Recare Visits, Rumination, and Those Endless Minutes

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You’re in the zone at the place after data collection before the exam ‒ the time when dental hygienists use their secret sauce to remove the biofilm, calculus, or debris (aka junk). Dental hygienists are lost in thought and hopefully only good ones.

But it can be the time when we mull over something that is weighing heavily on our minds. Rumination is not having an off switch in your brain. Some people say they have “racing thoughts,” or they “can’t shut off their mind.” Some of us are overthinkers. I have the belief that, by rolling it over in my head, I gain some spectacular insight into life, or it grants me the ability to fix a problem when there may not be a legitimate problem or a fix to be had.

Personality traits lend themselves to the propensity to ruminate ‒ being a perfectionist, a neurotic, or a person who is hyper-focused on relationships. Having trauma ‒ whether emotional or physical ‒ can be another reason we go to the rumination spiral. Our ongoing stress and less control over the world or our homes seems to increase the thoughtful hamster wheel.1

The Brain’s Default Mode

Temporary rumination can be simply reliving a conversation or worrying about an upcoming test or event. Reflective rumination is to gain insight to a problem perhaps and coming up with solutions. Brooding rumination is rerunning perceived mistakes or negative parts of ourselves. This can be particularly hard to stop.

Why do we do this? It is like a default mode in the brain; an autopilot called the default mode network (DMN). DMN is an interconnection of brain regions that are active when we are lost in thought, and it can happen when we are daydreaming or even reminiscing. The network’s dysregulation has been linked to autism, schizophrenia, patients with Alzheimer’s, and Parkinson’s disease. The DMN network is more connected in the brains of lonely people, too.2

Rumination isn’t really a friend. A meta-analysis in 2019 found that rumination is strongly correlated with depression.3 This isn’t anything new. In 2011, rumination was found to be contributory to the development of anxiety.4 It is important to note that rumination is different than worry. Nolan-Hoeksema et al. stated that rumination is anchored around negative material, and worry is around the process of uncertainty.5

This is a little of a splitting-hairs framework to me. My Dad worried every day about everything, going through all sorts of scenarios. He was the man who said, “Honey, accidents don’t happen; it’s just poor planning.” He lived till the age of 94 and had every brain faculty that he had at 30. It didn’t seem to affect him much, and he may have been a unicorn.

Impact of Negative Thoughts

Research brought all of this to light for me. I examined the relationship between negative thinking behaviors and rumination related to brain health. A study measured rumination about the past and worry about the future and what led to in regards to cognitive decline. Findings showed that the more negativity, the more amyloid plaque buildup associated with Alzheimer’s disease.6 In the study, they also tested for levels of anxiety and depression and found a greater cognitive decline in depressed and anxious people.

Ding, ding, ding.

Positive Thoughts in the Operatory

How do we change the loop? When dental hygienists are in your operatory during those 40 minutes, and the mind is ruminating over anything and everything, here are a few tips.

  1. Train to be an optimist. It works like training other muscles. One of the best ways is called the “best possible self” method. You imagine, or journal about yourself in the future where you have achieved all your life goals and your problems are resolved.7
  2. Meditation. Yes, at work. Even carving out 15 minutes will bring a great benefit.8 Meditation combined with aerobic exercise reduces rumination as well.9 Taking a brisk walk at lunch with no phone, good breathing, and minimal thoughts sounds heavenly. The incorporation of nature yields even better benefits.10
  3. Thankfulness. Gratitude is inversely related to experiences of rumination.11 Simply, it is the practice of recognizing the positive and giving thanks. To stop a cycle you may be on, make a quick brain list of three things you’re grateful for in the present moment (even if that is an ultrasonic scaler, the appointment is almost over, and that the AC works).
  4. Body awareness. In 2016, a study about interoceptive awareness (the awareness of the internal state of the body) found that when body awareness was high, rumination was low.12 Quietly listening to your beating heart or what your breath feels like are examples of interoceptive awareness.
  5. Mindfulness. Mindfulness helps to keep us present and teaches us that our thoughts may not always be correct.12 Community psychologist Marny Lishman says, “The primal brain doesn’t know the difference between thought and reality.” Thoughts are quite unreliable. Mindfulness reduces the ruminative ideas we have that can become self-perpetuating and uncontrollable.13 It can soften the focus on ourselves and build more self-compassion. We need a little more self-awareness and a little less self-focus.14

Self-awareness is tricky. We think that an introspective analysis of ourselves will improve self-awareness, and it doesn’t. The most common introspective question is, “Why.” The “why” questions are ineffective because we don’t have access to the unconscious thoughts, feelings, and motives we are searching for. “Why” invites unproductive negative thoughts.

“What” questions help us stay objective, future-focused, and empowered to act on new insights, and that increases productive self-insight and decreases unproductive rumination. Empathy and self-awareness are closely linked. A suggestion may be simply to practice empathy for your patients and teammates to help foster a little less self-focus.

While you are scaling and letting your mind wander just a bit, try to sit still, not think, and stop the rumination spiral. When you have a break, embrace doing nothing, no phone, no words ‒ just be. As we step into 2022, let’s work to step out of our heads and into the year with a little zoning out. It’s good for our souls.

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  1. Kim, J.S., Jin, M.J., Jung, W., Hahn, S.W., Lee, S.H. Rumination as a Mediator between Childhood Trauma and Adulthood Depression/Anxiety in Non-clinical Participants. Front Psychol. 2017; 8: 1597. doi:10.3389/fpsyg.2017.01597. Retrieved from
  2. Spreng, R.N., Dimas, E., Mwilambwe-Tshilobo, L., et al. The Default Network of the Human Brain is Associated with Perceived Social Isolation [published correction appears in Nat Commun. 2021 May 21 ;12(1): 3202]. Nat Commun. 2020; 11(1): 6393. doi:10.1038/s41467-020-20039-w. Retrieved from
  3. Chen, N.X., Zhu, Z.C., Castellanos, F.X., Yan, C.G. Rumination and the Default Mode Network: Meta-analysis of Brain Imaging Studies and Implications for Depression. NeuroImage. 2020; 206: 116287. Retrieved from
  4. McLaughlin, K.A., Nolen-Hoeksema, S. Rumination as a Transdiagnostic Factor in Depression and Anxiety.Behav Res Ther. 2011; 49(3): 186-193. doi:10.1016/j.brat.2010.12.006. Retrieved from
  5. Nolen-Hoeksema, S., Wisco, B.E., Lyubomirsky, S. Rethinking Rumination. Perspect Psychol Sci. 2008; 3(5): 400-424. doi:10.1111/j.1745-6924.2008.00088.x. Retrieved from
  6. Marchant, N.L., Lovland, L.R., Jones, R., et al. Repetitive Negative Thinking is Associated with Amyloid, Tau, and Cognitive Decline. Alzheimer’s Dement. 2020; 16(7): 1054-1064. doi:10.1002/alz.12116. Retrieved from
  7. Malouff, J.M., Schutte, N.S. Can Psychological Interventions Increase Optimism? A Meta-analysis. Journal of Positive Psychology. 2017; 12:6, 594-604. Retrieved from
  8. Campbell, T.S., Labelle, L.E., Bacon, S.L., et al. Impact of Mindfulness-based Stress Reduction (MBSR) on Attention, Rumination and Resting Blood Pressure in Women with Cancer: A Waitlist-controlled Study. J Behav Med. 2012; 35(3): 262-271. doi:10.1007/s10865-011-9357-1. Retrieved from
  9. Lavadera, P., Millon, E.M., Shors, T.J. MAP Train My Brain: Meditation Combined with Aerobic Exercise Reduces Stress and Rumination While Enhancing Quality of Life in Medical Students. J Altern Complement Med. 2020; 26(5): 418-423. doi:10.1089/acm.2019.0281. Retrieved from
  10. Bratman, G.N., Hamilton, J.P., Hahn, K.S., et al. Nature Experience Reduces Rumination and Subgenual Prefrontal Cortex Activation. Proc Natl Acad Sci U S A. 2015; 112(28): 8567-8572. doi:10.1073/pnas.1510459112. Retrieved from
  11. Liang, H., Chen, C., Li, F. et al. Mediating Effects of Peace of Mind and Rumination on the Relationship between Gratitude and Depression among Chinese University Students. Curr Psychol. 2020; 39:1430–1437. Retrieved from
  12. Lackner, R.J., Fresco, D.M. Interaction Effect of Brooding Rumination and Interoceptive Awareness on Depression and Anxiety Symptoms. Behav Res Ther. 2016; 85: 43-52. doi:10.1016/j.brat.2016.08.007. Retrieved from
  13. Raes, F., Williams, J. The Relationship between Mindfulness and Uncontrollability of Ruminative Thinking. Mindfulness. 2010; 1(4): 199-203. Retrieved from
  14. Harrington, R., Loffredo, D.A. Insight, Rumination, and Self-reflection as Predictors of Well-being. J Psychol. 2011; 145(1): 39-57. doi:10.1080/00223980.2010.528072. Retrieved from
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Anne O. Rice, RDH, BS
Anne O. Rice, RDH, BS, has been a clinical dental hygienist for over 30 years and received her degree from Wichita State University. Her oral-systemic passion led her to found Oral Systemic Seminars in 2017, in which she now devotes her time, focus, and study primarily to dementia prevention and sleep hygiene. She completed the Bale Doneen Preceptorship for Cardiovascular Disease Prevention for Healthcare Practitioners. In 2020 Anne became certified as a Longevity Specialist with the Alzheimer’s Research and Dementia Foundation, a Fellow with The American Academy of Oral Systemic Health, and in 2021 published her manuscript Alzheimer’s Disease and Oral-Systemic Health: Bidirectional Care Integration Improving Outcomes. The perspective article was part of a research topic: Integrating Oral and Systemic Health: Innovations in Transdisciplinary Science, Health Care and Policy. Anne is a consultant with Weill Cornell Medical Center’s Alzheimer’s Prevention Clinic and is a consultant with Florida Atlantic College of Medicine under the direction of Dr. Richard Isaacson.