“medical staff,” “dentist” and “dental practitioners”
were searched in PubMed, Web of Science, Scopus,
and Google Scholar databases in English literatures
published from the beginning of 1980 to till 2023.
Fundamental studies on burnout in medical and
dental practices especially pertaining to the field of
Orthodontics were examined, and the entire
relevant literature was included. Eventually, the
narrative technique was applied based on
Maclure’s[13] description of how a researcher
engages with the material, comprising reading,
writing, thinking, interpreting, arguing, and
justifying. Finally, the critical topics in this realm
were discussed as follows.
Results And Review Of Literature
Definition
Burnout is a pathological syndrome
caused by prolonged occupational stress, leading to
emotional exhaustion and maladaptive detachment.
Initially identified through occupational
psychology research, it mainly affected human
service workers [11,12,13]. Researchers
characterized burnout as a psychological construct
through qualitative surveys, field observations,
interviews, and confirmatory factor analysis,
establishing its construct, discriminant, and
convergent validity [14,15]. This syndrome
commonly occurs among individuals engaged in
"people-work," resulting in increased emotional
exhaustion and negative, cynical attitudes towards
clients. These aspects of burnout often intertwine,
leading to a callous perception of others,
particularly clients, as deserving of their troubles.
Workers also tend to evaluate themselves
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JCHR (2024) 14(2), 3220-3235 | ISSN:2251-6727
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negatively concerning their work with clients,
feeling dissatisfied with their accomplishments.
Burnout among dentists can lead to avoidance of
social interactions with colleagues, patients,
friends, and even family members. The prolonged
experience of burnout may also result in
depression, posing a serious risk to the dental
profession by threatening the available workforce
and causing personal tragedy for individuals. In
India, there is a lack of information on burnout, and
only a few studies have been conducted. One study
focused on stress and burnout among postgraduate
students in a university, revealing that 21% of the
total subjects experienced burnout. Another study
explored burnout among dental faculty and
students, showing that third-year, final-year, and
postgraduate students experienced higher levels of
burnout compared to others. The limited research
on burnout in the Indian dental community
highlights the need for further investigation and
attention to this important issue [16].
According to Maslach et al., burnout has
three dimensions: emotional exhaustion,
depersonalization and cynicism, and feelings of
inefficacy. These dimensions can coexist in varying
degrees, making burnout a continuous and
heterogeneous construct rather than a dichotomous
one. The Maslach Burnout Inventory (MBI), a
widely used 22-item questionnaire with 7-point
Likert scales, measures all three burnout
dimensions. It is commonly employed in the
medical literature and has become the gold
standard for identifying clinically significant
burnout. The significance of burnout in various
professions, including medical practice, has led to
its widespread study using the MBI, highlighting
the importance of identifying and addressing
burnout for professionals' well-being and quality of
service [8,16].
Incidence and Prevalence of Burnout in
Orthodontics
Burnout's association with the dental
profession emerged in the 1980s, with several
studies examining dentist burnout, particularly in
Europe [17,18]. These studies found that a portion
of British dentists and Colombian dental students
were at risk for burnout, and there was a correlation
between work environments, fatigue, and burnout
among Finnish dentists. Similarly, approximately 1
out of 5 Dutch dentists were found to be at risk for
burnout, leading to explorations of interventions in
Holland [3,19]. Regional studies in the United
States also investigated burnout among dentists and
dental students [20]. One study in Texas showed
low scores on personal accomplishment among
dentists but not an overall high level of burnout
[22]. The Michigan and Oklahoma Dental
Associations have discussed burnout in dentistry
but have not provided specific prevalence
estimates. A systematic review in the US dental
education context highlighted a possible correlation
between stress levels in dental students and burnout
risk. In the orthodontic field, burnout is a pervasive
concern with varying prevalence rates. Studies
reported an 83.6% burnout prevalence among
Australian orthodontists and 16.2% among
orthodontists in the United States [20]. These
findings align with elevated burnout rates observed
in other healthcare professions [21]. The high
prevalence of burnout among orthodontists
emphasizes the importance of understanding its
root causes and implementing targeted
interventions. Overall, burnout is a significant issue
in both dentistry and orthodontics, necessitating
attention and measures to safeguard the well-being
of dental professionals and enhance patient care.
Numerous studies have reported a high
prevalence of burnout among dentists. Studies
reporting the prevalence of Burnout (Table 2). The
demanding nature of the occupation and close
proximity to patients contribute to interpersonal
stressors, leading to burnout. Work-related stress
and long working hours negatively impact dentists'
psychological well-being and family life. Peterson
U et al. (2008) [23] found an association between
burnout and various issues, including depression,
anxiety, alcohol consumption, sleep problems, and
musculoskeletal complaints among service
workers, including dentists. Addressing burnout is
crucial to improve dentists' well-being and the
quality of patient care [24].
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Table 2: Studies reporting the prevalence of Burnout
Author (Year)
Place of the
study
Participants
Burnout
prevalence
Study findings
Demerouti et
al[10]
Netherlands
Employees
Varies
The Job Demands-Resources
model of burnout was proposed
to explain burnout based on job
demands and resources. The
model has been applied to
assess burnout in various
occupational settings[15].
Humphris et
al[25]
Europe
Dental students
36%
psychological
distress
22% emotional
exhaustion
The study assessed stress in
undergraduate dental students
from seven European countries.
Dental students reported a
burnout prevalence of 36%.[5]
Thomas[16]
USA
Medical residents
55.6%
The study focused on burnout
in medical residents and found
a prevalence of 55.6%. Long
working hours and high
workload were significant
contributors to burnout[7].
Shapiro et al.
(2005)[26]
Not specified
Health care
professionals
Not specified
Significant reductions in
perceived stress, anxiety, and
symptoms of burnout among
healthcare professionals.
Improvements in overall well-
being and self-compassion.
Mindfulness-based stress
reduction (MBSR) intervention
equipped participants with
effective coping strategies for
managing challenges in their
work. Potential value of MBSR
in promoting resilience and
well-being in healthcare
professionals.
Soler et al.[27]
Europe
Medical
practitioners
24.8%
The study assessed burnout in
family doctors across Europe,
reporting a prevalence of
24.8%. High work demands
and lack of autonomy were
associated with burnout.
Schaufeliet
al[28]
Netherlands
Employees
Varies
The study proposed the
Maslach Burnout Inventory to
measure burnout across various
professions, including
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healthcare. Burnout rates
differed among occupations.
Epstein et
al[29]
USA
Physicians
44.3%
The study explored burnout in
physicians, with a prevalence
of 44.3%. Lack of control over
work and work-life imbalance
were associated with burnout.
Mache et al[30]
Germany
Health care
professionals
29.8%
The study examined burnout in
healthcare professionals,
including dentists.
Orthodontists reported a
burnout prevalence of 29.8%.
West et al.[31]
Minnesota
Physicians
54.1%
An intervention for physicians
utilizing a facilitated small-
group curriculum improved
meaning and engagement in
work and reduced
depersonalization, with
sustained results at 12 months
after the study. The study's
findings highlight the potential
benefits of targeted
interventions in addressing
burnout and improving the
well-being and job satisfaction
of physicians.
Dyrbye et
al.[32]
USA
Medical students
and residents
45.2%
The study investigated burnout
in medical students, reporting a
prevalence of 45.2%. The
demands of medical education
and training were linked to
burnout.
Shanafelt et
al[33]
USA
Physicians
Varies
The longitudinal study
examined burnout trends in
physicians over three years.
Burnout rates increased
significantly during the study
period.
Maslach et
al[9]
USA
Employees
Varies
The study developed the
Maslach Burnout Inventory to
assess burnout across
occupations. The inventory has
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been widely used to measure
burnout in various professions,
including healthcare.
Dewa et al[34]
Canada
Healthcare
professionals
Varies
The systematic literature
review assessed the
relationship between burnout
and the quality of healthcare.
The study found mixed results
concerning the impact of
burnout on patient care.
Table 3: Summary of various studies on Burnout among the medical and dental professionals
Author & year of
study
Study
model/design
Place of
study
Study
participants
Chief findings
of the study
Outcome of the
study
Garbee et al [35]
Not specified
Not
specified
Dental students
Academic
workload and
clinical
experiences as
stressors
Dental students
perceive
academic
workload and
clinical
experiences as
stressors
Moore and
Brodsgaard[36]
Not specified
Not
specified
Dentists
Dentists' stress
related to
perceptions of
anxious patients
Dentists' stress is
influenced by
perceptions of
anxious patients
Naidu et al[37]
Not specified
West
Indies
Dental students
in the West
Indies
Stress related to
academic
workload and
personal issues
Dental students
in the West
Indies
experience stress
from academic
workload and
personal issues
Polychronopoulouand
Divaris[38]
Not specified
Greece
Greek dental
students
Academic and
clinical sources
contribute to
stress
Greek dental
students face
stress from
academic and
clinical sources
Puriene et al [39]
Not specified
Lithuania
Lithuanian
dentists
Positive mental
health and job
satisfaction
related
Lithuanian
dentists
experience
positive mental
health and job
satisfaction
Puriene et al [40]
Not specified
Lithuania
Dental personnel
and patients
Stressful
relationship
between dental
personnel and
The relationship
between dental
personnel and
patients can be
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patients
stressful
Dentonet al [41]
Not specified
United
Kingdom
Dentists
High levels of
burnout and low
work
engagement
Dentists in the
UK experience
high burnout and
low work
engagement
Muirhead et al [42]
Not specified
Canada
Canadian dental
students
Stress and lack
of social support
among Canadian
students
Canadian dental
students
experience stress
and lack of
social support
Alzahem et al [43]
Systematic
Review
Not
specified
Dental students
Stress levels
among dental
students
Stress is
prevalent among
dental students
Elani et al [44]
Systematic
Review
Not
specified
Dental students
Stress levels
among dental
students
Stress is a
significant issue
among dental
students
Chainani et al [45]
Not specified
India
Dental
professionals in
Mysore
Working
conditions and
personal factors
predict burnout
Burnout in
dental
professionals in
Mysore is
influenced by
working
conditions and
personal factors
Vasconi et al [46]
Not specified
Not
specified
Orthodontists
Work-related
cardiovascular
stress in
orthodontists
Orthodontists
experience
work-related
cardiovascular
stress
Chacko et al [47]
Not specified
India
Orthodontic PG
students
High stress
levels among
orthodontic PG
students
Orthodontic PG
students in India
face high stress
levels
Lacyet al [48]
Not specified
Not
specified
Physicians
High prevalence
of burnout
among
physicians
Physician
burnout is a
critical
healthcare issue
Nettam et al [6]
Not specified
India
Postgraduate and
undergraduate
students
Stress and
burnout differ
among
postgraduate and
undergraduate
students
Stress and
burnout levels
differ between
postgraduate and
undergraduate
orthodontic
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students in India
Meyerson et al [49]
Not specified
Israel
Israeli dentists
High burnout
and lower
quality of life in
dentists
Israeli dentists
experience high
burnout and
lower quality of
life
Khanagar et al [50]
Systematic
Review
Saudi
Arabia
Undergraduate
dental students
Psychological
distress
prevalent among
dental students
Dental students
in Saudi Arabia
experience
psychological
distress
Al-Rawi et al [51]
Not specified
UAE
Dental students
Prevalence of
burnout during
COVID-19
lockdown
Dental students
in UAE
experience
burnout during
the COVID-19
lockdown
Antoniadou [52]
Not specified
Greece
Greek dentists
Factors affecting
burnout in Greek
dentists
Factors
contributing to
burnout among
Greek dentists
before and
during the
pandemic
Signs and symptoms
Professional burnout is a gradual erosion of a
person and reduced personal accomplishment. This
is seen in professionals who must encounter people
for most of the time as a professional job. With the
fast-evolving knowledge and resulting competition
dentistry has become one of the stressful
professions. Dental and orthodontic speciality work
is characterized by isolated conditions and a strong
reliance on technical skills, also less quality time
with family and friends, lack of time for exercise
and food etc; resulting into stressful life [53].
Summary of various studies on Burnout among the
medical and dental professionals (Table 3).
The World Health Organisation (WHO)
has officially recognized burnout syndrome as a
disease after the approval of the eleventh revision
of the International Statistical Classification of
Diseases and Related Health Problems (ICD-11)
which was approved in 2022. Burnout syndrome
has significant adverse effects on organizations,
clinics, and companies [54]. It leads to substandard
patient service, increased absenteeism, clinical
errors, and financial losses. Moreover, individuals
experiencing burnout may suffer consequences akin
to symptoms of depression, and in severe cases, it
could even lead to suicide. According to the
process model, burnout syndrome is not an abrupt
occurrence but rather develops gradually,
progressing through three dimensions of
experienced feelings, ranging from low to moderate
and high levels of severity [55].
Burnout syndrome is a multidimensional
construct, encompassing these three phases, and it
has been associated with high levels of burnout in
the dental profession. Phases of Burnout (Table 4).
They can be enumerated as under: -
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Table 4:- Phases of Burnout [3,19,49,56,57,58,59]
Phases
Characteristics
Phase 1:-Emotional Exhaustion (EE)
Loss of energy, Psychological and physical
exhaustion, Constant fatigue, Feelings of lacking
strength, Overwhelmed in terms of emotional
resources
Phase 2:-Depersonalisation (DP)
Irritability, Cynicism, Bad moods, Rejection of or
negative feelings towards recipients of one’s work,
Emotional distancing, Lack of empathy, Defensive
construct to protect from feelings of frustration
Phase 3:-Low Personal Accomplishment (PA)
Low self-esteem, Poor performance at work,
consistently bad attitude, Negative self-perception,
Feelings of failure, Avoidance of social relationships,
Depression, Limited ability to solve work and
personal problems
Dhillon et al. enumerated the signs and symptoms
of burnout amongst the dentists as: depression, lack
of energy, lack of desire, decreased productivity,
increased absence and/or tardiness, abuse of
alcohol/drugs, boredom, and anger/resentment in
the workplace, sleep problems and inability to
relax[60]. Early warning signs and symptoms of
occupational burnout (Table 5)
Table 5:- Early warning signs and symptoms of occupational burnout [61]
Stages
Signs and symptoms
Physical
✓ Feeling constantly tired
✓ Experiencing frequent headaches or muscle pain
✓ Noticing a weakened immune system
✓ Experiencing changes in sleep patterns and appetite
Emotional
✓ Having a sense of failure and self-doubt
✓ Feeling helpless and losing motivation
✓ Experiencing reduced satisfaction and inefficacy
✓ Feeling emotionally detached and isolated
Behavioural
✓ Withdrawing from social interactions and responsibilities
✓ Engaging in alcohol or drug abuse
✓ Frequently skipping work or leaving early
✓ Displaying frustration and irritability towards others
Factors inducing Burnout and its impact on
Dentists/Orthodontists
Dentistry is a very demanding profession
that requires continuous hard work and dedication
hence the reasons for developing burnout are
numerous. If we start with the struggles that a
newly graduated dentist in India faces, then the
first one would be meagre job availabilities
rather it would be true to state nil job opportunities.
Only 1% of the total GDP is allocated for public
health care moreover, there is no specific separate
allocation for oral health-care. There are only
11,000 sanctioned Government jobs for dentists in
India [60]. The various stress inducing factors and
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its impact on the orthodontists are enumerated as under (Table 6):-
Table 6: Stress inducing factors in Burnout and its impact on Dentists/Orthodontists
Authors and the year of
study
Stressors
Impact of Burnout in Dentistry or
Orthodontics practice
Maslach et al[62]
Workload
High patient load and time pressure
leading to exhaustion, a common
stress dimension of burnout.
Lack of sufficient control
Insufficient control over resources for
effective service provision,
particularly in community-based
dentistry.
Lack of recognition and appropriate
reward
Dentists' skills and quality of
workmanship may go unnoticed or
unappreciated by patients, leading to
feelings of inefficacy and burnout.
Lack of social support
Social support from colleagues and
peers can act as a buffer against job
stress and burnout.
Felton et al[63]
Quality of working life
Problems related to the physical
environment, such as poor working
posture, can significantly contribute
to burnout.
Ayatollahi et al.[64]
Occupational hazards
Dentists may face exposure to
infectious diseases (e.g., HIV, TB,
HBV), ocular problems, eye injuries,
latex allergy, and musculoskeletal
pain, all of which can contribute to
burnout.
Causes and consequences of Burnout in
Orthodontists/Dentists
Maslach et al[9] and Shanafelt et al[65]
concluded from their researches that burnout
among orthodontists and dentists can be attributed
to a combination of factors inherent to their
profession. The demanding nature of patient care,
high workload, and lack of control over resources
can contribute to emotional exhaustion, one of the
key dimensions of burnout. Additionally, the lack
of recognition and reward for their expertise and
efforts may lead to feelings of inefficacy and
contribute to burnout [66] According to Dyrbeet
al[32] and Shanafelt et al[33], Burnout in
orthodontists and dentists can have significant
consequences, both on a personal and professional
level. It can result in decreased job satisfaction,
reduced quality of patient care, and increased risk
of clinical errors. Furthermore, burnout can
negatively impact their physical and mental health,
leading to increased levels of depression, anxiety,
and alcohol consumption as was proposed by
Shanafelt et al[67] and West et al[68] These
consequences not only affect the individual's well-
being but can also have implications for the overall
dental healthcare system. Addressing the root
causes of burnout and implementing interventions
to promote work-life balance and support the well-
being of orthodontists and dentists are essential to
mitigate burnout and ensure the delivery of high-
quality patient care.
Severity and risk assessment for Burnout in
Orthodontists/Dentists
Burnout among dentists is a significant
concern that requires careful severity and risk
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assessment. Several studies have emphasized the
importance of evaluating the severity of burnout to
identify its impact on dentists' well-being and job
performance [56]. Risk assessment is crucial to
identify dentists who may be more vulnerable to
burnout and implement appropriate interventions
[68]. Factors such as heavy workload, lack of
control over resources, and inadequate social
support have been associated with higher burnout
risk among dentists. Understanding the severity
and risk of burnout can aid in developing targeted
strategies to mitigate its adverse effects on dental
professionals and enhance the overall well-being of
the dental workforce [3,69].
Prevention, care and treatment of burnout cases
a. Prevention: -[16,34,68,69]
Promote work-life balance: Encouraging
orthodontists to maintain a healthy balance between
work and personal life can help reduce stress and
prevent burnout.
Create a supportive work environment: Fostering a
positive and supportive workplace culture can
provide a buffer against burnout and enhance job
satisfaction.
Provide resources for stress management: Offering
resources such as stress management workshops
and counselling services can help individuals
develop effective coping mechanisms.
Encourage open communication: Facilitating open
and honest communication between orthodontists
and their colleagues can create a sense of
community and support.
b. Care: - [10,33,70]
Regular assessment: Regularly assessing the well-
being and stress levels of orthodontic professionals
can help identify signs of burnout early and provide
appropriate support.
Employee assistance programs: Implementing
employee assistance programs can offer
confidential counselling and support for
orthodontists facing burnout.
Peer support networks: Establishing peer support
networks within orthodontic practices can provide a
valuable platform for sharing experiences and
coping strategies.
c. Treatment: -[16,30]
Individual counselling and therapy: Providing
individual counselling and therapy sessions can
help orthodontists address the underlying causes of
burnout and develop personalized coping strategies.
Cognitive-behavioural therapy: Cognitive-
behavioural therapy has shown efficacy in
managing burnout by helping individuals reframe
negative thoughts and behaviours.
Mindfulness-based interventions: Mindfulness
practices have demonstrated positive effects in
reducing burnout symptoms and enhancing well-
being.
Burnout is considered to be a major concern in the
field of orthodontics since it can have a negative
impact on the well-being and professional
performance of orthodontic practitioners. This
narrative review drew on a variety of evidence-
based literature from PubMed-indexed articles to
highlight the causes, signs and symptoms, and
preventive measures for burnout in orthodontics.
Long working hours, administrative stress, and a
lack of influence over work decisions were
highlighted as potential drivers to burnout in
orthodontics. Further research into the impact of
technology breakthroughs, shifting treatment
modalities, and changing patient demographics on
burnout prevalence is required for future views on
burnout in orthodontics. Developing personalised
therapies and techniques to combat burnout among
orthodontic professionals will also be critical in
guaranteeing the long-term well-being and efficacy
of orthodontic practise. Collaboration between
professional bodies, academic institutions, and
healthcare providers is critical to effectively
combating burnout in the field of orthodontics.
Conclusion
To summarise, among the indications and
symptoms found were emotional weariness,
decreased job satisfaction, and worse patient-
provider communication. Preventive approaches
included fostering work-life balance, supportive
work environments, and stress management
techniques. Regular assessments, employee
assistance programmes, and peer support networks
were advised as part of a holistic care approach to
effectively treat burnout. Individual counselling,
cognitive behavioural therapy, and mindfulness-
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based therapies were among the treatment
possibilities.
Conflict Of Interest
The authors declare no conflicts of interest.
Source Of Funding
None.
References
[1] Pradhan M, Patil SN, Kokane VB,
Mokhade V, Uttarwar V. Burnout syndrome in
dental profession. IOSR J Dent Med Sci.
2020;19(6):30-7.
[2] Dwivedi A,Purohit BM,Bhambal A. Is
Dentistry Turning into Weary Profession?
Dimensionality of Experienced Professional
Burnout among Dentists in Central India. Journal
of Dent Oro Surg. 2016;1(5):122.
[3] Gorter R, Freeman R, Hammen S,
Murtomaa H, Blinkhorn A, Humphris G.
Psychological stress and health in undergraduate
dental students: fifth year outcomes compared with
first year baseline results from five European dental
schools. Eur J Dent Educ. 2008 May;12(2):61-8.
doi: 10.1111/j.1600-0579.2008.00468.x. PMID:
18412732.
[4] Rada RE, Johnson-Leong C. Stress,
burnout, anxiety and depression among dentists. J
Am Dent Assoc. 2004 Jun;135(6):788-94. doi:
10.14219/jada.archive.2004.0279. PMID:
15270165.
[5] Joffe H. Dentistry on the couch. Aust Dent
J. 1996 Jun;41(3):206-10. doi: 10.1111/j.1834-
7819.1996.tb04857.x. PMID: 8768647.
[6] VenkateshNettam, Mandava P,
SankarSingaraju G, Ganugapanta VR, Yelchuri H,
RevathiPeddu. Comparison of stress, burnout and
its association among postgraduate orthodontic and
undergraduate students in India. Indian J Dent
Sci.2018;10:66-71.
[7] Bakker AB, Demerouti E, Ana Isabel
Sanz-Vergel AI.Burnout and Work engagement:
The JD-R approach. Annual Review of
Organizational Psychology and Organizational
Behavior. 2014;1(1):389-411.
[8] MaslachC, JacksonSE. The measurement
of experienced burnout. Journal of Organizational
Behavior. 1981;2(2), 99–
113. doi:10.1002/job.4030020205.
[9] Maslach C, Leiter MP. Understanding the
burnout experience: recent research and its
implications for psychiatry. World Psychiatry. 2016
Jun;15(2):103-11. doi: 10.1002/wps.20311. PMID:
27265691; PMCID: PMC4911781.
[10] Demerouti E, Bakker AB, Nachreiner F,
Schaufeli WB. The job demands-resources model
of burnout. J Appl Psychol. 2001 Jun;86(3):499-
512. PMID: 11419809.
[11] Nash IS. Resident burnout. Ann Intern
Med. 2002 Oct 15;137(8):698-700; author reply
698-700. doi: 10.7326/0003-4819-137-8-
200210150-00019. PMID: 12379075.
[12] Beckman JA, Fang JC. Resident burnout
[letter]. Ann Intern Med. 2002; 137:698-700.
[13] Geurts S, Rutte C, Peeters M. Antecedents
and consequences of work-home interference
among medical residents. Soc Sci Med. 1999
May;48(9):1135-48. doi: 10.1016/s0277-
9536(98)00425-0. PMID: 10220015.
[14] Cohen JJ. Heeding the plea to deal with
resident stress. Ann Intern Med. 2002 Mar
5;136(5):394-5. doi: 10.7326/0003-4819-136-5-
200203050-00013. PMID: 11874313.
[15] Levey RE. Sources of stress for residents
and recommendations for programs to assist them.
Acad Med. 2001 Feb;76(2):142-50. doi:
10.1097/00001888-200102000-00010. PMID:
11158832.
[16] Thomas NK. Resident burnout. JAMA.
2004 Dec 15;292(23):2880-9. doi:
10.1001/jama.292.23.2880. PMID: 15598920.
[17] Ireland EJ. Dental practice burnout.
Compend Contin Educ Dent. 1983;4: 367–9.
[18] Davis EL, Tedesco LA, Meier ST. Dental
student stress, burnout, and memory. J Dent Educ.
1989 Mar;53(3):193-5. PMID: 2745836.
[19] Te Brake JH, Bouman AM, Gorter RC,
Hoogstraten J, Eijkman MA. Using the Maslach
Burnout Inventory among dentists: burnout
measurement and trends. Community Dent Oral
Epidemiol. 2008 Feb;36(1):69-75. doi:
10.1111/j.1600-0528.2007.00372.x. PMID:
18205642.
[20] Calvo JM, Kwatra J, Yansane A, Tokede
O, Gorter RC, Kalenderian E. Burnout and Work
Journal of Chemical Health Risks
www.jchr.org
JCHR (2024) 14(2), 3220-3235 | ISSN:2251-6727
3233
Engagement Among US Dentists. J Patient Saf.
2021 Aug 1;17(5):398-404. doi:
10.1097/PTS.0000000000000355. PMID:
28671911.
[21] Shelly JJ, Wong M, Rackcliffe J. Are
Texas dentists burned out? Tex Dent J. 1989
Dec;106(12):9-14, 53. PMID: 2638047.
[22] Heath JR, Macfarlane TV, Umar MS.
Perceived sources of stress in dental students. Dent
Update. 1999 Apr;26(3):94-8, 100. doi:
10.12968/denu.1999.26.3.94. PMID: 10528548.
[23] Peterson U, Demerouti E, Bergström G,
Samuelsson M, Asberg M, Nygren A. Burnout and
physical and mental health among Swedish
healthcare workers. J Adv Nurs. 2008
Apr;62(1):84-95. doi: 10.1111/j.1365-
2648.2007.04580.x. PMID: 18352967.
[24] Basson RA. Management and prevention
of Burnout in the dental practitioner. Dentistry.
2012;3(2):1000168.
[25] Humphris G, Blinkhorn A, Freeman R,
Gorter R, Hoad-Reddick G, Murtomaa H,
O'Sullivan R, Splieth C. Psychological stress in
undergraduate dental students: baseline results from
seven European dental schools. Eur J Dent Educ.
2002 Feb;6(1):22-9. doi: 10.1034/j.1600-
0579.2002.060105.x. PMID: 11872070.
[26] Shapiro SL, Astin JA, Bishop SR,
Cordova M. Mindfulness-based reduction for
health care professionals: results from a
randomized trial. Int J Stress Management.
2005;12(2):164-76.
[27] Soler JK, Yaman H, Esteva M, Dobbs F,
Asenova RS, Katic M, Ozvacic Z, Desgranges JP,
Moreau A, Lionis C, Kotányi P, Carelli F, Nowak
PR, de Aguiar Sá Azeredo Z, Marklund E,
Churchill D, Ungan M; European General Practice
Research Network Burnout Study Group. Burnout
in European family doctors: the EGPRN study.
Fam Pract. 2008 Aug;25(4):245-65. doi:
10.1093/fampra/cmn038. Epub 2008 Jul 11. PMID:
18622012.
[28] Schaufeli WB, Leiter MP, Maslach C.
Burnout: 35 years of research and practice. Career
Dev Int. 2009;14(3):204-20.
[29] Epstein RM, Krasner MS. Physician
resilience: what it means, why it matters, and how
to promote it. Acad Med. 2013 Mar;88(3):301-3.
doi: 10.1097/ACM.0b013e318280cff0. PMID:
23442430.
[30] Mache S, Vitzthum K, Wanke E; David A;
Klapp BF, Danzer G. Exploring the impact of
resilience, self-efficacy, optimism and
organizational resources on work engagement.
Work. 2014;47(4):491-500. doi: 10.3233/WOR-
131617. PMID: 23531578.
[31] West CP, Dyrbye LN, Rabatin JT, Call TG,
Davidson JH, Multari A, Romanski SA, Hellyer
JM, Sloan JA, Shanafelt TD. Intervention to
promote physician well-being, job satisfaction, and
professionalism: a randomized clinical trial. JAMA
Intern Med. 2014 Apr;174(4):527-33. doi:
10.1001/jamainternmed.2013.14387. PMID:
24515493.
[32] Dyrbye LN, Varkey P, Boone SL, Satele
DV, Sloan JA, Shanafelt TD. Physician satisfaction
and burnout at different career stages. Mayo Clin
Proc. 2013 Dec;88(12):1358-67. doi:
10.1016/j.mayocp.2013.07.016. PMID: 24290109.
[33] Shanafelt TD, Hasan O, Dyrbye LN,
Sinsky C, Satele D, Sloan J, West CP. Changes in
Burnout and Satisfaction with Work-Life Balance
in Physicians and the General US Working
Population Between 2011 and 2014. Mayo Clin
Proc. 2015 Dec;90(12):1600-13. doi:
10.1016/j.mayocp.2015.08.023. Erratum in: Mayo
Clin Proc. 2016 Feb;91(2):276. PMID: 26653297.
[34] Dewa CS, Loong D, Bonato S,
Trojanowski L, Rea M. The relationship between
resident burnout and safety-related and
acceptability-related quality of healthcare: a
systematic literature review. BMC Med Educ. 2017
Nov 9;17(1):195. doi: 10.1186/s12909-017-1040-y.
PMID: 29121895; PMCID: PMC5680598.
[35] Garbee WH Jr, Zucker SB, Selby GR.
Perceived sources of stress among dental students.
J Am Dent Assoc. 1980 Jun;100(6):853-7. doi:
10.14219/jada.archive.1980.0279. PMID: 6929835.
[36] Moore R, Brødsgaard I. Dentists'
perceived stress and its relation to perceptions
about anxious patients. Community Dent Oral
Epidemiol. 2001 Feb;29(1):73-80. PMID:
11153566.
[37] Naidu RS, Adams JS, Simeon D, Persad S.
Sources of stress and psychological disturbance
Journal of Chemical Health Risks
www.jchr.org
JCHR (2024) 14(2), 3220-3235 | ISSN:2251-6727
3234
among dental students in the West Indies. J Dent
Educ. 2002 Sep;66(9):1021-30. PMID: 12374261.
[38] Polychronopoulou A, Divaris K. Perceived
sources of stress among Greek dental students. J
Dent Educ. 2005 Jun;69(6):687-92. PMID:
15947215.
[39] Puriene A, Aleksejuniene J, Petrauskiene
J, Balciuniene I, Janulyte V. Occupational hazards
of dental profession to psychological wellbeing.
Stomatologija. 2007;9(3):72-8. PMID: 17993739.
[40] Puriene A, Aleksejuniene J, Petrauskiene
J, Balciuniene I, Janulyte V. Self-perceived mental
health and job satisfaction among Lithuanian
dentists. Ind Health. 2008 Jul;46(3):247-52. doi:
10.2486/indhealth.46.247. PMID: 18544885.
[41] Denton DA, Newton JT, Bower EJ.
Occupational burnout and work engagement: a
national survey of dentists in the United Kingdom.
Br Dent J. 2008 Oct 11;205(7):E13; discussion
382-3. doi: 10.1038/sj.bdj.2008.654. PMID:
18849939.
[42] Muirhead V, Locker D. Canadian dental
students' perceptions of stress and social support.
Eur J Dent Educ. 2008 Aug;12(3):144-8. doi:
10.1111/j.1600-0579.2008.00512.x. PMID:
18666895.
[43] Alzahem AM, van der Molen HT, Alaujan
AH, Schmidt HG, Zamakhshary MH. Stress
amongst dental students: a systematic review. Eur J
Dent Educ. 2011 Feb;15(1):8-18. doi:
10.1111/j.1600-0579.2010.00640.x. PMID:
21226800.
[44] Elani, H. W., Allison, P. J., Kumar, R. A.,
Mancini, L., Lambrou, A., &Bedos, C. (2014). A
Systematic Review of Stress in Dental Students.
Journal of Dental Education, 78(2), 226–
42. doi:10.1002/j.0022-0337.2014.78.2.tb05673.x
[45] Chainani SH, Sunitha S, Reddy C,
Manjunath M, Rudraswamy S. Working conditions
and personal characteristics: Predicting burnout
among dental professionals in Mysore, India: A
questionnaire survey. J Indian Assoc Public Health
Dent 2015;13:313-7.
[46] Vasconi L, Veronesi M, Lombardo L,
Borghi C, Siciliani G. Work-related cardiovascular
stress in orthodontists: A pilot project. Journal of
the World Federation of Orthodontists.
2016;5(4):135–39. doi:10.1016/j.ejwf.2016.12.003
[47] Chacko A, Tikku T, Srivastava K.
Evaluation of psychological stress in orthodontic
PG students in India. Int J
OrthodRehabil.2017;8:19-25.
[48] Lacy BE, Chan JL. Physician Burnout:
The Hidden Health Care Crisis. Clin Gastroenterol
Hepatol. 2018 Mar;16(3):311-17. doi:
10.1016/j.cgh.2017.06.043. Epub 2017 Jun 30.
PMID: 28669661.
[49] Meyerson J, Gelkopf M, Eli I, Uziel N.
Burnout and professional quality of life among
Israeli dentists: the role of sensory processing
sensitivity. Int Dent J. 2020 Feb;70(1):29-37. doi:
10.1111/idj.12523. Epub 2019 Sep 27. PMID:
31560417; PMCID: PMC9379207.
[50] Khanagar SB, Al-Ehaideb A, Jamleh A,
Ababneh K, Maganur PC, Vishwanathaiah S,
Awawdeh MA, Naik S, Al-Kheraif AA, Bhandi S,
Zanza A, Testarelli L, Patil S. Psychological
Distress among Undergraduate Dental Students in
Saudi Arabia and Its Coping Strategies-A
Systematic Review. Healthcare (Basel). 2021 Apr
7;9(4):429. doi: 10.3390/healthcare9040429.
PMID: 33917191; PMCID: PMC8068084.
[51] Al-Rawi NH, Yacoub A, Zaouali A,
Salloum L, Afash N, Shazli OA, Elyan Z.
Prevalence of Burnout among Dental Students
during COVID-19 Lockdown in UAE. J Contemp
Dent Pract. 2021 May 1;22(5):538-544. PMID:
34318774.
[52] Antoniadou M. Estimation of Factors
Affecting Burnout in Greek Dentists before and
during the COVID-19 Pandemic. Dent J (Basel).
2022 Jun 13;10(6):108. doi: 10.3390/dj10060108.
PMID: 35735650; PMCID: PMC9221850.
[53] Bedre VV, Chachada A, Atulkar M.
Professional Burnout in Orthodontists- an online
survey. Int J Oral Health Med Res. 2016;3(1):36-7.
[54] Hu YY, Ellis RJ, Hewitt DB, Yang AD,
Cheung EO, Moskowitz JT, Potts JR 3rd, Buyske J,
Hoyt DB, Nasca TJ, Bilimoria KY. Discrimination,
Abuse, Harassment, and Burnout in Surgical
Residency Training. N Engl J Med. 2019 Oct
31;381(18):1741-1752. doi:
10.1056/NEJMsa1903759. Epub 2019 Oct 28.
PMID: 31657887; PMCID: PMC6907686.
[55] Gómez-Polo C, Casado AMM, Montero J.
Burnout syndrome in dentists: Work-related factors.
Journal of Chemical Health Risks
www.jchr.org
JCHR (2024) 14(2), 3220-3235 | ISSN:2251-6727
3235
J Dent. 2022 Jun;121:104143. doi:
10.1016/j.jdent.2022.104143. Epub 2022 Apr 25.
PMID: 35472454.
[56] Maslach C, Leiter MP, Schaufeli
W. Measuring Burnout. Oxford Handbooks
Online. 2008;doi:10.1093/oxfordhb/978019921191
3.003.000:10.1093/oxfordhb/9780199211913.003.0
005.
[57] Ríos-Santos JV, Reyes-Torres M, López-
Jiménez A, Morillo-Velázquez JM, Bullón P.
Burnout and depression among Spanish
periodontology practitioners. Med Oral Patol Oral
Cir Bucal. 2010 Sep 1;15(5):e813-9. PMID:
20173713.
[58] Collin V, Toon M, O'Selmo E, Reynolds
L, Whitehead P. A survey of stress, burnout and
well-being in UK dentists. Br Dent J. 2019 Jan
11;226(1):40-49. doi: 10.1038/sj.bdj.2019.6.
PMID: 30631165.
[59] Singh P, Aulak DS, Mangat SS, Aulak
MS. Systematic review: factors contributing to
burnout in dentistry. Occup Med (Lond). 2016
Jan;66(1):27-31. doi: 10.1093/occmed/kqv119.
Epub 2015 Oct 5. PMID: 26443193.
[60] Dhillon S, Deshpande A, Porwal P,
Poonacha KS. Professional Burnout in Dentistry: a
review. Heal Talk. 2014;6(5):28-9.
[61] Khosravi M, Ghiasi Z, Ganjali A. A
narrative review of research on healthcare staff’s
burnout during COVID-19 pandemic. Proceedings
Singapore Healthcare. 2022;31:1-6.
[62] Maslach C, Schaufeli WB, Leiter MP. Job
burnout. Annu Rev Psychol. 2001;52: 397-422.
[63] Felton JS. Burnout as a clinical entity- its
importance in healthcare workers. OccupMed.
1998;48(4):237-50.
[64] Ayatollahi J, Ayatollahi F, Ardekani AM,
Bahrololoomi R, Ayatollahi J, Ayatollahi A, et al.
Occupational hazards to dental staff. Dent Res J
2012;9:2-7.
[65] Shanafelt TD, Boone S, Tan L, Dyrbye
LN, Sotile W, Satele D, West CP, Sloan J,
Oreskovich MR. Burnout and satisfaction with
work-life balance among US physicians relative to
the general US population. Arch Intern Med. 2012
Oct 8;172(18):1377-85. doi:
10.1001/archinternmed.2012.3199. PMID:
22911330.
[66] Almutairi AM,Almimoni MAM, Dhwi
SFN, Alassaf A, Almulhim B, Alghamdi S,
Mallineni SK.Sources of stress and well-being
among Saudi Arabian undergraduate dental
students. J Popul Ther Clin Pharmacol Vol
30(1):e101–e112.
[67] Shanafelt TD, West CP, Sloan JA,
Novotny PJ, Poland GA, Menaker R, Rummans
TA, Dyrbye LN. Career fit and burnout among
academic faculty. Arch Intern Med. 2009 May
25;169(10):990-5. doi:
10.1001/archinternmed.2009.70. PMID: 19468093.
[68] West CP, Shanafelt TD, Kolars JC. Quality
of life, burnout, educational debt, and medical
knowledge among internal medicine residents.
JAMA. 2011 Sep 7;306(9):952-60. doi:
10.1001/jama.2011.1247. PMID: 21900135.
[69] ShaikhSA, Aldhuwayhi S, Mallineni SK,
Varadharaju VK, Thakare AA, Mustafa MZ. Stress
perception among dental practitioners in Saudi
Arabia during the COVID-19 pandemic: a cross-
sectional survey. Signa Vitae.
2022.doi:10.22514/sv.2022.042
[70] Shanafelt TD, Balch CM, Bechamps G,
Russell T, Dyrbye L, Satele D, Collicott P, Novotny
PJ, Sloan J, Freischlag J. Burnout and medical
errors among American surgeons. Ann Surg. 2010
Jun;251(6):995-1000. doi:
10.1097/SLA.0b013e3181bfdab3. PMID:
19934755.
