Mind-Body Wellness in Dentistry

By Christina DiBona Pastan, DMD

It was a September morning and, as I walked into my second-year endodontic resident’s operatory, I experienced her completely different then I had previously observed. She was moving and talking fast, setting up her bracket tray at turbo speed. I was about to mentor her on her first apicoectomy. She began to articulate to me her fear in performing her first surgical procedure: concern that she would perforate the sinus and not be able to control the bleeding. As this was happening, instruments began falling on the operatory floor. I knew in that moment I could relate because I once was in her shoes. However, being a long-time practitioner and teacher of yoga and meditation, I have evolved into a very different individual and a very different endodontist. More important than the apicoectomy was for me to make her aware that she was not in the right frame of mind and body to perform this procedure on a patient.

I stepped out of my traditional clinical instructor mode and asked her if I could teach her a breathing skill that I know calms the body and focuses the mind. She agreed and within minutes I watched my student’s entire demeanor change. Her body relaxed, her breathing slowed down and she centered herself. She looked at me with confidence and said, “I think I can do the surgery now.” I knew my resident could perform the surgery, but what she didn’t know was that she was not in the right frame of mind and body to perform surgery, and ultimately the outcome and her patient’s experience would have been compromised.

My resident executed the procedure, the result excellent and the patient happy and at ease. When the clinic session ended, she shared the impact of what I had taught her. My resident shared her struggles with anxiety and how she found ways to mask it but, in that moment, it got the best of her. In her seventh year of dental education, she was grateful to learn a new skill to cope with it personally, but also a skill which made her a better professional. This led me to pursue a formal training in yoga and meditation and to address with the administration at Tufts University School of Dental Medicine the importance of teaching Mind-Body wellness techniques, specifically through the ancient practices of yoga, diaphragmatic breathing, and mindfulness meditation in the curriculum to all our students. For the past eight years in my role as Director of Mind-Body Wellness, I have witnessed the positive effects of teaching and incorporating these practices with our students in the basic science curriculum, preclinical simulation lab and patient clinic, and the impact it has had on our student’s overall personal and professional success.

The ultimate goal of dental providers is to deliver mindful, compassionate and empathetic care to patients. This is achieved through competent clinical and technical skills in conjunction with sensitive communication skills. Dentistry is a stressful profession and when stress is not managed properly in the clinical environment, it can affect this goal. In 1975, Herbert Benson published his article on the relaxation response proving that stress not only contributes to health problems, but that mental focus techniques are good for the body.¹ The stressors of dentistry begin with dental students in the first year of their dental training and several dental schools in the U.S. are bringing attention to health and wellness for their students. Along with reinforcing healthy eating, exercise and sleep hygiene, mindfulness practices to calm the mind and relax the body are essential to overall wellbeing.

The first code of ethics written by the ADA in 1866 states, “The dentist should be temperate in all things, keeping mind and body in the best possible health, that their patients may have the benefit of that clearness of judgement and skill which is their right.” I don’t know if, back in 1866, the ADA was thinking of yogic breathing to achieve this goal, but the organization was definitely making the connection between mind-body wellness and its effect on patient care. Mind-body science has made enormous progress in evidence-based research in many areas and notably in the practices of yoga and meditation’s effects on stress reduction and self-regulation. Self-regulation is the ability to monitor and control our own feelings, thoughts and emotions and alter them in accordance with the situation.

Dental education is evolving and providing resources to teach self-regulation and coping skills to dental students. This provides support with the curriculum’s demands, but also gives exposure to a skill set that better prepares the students to be professionals that are mindful, compassionate and empathetic practitioners. Professionalism and mind-body practices are broad, overlapping constructs that both aim to foster the qualities of self-awareness, acceptance, wisdom, compassion and empathy—all qualities we strive for when treating patients.² Michelangelo was said to sculpt by liberating the figure from the marble and, in similar fashion, ancient mind-body practices say that compassion and empathy lie within each of us and emerge after removing the stumbling blocks that cloud our minds. Specific meditation practices have been studied on the potential to affect empathy. Training in compassion may reflect a coping strategy to overcome empathetic distress and strengthen resilience.³

Whenever we are clear minded and relaxed, we become consciously aware and interact with the world differently. We are more skillful in our actions, we are better communicators and listeners, we are more patient, kinder to others and less reactive—all qualities that are essential for the dental professional. The Commission on Dental Accreditation’s 2018 accreditation standards require that students be prepared for dental practice in a diverse society, developing core professional attributes such as altruism, social accountability and empathy.⁴  A way for dental schools to develop these core professional attributes in their students and faculty is to consider the incorporation of exposure to mind-body practices into the framework of dental education.

Christina DiBona Pastan, DMD, is Assistant Clinical Professor of Endodontics and Director of Mind-Body Wellness, Tufts University School of Dental Medicine.

1. Benson H, Beary JF, Carol MP. The relaxation response. Psychiatry 1974;37(1):37-46.
2. Lovas J, Lovas, D., Lovas, M. Mindfulness and Professionalsm in Dentistry. Journal of Dental Education 2008;72(9):998-1009.
3. Klimecki O, Leiberg, S., Richard,M.,SInger, T. . Differential patterns of functional brain plasticity after compassion and empathy training. Social Cognitive and Affective Neuroscience 2013;9(6):873-79.
4. Accreditation CoD. Accreditation Standards for dental education programs. Chicago: American Dental Association 2018.