You are sweating, feeling restless, tense, irritable and notice that your heartbeat has sped up.
You are stressed out, on the precipice of your breaking point.
But you are not alone.
With May being Mental Health Awareness Month, the ADA is ramping up its efforts to show its member dentists that the Association and the profession is committed not only to helping dentists facing overwhelming stress and anxiety but also supporting members’ wellness so that patient care is never compromised.
“As dentists, taking care of our mental health allows us to take care of others. Now, more than ever, our profession must prioritize the mental health of all dentists so that they can provide the very best oral health care to their communities,” said ADA President Cesar R. Sabates, D.D.S. “Mental health is a vital part of the health, happiness, and overall well-being of our members.”
The 2021 Dentist Well-Being Survey Report revealed that the percentage of dentists diagnosed with anxiety more than tripled in 2021 compared with 2003.
Results from the 2021 survey indicated that dentists continue to be plagued with mental and emotional health concerns. Many were less likely to feel in control of their work environment, reported a higher level of stress at work and scored high on a depression scale.
According to the survey, many dental professionals are dealing with burnout and other conditions related to stress that in worst-case scenarios could impair their abilities to practice competent dentistry.
Dentists from across the ADA agreed with Dr. Sabates’ message that there is a sense of urgency in the message that mental health is an ongoing process deserving of sustenance.
“We want people to know that this whole stigma of needing to hide from mental health issues must be addressed now,” said Seth Walbridge, D.M.D., chair of the ADA New Dentist Committee.
Prioritizing mental health
The magnitude of mental health’s importance was re-emphasized at the Las Vegas convening of the 2021 ADA House of Delegates.
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 re-sources to support the mental health of dentists and collect information regarding existing health and wellness programs from across the tripartite and other professional organizations including, but not limited to, the American Student Dental Association and the ADA New Dentist Committee.
It further resolved that the ADA use the collected information to:
The resolution also instructed the ADA to explore safeguarding dentists from punitive action by state dental boards with regard to mental health issues and report back to the 2022 House of Delegates with an actionable plan.
Dentistry ‘relatively stressful career’
Amir Karzim, D.D.S., a Long Beach general dentist, attested to the demands of delivering care amid the pandemic.
“COVID-19 had compounded the stresses in my own life but the lives of those around me as well,” he said. “From adapting my sleep schedule in the early onset of the pandemic to allowing more time to put on and take off PPE, to having to placate frustrated patients dealing with the additional stringent regulations to seek care for their oral health. COVID has made dentistry in the 2020s an emotionally taxing journey.”
Jessica Cohen, D.M.D., an Illinois-based orthodontist, said that she thinks the events over the past two years have definitely changed dentistry stress levels, and enumerated the reasons.
“Office air filtration systems are more complex in some offices, which is added overhead,” she said. “[Other reasons include] N95 mask wearing, a smaller potential employee population which can lead to staffing issues, dentists retiring earlier than anticipated, small practices merging with larger practices, et cetera.”
Shane Ricci, D.D.S., a member of the ADA Council on Dental Practice, agreed.
"I think, in general, being a dentist has always been a relatively stressful career," Dr. Ricci said. "The nature of working in a person's mouth, often while they are in pain and have anxiety, and then asking them to pay a sometimes large balance that isn't covered by their insurance, among many other challenges, can be stressful in the best of scenarios."
Dr. Ricci added: "Add to these stresses the effects during and post pandemic, increasing costs of PPE, inflation, insurance companies cutting fee schedules and other evolving complications to dentistry. I think all of these factors weigh heavily on dentists, especially as many of us have large student loans, families to support and retirements to consider. I know for me, personally, the last couple of years has increased my own anxiety and stress levels."
Robert Trager, D.D.S., a New York-based dentist, said he sees many people every day who are stressed out, and those stresses can carry over to dentists like him who treat them.
"It's been very stressful," he added, saying that many of his dental colleagues are bemoaning the fact that they can't and hygienists and assistants due to the nationwide staff shortage.
The ongoing COVID-19 pandemic has added stressors to dentists' lives, said Jim Hoddick, D.D.S., ADA Council on Dental Practice chair, along with other factors.
"I don't think that increased stress is unique to the dental profession," Dr. Hoddick added. "It is my sincere hope that we can all help support each other as we come out of this pandemic."
Dr. Hoddick's comments about stress affecting all is backed by a 2021 survey of 1,500 U.S. workers that reported that more than half were feeling burned out as a result of their job demands. About 4.3 million Americans quit their jobs in December 2021 in what has come to be known as the Great Resignation.
Dr. Walbridge said that the "pandemic has crushed many dentists with added stressors."
He continued: "Obviously, the financial aspect of the pandemic is a stressor, but now we have a major shortage of staff and team members to help provide for patients. This is currently what I feel is one of the major concerns seen across the country and related to the pandemic."
Psychology of stress
Sheela Raja, Ph.D., a clinical psychologist and associate professor at the Colleges of Medicine and Dentistry at University of Illinois Chicago, leads the college's Resilience Center.
"The pandemic has been particularly stressful for dentists," said Dr. Raja. She added that - rightly so - there was a lot of focus on frontline health care providers such as emergency department physicians, but there also needs to be a focus on dentists and mental health.
Dr. Raja said that dentists are human beings, understandably affected by what is happening in the world at large.
"Many people are struggling with anxiety and depression right now," she said. "There have been so many prolonged stressors in recent years that we must and ways to support the well-being of our health care workforce - including dentists."
Dr. Raja talked about the need for trauma stewardship - the idea that that people need to take care of themselves if they are going to be able to care for others. If that doesn't happen, she said, what could result in what is called compassion fatigue, where dentists are in danger of losing empathy for patients because the providers are feeling so overwhelmed.
There is also another type of trauma that could happen to dentists, she said.
"Vicarious trauma is when we might be taking on the stressors of the patients we serve," Dr. Raja said.
"If we are serious about wellness in health care and health care providers, it is going to take individual and policy change to make it work," she said.
The ADA has also been active in advocating for help for dentists struggling with mental health issues.
In March, a coalition that included the ADA praised Congress for passing the Dr. Lorna Breen Health Care Provider Protection Act, legislation that will give health care workers better access to education and training in order to manage stress.
Lorna Breen, M.D., was an emergency room physician in New York who died by suicide in 2020 after treating COVID-19 patients.
In a March 8 letter to leaders in the House and Senate, the coalition, led by the American College of Emergency Physicians, thanked the lawmakers for sponsoring the bill.
The coalition said the COVID-19 pandemic has magnified longstanding issues faced by front line health care providers and stressed there "has never been a more critical time" to address mental health.
"By passing this bipartisan and bicameral legislation, lives will be saved," they wrote. "For decades, health care professionals have faced greater rates of mental and behavioral health conditions, suicide and burnout than other professions, while fearing the stigma and potential career repercussions of seeking care," the letter continued.
"When we take care of our health workforce, we ensure that patients have optimal care and support and that our health care systems can thrive," the letter concluded.
"As a profession, we should all be aware that our colleagues, staff, patients are all under stress. If we are concerned about them the ADA offers many ways to help," said Jim Hoddick, D.D.S.
ADA resources to help
"As for me, I plan to share a smile and give an unexpected act of kindness," said Dr. Hoddick. "As a profession, we should all be aware that our colleagues, staff, patients are all under stress. If we are concerned about them the ADA offers many ways to help."
The New Dentist Committee, in collaboration with other divisions in the ADA, is working with Chicago-based nonprofit Hope for the Day to add to the resources the ADA has to let dentists know that help is out there.
Hope For The Day, empowering the conversation on proactive suicide prevention and mental health education, was created in 2011 by its founders to honor friends and family who had died by suicide.
Since then, the nonprofit has evolved and grown by creating educational resources and programming called Proactive Prevention, and its work is already represented in all 50 states, 26 countries and 17 different languages.
There is also the ADA's Dentist Health and Wellness Program, composed of dentists and dental team members who are concerned about the health and well-being of their peers.
"Given all the recent events that have affected members of our profession, I think now is as important a time as ever to help raise awareness while also facilitating acceptance of those who may be affected by mental health issues," said Princy Rekhi, D.D.S., chair of the ADA Dental Wellness Advisory Committee.
The ADA website itself houses many resources on mental health at ADA.org/Wellness, including The Ultimate Workplace Mental Health Kit, co-developed by the National Alliance on Mental Illness Chicago, part of one of the nation's largest grassroots mental health organizations. In 2021, NAMI Chicago entered into a formal agreement with the ADA to develop a series of mental wellness tools and resources that can be used easily and effectively in the dental practice setting.
In addition, the ADA's Beyond the Mouth podcast series explores a range of non-clinical issues affecting dentists and their teams. Several of these podcasts include discussions with experts on how dentists can increase self-care and staff -care during COVID-19 and beyond.
The ADA Accelerator Series is an online hub for wellness, leadership and work/life balance tools that Manny Chopra, D.M.D., a member of the Council on Dental Practice, recommends.
"One concern that has arisen in the past few years, which has been exacerbated with the COVID-19 pandemic, is the mental wellness and general health of our practitioners," he said. "The financial stress of running a business, the higher cost of PPE and the lower reimbursement rates from dental benefit providers has resulted in poorer sleeping and dietary patterns for many dentists. At the ADA, we are studying these stress patterns and through the Accelerator Series, we are providing education and guidance to practitioners with any assistance that they may need."
Keeping active can burn off stress.
Dr. Traeger said that he goes to the gym every day of the workweek to keep his worries at bay and believes that talking about them openly can be helpful.
"You have to keep active," he said. "The more you avoid it, the worse it is."
In 2021, ADA Member Advantage endorsed ClassPass, which allows Association members free access to over 4,000 hours of on-demand audio and video workouts. ClassPass, a monthly subscription service that provides access to tens of thousands of different studios, gyms and wellness offerings in over 2,500 cities worldwide, allows ADA members to receive 10% off on in-person class packages.
Kayla Yip, D.M.D., is a resident at the University of Illinois Chicago College of Dentistry and ClassPass member. She said thatstress is a part of life, but she has found ways to not sacri?ce what she calls "wellness time."
"You have to listen to your body," she said. "We have to take care of ourselves."
ADA members can visit ADA.org/ClassPass and sign up for discounts using the company code ADA2021.
State well-being programs
According to the 2021 Dentist Well-Being Survey Report, less than half (46%) of dentists were aware of available of state dentist well-being programs.
For those unaware and in need, the ADA Catalog features a free- for-members offering, the Dentist Well-Being Program Directory, which contains the contact information for the well-being programs offered in the 50 states and the District of Columbia.
Barry Taylor, D.M.D., is the executive director of the Oregon Dental Association, which has a wellness committee as well as a Peer to Peer Ambassador Program developed in partnership with a psychologist.
Dr. Taylor is open about talking about his own experience batting depression, so supporting the mental wellness of dentists is a priority of his.
"Dentistry has always been stressful," said Dr. Taylor, whose past includes stints as a practitioner and in academia. "It's particularly stressful now."
The ODA's Peer to Peer Ambassador Program offers a network of colleagues armed with resources to help support dentists and dental students who are dealing with wellness issues, including, but not limited to, stress management, practice issues, debt, fraud, family obligations, illness, isolation, injury, depression, loss, grief and addiction.
In addition, in 2021 the ODA partnered with Permanente Dental Associates and the Oregon Wellness Program to offer free access to well-being resources for all licensed Oregon dentists. The expansion of the program to include Oregon dentists means ODA members can now receive up to eight free confidential, anonymous counseling sessions with one of the Oregon Wellness Program's mental health clinicians.
As an association - by definition a connection or cooperative link between people - the ODA believes that associations' roles are crucial, Dr. Taylor said.
"We're in a unique position to help," he said. "We should be taking care of one another."
"This is why we are at a pivotal point in our society," Dr. Kazim said. "We are now having open frank discussions about mental health. With the advent of technology,we even have the options for mental health discussions at our fingertips in the form of mobile apps. This allows those who need help to seek it without having to deal with stigmas placed by differing societies or expectations."
He continued: "If you are not well, how can you be expected to help others seek wellness in their own right? We must be at our best - physically, spiritually and mentally - so that we can be prepared to help our patients seek the best care possible. This is why self-care is so integral for optimal performance. Wellness, in all respects, is important to manage a healthy life."
If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK).