Research | Published:

An analysis of stress and burnout in UK general dental practitioners: subdimensions and causes

BDJ volume 226, pages 125130 (25 January 2019) | Download Citation

Key points

  • Shows that GDPs exhibit the highest levels of stress and burnout among UK dentists.

  • Shows that levels of productivity stress are higher among GDPs practising NHS treatment.

  • Suggests that practice ownership does not moderate the relationship between patient-led stress and burnout.

  • Suggests that practice ownership does positively moderate the association between regulatory stress and burnout.



Dentistry is well documented as a stressful profession. The majority of UK dentists work in general practice, which can carry multiple sources of stress. Previous research has acknowledged the propensity of these sources of stress for general dental practitioners (GDPs) when undertaking clinical, administrative and managerial tasks. The results of these accumulative stress sources can lead to burnout among GDPs. Understanding the environmental drivers of stress is an important step in high, and in some reported cases, unsustainable levels of stress and burnout.


To investigate the key dimensions of stress among GDPs and to model causality between these stress subdimensions and burnout as an outcome. To further identify the moderating influence of dentistry type (NHS, private) and performer type (practice owner, associate, corporate associate).

Materials and methods

The data are drawn from an online survey of UK dentists comprising BDA members and non-members. A total of 1513 GDP responses were used in the final analysis. The analysis was conducted using structural equation modelling.


We identify four subdimensions of stress in general dentistry; productivity stress, work content stress, patient-led stress and regulatory stress. Each dimension of stress is shown to have a significant causal link to burnout among the GDP population. While burnout levels among this population are already in excess of accepted thresholds, we find that stress is further elevated in specific areas of dentistry type and when performer type is considered.


This study contributes across three main areas. First, stress dimensions in general dental practice are identified. Second, these dimensions are shown to have a causal relationship with burnout. Third, specific cases of general dentistry are shown to elevate already problematic areas of stress among GDPs.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. 1.

    , , , , . A survey of stress, burnout and well-being in UK dentists. Br Dent J; In press.

  2. 2.

    , . A survey of stress levels, self-perceived health and health-related behaviours of UK dental practitioners in 2005. Br Dent J 2008; 204: 19–23.

  3. 3.

    , . 'It's difficult being a dentist': stress and health in the general dental practitioner. Br Dent J 2004; 197: 89–93.

  4. 4.

    , , . Occupational burnout and work engagement: a national survey of dentists in the United Kingdom. Br Dent J 2008; 205: 382–383.

  5. 5.

    . Burnout and psychiatric morbidity among doctors in the UK: a systematic literature review of prevalence and associated factors. B J Psych Bulletin 2016; 41: 197–204.

  6. 6.

    , , , , . Work characteristics and sickness absence in burnout and nonburnout groups: A study of Swedish healthcare workers. Int J Stress Manag 2008; 15: 153–172.

  7. 7.

    , . Is there a well-being gap among UK dentists? BDA: London, 2015. Available at: (accessed June 2018).

  8. 8.

    , , . A study to explore specific stressors and coping strategies in primary dental care practice. Br Dent J 2016; 220: 471.

  9. 9.

    . NHS dental services in England. London: Department of Health, 2009.

  10. 10.

    , . Stress, burnout, anxiety and depression among dentists. J Am Dent Assoc 2004; 135: 788–794.

  11. 11.

    , , . Private or NHS General Dental Service care in the United Kingdom? A study of public perceptions and experiences. J Pub Health Med 1999; 21: 415–420.

  12. 12.

    , , , , . Entrepreneurial burnout: Exploring antecedents, dimensions and outcomes. J Res Market Entrepren 2010; 27: 71–79.

  13. 13.

    , , , . Occupational stress among general practice dentists. J Occup Psychol 1988; 61: 163–174.

  14. 14.

    , , , , . Multivariate Data Analysis. 6th ed. New York: Pearson Education Inc, 2006.

  15. 15.

    , . Surveys in social research. Routledge, 2013.

  16. 16.

    . A test of missing completely at random for multivariate data with missing values. J Am Stat Assoc 1988; 404: 1198–1202.

  17. 17.

    . Structural equation modeling with AMOS: Basic concepts, applications, and programming. Routledge, 2016.

  18. 18.

    . Principles and Practice of Structural Equation Modeling. 3rd ed. New York: Guilford Press, 2011.

  19. 19.

    , . Conducting survey research in strategic management. In Ketchen Jr D J, Bergh D D (editors) Research methodology in strategy and management. pp. 227–249. Emerald Group Publishing Limited, 2004.

  20. 20.

    BDA. The state of General Dental Practice in 2013. BDA Research Report.

  21. 21.

    . Dentists Beware – Legal changes from October 2015. Available at (accessed June 2018).

Download references


Thank you to the BDA Trust and the Shirley Glasstone Hughes Trust for funding this research, and all of those who participated.

Author information


  1. Lecturer in Marketing and Strategy, Cardiff University

    • M. Toon
  2. Research Analyst, British Dental Association

    • V. Collin
  3. Head of Policy and Research, British Dental Association

    • P. Whitehead
  4. Research Associate, Cardiff University.

    • L. Reynolds


  1. Search for M. Toon in:

  2. Search for V. Collin in:

  3. Search for P. Whitehead in:

  4. Search for L. Reynolds in:

Corresponding author

Correspondence to M. Toon.

About this article

Publication history