Career Status and Mental Health Among Female Dentists in China: A Nationwide Cross-Sectional Survey

Abstract

Introduction and aims

Female dentists make up a large proportion in China and often face heavy workloads and occupational pressure. This study aims to conduct a comprehensive analysis of the current situation, challenges and mental health conditions of female dentists in China.

Methods

A cross-sectional survey among female dentists in China was conducted using a structured questionnaire. The survey collected information on demographic characteristics, workload, income satisfaction, psychological status, occupational stress, and occupational attitudes. Logistic regression was used to analyse factors associated with income satisfaction, anxiety symptoms, depressive emotions, and professional commitment.

Results

A total of 3,504 valid responses from female dentists across China were collected. 27.22% participants reported income dissatisfaction, with 55.5% perceiving income not proportional to their effort and 45.32% believing they earned less than male colleagues of the same level. Age, practice status, clinical specialty, annual income and workload all affect income satisfaction. Family responsibilities substantially impacted careers, with 44.06% having given up opportunities for advancement due to family reasons. Mental health burdens were substantial, with 97.6% reporting occasional or frequent anxiety and 86.24% experiencing depressive moods. Work-family imbalance is the strongest positive predictor of anxiety and depression. A total of 78.48% participants expressed love for their profession, though only 40.83% would actively recommend it to others. Dissatisfaction with income, work intensity and promotion speed and work-family imbalance significantly reduces professional commitment.

Conclusions

Female dentists in China constitute a highly qualified group yet facing multifaceted professional obstacles. Income satisfaction, psychological well-being, and occupational enthusiasm among female dentists are influenced by multiple factors. Systemic interventions are urgently needed to address pay equity, provide support for work-family balance and mental health to ensure a sustainable and healthy future for the dental workforce.

Clinical Relevance

This survey provides important insights into the current career landscape of female dentists in China and may inform strategies aimed at improving porfessional development and workforce equity.

Introduction

Over recent decades, the global health workforce has undergone considerable feminization and women are now the majority of health professionals worldwide.1, 2, 3 A similar trend has also been observed in dentistry. Globally, women account for approximately 70% of the healthcare workforce and around 60% of dental professionals.³ Despite the increased numbers, gender equality in professional careers has not been reached. Women are still highly underrepresented in management positions, and only occupy about 25% of management positions and 5% of senior leadership positions in major health organizations worldwide.^1,2 In dentistry specifically, the increased involvement of women has not translated into equal representation in professional leadership and income equity.⁴ In the United States, although the number of practicing female dentists has increased substantially since 2001, women remain underrepresented in leadership positions and continue to experience income disparities compared with male counterparts.³ China has also undergone a similar transformation. Data from the China Health Statistical Yearbook demonstrate that the proportion of female health professionals increased significantly from 63.85% in 2002 to 72.4% in 2020.⁵ Growth has been particularly evident in dentistry, nursing, pharmacy, traditional Chinese medicine, and public health sectors. However, women are still concentrated in service or junior positions, and their representation in academic and leadership roles remains relatively limited.^5,6

Beyond structural inequalities, gender-related challenges also influence professional experience and career development. Studies suggest that female dental students and female dentists may exhibit relatively lower confidence and higher stress levels compared to men during clinical practice although their ability levels are comparable.⁷ Gender bias in the academic field has also been reported. Women are more likely to receive unfavourable evaluations during professional assessment processes, highlighting the necessity of intervention to address implicit bias.⁸ Furthermore, female healthcare professionals frequently encounter greater difficulties balancing their work and family roles, including childcare burdens, insufficient parental leave policies and discrimination in the workplace.^9,10 In addition, growing evidence indicates that healthcare professionals are at increased risk of psychological problems, including anxiety, depression, and burnout, which may negatively affect job performance, career satisfaction, and quality of care.^11,12 These challenges may be more pronounced among female practitioners because of the combined demands of professional and family responsibilities. It has been reported that more than 30% of dentists experience stress, and women’s odds of reporting stress are twice as high as men’s.¹²

Despite these observations, there remains a lack of large-scale, systematic investigations focusing specifically on female dentists as a distinct population. Dentistry is characterized by high workload, high clinical precision demands, and frequent patient-related stress, all of which may increase psychological burden. Female dentists may therefore experience a distinct combination of occupational pressures and gender-related challenges. However, in most previous studies, gender has been examined only as a secondary variable rather than a primary focus of analysis. As a result, evidence regarding career development, psychological health, and occupational experiences among female dentists remains insufficient, particularly within China’s rapidly evolving healthcare system.

Therefore, this study conducted a nationwide survey of Chinese female dentists to systematically examine their professional development status, workplace challenges, psychological health, and career expectations. By focusing specifically on female dentists, this study aims to provide a clearer understanding of gender-specific challenges within the dental workforce, identify key factors influencing income satisfaction, psychological well-being, and professional commitment, and generate evidence-based insights to improve gender equality and professional sustainability.

Materials and methods

Study design and participants

This cross-sectional survey study was conducted using an anonymous nationwide questionnaire. Participation was voluntary, and informed consent was obtained electronically prior to questionnaire completion. Eligible participants were licensed female dentists in mainland China. A convenience sampling strategy was adopted due to the exploratory nature of this nationwide survey and the lack of a centralized sampling framework for female dentists in China. The questionnaire was distributed through an online survey platform and disseminated via professional dental networks and social media channels.

Questionnaire development and content

The questionnaire was developed based on previous studies addressing gender equity, occupational stress, and professional development among healthcare professionals. Relevant literature was reviewed to inform item generation, and key domains were adapted from previously validated survey instruments where applicable.^13,14 The survey instrument was refined through expert consultation with dentists and statisticians to ensure content validity and clarity. A panel of dentists and statisticians reviewed the questionnaire items for relevance, clarity, and comprehensiveness to ensure acceptable content validity. Prior to formal distribution, the questionnaire was pre-tested in a small sample of female dentists (n=15) to assess comprehensibility and feasibility, and minor revisions were made accordingly. Questionnaires with incomplete responses or logical inconsistencies were excluded. A total of 3,504 valid questionnaires were included in the final analysis.

The questionnaire consisted of 6 domains:

1. Demographic and professional characteristics

Including age, geographic region, marital status, work experience, educational level, professional title, primary practice setting, and clinical specialty.

2. Income and workload characteristics

Including annual after-tax income, income satisfaction, perceived income fairness compared with male colleagues, weekly working hours, and satisfaction with work intensity.

3. Career development and academic participation

Including satisfaction with promotion speed, participation in academic conferences, and opportunities for continuing education and professional advancement.

4. Family support and work-family balance

Including the extent to which family responsibilities affected professional work, whether participants had declined educational or promotion opportunities due to family reasons, and perceived conflicts between family roles and career development.

5. Workplace environment and professional experiences

Including patient volume, occurrence of medical disputes, and experiences of uncomfortable behaviours from patients or colleagues.

6. Psychological status and lifestyle factors

Including work-related anxiety, depressive mood, professional enthusiasm, leisure activities, and personal lifestyle behaviours.

Most questions were single-choice items using categorical or Likert-scale response formats, while selected items allowed multiple responses.

Statistical analysis

All statistical analyses were performed using R software (version 4.4.3). All statistical tests were 2-sided, and P value < .05 was considered statistically significant. Descriptive statistics were used to summarize participant characteristics. Categorical variables were presented as numbers and percentages. To investigate the factors associated with “anxiety,” “depression,” and “professional enthusiasm” among female dentists, binary logistic regression analysis was performed for each dependent variable. For the ordered categorical variable "income satisfaction" (encoded as: 1 = satisfied, 2 = neutral, 3 = dissatisfied), a multivariate ordered logistic regression model was adopted. The relationship between each independent variable and the respective dependent variable was analyzed individually to calculate the odds ratio (OR) and its 95% confidence interval (CI). Different regression models included distinct sets of variables. The specific variables incorporated into each regression model are presented in the corresponding Results tables.

Ethical considerations

This study was approved by the Institutional Review Board of Shanghai Ninth People’s Hospital affiliated to Shanghai Jiao Tong University, School of Medicine (SH9H-2025-T520-1). This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement.¹⁵

Results

Participant characteristics

A total of 3504 valid questionnaires were collected in total in this survey. The demographic and professional characteristics of the participants are summarized in Table 1. Most respondents were aged 30-40 years (49.8%), followed by 40-50 years (24.49%), while 9.9% were aged over 50 years. In terms of geographic distribution, the majority of participants were from eastern China (53.51%), followed by the central region (22.97%), western region (21.26%), and northeast region (2.25%).

Table 1.

Background and basic information of the participants.

Option		Number	Proportion (%)
Age (y)	20-30	554	15.81
	30-40	1745	49.80
	40-50	858	24.49
	50-60	314	8.96
	≥ 60	33	0.94
Region	Eastern China	1875	53.51
	Central China	805	22.97
	Western China	745	21.26
	Northeast China	79	2.25
Marital Status	Unmarried	653	18.64
	Married	2709	77.31
	Divorced	132	3.77
	Widowed	10	0.29
Work Experience(y)	< 5	489	13.96
	5-10	957	27.31
	10-20	1298	37.04
	20-30	496	14.16
	30-40	243	6.93
	≥ 40	21	0.60
Highest Education Level	Associate Degree	495	14.13
	Bachelor's Degree	1655	47.23
	Master's Degree	1018	29.05
	Doctoral Degree	336	9.59
Professional Title	Assistant Dentist	142	4.05
	Junior Title	728	20.78
	Intermediate Title	1771	50.54
	Associate Senior Title	613	17.49
	Senior Title	250	7.13
Primary Practice Setting	Public Dental Specialty Hospital	918	26.20
	Public General Hospital	1354	38.64
	Private Dental Clinic (Employee)	882	25.17
	Private Dental Clinic (Owner/Partner)	350	9.99
Clinical Specialty (Multiple Choice)	Pediatric Dentistry	1669	47.63
	Implantology/Prosthodontics	1315	37.53
	Oral Surgery	1266	36.13
	Orthodontics	1959	55.91
	Endodontics/Operative Dentistry (Oral Medicine)	2159	61.62
	Auxiliary Department (e.g., Radiology, Pathology)	125	3.57

Regarding educational background, 47.23% of the respondents held a bachelor’s degree, while 38.64% had postgraduate degrees. For professional titles, more than half held intermediate title and most respondents worked in public hospitals (64.84%), while 35.16% worked in private dental clinics. The majority of respondents are engaged in orthodontics, endodontics and paediatric dentistry.

Workload, career development and income satisfaction

The distribution of workload, career development opportunities, and income satisfaction among female dentists is shown in Table 2. More than 69.63% of respondents reported working more than 40 hours per week, and 53.59% treated more than 10 patients per day.

Table 2.

Workload, career development and income satisfaction.

Variable	Category	n (%)
Weekly working hours	< 40	30.37
	40-50	49.91
	≥ 50	19.72
Daily patient numbers	< 10	46.41
	10-20	37.01
	≥ 20	16.58
Approximate Annual Income	< 100,000 RMB	25.86
	100,000-200,000 RMB	41.52
	200,000-00,000 RMB	18.46
	300,000-500,000 RMB	9.42
	≥ 500,000RMB	4.74
Satisfaction with income	Very satisfied	2.05
	Satisfied	21.46
	Neutral	49.26
	Dissatisfied	23.4
	Very dissatisfied	3.82
Perceived income compared with own work	Proportional	44.49
	Not proportional	55.5
Perceived income compared with male colleagues	Higher	5.19
	Similar	49.49
	Lower	45.32
Satisfaction with promotion speed	Very satisfied	2.77
	Satisfied	25.23
	Neutral	46.78
	Dissatisfied	20.95
	Very dissatisfied	4.28
Affect work due to family reasons	Never	19.43
	Occasionally	33.16
	Sometimes	30.02
	Frequently	13.78
	Always	3.6
Gave up training/promotion due to family reasons	Yes	44.06
	No	42.04
	Not sure	13.9
Participation in academic conferences (past year)	None	7.99
	1-3 days	33.39
	≥4 days	58.62
Medical disputes (annual frequency)	None	51.88
	1-3	44.24
	≥ 4	3.89

Table note: Values are presented as number (percentage).

In terms of professional development, 58.62% of participants attended academic conferences for more than 3 days per year, while 25.23% expressed dissatisfaction with their promotion speed. Family responsibilities also affected career development. Approximately 80.57% reported that family responsibilities had occasionally or frequently affected their work, and 44.06% reported that they had given up opportunities for further education or promotion due to family reasons.

Regarding income level, 67.38% of respondents reported annual income below 200,000 RMB. 23.51% reported being satisfied with income and 27.22% reported dissatisfaction, while 49.26% indicated neutrality. Additionally, 55.5% believed that their income was not proportional to their work effort, and 45.32% reported earning less than male colleagues at the same level.

The results of the ordinal logistic regression analysis for income satisfaction are shown in Table S1. Compared with dentists aged 20-30 years, those aged 40-50 years (OR = 0.71, P = .044) and > 50 years (OR = 0.45, P < .001) were less likely to report higher income satisfaction. Dentists working in public general hospitals reported higher income satisfaction than those in public specialty hospitals (OR = 1.34, P < .001), while private practice showed no significant difference (OR = 0.90, P = .31). Orthodontists reported lower satisfaction than paediatric dentists (OR = 0.83, P = .043). Annual income > 200,000 RMB was associated with lower satisfaction (OR = 0.34, P < .001), whereas working > 40 hours per week was associated with higher satisfaction (OR = 1.43, P < .001) (Fig.1).

Fig. 1.

Multivariate logistic regression analysis of factors associated with income satisfaction. Variables are listed on the left. The squares represent the odds ratios, and the horizontal lines represent the 95% confidence intervals. The vertical dashed line at 1.0 indicates the line of no effect.

Psychological status and occupational stress

The psychological status and occupational stress experienced by female dental professionals are summarized in Table 3. Overall, 97.6% of respondents reported experiencing work-related anxiety, while 86.24% reported depressive symptoms. Furthermore, 17.75% believed that work had a significant impact on their psychological status and 58.11% reported feeling emotionally distressed due to work.

Table 3.

Psychological status and occupational stress.

Variable	Category	n (%)
Frequency of work-related anxiety	Never	2.4
	Occasionally	38.9
	Sometimes	28.97
	Frequently	25.23
	Always	4.51
Frequency of depressive mood	Never	13.76
	Occasionally	47.55
	Sometimes	28.17
	Frequently	8.9
	Always	1.63
Perceived impact of work on mental health	None	2.31
	Slight	11.96
	Moderate	67.98
	Large	17.75
Main sources of occupational stress*	High workload/time pressure	58.11
	Patient expectations	59.59
	Skill updating pressure	56.51
	Promotion pressure	44.29
	Interpersonal relationships	35.19
	Performance pressure	50.71

^⁎Multiple responses allowed.

Values are presented as number (percentage). Percentages for multiple-response items were calculated using the total sample size as the denominator.

Binary logistic regression results for work-related anxiety are presented in Table S2. Work-family imbalance was the strongest predictor of anxiety (OR = 2.83, 95% CI: 2.41-3.32, P < .001). Working > 40 hours per week (OR = 1.46, P < .001) and experiencing medical disputes with patients (OR = 1.45, P < .001) were also associated with increased anxiety. Compared with participants aged 20-30 years, those aged 30-40 years were less likely to report anxiety (OR = 0.66, P = .004). Similarly, respondents with > 20 years of work experience showed lower anxiety compared with those with < 10 lt; 10 years of experience (OR = 0.63, P = .012) (Fig.2).

Fig. 2.

Binary logistic regression analysis of factors associated with work-related anxiety. Variables are listed on the left. The squares represent the odds ratios, and the horizontal lines represent the 95% confidence intervals. The vertical dashed line at 1.0 indicates the line of no effect.

The results of the binary logistic regression analysis for depressive symptoms are shown in Table S3. Work-family imbalance was also significantly associated with depressive symptoms (OR = 2.06, P < .001). Lower income satisfaction (moderate: OR = 1.22, P = .05; dissatisfied: OR = 1.78, P < .001) and lower promotion speed satisfaction (moderate: OR = 1.45, P < .001; dissatisfied: OR = 1.63, P < .001) were also associated with increased depressive symptoms. In addition, experiencing gender-related discomfort from male patients or colleagues (OR = 1.57, P < .001), working > 40 hours per week (OR = 1.40, P < .001), and having medical disputes with patients (OR = 1.31, P < .001) were significantly associated with depression (Fig.3).

Fig. 3.

Binary logistic regression analysis of factors associated with depressive symptoms. Variables are listed on the left. The squares represent the odds ratios, and the horizontal lines represent the 95% confidence intervals. The vertical dashed line at 1.0 indicates the line of no effect.

Workplace environment and doctor-patient conflict

The working environment and doctor-patient relationship issues faced by female dentists were also investigated. Approximately 62.5% of respondents reported that their gender had led to dissatisfaction from patients, while 38.87% reported experiencing inappropriate behaviours from male patients or male colleagues. In addition, 51.88% reported experiencing medical disputes with patients at least once per year. These findings highlight the occupational challenges faced by female dentists in clinical practice.

Lifestyle and personal well-being

Lifestyle behaviours among female dentists were also assessed. Approximately 82.88% of people reported never doing or doing personal image management very occasionally, including skin care, hair care or manicure. In terms of daily habits, 84.56% reported never wearing high heels at work, and 62.56% reported never wearing makeup during working hours. Additionally, 44.61% reported seldom shopping for clothing, reflecting lifestyle and self-presentation behaviours among female professionals (Fig.4).

Fig. 4.

Lifestyle behaviours among female dentists. (A) The frequency of working in high heels; (B) The frequency of working with make up on; (C) The frequency of shopping; (D) The frequency of personal image management.

Professional commitment

The level of professional commitment among female dentists was also evaluated.

Overall, 78.48% reported that they loved their profession, while 21.52% reported only moderate enthusiasm or lack of enthusiasm. Only 54.05% believed that their professional achievements had met their expectations and only 40.83% stated that they would recommend the dental profession to others in terms of career recommendation (Fig. 5).

Fig. 5.

Professional commitment of female dentists. A. Level of female dentists professional commitment of female dentists; B The willingness to recommend this profession;C.The answer of whether the professional achievements have met expectations.

The results of the binary logistic regression analysis for professional commitment are presented in Table S4. Compared with respondents with < 10 years of work experience, those with 10-20 years (OR = 1.59, 95% CI: 1.28–1.97, P < .001) and > years (OR = 1.66, 95% CI: 1.23–2.26, P = .002) were more likely to report loving their profession. Higher professional titles were also positively associated with professional commitment (intermediate: OR = 1.35, P = .006; senior: OR = 2.69, P < .001). Lower income satisfaction, work intensity satisfaction, and promotion satisfaction were significantly associated with reduced professional commitment (all P < .01). Work-family imbalance showed a marginal negative association (OR = 0.83, P = .05) (Fig. 6).

Fig. 6.

Binary logistic regression analysis of factors associated with professional commitment. Variables are listed on the left. The squares represent the odds ratios, and the horizontal lines represent the 95% confidence intervals. The vertical dashed line at 1.0 indicates the line of no effect.

Discussions

This study examined income satisfaction, psychological status, and occupational attitudes among female dentists and explored their associated factors using regression analyses. The results suggest that income satisfaction, workload, and occupational stress are closely related to emotional well-being and professional attitudes in this population. These findings highlight the multidimensional challenges faced by female dentists and underscore the importance of improving both working conditions and psychosocial support in healthcare settings.

Work-family balance and psychological well-being

One of the most notable findings of this study is the strong association between work-family imbalance and psychological distress. Participants who reported imbalance between work and family responsibilities had significantly higher risks of both anxiety and depressive symptoms. This finding is consistent with previous research indicating that work-family conflict is a major contributor to psychological stress among healthcare professionals. A survey of 384 healthcare professionals in Uganda found that work-family imbalance was significantly associated with the risk of anxiety, with an adjusted prevalence ratio ranging from 1.74 to 2.19.¹⁶ A survey in China after the COVID-19 also pointed out that medical practitioners with work-family imbalance have a significantly increased risk of anxiety, and their possibility of entering a higher anxiety level is about 3 times that of the balanced group.¹⁷

Workload also played an important role in psychological outcomes in this study. Long working hours have repeatedly been identified as a risk factor for occupational stress in healthcare professions. Dentistry is widely recognized as a demanding profession involving high clinical responsibility, patient expectations, and time pressure. Previous research has shown that occupational stress among dentists can exceed 80%, and stress is closely associated with reduced job satisfaction and burnout symptoms.¹⁸ Job burnout also plays a mediating role between work-family conflict and the intention to quit.¹⁹ In addition, experiencing medical disputes with patients was associated with higher risks of anxiety and depression. This finding reflects the increasing pressure faced by healthcare professionals in clinical practice. Patient dissatisfaction, complaints, and medical disputes may significantly increase emotional stress and reduce professional confidence.

The degree of work-related anxiety showed a decreasing trend with the increase of working experience. Young professionals aged 20 to 30 with less than 10 years of work experience are at high risk of anxiety. This might be because they are in the process of starting a family, facing greater conflicts between work and family, and have relatively lower incomes, thus facing greater economic pressure. At the same time, income satisfaction and promotion satisfaction are also inversely related to the risk of depression.

Career expectations and income satisfaction

Income satisfaction represents an important component of overall job satisfaction and workforce stability. Multiple cross-sectional studies have consistently pointed out that dentists' satisfaction with their salaries is generally low. A 2024 survey of registered dentists in Pennsylvania, USA, revealed that 60.4% of the respondents believed their salaries were unfair.²⁰ In this study, several demographic and occupational factors were associated with income satisfaction. Previous studies have shown that salary level and salary fairness perception are the key determinants influencing the job satisfaction of medical staff.^21,22

However, annual income had a significant negative impact on satisfaction in this study. This seemingly contradictory finding may be related to the difference between actual income and individual expectations. Although dentists with higher incomes receive greater financial compensation, they are also more likely to face heavier workloads, greater professional pressure, and higher expectations regarding career achievement, which may lower their level of satisfaction. In addition, income satisfaction is influenced not only by absolute earnings, but also by subjective perceptions and comparisons with peers at similar professional or academic levels. Previous studies have similarly shown that occupational satisfaction is closely associated with perceived fairness, effort-reward balance, and career expectations rather than income alone.²³ Interestingly, older dentists were less likely to report higher income satisfaction than younger practitioners. This finding may reflect changing expectations across career stages. As professionals gain experience and assume greater responsibilities, they may also develop higher expectations regarding financial compensation and professional recognition.

Practice setting also influenced income satisfaction. Dentists working in public general hospitals reported higher income satisfaction compared with those in public specialty hospitals. Differences in workload distribution, institutional resources, and patient volume across healthcare settings may partly explain this finding. Similar disparities in job satisfaction across practice environments have been reported in previous studies examining dental workforce conditions.

Salary satisfaction is not an isolated variable. Its effect is regulated by multiple factors such as workload, organizational support, career motivation and work environment. Therefore, improving the salary system for dentists needs to be advanced in combination with structural reform and soft support.

Career development and professional commitment

Professional commitment was strongly associated with career stage and professional advancement. Dentists with longer work experience and higher professional titles were more likely to report loving their profession. These findings suggest that professional identity and career stability may strengthen over time. As dentists accumulate clinical experience and achieve career recognition, they may develop a stronger sense of professional competence and fulfilment. A study of dentists in South Korea found that clinical experience was a predictor of stronger and consistent professional values, indicating that professional commitment increases with the accumulation of experience.²⁴ Similarly, research in Saudi Arabia also shows that the years of practice are significantly positively correlated with job satisfaction.²⁵

Conversely, lower satisfaction with income, work intensity, and promotion opportunities was associated with reduced professional commitment. These findings highlight the importance of career development conditions in maintaining enthusiasm for the profession. Dissatisfaction with promotion systems or perceived inequities in professional advancement may undermine long-term professional motivation, as has been found in many previous studies. 87.1% dentists in Pennsylvania believed that there are very few promotion opportunities, and such institutional restrictions are thought to potentially reduce professional commitment and affect career stability.²⁰ A survey in China also showed that concerns about income are an independent negative correlation factor for dentists' intention to resign.²⁶

Work-family imbalance also showed a marginal negative association with professional commitment. This result further supports the idea that sustainable professional engagement requires a balance between professional responsibilities and personal life. In healthcare professions, particularly for female practitioners who may face greater family responsibilities, maintaining this balance may be essential for long-term career satisfaction.

Professional commitment is not a static trait but is the result of dynamic shaping by structural and developmental factors such as career stage, promotion mechanism, income equity, work intensity and work-family balance. To enhance the professional commitment of the dental community, efforts should be made from multiple dimensions, including improving career development paths, optimizing salary systems, reducing unreasonable workloads, and supporting individuals in achieving a sustainable balance between their careers and personal lives.

The findings of this study may have important implications for workforce management and gender equity policies in dentistry. Given the associations between workload, work-family imbalance, psychological distress, and professional enthusiasm, healthcare institutions should consider creating more supportive working environments for female dentists. Potential strategies could include optimizing workload distribution, improving promotion transparency, strengthening psychological support, and offering more flexible policies to help balance professional and family responsibilities. In addition, reducing gender-related bias in the workplace and strengthening institutional support could contribute to the long-term stability and sustainability of the dental workforce.

Limitations

Several limitations should be acknowledged when interpreting the findings of this study. The cross-sectional design precludes causal inferences about occupational factors and psychological outcomes. Moreover, reliance on self-reported data may introduce bias. Although we recruited participants from multiple regions, the sample may not fully represent all female dental professionals in China.

Future research could benefit from longitudinal designs to examine how professional satisfaction and mental health evolve throughout professional careers. In addition, comparative studies including both male and female dentists may help further clarify gender-related differences in occupational experiences.

Conclusions

This study analysed the current situation and challenges of female dentists in terms of career development, gender equality, work-family balance, and mental health based on data from 3,504 valid questionnaires. Research has found that female dentists generally face problems such as low income satisfaction, restricted career advancement, obvious conflicts between work and family, and high psychological pressure. The lack of economic equity, the squeeze of family responsibilities, and mental health risks constitute the triple shackles for the career development of female dentists. These results highlight the importance of improving working conditions, optimizing compensation systems and strengthening psychological support within medical institutions. Improving the balance between work and family should be regarded as an important priority in supporting the well-being of dental professionals. Addressing occupational stress and enhancing the working environment may help improve the mental health of dental professionals. Transparent promotion systems and opportunities for continuous professional development may help maintain the enthusiasm and professional identity of dentists. Targeted organizational intervention may help enhance job satisfaction, reduce psychological distress, and promote the long-term stability and development of the healthcare workforce.

Funding

This study was supported by the National Natural Science Foundation of China (82301075, 82401159, 82571126, 32171348), National Key Research and Development Program of China (2022YFC2405904), Innovative Research Team of High-level Local Universities in Shanghai (SHSMU-ZLCX20212402), and Fundamental Research Program Funding of Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (JYZZ085), and China Postdoctoral Science Foundation (2024M762080).

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Author contributions

Ting Dong analyzed the data and was a major contributor in writing the manuscript. Yuanmeng Yang contributed to the data statistical analysis. Lu Liu, Ningjuan Ouyang and Lingjun Yuan contributed to the collection of the data. Lunguo Xia participated in the questionnaire design. Niansong Ye participated in the questionnaire design and revised the manuscript. Bing Fang was the major contributor in the conception of the study. All authors read and approved the final manuscript.

Conflict of interest

None disclosed.