As a rule, dentists want to do their very best for patients. We spend five years at dental school learning skills from the best in our field before launching into the world of NHS dentistry. Here, things can be very different. We must consider practice overheads, UDAs and appointment lengths, none of which were a factor while training. All the while, we're encouraged to learn additional techniques to offer new and improved treatment to patients. These extra pressures don't always allow us to practise how we want. And so starts the squeeze. How do we maintain a consistent quality of treatment, which takes time and effort to deliver, under increasing pressure to deliver on our targets as demanded by the NHS system?

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It's here where we can start to experience moral distress, where we're expected to work in an environment that clashes with our personal values. It's an increasingly acknowledged healthcare problem, but it is rarely discussed within dentistry. We're all working hard at our jobs, and dentistry is stressful at the best of times. But if the system we're working in, or the people we're working for, doesn't allow us to carry out the dentistry we feel patients deserve, the moral distress amplifies the occupational stress we feel until it can become overwhelming. From here, it's easy to start cutting corners, often gradually to begin with and sometimes without even noticing. But these cumulative shortcuts can lead to a result of producing substandard care, often unknowingly, a process called ethical fading.

There's no easy solution to moral distress. It's usually caused by factors out of our control, especially if working in the target-based, underfunded NHS system. But talking about it to those in control is the first step to changing the system. Of course, dentists and those in charge are well aware of the failings of the current NHS dental contract, and there's no change in sight. So, what can we do on a personal level?

It's up to us to support ourselves and each other. We must constantly monitor our values and ask ourselves if we're working within that value set. And if not, what can we do about it? Do we change how we work or where we work? Can we change the system we're working in? And if we're at the head of a business or organisation, do we have organisational values, and are we sticking to them and showing the compassion to our staff and patients they deserve? And are we willing to listen to those who come to us raising issues? Or does our performance fade to an unacceptable level from where it isn't easy to recover?

And if we see that others are struggling, are we working in an environment where we can have an open discussion and offer help? Because the amplification of personal stresses by moral distress can lead to disastrous consequences.