States remove stigmatizing mental health questions from dental licensure applications

Reforms prevent discrimination against dentists seeking care

States across the U.S. continue to take steps to remove stigmatizing questions related to mental health, including substance misuse, from dental licensure applications.

In September, leaders from the American Dental Association and the Federation of State Medical Boards presented a unified message at the American Association of Dental Boards annual meeting that patient safety is a priority and can be enhanced through efforts that safeguard provider health.

According to survey data from the 2024 ADA Council on Communications Trend Report, 36% of dentists felt defeated, wanted to quit dentistry or did not want to go to work at least several times a month in the six months leading up to the survey and 82% felt some type of major stress in their career.

In 2023, the ADA House of Delegates passed a resolution to assist states in developing and advocating for legislation or regulations that prevent discrimination in licensing, credentialing and other matters against dentists who have ever received counseling, therapy or treatment for mental health issues, including substance misuse.

Three states — Florida, New Jersey and Wisconsin — are participating in the ADA’s pilot program. Read about these states and others below that have achieved licensure reform or are in the process of making changes. More resources related to licensure reform and other wellness topics are available at ADA.org/wellness.

Texas

In 2023, the Texas State Board of Dental Examiners moved away from "have you ever" questions dealing with treatment for depression and substance use disorder, changing language on both initial and renewal licensure applications.

Applications now include the following question, which is consistent with recommended language from the Federation of State Medical Boards that addresses current impairment: “Are you currently suffering from any condition for which you are not being appropriately treated that impairs your judgment or that would otherwise adversely affect your ability to practice dentistry in a competent, ethical and professional manner?” Current impairment is different from current illness or treatment.

The board also includes language below the question that states it recognizes dentists may face mental health and substance use issues and lists options they can pursue, such as seeking medical care, self-limiting their practice or anonymously self-referring to the Professional Recovery Network, a peer assistance program dedicated to helping health care professionals enter treatment confidentially. The language states that if dentists fail to adequately address a health condition that makes them unable to practice dentistry with reasonable skill and safety to patients, the board may take action against their license.

The Texas State Board of Dental Examiners was the first state board of dentistry to be recognized by the Dr. Lorna Breen Heroes' Foundation as a Wellbeing First Champion. The foundation, which was started by the family of an emergency room doctor who died by suicide in 2020 during the COVID-19 pandemic, champions licensure and credentialing reform for physicians and other health care providers.

A coalition led by the foundation developed the Wellbeing First Champion Challenge program to support licensure boards in auditing and changing their applications, forms and addendums to be free of intrusive mental health questions and stigmatizing language. The coalition verifies these materials and then recognizes licensure boards as a Wellbeing First Champion.

Virginia

In 2023, the Medical Society of Virginia reached out to the Virginia Dental Association to see if it would support legislation seeking to remove stigmatizing and antiquated questions about mental health from all state health care provider licensure forms. The bill was passed and signed into law that year and went into effect immediately.

Licensure applications now include the following two questions: “Do you have any reason to believe that you would pose a risk to the safety or well-being of your patients or clients?” and “Are you able to perform the essential functions of a practitioner in your area of practice with or without reasonable accommodation?”

The Medical Society of Virginia also asked the Virginia Dental Association if it would support adding dentists and dental hygienists to the state’s SafeHaven program, which allows health care providers to seek help for career wellness and burnout without fear of losing their professional license. The program initially was limited to physicians when it was established in 2020. The updated SafeHaven legislation went into effect July 1, 2024.

State dental associations may consider reaching out to their state medical societies to see if there is an opportunity to work together on licensure reform for health care providers.

Iowa

After an Iowa dentist died by suicide in 2020, the Iowa Dental Association and Iowa Dental Board recognized the urgency in addressing dentists’ mental health and eliminating stigmatizing language from initial and renewal licensure applications.

In June 2024, the board eliminated all questions related to medical conditions, alcohol and drugs from applications. Instead, applicants have to indicate they have read and understand a health notice that states the board understands dentists may struggle with mental health conditions and substance use disorders and expects them to properly address these concerns. The notice provides a link to practitioner health programs and states dentists could be subject to board review if they fail to address health conditions that may impair their ability to meet the minimum standard of care.

Minnesota

The Minnesota Board of Dentistry changed its licensing questions so that dentists who participate in the Health Professionals Services Program or want to self-refer are not penalized for doing so and getting the help they need. The program monitors and assists licensees with physical, psychological and substance use disorders so they can still practice as long as they are accountable and compliant with the program.

Licensure applications currently ask dentists if they have any diagnosed and/or treated mental, physical or cognitive condition or illness that has not been reported to the program and could affect their ability to practice with reasonable skill and safety. Another question asks the same thing about substance use disorders.

Oregon

The Oregon Dental Association has been pursuing licensure reform since August 2023. Its goal would be to have the Oregon Board of Dentistry eliminate “have you ever” questions from dental licensure applications to align with updated language already used by the Oregon Medical Board for physicians. The Oregon Dental Association’s efforts are supported by the Oregon Dental Hygienists’ Association and two large group practices that employ about a quarter of dentists in the state.

North Dakota

The North Dakota Dental Association is working with the North Dakota Board of Dental Examiners to include dentists in physician assistance programs by 2025. After that change takes place, the organizations plan to review licensure application language.

Florida, New Jersey, Wisconsin

In 2023, the ADA Council on Dental Practice surveyed state dental associations, and 16 responded with interest in participating in the ADA’s pilot program to get started with auditing dental licensure applications, changing questions that may be barriers for dental professionals to seek mental health care and communicating any changes to licensees.

A workgroup from the council’s Dental Team Wellness Advisory Committee selected Florida, New Jersey and Wisconsin to participate in the project based on several criteria, including whether dentists’ initial and renewal licensure applications could be improved to remove intrusive questions.

ADA and state dental association staff met with an American Medical Association subject matter expert to identify direct and indirect language in dental licensure applications that could be considered stigmatizing. While many of the questions were appropriately aligned with language used in other physician licensure applications, the American Medical Association reviewer found each dental application asked at least one “have you ever” question related to an applicant’s past adverse actions or behavior.

Each application also included at least one question about the applicant’s mental health and substance use treatment that was inconsistent with recommendations from the American Medical Association and Federation of State Medical Boards. Recommended language addresses all mental and physical health conditions as one, similar to the question currently included on dental licensure applications in Texas.

The reviewers also found each application could benefit from a positive statement indicating the board encourages individuals suffering from mental health or substance use disorders to seek confidential care or assistance. There are 29 physician health programs in 28 states, including two in Arizona, that are members of the Federation of State Physician Health Programs. These programs offer confidential support to dentists and, in some cases, dental team members.

The state dental associations are reviewing the recommendations they received about their licensure applications and will determine their next steps to approach their state dental boards.