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Clinical anxiety in the dental hygiene profession

Sept. 17, 2019
We all experience anxiety, but sometimes it can reach unhealthy levels. Marie Paulis, RDH, examines how debilitating anxiety can affect dental hygienists in the workplace.

Imagine arriving at the dental office with a pit in your stomach that goes beyond the typical nervousness that many people experience. You’re not certain if you can even get out of the car. You manage to get in the door of the office, but then it really hits—the dry mouth, the feeling that your vision is fading, and a tightness in your chest. Yes, this is what many patients experience due to dental fear. But what happens when this is the dental hygienist who is experiencing anxiety and even panic attacks while at the workplace?

Anxiety comes in many forms. There is the occasional feeling of worry that everyone experiences in response to an event, real or imagined. Then there are true anxiety disorders, which include panic attacks and panic disorder, generalized anxiety disorder, social anxiety disorder, and agoraphobia, among others.1 Although anxiety and depression frequently occur together, they are distinct from each other in that those with anxiety tend to be in a state of alertness and worry about the future, whereas those with depression experience extreme sadness and assume their sadness will remain with them far into the future.2 Anxiety affects about 44 million adults, with about 3% of the population suffering from generalized anxiety disorder.In the United States, seven out of 10 adults say that anxiety has a moderate affect on their daily lives.3

Many people suffer in silence, frustrated that they are not “strong” enough to handle the pressures of everyday life. However, once you talk about what you are feeling, you might be surprised to feel the weight of your anxiety start to lift over time. Some symptoms of generalized anxiety disorder (GAD) mimic many other everyday experiences, and this prevents many people from seeking treatment. For example, GAD signs include having difficulty concentrating, feeling irritable, experiencing muscle tension, worrying extensively, and experiencing sleep disturbances. However, what distinguishes GAD from just another stressful day is that someone with GAD experiences these things on most days for at least 6 months, and it disrupts management of everyday tasks at school, work, or in social situations.4

To put it in dental terms, general anxiety disorder might be compared to a carious lesion, in that it might appear to be minor on the surface, but hidden underneath is a much larger problem in need of assistance and intervention. If GAD is tooth decay, then panic attacks are like an acute abscess, rising quickly, sometimes out of nowhere, and causing quickly escalating symptoms that cannot be ignored.

Consider this scenario: You are at work and about to call in your first patient, when suddenly, out of nowhere, it hits! Your heart starts to pound so hard that your scrub top is vibrating with its beat. You begin to sweat to the point that the back of your hair is damp. You start to tremble all over. You feel a stabbing chest pain that makes you wonder if you’re having a heart attack, because that couldn’t feel any worse than this, and you get a tingling sensation in your cheeks that ripples up through your head . . .

This describes some of the symptoms of a panic attack that many people struggle with on a regular basis.2 It is impossible to ignore, yet not as easy to admit to as, say, the flu. Do you take five minutes and hide in the bathroom? Call a friend? Go home sick? Try to hide behind your personal protective equipment?

Let’s face it, not many of us would feel comfortable taking a mental health break or admitting to our coworkers that we are suffering from a "mental illness." We hygienists tend to be a tough breed. We are professionals who work through it! But what if you physically cannot manage that? This mentality needs to change. Would anyone expect you to "work through" the symptoms of low blood sugar of you were diabetic? We deserve the same kindness and respect we provide our patients.

It is important to seek help if you need it. According to the World Health Organization, one in 13 people experience anxiety at some point in their lives, so you are not alone.1 Although not a replacement for a professional evaluation, the Beck Anxiety Inventory (BAI) is a simple self-assessment survey that has been in use for more than 30 years as an initial tool to determine if anxiety levels are low, moderate, or concerning.5 After taking this simple survey, you may be able to better assess if what you are feeling is in need of treatment. However, even if you rate yourself "low anxiety," if you are feeling like you need help, please seek it because sometimes we even lie to ourselves!

Like many pervasive health problems, there is not typically a fast cure for anxiety problems. Therapy often helps and medication may also help. For many people, the best assistance comes in the form of a combination of medication and therapy. Therapy may be attended the traditional way or by way of “telemental” health or online therapy if you don’t have the time or desire to attend in person.6 Cognitive behavioral therapy (CBT) may be just as or more effective than medicationand has shown to be more effective in protecting against future relapses.7,8

CBT has some distinctive characteristics. Ideally, an experienced therapist works with you on a time schedule, which is something we as dental hygienists are used to abiding by. It is evidence-based therapy in which the treatment plan is adjusted according to what is working for the client. For example, one person may respond best to writing down some problems to work through, while someone else may prefer talking with the therapist. CBT is goal-oriented, structured, and collaborative. Both the client and the therapist are participants. Unlike some types of behavioral therapy, CBT deals mostly with present events and attempts to assist the client to put things into perspective. Lastly, CBT teaches skills to use beyond the active therapy phase so the client may continue to move towards living a healthier life. (8)

Since many anxiety disorders stem from fear of something that may happen, many of the coping strategies deal with teaching people to live “in the moment” and not ruminating about the future or past. One strategy that is becoming more and more mainstream is meditation. Although a professional therapist should be consulted for anyone experiencing panic attacks or true anxiety disorders, for anyone interested in meditation, there are excellent books, podcasts, apps and websites dedicated to the topic that can assist you in getting on the meditation bandwagon. Mindfulness meditation has been shown to help people suffering from GAD improve work attendance and seek less medical treatment.9

What exactly is meditation? Well, if you have never tried it, you should! If you’ve tried it and have been unsuccessful, research suggests you consider trying it again. Meditation is not humming with a bunch of other people with your thumb and index finger tapped together and resting on your knees. To put it simply, meditation is setting some time, even a few minutes, to sit quietly while attempting to concentrate on one thing. That thing might be a word or a phrase that you find comforting or relaxing. When your aware of your mind wandering to something else, gently go back to your word or phrase. While you’re doing this, be conscious of your positioning and try to relax, close your eyes, and breathe deeply and slowly. As you get better and more skilled at meditation, you will be able to concentrate without your mind wandering for a longer time. After practicing for a few weeks, you may find yourself automatically going to this relaxed state in times of difficulty or stress. It is amazingly transformative and is something we can all do in short moments of time.3

Along with reducing anxiety symptoms, some studies suggest that meditation might be useful in reducing the harmful effects of other diseases that may also be associated with increasing anxiety. For example, meditation may reduce hot flashes in women experiencing menopause, reduce the severity of viruses such as the flu, and may even reduce symptoms of diseases such as irritable bowel syndrome.9

Ironically, many people suffering from anxiety withdraw from friends, family and coworkers because they are embarrassed, afraid, or may not know themselves what they are experiencing, and this isolation exacerbates the anxiety symptoms.2 If you or someone you know is experiencing anxiety, please reach out and talk about it. In the midst of it, you may think you are going “crazy” and that you need to suffer through it, but there is evidence-based treatment that can assist you cope with anxiety and feel like yourself again.


1. Anxiety and Depression Association of America. Understand the facts. https://adaa.org/understanding-anxiety#. Accessed February 6, 2019

2. Anxiety and Depression Association of America. Anxiety, stress, depression, and sleep. 2018. https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/stress/stress-and-anxiety-interfere. Accessed June 20, 2019.

3. Gelles D. How to meditate. The New York Times. https://www.nytimes.com/

guides/well/how-to-meditate. Accessed June 19, 2019.

4. National Institute of Mental Health. Anxiety disorders. Accessed June 19, 2019 from https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml

5. Beck, AT, Epstein N, Brown G, & Steer RA. An inventory for measuring clinical anxiety: Psychometric properties. J Con Clin Psych.1988;56:893-897.

6. Anxiety and Depression Association of America. Find a therapist directory. 2018. https://members.adaa.org/page/FATMain? Accessed June 20, 2019.

7. Anxiety and Depression Association of America. Myth-Conceptions about anxiety. https://adaa.org/understanding-anxiety/myth-conceptions. Accessed February 6, 2019  

8. Gillhan S. Retrain Your brain: Cognitive behavioral therapy in 7 weeks. Althea Press. 2016. ISBN: eBook 978-1-62315-781-4

9.Hoge EA, Guidos BM, Mete M, Bui E, Pollack MH, Simon NM, Dutton MA. Effects of mindfulness meditation on occupational functioning and health care utilization in individuals with anxiety. J of Psychosom Res, 2017;95,7-11. doi: 10.1016/j.jpsychores. 

Marie Paulis, RDH, has been a dental hygienist for 27 years. She is currently the dental hygiene program director at the University of New Haven. Paulis has been published in journals, is certified in laser use by the Academy of Laser Dentistry, and serves as an examiner for the Commission on Dental Competency Assessments. For more information, email her at [email protected].