Responding to the Mental Health Needs of Dentists

By Alan Budd, DMD

When first-year students at Tufts University School of Dental Medicine feel overwhelmed, they might unwind with a yoga class or meditation session. Dr. Christina DiBona Pastan, an endodontist and director of Mind-Body Wellness at Tufts, has developed a course on wellness that is required of all students. The curriculum focuses on lowering stress to improve students' overall wellbeing, decreasing burnout and increasing resilience.

Support for a dentist's health and wellness has come a long way. The first programs formed in the late 1970s consisted of dentists in recovery; think Alcoholics Anonymous for dentists. These groups were a lifeline for dental professionals with substance use. Due to stigma, they were also a well-kept secret. To an extent, they still are. According to the 2021 American Dental Association (ADA) Wellbeing Survey, only 46% of dentists know that their state association has a wellbeing program.1 The notion that patient care and self-care can coexist continues to escape many of our colleagues.

Front-line worker health suffered terribly during the pandemic. Dentists have had their share of challenges. The percentage of dentists diagnosed with anxiety more than tripled in 2021 compared to 2003, according to the ADA's 2021 Dentist Health and Wellbeing Survey Report.2

Even before the COVID-19 pandemic, health workers were experiencing alarming levels of burnout – broadly defined as a state of emotional exhaustion, depersonalization and a low sense of personal accomplishment at work. Burnout can also be associated with mental health challenges such as anxiety and depression.3

Anxiety and depression aren't the only mental health issues. Many are also experiencing notably higher rates of insomnia, anxiety, stress, fatigue, burnout, depression, somatization, obsessive-compulsive symptoms and post-traumatic stress disorder.4 More than 50% of public health workers reported symptoms of at least one mental health condition, such as anxiety, depression or increased levels of post-traumatic stress disorder (PTSD).5

There has been a notable increase in substance use.6,7,8,9 Experts say misuse of opioids and stimulants is also on the rise.10 In response to a CAGE-AID questionnaire, 12% of dentists agreed with one statement, and 11% agreed with two or more. A "yes" answer to even one item indicates a possible substance use disorder and a need for further testing.11

The isolation of private solo practice, access to controlled substances, denial of a problem because of higher education and enabling coworkers may be partly to blame for difficulty identifying ill or impaired dentists. Direct observation is vital to detecting diversion and may be the only way to identify an impaired colleague.12

These findings and some high-profile suicides among leaders of organized dentistry have spurred the ADA and ADA Council on Dental Practice to take action on supporting the wellness of dentists:

• The House passed Res. 95H-2021, Prioritizing the Mental Health of Dentists, which stipulated that the ADA, in conjunction with mental health consultants, analyze the availability of resources to support the mental health of dentists.13 The ADA is an active contributor to the National Academy of Medicine's Action Collaborative on Clinician Wellbeing and Resilience.14 This program was launched in 2017 to improve baseline understanding of challenges to clinician wellbeing, raise the visibility of clinician stress and burnout and elevate evidence-based, multidisciplinary solutions.15 "The stressors of the dental profession begin with dental students in their first year of dental school. At Tufts, we teach our students practical applications of mindbody practices in the academic and clinical settings and we are seeing the benefits in them personally and professionally. Stress management resilience building skills are essential for overall wellbeing and also contribute to developing grounded professionals enabled to deliver mindful and compassionate patient care," according to Christina

DiBona Pastan, DMD, Director of Mind-Body Wellness Office of Student Services.

• The ADA is training the first cohort of dental professionals called to serve on its new initiative, the Wellness Ambassador Program, in which volunteers will work to ensure that peer dentists struggling with health obstacles are aware of support services. Chief among the ambassadors' messaging is that members and nonmembers can download the ADA Dentist Well Being Program Directory at bit.ly/3YZWdEZ for free through the ADA store to find their state program director's contact information, with all calls or emails kept strictly confidential.16

• The National Council of Dentist Health Programs is a national member organization of state dentist wellness programs (DHP) established in 2022. State member programs provide a confidential, therapeutic alternative to discipline and have the support of organized dentistry in their state, often through legislation, exceptions to mandated reporting, or other safe haven provisions. In addition to working with participants, DHPs provide education, outreach and advocacy to their communities to support dentist health and wellbeing.

If you or a dental colleague are experiencing substance use or other mental health crises, we encourage you to contact the ADA Dentist Wellbeing Advisory Committee. All calls are confidential.

References Available Upon Request