Dentist Dr Linda Doan looks at the psychological after-effects of COVID-19 on young dental practitioners

A sense of belonging, and by extension the feeling of connection to others, is integral to our sense of wellbeing. I lament the fact that the powers-that-be employed the term “social distancing” to discourage physical interaction as, in my view, “physical distancing” would have been more appropriate as we navigate COVID-19. In times of distress, socially isolating ourselves and minimising our connection with others will amplify feelings of loneliness and uncertainty. The secluded nature of our profession provides little opportunity for consistent collegial interaction and the opportunity to share our experiences. This article intends to explore how lockdown has impacted our current and upcoming young dentist contingent.

Experiences under lockdown

A survey was posted on the online groups The Young Dentist Hub, then later DPR, to explore the experiences of dental students and young dentists in the lead up to, and during, the COVID-19 lockdown in the March-June period. The survey was designed with the following intentions:

1. To uncover the various thoughts, feelings and activities dental students and young dentists experienced in the lead up to and throughout the pandemic.
2. As a reflective piece for the respondent, first asking the respondent about their ‘negative’ experiences, then towards the survey’s end giving an opportunity for respondents to reflect back on the ‘positive’ experiences and what they have ‘gained’ despite the implications of COVID-19. It was hoped that this would help empower respondents to confidently get back into their professional and personal lives.

The survey was created on the back of significantly dwindling COVID-19 infection numbers, when practising clinical guidelines reverted to Level 1 and there was a palpable increase in optimism across the country. A total of 36 responses was collected, of which 11% were final year dental students, 28% were dentists with five or more years of experience, and the remaining 61% were dentists of between one and four years of experience.

Making sense of the chaos: Maslow’s hierarchy of needs

COVID-19 brought about chaos and confusion in our working and personal lives. Our survey respondents reported feelings of restlessness and that working through the lockdown period was a stressful time, both emotionally and physically demanding.

As a scientifically minded bunch, what better way to make sense of the emotional confusion surrounding COVID-19 than to use a scientific explanation? I have therefore tried to link the survey results back to Maslow’s Hierarchy of Needs (1943), which posits that humans generally require basic needs at lower levels to be fulfilled, before they can ascend to the highest tier and be completely content with their lives (Figure 1).

Level 1. Physiological needs – survival needs such as food, water, warmth, sleep

If our health is comprised, it can be challenging to fulfil other aspects of our lives. 64% of our respondents were concerned about contracting COVID-19 in the lead up to the lockdown around March-April. This was a close second to the most commonly reported concern, which was “worried about family, friends contracting COVID-19” at 67%.

The virus was very poorly understood at the start, and it is easy to see why all of a sudden, many felt like the good health that they had taken for granted was in serious jeopardy. Interestingly, as restrictions lifted and the rate of infection decreased in June, only 47% of survey respondents remained concerned about contracting COVID-19, making it less of a concern for our surveyed respondents than those of reduced income (53%) and not being able to travel (53%).

Level 2. Safety needs – emotional and financial security, social stability, law and order

Our feeling of safety is met when we feel we can exert control and expect a certain amount of predictability in our lives. Maslow’s work suggests for most of us to achieve loftier goals higher on the pyramid, our need of safety has to be fulfilled. The majority in the profession experienced changes in their clinical practice, ranging from reduced hours to being laid off or reduced income. This is reflected in our study as 42% of respondents were worried about daily expenses including loans that could not be met, even with JobKeeper support. Final year dental students were understandably concerned about employability after graduation and not graduating in time. The group least affected in their working hours and pay appear from our study to be those working in the public sector.

Level 3. The need for love and belonging – intimate relationships and friends

Level 3 is where our needs are met through connections with others. From the survey results, it seems that the young dentist contingent derives deep contentment through our interactions with our family, friends and partners, and also from the wellbeing of our patients. A third year dentist voiced they were concerned about the potential of being an asymptomatic carrier and spreading the virus in the clinical setting, affecting patients and staff. Another dentist working in the public setting stated they were concerned about the risk to patients and the risk of spread, noting government clinics often involve working with high risk populations.

Of note was how important our friends and family are to us, as the highest reported concern from the survey was friends or family contracting COVID-19 (67%), and the third highest concern was not being able to see them (53%). Respondents also reported being separated from their partners and having to manage long distance relationships as a result of the lockdown, with the untold difficulties this creates.

Level 4. Esteem needs – dignity, mastery, independence, desire for reputation and respect

The pains and extraordinary accomplishment of completing the years of dental studies are probably felt most acutely by our recent graduates and young dentists. Then there is the desire to master our skillset as we build up our experience and confidence in the clinical setting. 39% of surveyed respondents were worried about lack of clinical practice and potential deskilling. 14% of respondents also said “yes” to the concern that “my identity as a dentist was challenged…I had moments I didn’t know who I was anymore without my job”.

Level 5. Self-actualisation – the achievement of fulfilling our highest potential

Maslow says that achieving your highest potential is to accomplish all that you believe you can be and do.

Self-actualisation is unique to the individual and it does not have to pertain to work achievements only. Self-actualisation can be the creation and invention of something, achieving your highest level of personal self, being a great father or mother to your children; possibly in combination with other monetary, physical or academic achievements.

In reference to other needs in life, Maslow suggests that a contented life is reliant on many aspects of our life going well. The lockdown period appeared to be a valuable time of re-evaluation and rest for many participants: for example, a survey respondent reported “being able to refocus my goals and what I wanted for my career”. The majority of respondents reported more time to look after their physical, mental and spiritual health (67%), 61% reported reconnection with old hobbies or learning new hobbies that likely added joy to their lives, and 42% reported feeling less stress and anxiety with reduced work hours!

Seemingly, despite the impact of COVID-19 on young dental practitioners' professional and personal lives, it appears not all is doom and gloom. When asked to self-evaluate their quality of life before and after lockdown, taking into consideration all aspects of life that is health, work, finances, goals and hobbies, 50% of respondents reported they emerged better around May and June compared to when lockdown started around March. 17% reported being worse off and 33% reported being “about the same”. It is reassuring to see responders reporting increased connection with friends and family despite the physical distancing. 11% of responders also found time to do social work and help others during lockdown.

Perhaps, then, while parallels between the survey results and elements of Maslow’s hierarchy can be drawn, the effects of COVID-19 itself did not inhibit the ability of practitioners to reflect and move forwards to consider what their highest potential will look and feel like, and the steps they can take to get there.

And on that note, I wish for us as individuals – and collectively as a profession – to continue to take charge of our lives despite the circumstances, to continually support one another, look out for our young dentists and, most importantly, take great care of ourselves and maintain good health.

The dentolegal perspective – Dr Annalene Weston, Dentolegal Consultant, Dental Protection

The ‘Coronacoaster’ has impacted every area of our lives, and in many ways life will never be the same. That said, it did provide many practitioners with some much needed downtime to consider what they wanted their future to hold and how they would achieve that.

Feelings of anxiety are commonplace in dentistry, regardless of the presence of a global pandemic, and talking through our feelings and concerns with others, and considering how to fulfil our basic physiological needs to empower us to grow personally and professionally, will set any young practitioner on a solid path to achieve their goals.