The impact of the COVID-19 pandemic on the mental health of dentists in Wales. Br Dent J 2022; http://doi.org/10.1038/s41415-021-3756-7

There is an alarming mental health crisis within dentistry. A 2019 BDA paper on stress and burnout found that 43% of dentists felt that they could not cope with the stress of their job, and 17.6% had seriously considered suicide. With the COVID-19 pandemic likely increasing levels of psychological distress, a cross-sectional survey was carried out to assess the mental health impact on dentists in Wales.

Initially during lockdown, many dentists reported reduced levels of stress and valued time away from the surgery. However, as dentists returned to face-to-face care, stress significantly rose. Dentists in general practice were extremely worried about their finances and the uncertainty surrounding contract reform within the NHS. The patient backlog has also been of great concern, especially to those within the CDS where services such as general anaesthesia and sedation have been affected due to the need for these clinics to act as Urgent Dental Care hubs.

With the high potential risk of occupational exposure to COVID-19, standard operating procedures required enhanced levels of PPE when carrying out aerosol generating procedures. This has been challenging for clinical staff for several reasons. Initially, there were issues surrounding poor supply and often PPE was ill-fitting; for example, many women found gowns to be too large. Fit testing for masks required men with facial hair to be clean-shaven and respondents noted that, while necessary, it did impact their sense of identity and was a visual reminder of the pandemic. Long sessions in high levels of PPE resulted in many suffering from pain in their necks, backs and shoulders; this has been cited as a major reason for decreased motivation and morale within the workforce.

Due to increased pressures to meet targets and difficult working conditions, there have been many negative impacts upon dentists including disrupted sleep, lower levels of exercise and increased reliance on maladaptive coping mechanisms; 40% of dentists reported drinking alcohol more frequently, over-the-counter painkiller use increased for 21% and many have reported an increased use of nicotine products. While this is concerning, it should be noted that many also made positive changes to their lifestyles to cope with stress, such as going for walks, practising yoga, meditation etc.

It is clear many are feeling the impact, but there seems to an uncomfortable silence around our collective mental wellbeing. Dentists are continuing to go into work, even when not feeling mentally well enough, and do not raise their stress levels with their line managers, citing barriers such as confidentiality, lack of empathy, or simply not wanting to burden them with additional stress. One respondent commented 'everyone is coping but that's what we all want everyone else to think', which is perhaps a thought shared by many readers.

The study concluded that there has been a profound impact during the pandemic on the mental health of dentists in Wales. Working conditions have been extremely challenging, and there is much uncertainty surrounding the future of dentistry and how issues such as the patient backlog will be addressed.