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Am I my colleague’s keeper? Should dentists care about other dentists’ health?

Dr.  Graeme M. Cunningham,  MD, FRCPC

Dr. Harry Vedelago, MD, FCFP

This disease of addiction shows no favourites. Dentists and other health professionals are susceptible to this disease just as they are to other diseases that plague mankind.

Addicted dentists who are reluctant to seek help and cast a blind eye to their problems are hurting themselves, their families and their patients, but also the dental profession as a whole. There is help available.

Over the past 20 years, there has been increasing awareness of the need for mental health and well-being support for health professionals. This began with the well-known Physician Health Program which is now established in every state in the United States and every province in Canada. The American Dental Association has also been part of this movement towards supporting dentists. In the last decade, Ontario has lead the way in Canada to develop a confidential and collegial supportive service for dentists and their families who have addiction issues.

Who’s at risk?

From the perspective of substance use disorder, dentists are no more at risk than the general public. However, they do have a number of risk factors by the very fact that they are dentists.

There is a significant genetic risk. Many dental students come from a home where one or more parents have been alcohol dependent. The personality characteristics of obsessive compulsive traits, perfectionism, the ability to work extremely hard and not looking after one’s own needs: these are characteristics of dental students at risk of substance abuse.

In addition, many dentists practise in solo practices and use mood altering medications both for anesthesia as well as analgesia.

It is possible that self-administration of these chemicals is a risk and at times does occur; for example, the misuse of nitrous oxide.

It has been the experience of the Homewood Health Centre Health Professional Treatment Program that most dentists entering the residential program use alcohol as their drug of choice, but many have also experience with nitrous oxide, cocaine and the opiate class analgesics.

How does it impact a dentist’s life?

Addiction has been described like a target with the addicted dentist in the centre and concentric circles representing the various areas of their life that have been affected one by one by the disease process:

  • Initially family life: family fights, separation and divorce, extramarital affairs and absences occur.
  • Employment status: this is reflected later in job changes, intervals between positions, and inappropriate references from jobs for which the dentist is apparently over trained.
  • The dentist’s health: often a complicated or vague medical history develops, deterioration of physical appearance occurs, withdrawal and intoxication signs are noted and accidents occur.

Professional duties are affected in terms of missed appointments, angry outbursts, sloppy surgical technique and poor dental judgment.

Office personnel are often the first to notice the changes in the dentist’s conduct; mood swings and slurred speech over the telephone are noted. Day-to- day professional conduct is impacted. By the time the disease manifests itself in the office setting, the dentist is very ill.

What questions should be asked?

Many of us use alcohol and prescription drugs in a safe and healthy fashion under the supervision of our own physician or healthy family members. However, a number of us cross the line into dangerous substance use. This is sometimes related to stress at work or just simply the habit of drinking alcohol nightly for relaxation purposes.

In an American Dental Association National Dentist Well-being Survey, dentists were asked four questions:

  1. Have you ever felt that you should cut down on your drinking or drugging?
  2. Have people annoyed you by criticizing your drinking or drugging?
  3. Have you ever felt bad or guilty about your drugging or drinking?
  4. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

If the answer is positive to any two questions, there is an 80% correlation with alcohol dependency. If the answer is positive to three or more questions, there is virtually a 100% correlation with alcohol dependency.

This simple screening set of questions used by family physicians and emergency room doctors very quickly separates those who are heave social drinkers from people who have moved into problematic alcohol or drug use.

Readers of this article may identify themselves within these questions. If you fall into the population who are answering positive to two or more questions, it is advised that further discussion take place with your family physician.

Principals of intervention

The basic principles of success in intervention consist of the following:

  • It should be carried out by more than one colleague, particularly those in positions of authority.
  • It should occur when the dentist is sober and soon after an incident precipitated by the problem.
  • The location should be quiet and non-threatening.
  • Documentation of specific incidents of impaired behaviour should be used if available.
  • Colleagues should have a non-judgmental attitude – the dentist has an illness.
  • Anticipate possible reactions such as denial, anger and threats, including legal threats.

The goal is for the dentist to agree voluntarily to an assessment by an independent specialist rather than to accept a stigmatizing diagnosis and mandatory treatment.

What is treatment?

Treatment of any addiction must begin with abstinence. Abstinence is the key that allows one to enter the room known as recovery. Abstinence is not a goal, it is a state which sometimes needs to be reached through management withdrawal mechanisms, or sometimes can simply be reached by quitting drugs or alcohol oneself.

Basically, treatment is simple. It teaches the addicted dentist how to be sober and how to maintain sobriety despite the normal buffeting of daily life events.

The core of being addicted is to be isolated. Therefore, the treatment is to help the dentist bring healthy people back into their life who can support the journey in sobriety.

Once diagnosed and treated, the prognosis for dentists is excellent. A number of studies have demonstrated an excellent prognosis for addicted dentists who have completed treatment and who have continued on a long-term monitoring program. However, duration of the follow-up care is of key importance.

The monitoring program may simply be attendance at Alcoholic Anonymous meetings or a health professional support group, or it may be more intense involving urine monitoring as well as aftercare contracts.

In this age of expected accountability for health professionals, a significant international wellness movement has developed and the Royal College of Dental Surgeons and the Ontario Dental Association have to be congratulated in leading this initiative in the dental profession in Canada.

After all, the goal is to move dentists from the place of shame of a stigmatizing illness, to the dignity of recovery.