Yoga for dentists
Are you suffering? Heather Mason explains how to identify the stressors and what you can do to combat it
It is an ironic tragedy that dentists devote their lives to enhancing and protecting patients’ smiles, yet the dental profession is plagued by some of the highest levels of mental health issues and suicidality of all careers (Alexander, 2001). Rates of musculoskeletal problems are also exceedingly high with a 2009 review reporting a 64-93% prevalence of pain, with the most common regions including the back, neck, wrists and hands (Hayes, 2009). Although mental health issues and physical problems are attributed to different factors; for example, muscle pain is associated partly with long periods of holding poor postures and repetitive motions, while isolated working conditions, the high expectation for perfectionism, coupled with patient anxiety, underscores and contributes to depreciating psychological health; these physical and mental factors mutually aggravate each other (Ardekani, 2012).
Reduction of stress and depression
Stress is well-known to exacerbate muscular pain, while chronic physical discomfort is correlated with lower mood and is a major risk factor for depression, not only due to the unpleasant of nature pain (Blackburn-Munro, 2001). Conversely, relieving physical pain has positive consequences for emotional well-being and vice versa.
Given the widespread nature of health problems in the dental profession a host of literature is already devoted to proper posture and improved habits that can reduce psychological strain. There is emerging interest in yoga as countless practitioners and an increasing corpus of clinical trials report it reciprocally addresses mental and physical issues, promoting a lifestyle that supports health. Furthermore, the practice of yoga is correlated with improved relationship satisfaction and a feeling of connectedness to other people, both of which lead to improved health behaviours and well-being. Currently, the strongest evidence exists for yoga’s role in reducing stress and depression and for relieving musculoskeletal issues, most notably back pain (Jeter, 2015).
Any type of yoga will likely curb some of the key health complaints of dental professionals via improved balance, flexibility, strength, and stress relief and dental professionals should carve out time to attend yoga classes. However, there are specific practices that individuals in this vocation should also consider both during working hours and beyond.
One of the most pervasive aspects of yoga is controlled breathing practices. These are done either in conjunction with postures or formally on their own. The yoga tradition has long upheld that altering breath patterns encourages transformation. This age-old belief aligns with modern scientific findings, which confirm that changing breathing patterns influences brain functioning and over time, certain techniques, lead to positive neuroplasticity. One of the simplest modes of yogic breathing known to reduce anxiety is to elongate the exhale in relationship to the inhale at a 1:2 ratio. Ideally, one should inhale for a count of three or four and exhale for a count of six to eight.
To experience the stress relieving benefits, it is best to practice for at least five minutes with more pronounced effects felt after 20 minutes. This mode of breathing can be done while doing dental work. The efficacy associated with an elongated exhalation is down to the relationship between the respiratory, cardiac, and autonomic nervous systems. During an inhalation there is an increase of sympathetic output to the heart increasing its rate, on the exhalation the vagus nerve, increases its signalling to the SA node, reducing heart rate. So, the long period of exhalation in comparison to the inhalation generates a sense of calm.
Another technique that has wide-ranging benefits is to breath in for a count of six and out for the same duration. A host of research trials find that this even breath rate increases heart rate variability, psychological health, and overall resiliency. This practice, often termed, coherent breathing, is also associated with reduce inflammation and chronic pain (Gerbarg, 2015). Research psychiatrists Streeter and Gerbarg hypothesize that breathing at this rate oscillates the vagus nerve at a particular rhythm, upregulating GABA, thus, delivering anxiolytic effects. Overtime, it is believed that coherent breathing alters neural circuitry in a manner than enhances one’s ability to modulate stress and engage in better self-care via improved body awareness. (Streeter, 2007, 2012, 2016). Likewise, this repetitive activation of the vagus is believed to increase its tone. High levels of vagal tone are correlated with greater mental health and better social engagement (Kok, 2010).
There are a number of apps that have chimes or bells set at this rate, cueing when to breathe in and out. As patients also tend to be anxious, dental professionals can have a chime track on in the background and suggest patients breathe at this rate with them. This joint activity has the potential to reverse the reciprocal dynamic of stress.
Joint freeing series
In addition to breathing practices dental professionals should consider a series of movements known in yoga as the joint freeing series (JRS). The JRS is designed to help each joint receive its full range of motion, thereby working all surrounding muscles. When a person holds a repetitive posture or engages in a repetitive movement, as dental professional do, one muscle, the prime mover or the agonistic muscle is regularly contracted while the opposing muscle, the antagonist, relaxes. Likewise, part of the joint will become weak while the other part may stiffen. The result is that agonist muscle becomes strong, but tight and can cause pain, while the antagonist muscle becomes weak and may not have the strength to support proper posture. Relatedly joint pain and repetitive strain and injury may emerge.
Through the JRS an individual reduces tension in agonist muscles and increases strength in antagonist muscles promoting overall muscle balance and contributing to better posture and pain relief. Doing the JRS should not be a substitute for a yoga class, which has many benefits, but is an important addition, as most classes are unlikely to actively attend to all the joints in a balanced way. By practicing the JRS a few times a week, attending a class or two in the evenings, and practicing breath techniques dental professionals should be able to find their own smile emerges with greater ease.
Alexander, (2001), Stress-related suicide by dentists and other health care workers. The Journal of the American Dental Association, 132(6), pp.786-794.
Ardekani, A., Ayatollahi, J., Ayatollahi, F., Bahrololoomi, R., Ayatollahi, J., Ayatollahi, A. and Owlia, M. (2012). Occupational hazards to dental staff. Dental Research Journal, 9(1), p.2.
Blackburn-Munro, G. and Blackburn-Munro, R. (2001). Chronic Pain, Chronic Stress and Depression: Coincidence or Consequence?. Journal of Neuroendocrinology, 13(12), pp.1009-1023.
Gerbarg, P., Jacob, V., Stevens, L., Bosworth, B., Chabouni, F., DeFilippis, E., Warren, R., Trivellas, M., Patel, P., Webb, C., Harbus, M., Christos, P., Brown, R. and Scherl, E. (2015). The Effect of Breathing, Movement, and Meditation on Psychological and Physical Symptoms and Inflammatory Biomarkers in Inflammatory Bowel Disease. Inflammatory Bowel Diseases, 21(12), pp.2886-2896.
Hayes, M., Cockrell, D. and Smith, D. (2009). A systematic review of musculoskeletal disorders among dental professionals. International Journal of Dental Hygiene, 7(3), pp.159-165.
Jeter, P., Slutsky, J., Singh, N. and Khalsa, S. (2015). Yoga as a Therapeutic Intervention: A Bibliometric Analysis of Published Research Studies from 1967 to 2013. The Journal of Alternative and Complementary Medicine, 21(10), pp.586-592.
Kok, B. and Fredrickson, B. (2010). Upward spirals of the heart: Autonomic flexibility, as indexed by vagal tone, reciprocally and prospectively predicts positive emotions and social connectedness. Biological Psychology, 85(3), pp.432-436.
Meta-analysis strengthens link between depression and inflammation. (2014). The Pharmaceutical Journal.
Streeter, C., Gerbarg, P., Whitfield, T., Owen, L., Johnston, J., Silveri, M., Gensler, M., Faulkner, C., Mann, C., Wixted, M., Hernon, A., Nyer, M., Brown, E. and Jensen, J. (2017). Treatment of Major Depressive Disorder with Iyengar Yoga and Coherent Breathing: A Randomized Controlled Dosing Study. The Journal of Alternative and Complementary Medicine, 23(3), pp.201-207.
Streeter, C., Jensen, J., Perlmutter, R., Cabral, H., Tian, H., Terhune, D., Ciraulo, D. and Renshaw, P. (2007). Yoga Asana Sessions Increase Brain GABA Levels: A Pilot Study. The Journal of Alternative and Complementary Medicine, 13(4), pp.419-426.
Streeter, C., Gerbarg, P., Saper, R., Ciraulo, D. and Brown, R. (2012). Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Medical Hypotheses, 78(5), pp.571-579.
The Minded Institute focuses on the development and professional training of evidence-based yoga therapy and mindfulness programmes. For more information email: firstname.lastname@example.org