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A Scoping Review on Burnout among Dental Hygienists in South Korea
J Dent Hyg Sci 2024;24:71-83
Published online June 30, 2024;  https://doi.org/10.17135/jdhs.2024.24.2.71
© 2024 Korean Society of Dental Hygiene Science.

Yang-Keum Han1 and An-Na Yeo2,†

1Department of Dental Hygiene, Daejeon Health University, Daejeon 34504, 2Department of Dental Hygiene, Baekseok Culture University, Cheonan 31065, Korea
Correspondence to: †An-Na Yeo, https://orcid.org/0000-0003-2500-1408
Department of Dental Hygiene, Baekseok Culture University, 1-18 Baekseokdaehak-ro, Dongnam-gu, Cheonan 31065, Korea
Tel: +82-41-550-2137, Fax: +82-41-550-2153, E-mail: dh.annayeo@gmail.com
Received May 9, 2024; Revised May 23, 2024; Accepted May 30, 2024.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Dental hygienists, who play a vital role in promoting oral health, experience burnout due to various factors. This study aimed to identify these factors through a scoping review of the literature on burnout among dental hygienists in Korea to develop prevention and intervention strategies for burnout.
Methods: The literature review was conducted following a scoping review protocol, which included five stages: identifying the literature question, identifying relevant studies, study selection, charting the data, summarizing, and reporting the results. Of the 352 documents initially reviewed, 35 were ultimately selected as final studies. These documents were analyzed to identify general characteristics and key variables related to burnout and to review the recommendations made by the studies.
Results: Analysis of the final documents revealed that most studies published between 2013 and 2018 involved sample sizes ranging from 201 to 300 participants. Burnout-related characteristics include age, salary, work experience, and marital status. Emotional labor was the key variable most frequently identified, followed by intention to leave, job stress, job satisfaction, job involvement, and self-efficacy.
Conclusion: This study suggests that strategies for preventing and intervening in burnout should be developed through both personal efforts and institutional measures. This approach will improve the work environment for dental hygienists and, consequently, enhance the quality of dental healthcare services.
Keywords : Burnout, Dental hygienists, Emotional intelligence, Employee turnover, Occupational stress
Introduction

1.Background

Dental hygienists are uniquely positioned in clinical settings and engage in continuous, direct interactions with patients. Despite being critical in promoting oral health and preventing diseases, they face various challenges. According to recent surveys on the health workforce conducted by the Ministry of Health and Welfare, dental hygienists have reported difficulties due to conflicts within the profession and have experienced high turnover rates due to excessive workload and psychological burnout1). Burnout among dental hygienists is more than just a personal issue; it can affect the quality of patient care and the efficiency of the healthcare system.

Burnout is a reaction that manifests as emotional exhaustion, depersonalization, and reduced personal accomplishment when emotional or interpersonal stressors persist over a long period2). The accumulation of excessive work demands can lead to indifference toward various aspects of the job, satisfaction with only minimal performance in the healthcare setting, and a decline in the quality of patient care. Furthermore, it can lead to decreased personal achievement and self-confidence3). Ultimately, burnout worsens dental hygienists’ physical and mental health, adversely affecting the quality of care and services provided to patients4).

Most domestic studies on burnout among dental hygienists have utilized the Maslach Burnout Inventory (MBI) developed by Maslach in the United States. These studies have shown that higher scores for emotional exhaustion and depersonalization and lower scores for personal accomplishment are associated with increased burnout intensity5). Subsequent measurements were also taken using modified tools such as the Maslach Burnout Inventory-General Survey (MBI-GS) and the Maslach Burnout Inventory Human Services Instrument)6). The relationship between burnout and various factors such as turnover intention7,8), job stress9), and emotional labor10) has shown positive correlations, whereas job satisfaction11), organizational commitment12), self-efficacy10), and happiness index9) have shown negative correlations. Additionally, general characteristics such as age13), marital status14), education level15), work experience13), and salary14) have also influenced burnout outcomes in different studies. Despite various previous studies on the leading causes and results of burnout among dental hygienists, most have presented isolated findings by focusing on specific variables. A systematic collection, analysis, and interpretation of these studies is necessary for a comprehensive understanding. Through a scoping review, it is imperative to understand the current state of research on this topic, identify areas for further investigation, and outline future research directions. Developing strategies to mitigate burnout among dental hygienists in clinical settings is essential.

2.Objectives

This study aimed to extensively review the existing literature on burnout among dental hygienists in Korea, examine the trends in the literature, and promote a comprehensive understanding of this issue. This study aimed to develop evidence-based prevention and intervention strategies by identifying various factors influencing burnout and synthesizing suggestions from the literature. Ultimately, this study contributes to improving the working environment of dental hygienists, thereby improving the quality of dental healthcare services.

Materials and Methods

This scoping review aimed to identify factors affecting burnout among Korean dental hygienists. This study was conducted according to the scoping review protocol outlined by Arksey and O’Malley16). The study process was divided into five stages: 1) identifying the research question, 2) identifying relevant studies, 3) study selection, 4) charting data, and 5) collating, summarizing, and reporting the results. The researchers adhered to this five-stage protocol and consulted the PRISMA Extension for Scoping Reviews (PRISMA-ScR) for the study design17).

1.Identifying the research question

Comprehensive literature reviews are recommended to formulate research questions that allow for an extensive research approach while precisely articulating the questions. The research question can be structured using the Population, Concept, Context (PCC) format18). For this study, the population comprised dental hygienists, the concept of burnout, and the context of dental healthcare facilities in South Korea. Accordingly, the research questions are as follows:

- What are the trends in burnout research among dental hygienists in Korea?

- What factors are related to burnout among dental hygienists in Korea?

- What are the suggested interventions based on research on burnout among dental hygienists in Korea?

2.Identifying relevant studies

1) Search strategy

The literature analyzed was sourced from January 2000 to December 2023 using Korean electronic databases, such as the Korean Studies Information Service System (KISS), Korea Institute of Science and Technology Information (KISTI), Research Information Service System (RISS), National Assembly Library (Nanet), KoreaMed Base (KMBASE), and Nurimedia (DBpia). Additional sources included the websites of the Korean Society of Dental Hygiene and the Korean Society of Dental Hygiene Science. The search terms used were ‘dental hygienists’ AND (‘소진’ OR ‘burnout’).

2) Inclusion and exclusion criteria

The inclusion criteria were research papers published in Korean academic journals from 2001 to 2023, focusing on burnout among dental hygienists working in Korean dental healthcare facilities, and written in Korean or English. The exclusion criteria were studies in which the subjects were not dental hygienists, dissertations, qualitative research, conference proceedings, books, or literature for which the full text was unavailable were excluded. We limited the literature to studies published in academic journals because we believe that a rigorous review process for journal publications ensures the quality of the studies19).

3.Study selection

A total of 352 articles were initially retrieved from the KISS (n=100), KISTI (n=29), RISS (n=69), Nanet (n=57), KMbase (n=11), DBpia (n=57), Journal of Korean Society of Dental Hygiene (n=23), and Journal of Korean Society Dental Science (n=6). The selection process involved reviewing titles and abstracts based on set criteria, followed by full-text reviews. Two researchers independently conducted the selection, and disagreements were resolved through discussion. The selection process results are presented using the PRISMA flow diagram, as recommended by the Joanna Briggs Institute guidelines (Fig. 1)20).

Fig. 1. Flow diagram for study selection according to PRISMA.

4.Charting data

The researchers developed a framework for analysis adapted to the objectives of this study based on methodologies used in nursing literature reviews in Korea21). The extracted information was organized into the general characteristics of the studies and thematic analysis. Data were entered into Microsoft Excel 2019 (Microsoft, Redmond, WA, USA).

5.Collating, summarizing, and reporting the results

The final set of studies was analyzed using descriptive statistics for frequencies and percentages. This phase is presented in the results section.

Results

1.General characteristics of the study

A total of 35 studies conducted in Korea on burnout among dental hygienists were analyzed. The general characteristics of these studies were examined based on the publication year, source of literature, number of subjects, and whether Institutional Review Board (IRB) procedures were followed. Detailed results are presented (Table 1).

General Characteristics of Included Studies

Variable Category Number (%)
Year of publication 2001∼2005 0 (0)
2006∼2012 8 (22.9)
2013∼2018 18 (51.4)
2019∼2023 9 (25.7)
Sample size ≤100 1 (2.9)
101∼200 8 (22.9)
201∼300 18 (51.4)
≥301 8 (22.9)
Journal Journal of Dental Hygiene Science 7 (20.0)
Journal of Korean Society of Dental Hygiene 11 (31.4)
Korean Public Health Research 1 (2.9)
Journal of Korean Academy Medical Sciences 1 (2.9)
Journal of Convergence for Information Technology 1 (2.9)
Journal of Korean Academy of Preventive Dentistry and Oral Health 3 (8.6)
Journal of Korean Society of Oral Health Science 3 (8.6)
Journal of Korea Entertainment Industry Association 2 (5.7)
Journal of Digital Policy 1 (2.9)
Journal of the Korea Convergence Society 2 (5.7)
Journal of the Korea Academia-Industrial cooperation Society 1 (2.9)
The Journal of the Korea Contents Association 1 (2.9)
The Korean Journal of Health Service Management 1 (2.9)
IRB approval Yes 16 (45.7)
Not reported 19 (54.3)


1) Year of publication

No studies were identified between the search start year of 2001 and 2005. From 2006 to 2012, 8 studies (22.9%) were published between 2013 and 2018, with 18 papers (51.4%); from 2019 to 2023, there were 9 studies (25.7%). In 2016, they featured the highest number of publications on burnout among 5 studies.

2) Sample size

The size of the samples varied: 1 study had less than 100 participants (2.9%), 8 studies had between 101 and 200 participants (22.9%), 18 studies had between 201 and 300 participants (51.4%), and 8 studies had more than 301 participants (22.9%). The most extensive study had 807 participants, and the smallest had 84 participants.

3) Journal of publication

The studies were published in 13 different journals, with the Journal of the Korean Society of Dental Hygiene featuring the most publications with 11 studies (31.4%), followed by the Journal of Dental Hygiene Science with 7 studies (20.0%). Journals, such as the Korean Academy of Preventive Dentistry and Oral Health and the Korean Society of Oral Health Science, published 3 studies (8.6%). The Korean Entertainment Industry Association and the Korean Convergence Society journals each published 2 studies (5.7%). The Journal of Korean Public Health Research, Korean Academy of Medical Sciences, Convergence for Information Technology, Digital Policy, Korea Academia-Industrial Cooperation Society, and Korea Content Association published 1 study each (2.9%).

4) IRB approval

Among the final selected studies, 16 (45.7%) reported IRB approval, while 19 (54.3%) did not have IRB approval.

2.Analysis of study topics

1) General characteristics related to burnout

Analysis of the general characteristics related to burnout in the selected studies revealed factors such as age, salary, level of education, marital status, work experience, job rank, type of workplace, working hours, average daily number of patients, number of employees, presence of lunch breaks, availability of rest areas, and engagement in hobbies. Studies have indicated a negative relationship between age and burnout, with 9 papers showing higher burnout in younger individuals and one paper showing higher burnout with increasing age (Table 2). Specifically, the literature indicated that burnout was highest among individuals aged 26∼30 and 30∼34 years, as evidenced by two and one studies.

Correlation Between Various Factors and Burnout among Dental Hygienists

Related variable Factor Relationship Literature Number
Age − A1, A4, A5, A10, A13, A22, A24, A25, A34 9
＋ A27 1
26∼30 years ＋ A12, A14 2
30∼34 years ＋ A16 1
Salary − A1, A4, A10, A14, A16, A24, A32, A34 8
Education level ＋ A24, A26 2
− A1, A14, A16, A22, A34 5
Marital status Single ＋ A1, A3, A10, A14, A16, A24, A29 7
Work experience ＋ A26 1
− A1, A4, A5, A10, A16, A24, A25, A30 8
6∼10 years ＋ A14, A27, A32, A34 4
Job rank − A4, A10, A24 3
Hospital size (type) Clinic ＋ A20, A23, A27 3
Hospital ＋ A10 1
University hospital ＋ A24 1
Working hours 10＋ hours/day ＋ A14 1
Average daily patients 40∼50/day ＋ A14 1
Number of employees ＋ A23 1
− A16 1
Lunch breaks Yes − A24 1
Rest area available Yes − A32, A34 2
Hobbies Yes − A32, A34 2


A total of 8 studies demonstrated that lower salaries correlated with higher levels of burnout. Two studies found higher burnout among those with higher educational levels, whereas 8 studies showed a negative relationship between educational level and burnout. Seven studies reported higher levels of burnout among unmarried individuals. In eight studies, less work experience was associated with higher burnout, whereas one study reported the opposite. Four studies reported higher burnout among those with 6 to 10 years of experience.

Job rank was negatively correlated with burnout in all 3 studies. Workplace type also influenced burnout levels, with 3 studies showing a positive relationship with burnout at dental clinics, one at a dental hospital, and one at a dental university hospital. Higher burnout was reported when working hours exceeded 10 hours per day, and the average daily number of patients was between 40 and 50, each noted in one study. Studies have shown varying impacts of the number of employees on burnout, with one study each finding higher burnout in settings with more and fewer employees. One study found lower burnout in workplaces with lunch breaks, while rest areas correlated with lower burnout, as reported in two studies. Additionally, two studies have indicated that hobbies are associated with lower burnout.

2) Key variables related to burnout

Analysis of the 35 selected studies revealed that the primary variables related to burnout included emotional labor in 11 studies and turnover intention in 10. Job stress was discussed in 7 studies, job satisfaction in 6 studies, job involvement in 3 studies, and self-efficacy also in 3 studies. Two studies covered emotional intelligence, verbal abuse, and professional identity were each covered in 2 studies. Coping behaviors, organizational effectiveness, health promotion behaviors, empathy fatigue, empathy satisfaction, social support, supervisor support, happiness index, self-esteem, peer support and relationships, physical threats, work environment, Framingham type A behavior pattern10), resilience, patient rudeness, supervisor rudeness, positive psychological capital, presenteeism, work engagement, grit, role conflict, role overload, and role ambiguity were each discussed in one study (Table 3)7-15,22-47).

Summary of Literature on Burnout among Dental Hygienists

No. Author Year Measurement tool Related variable Recommendation
A1 Kim and Yoon13) 2007 MBI-GS Coping behavior Formation of a positive, proactive personality; urgent need for systematic programs to enhance job values and satisfaction among junior dental hygienists; personal active coping strategies for burnout necessary.
A2 Kim and Yoon22) 2008 MBI-GS Organizational effectiveness Improvement of the work environment; enhancement of responsibility and commitment to the organization; establishment of appropriate compensation systems; activation of promotion systems; diversification of welfare systems; flexible management mindset of hospital administrators.
A3 Park23) 2009 MBI-HSS Job satisfaction Development of various programs by the dental hygienist association.
A4 Heo and Ji44) 2010 Tedium scale Job stress, Turnover intention Intensive management of job-related and interpersonal stress.
A5 Lee and Kim24) 2010 MBI-HSS Job satisfaction Active communication, discussions and consultations with managers, an organic management system, continuous self-development and enhancement of professional qualities by dental hygienists.
A6 Choi et al.12) 2010 MBI-HSS Turnover intention,
Organizational commitment		 Strengthening of bonds among organizational members, strategies to enhance organizational commitment among dental hygienists.
A7 Lee25) 2011 MBI-HSS Health-promoting behavior Participation in professional health promotion programs for physical activity, nutrition, and stress management.
A8 Choi et al.7) 2011 X Turnover intention Stress management, creating a favorable environment to exercise skilled work.
A9 Oh and Jin26) 2013 MBI Emotive dissonance Organizational management of individual emotional labor.
A10 Han and Kim14) 2014 PROQOL Empathy fatigue, Empathy satisfaction, Social support Development of training programs for overcoming burnout (including regular seminars).
A11 Jeong et al.47) 2014 MBI-GS Emotional intelligence, Supervisor support, Self-efficacy Implementation of a five-day workweek, provision of rest areas, support for hobbies and cultural activities, internal organizational efforts (support from supervisors).
A12 Jeong and Han8) 2015 Tedium scale Turnover intention, Emotional labor Support for self-development (graduate studies, hobbies), organizational attention.
A13 Oh45) 2015 MBI-GS Emotional dissonance, Turnover intention Effective management of emotional aspects necessary.
A14 Min et al.9) 2015 MBI-GS Turnover intention, Job stress, Happiness index Joint efforts in the dental field, institutional and administrative support.
A15 Jang and Lee27) 2015 MBI-GS Emotional labor, Self-esteem Identification of organizational member issues, provision of hospital programs to enhance self-esteem.
A16 Lee and Ro28) 2016 MBI-GS Career commitment, Organizational commitment, Work involvement Provision of practical psychological counseling to prevent emotional depletion, appropriate rewards.
A17 Kim46) 2016 MBI-GS Emotional labor performance, Peer support Awareness of the importance of emotional labor management, systems for different groups established by managers and administrators.
A18 Jung29) 2016 MBI-GS Degree of emotional labor, Job stress Need for systemic improvements, support for informal gatherings and clubs, vacations, refresh training, incentives, reduction of overtime outside of dental hygienist duties, adequate staffing, granting of discretionary powers.
A19 Ji30) 2016 MBI-GS Turnover intention, Job stress Creation of a human environment conducive to long-term employment (3＋ years).
A20 Min and Kim11) 2016 MBI-GS Turnover intention, Job satisfaction, Job stress Implementation of a preceptor program, considerate care taking into account individual characteristics.
A21 Jeon et al.31) 2017 MBI-GS Verbal violence, Physical threat, Work environment, Peer relationships Managerial intervention in resolving issues when violence occurs.
A22 Jeung et al.10) 2017 MBI-GS Emotional labor, Self-efficacy, Framingham type A Behavior Pattern Development of burnout-related manuals and guidelines, preparation of coping strategies.
A23 Kang and Jang32) 2017 MBI-GS Emotional labor Self-restraint of emotions, organizational-level compensation and management, expansion of welfare benefits.
A24 Jang and Han15) 2018 MBI-GS Professional identity, Role stress, Resilience Enhancement of resilience programs, development of continuing education programs.
A25 Kim and Choi33) 2018 MBI-GS Emotional dissonance, Job satisfaction Receptor system. Improvement of communication systems and welfare policies.
A26 Kim34) 2018 MBI-GS Emotional intelligence Development of emotional regulation programs to reduce burnout and enhance job satisfaction, resulting in increased satisfaction among both external and internal customers.
A27 Yun and Min43) 2019 Tedium scale Job stress, Turnover intention, Emotional labor Development and application of programs to reduce emotional labor and burnout.
A28 Cho et al.35) 2019 MBI-GS Patient rudeness, Supervisor rudeness, Job satisfaction Responsibilities and training for dental clinic managers or lead dental hygienists to handle rudeness, lists of rude patients, emotional intelligence enhancement programs, regular workshops, character education for creating a healthy organizational culture for college freshmen and new dental hygienists.
A29 Min36) 2020 PROQOL Positive psychological capital Psychological support, institutional measures.
A30 Lee et al.37) 2020 MBI-GS Verbal violence Development of situational coping manuals, education programs for preventing and intervening in verbal violence, administrative and management systems.
A31 Min and Min38) 2021 Tedium scale Presenteeism Development of health promotion programs, organizational support.
A32 Oh and Han39) 2022 Tedium scale Job embeddednes, Emotional labor Provision of rest areas, support for hobbies and leisure activities.
A33 Park et al.40) 2022 Tedium scale Job satisfaction, Organizational commitment Psychological counseling and short-term leaves.
A34 Won41) 2022 Tedium scale Grit Recognition of professional identity, goal setting, and organizational support necessary for achieving goals.
A35 Baek and Ji42) 2023 MBI-GS Role conflict, Role overload, Role ambiguity, Professional identity Establishment of professional identity.

MBI-GS: Maslach Burnout Inventory - General Survey, MBI-HSS: Maslach Burnout Inventory - Human Services Survey, PROQOL: Professional Quality Of Life Scale.

3) Recommendations for burnout

The 35 selected studies offered various recommendations categorized into individual and systemic efforts. At the individual level, dental hygienists should adopt a proactive and positive attitude toward managing burnout and engaging in hobbies and various programs for professional identity development. Participation in specialized health promotion programs on nutrition and stress management is also recommended. At the organizational level, managers should adopt a flexible management style to enhance organizational effectiveness. Systematic efforts should include developing burnout prevention and management programs through regular seminars or continuing education professional associations provide. Therefore, burnout guidelines and manuals need to be developed. Improvements in the work environment are recommended, such as adequate staffing, provision of discretionary powers, activation of promotion systems, and establishment of a proper remuneration system. Proposals have been made to diversify welfare systems, including support for hobbies and cultural activities, incentives, club activities, and the provision of rest areas. The preceptor system has been suggested to reduce burnout among newer dental hygienists. Supportive measures, such as psychological counseling to overcome burnout, were also deemed necessary, alongside a call for collaborative efforts within the dental community.

Discussion

1.Interpretation and comparison to previous studies

This study used a scoping review methodology to analyze and discuss domestic literature on dental hygienist burnout, focusing on its causes and mitigation strategies. Unlike in-depth analyses of individual studies, this scoping review broadly examines the status and scope of research in the field48). The Journal of Dental Hygiene Science and the Journal of the Korean Society of Dental Hygiene are the leading journals in dental hygiene. A total of 35 studies published between 2001 and December 2023 were selected as final references, reflecting the period of literature published in these two journals from their inception to the present. Burnout among dental hygienists is complex and influenced by various factors, such as working conditions, personal characteristics, and organizational systems. This study synthesized trends and findings from the selected literature by comparing studies and collating suggestions to improve the work environment for dental hygienists.

Analysis of publication years revealed that most studies (51.8%) were published between 2013 and 2018. The first domestic study on dental hygienist burnout was published in 2007, and the international literature dates back to 198449). A significant increase in empirical studies was noted post-2005 following a critical review highlighting the lack of substantial literature on this topic50). Domestically, a 2012 “2nd job analysis”51) by the Korean Health Personnel Licensing Examination Institute highlighted discrepancies.

Between the duties performed by dental hygienists and those legally prescribed, potentially leading to adverse administrative actions, increased job stress, and turnover intention. This has amplified calls for legal revisions to reflect better the reality faced by clinical dental hygienists, prompting further research on their actual conditions52).

The study sample size ranged from 84 to 807 participants, with 51.4% of the final studies including 201 to 300 participants. While most studies determined sample sizes based on statistical power and effect size, some needed to justify their sample size calculations, leading to inconsistencies in the sampling strategies between studies. There is a clear need for literature reviews with appropriate sample sizes in dental hygiene research to establish guidelines that ensure sufficient statistical power for the objectives of similar studies.

An analysis of published journals revealed that over half of the literature on dental hygiene education, which began in 1965, came from the Journal of Dental Hygiene Science and the Journal of the Society of Dental Hygiene, both flagship journals with a history of over 20 years. This indicates that many dental hygienists have researched various capacities, demonstrating academic advancement in dental hygiene and emphasizing the need for evidence to enhance professional scope and expertise. In addition to dental hygiene journals, research has been published in journals on preventive dentistry, oral health, health medicine, and integrated studies, allowing for a broad range of perspectives.

Ethical considerations showed that 16 papers were approved, whereas 19 did not provide details on compliance with research ethics. Since 2013, compliance with regulations concerning human subject research ethics under the Bioethics and Safety Act has been mandatory53); several recent studies have lacked IRB approval, highlighting the need for education on the importance of IRB reviews and more robust recommendations for IRB approval.

Examination of the general characteristics associated with burnout in the remaining 35 studies revealed inconsistent findings. Studies have found a negative correlation between burnout and factors such as age, experience, job rank, and marital status. Most studies indicated higher burnout levels among younger, less experienced, and lower-ranked individuals and those who were unmarried. This might be interpreted as older, more experienced, or higher-ranked individuals having a better understanding of burnout triggers and managing conflicts during clinical practice more effectively and married individuals with more emotional and psychological stability13). Some studies classified ages 26∼30 and 30∼34 years and found higher burnout among individuals with 6∼10 years of experience, suggesting that the initial enthusiasm for the job diminishes as one becomes more skilled, leading to conflicts over roles, social support, and self-achievement after about three years54). The need for organizational seminars and continuing education programs targeting new dental hygienists is evident. In addition, universities should minimize the discrepancies between educational curricula and clinical practice, and postgraduate in-service training programs should be developed to offer advanced courses. In contrast, some studies have shown higher burnout with increasing age, suggesting that burnout follows the assignment of responsibilities and a lack of confidence43). Enhancing promotion and incentive systems may reduce burnout among older, higher-ranking dental hygienists.

Salary plays a significant role in the burnout of dental hygienists in Korea, with all eight studies showing a negative relationship between burnout and turnover intention9,44). Turnover intention reflects dissatisfaction with one’s current job and a desire to change workplaces or professions and serves as a crucial predictor of job turnover55). Systematic reviews on turnover intention among Korean dental hygienists have highlighted burnout as a highly influential factor56). Dental hygienists must continuously develop and enhance their professional qualities to cope with burnout. Managing nutrition and stress is crucial. This should lead to ongoing internal growth, strengthen organizational cohesion, foster member cooperation, ensure adequate staffing, and allow task discretion.

The final literature search identified emotional labor as the most prevalent factor related to burnout, appearing in 11 articles. Dental hygienists must constantly adjust their emotions from the patient’s perspective to ensure service quality satisfaction, which can lead to frequent intentions to leave due to burnout caused by emotional labor45). Kim’s study46) suggests that colleague support (employing support) within organizational relationships can moderate job burnout. A conducive environment for effective communication with colleagues and supervisor support is necessary, and tailored management systems for each group are required. Enhancing welfare systems that allow for self-development and strengthening the preceptor system is essential for reducing emotional labor and decreasing burnout among dental hygienists.

Following emotional labor, the turnover intention has also significantly impacted burnout. Frequent turnover of dental hygienists has led to persistent staffing shortages in clinical dental settings56). Most studies have found a positive correlation between higher burnout levels and increased turnover intention3,9,12,20,44). Lee’s systematic review and meta-analysis literature56) of the turnover intention of dental hygienists. Among the factors demonstrating a medium effect size or greater on turnover intention, ten were protective factors, showing high correlations with organizational commitment, perceived organizational support, and job satisfaction. These findings indicate that protective factors have a more substantial impact on turnover intention than risk factors do. Therefore, strategies promoting protective factors may effectively reduce turnover intention, mitigating burnout.

The final literature review summarizes the suggestions for burnout in terms of personal and organizational commitment. empathy satisfaction14), job satisfaction11), self-efficacy10), organizational commitment12), supervisor support47), and professional identity15). A systematic review of burnout among nurses found results similar to this study57), with empathy satisfaction, job satisfaction, professional self-concept, self-efficacy, and health status as protective factors. To develop a positive professional self-concept and self-efficacy, continuous education should be provided, from undergraduate dental hygiene education to dental clinical practice. Continuous self-development and professional improvement of dental hygienists are necessary through in-service training programs and continuing education or seminars at the association level. Appropriate remuneration and welfare systems should be established and expanded for job satisfaction to maintain long-term intentions. In addition, communication systems should be improved through interceptor systems, and individual characteristics should be considered to form a healthy organizational culture. Individual efforts are important; however, dental hygienist burnout also requires collective efforts from institutional and administrative dental communities.

2.Limitations and suggestions for further studies

This study has limitations, as it excluded qualitative literature and selected only a subset of studies focusing on clinical dental hygienists in Korea, thus not encompassing a broad range of results. However, its significance lies in analyzing the current literature on burnout among dental hygienists published in Korea, identifying factors influencing burnout, and providing evidence-based suggestions for developing prevention and intervention strategies based on the findings of the reviewed studies.

Acknowledgements

None.

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Ethical approval

This research received review exemption from Daejeon Health University Institutional Review Board.

Author contributions

Conceptualization: Yang-Keum Han and An-Na Yeo. Formal analysis: Yang-Keum Han and An-NA Yeo. Supervision: Yang-Keum Han. Writing-original draft: An-Na Yeo. Writing-review & editing: Yang-Keum Han and An-Na Yeo.

Funding

None.

Data availability

Data supporting the results of this study are available from the corresponding author or the Korean Society of Dental Hygiene Science upon reasonable request.

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