The Story of Student A

Addiction to alcohol and drugs remains among the most misunderstood phenomena in medicine. Though the American Medical Association classified alcoholism as a disease in 1956, many people, inside and outside of health care, continue to look at it as a moral issue or the result of a lack of willpower. Alcoholism and addiction know no prejudice. They affect the entire spectrum of the population, at an estimated range of 6% to 10%. Some surveys report that the dentists’ easy access to drugs such as Vicodin, Valium and nitrous oxide makes our profession more susceptible. My story started in dental school. It was much harder than I expected. I always pulled good grades in undergrad. My classmates were really smart and good with their hands. I was struggling. I questioned why I decided to go to dental school. I started drinking at night just to unwind. I was soon drinking an entire bottle of wine every night. All the effort in studying was totally negated the next day. I had no recollection of any of the information I had spent all that time trying to learn.

At first, it was innocent. I needed a drink to fall asleep. One became several and I still couldn’t sleep. I was so anxious! I went to a doctor who prescribed me sleeping pills. Now I could fall asleep, but the combination of the wine and the sleeping pills made it impossible to wake up in the morning. Things quickly started to spiral out of control. My grades were low, my self-esteem was low, I didn’t know what was happening. I never failed at anything. My addiction snuck up on me and took over fast. I was self-destructing and within six months, things got really bad. Some of my classmates asked me what was wrong. They knew I was struggling, but I could not show any signs of weakness. I brushed them off. Alcohol was not my problem, it was the stress of school that was my problem. Alcohol was my solution. I isolated from my classmates. God forbid they see my shortcomings. Alcoholism and addiction are diseases of denial and perception. It is difficult to differentiate the true from the false. It is also a disease of isolation. The end result of untreated addiction is death, jail, or hospitalization. Then came my DUI. I didn’t think I was drunk. Unfortunately, the police officer though differently as he arrested me. I spent the night in jail. When I awoke, I knew things needed to change, but I didn’t know how. I worked so hard to get into dental school. I thought about quitting. Dentistry wasn’t for me. It was too hard. If I quit, life wouldn’t be so difficult and I wouldn’t drink anymore. That was the answer. I went to the dean at school to let him know of my plans to quit. I made a mistake applying. It was just too hard. He listened to me in a very empathetic manner. I trusted him. Before I knew it, I told him of my recent DUI. He smiled and gave me a phone number to a local dentist that he thought could help. Most state dental associations have Well Being programs. The Indiana Dental Association’s Well Being Program is run by a licensed clinical social worker and is overseen by a committee of IDA members who want to help fellow dentists who are struggling with substance abuse disorders. Their hope is to help the dentist get the help he/she needs before trouble arises or someone gets hurt. All inquires remain anonymous. Dental students are just as susceptible to addiction. Help is available through the leadership at the dental school. I made the call. I was scared, like anyone would be, but deep down I felt a sense of relief. My life was taking me in directions that could only in my mind, lead to devastation. The dentist agreed to meet with me at once. We spoke for hours. He got me into a program to help with my stress and my drinking. That was several years ago. Now I am a practicing dentist in a job that I love. How dark is was before the dawn! Thank you Well Being Committee. You saved my life and gave me the help and hope that I needed. Professional diversion programs allow for dentists to get help and create opportunities to continue to practice. They have a success rate upwards of 85 percent, far higher than the general population. It should also be noted that alcoholics and addicts who try to get better on their own without formal treatment have about a 6% success rate.

The ADA Code of Ethics states, “It is unethical for a dentist to practice while abusing controlled substances, alcohol, or other chemical agents, which impair the ability to practice. All dentists have an ethical obligation to urge chemically impaired colleagues to seek treatment. Dentists with firsthand knowledge that a colleague is practicing dentistry when so impaired have an ethical responsibility to report such evidence to the professional assistance committee of a dental society.” Reporting a colleague/fellow student is not only an ethical mandate, but it could also save a life.

Dr Brett Kessler ADA 14th District Trustee

(Reprinted with permission of Dr Kessler)

Utah Professional Health Program (UPHP) is available to healthcare professionals with substance use disorders, and offer a confidential, non-punitive approach while assisting the health care professionals on their road to recovery. UPHP serves to promote the health and well being of licensed healthcare professionals through coordination of assessment, treatment placement and long term aftercare monitoring. For more information, contact Kelli Jacobsen, MSW, LCSW Program Manager | 801-530-6291

ORAL PATHOLOGY PUZZLER: DO YOU SEE

WHAT I SEE? (continued from page 6)

Correct answer: (b) Oral Lymphoepithelial Cyst.

An oral lymphoepithelial cyst is an uncommon lesion that occurs in the oral cavity and typically presents as a non-ulcerated papule (soft tissue mass less than 1cm in size). When they occur, they are found within oral lymphoid tissue. Lymphoid tissue is located all around the oral cavity (Waldeyer ring). Palatine tonsils, lingual tonsils, pharyngeal adenoids are more common locations. However, accessory oral tonsillar tissue or lymphoid tissue can be found on the ventral tongue, floor of mouth and other soft palate.

This oral lymphoid tissue is located just beneath the mucosal surface. The epithelium invaginates into the tonsillar tissue, resulting in “pouches” or “crypts” that can fill up with keratinaceous debris or the crypts can become closed off or obstructed, resulting in a keratin filled cyst within the lymphoid tissue just below the mucosal surface. The typical color is white or yellow (see clinical image) but can clinically appears as pink or red, depending on its proximity to the surface. While usually asymptomatic, patients occasionally complain or drainage or swelling. Pain is rare but may result due to trauma of the lesion. Oral lymphoepithelial cysts may develop in people of any age, but are most common in young adults. They are most frequently located on the floor of mouth, ventral tongue, posterior lateral border of the tongue, palatine tonsil and soft palate (areas where lymphoid tissue is normally found). Microscopic examination (see histology image) demonstrates a cystic cavity (white area in the middle of the image) that is lined by stratified squamous parakeratinized epithelium without rete ridges. Desquamated epithelial cells fill the cyst lumen. Lymphoid tissue is noted surrounding the cystic space with germinal centers often being present, but not always.

Surgical excision is the treatment of choice. Recurrence is rare. The differential, based on the yellow color, typically includes a lipoma (tend to be larger), abscess (drainage usually noted), tonsillolith (not usually covered by epithelium).

Works Cited

Neville, Damm, Allen, Chi (2016). Oral and Maxillofacial Pathology, 4th Ed. St. Louis: Elsevier. Dr Bryan Trump University of Utah School of Dentistry

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