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Beyond the Bite

The Official Blog of the Florida Dental Association

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Responding to the Mental Health Needs of Dentists

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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 AA for dentists. These groups were a lifeline for dental professionals with substance use. Due to stigma, they were also a wellkept 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

How to Stay on Track with Your Professional Development Plan

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By Karen Weeks

A professional development plan is key to a successful career in the dental field. By assessing your skills and knowledge, setting goals and getting the necessary training or continuing education, you can boost your career and achieve your long-term goals. The Florida Dental Association invites you to keep reading to learn how to create a professional development plan to help you stay on track.

Create a Standout Resume: Robert Half points out that one of the most critical parts of any professional development plan is creating a stellar resume. Your resume is often the first impression you make on potential employers, so it’s important to take the time to craft a document that accurately reflects your skills and experiences. An online resume maker is the easiest way to create a standout resume. 

Gauge Your Current Skills and Knowledge: Before you can set goals, CareerAddict notes that you need to assess your current skills and knowledge. This will help you identify areas where you need improvement. There are several ways to evaluate your skills and knowledge. You can take an online quiz or assessment, participate in a focus group or reflect on your past experiences. Once you have a good understanding of your strengths and weaknesses, you can begin setting goals.

Be Prepared to Adjust to Varying Roles: As you progress in your dental career, your professional roles will inevitably change. It’s important to adjust your professional development plan accordingly. For example, if you are promoted from an entry-level position to a management role, you will need to update your plan to reflect your new responsibilities. As your roles change, so should your goals. Be sure to regularly review and update your professional development plan always to reflect your current situation.

Assess Whether You Need Additional Training or Education: Once you have assessed your skills and knowledge and set goals, it’s time to get the necessary training or continuing education. There are many ways to do this, such as taking classes at a local community college or university or attending workshops or seminars offered by professional organizations. Many employers also provide training programs for employees who wish to further their careers within the company. Be sure to take advantage of these opportunities when they arise.

Keep Documentation of Your Development: It’s essential to document your professional development along the way so that you can track your progress and show potential employers what you have accomplished. Keep copies of certificates or transcripts from courses or training programs you have completed. You can also keep a portfolio of projects you have worked on or articles you have written. Whatever method you choose, be sure to keep meticulous records so that you can easily access them when needed.

What’s more, instead of using many files, you can keep all related documents in one file, which will cut time on having to find a document. To delete PDF pages, you can use an online PDF page remover to quickly delete pages and then save your file when you’re done. 

Prepare to Start Your Own Business: If starting your own business is one of your ultimate goals, it’s important to understand what it takes to make that dream a reality. In addition to having a detailed business plan, you will need capital investment, market research and a solid understanding of small business accounting. You must also obtain the necessary licenses and permits before starting operations. 

Give careful consideration to how you structure your business. An limited liability company (LLC) provides extra protection, flexibility and tax benefits. You can affordably file your LLC by working with a formation service but read reviews to help you decide which service is best for you. While starting a business is no small feat, it can be immensely rewarding both professionally and personally.

A well-thought-out professional development plan is essential for anyone looking to boost their career in the dental field. By taking the time to assess your skills and knowledge, set goals, get the necessary training and learn how to start a business, you can put yourself on the path to success. Use the tips outlined above to create a professional development plan to help you stay on track and achieve your career goals.

The Expiration of Telehealth Waivers for Dentists: Navigating the Future of Remote Dental Care

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Over the past couple of years, telehealth has revolutionized the healthcare industry, including dentistry. However, as the COVID-19 pandemic wanes and the healthcare landscape evolves, the telehealth waivers that allowed dentists to provide virtual care through non-compliant platforms are expiring. Let’s explore the implications of these expiring waivers and how dentists can navigate the future of remote dental care.

The Rise of Telehealth in Dentistry:

Telehealth emerged as a crucial tool during the pandemic, enabling dentists to connect with patients remotely for consultations, follow-ups, and non-emergency care. These waivers expanded access to dental services, particularly for underserved populations, reduced unnecessary in-person visits, and improved overall patient experience. Dentists embraced telehealth to ensure continuity of care while minimizing the risk of virus transmission.

Implications of Expiring Waivers:
Using platforms like Apple Facetime, Skype, Zoom, and other non-public facing platforms were part of the Notice of Enforcement Discretion the OCR laid out in March of 2020. Now that virtually every EHR/PM solution and other technologies have emerged over the last 3 years, practices can easily implement compliant solutions.

Dentistry will always predominantly be an in-person health care service but with the expiration of telehealth waivers, those dentists that found telehealth an important addition to their practice need guidance on which compliant platforms to use. Dentists must evaluate the effectiveness, efficiency, and patient satisfaction associated with virtual care. Additionally, they should consider the legal and regulatory implications of providing telehealth services without waivers and adapt their practices accordingly.

Navigating the Future of Dental Care:

To navigate the post-waiver landscape, dentists can take several steps. First, staying informed about the evolving guidelines and regulations surrounding telehealth is crucial.

• The first step is assessing risks and vulnerabilities through a Security Risk Analysis. This knowledge will help dentists adapt their practices and comply with existing laws.

• Second would be to have policies in place to ensure the telehealth services these dentists provide to patients is telling the story of how they are protecting that sensitive patient information.
 
• Finally, investing in technology and software solutions that facilitate secure and efficient virtual consultations can enhance the patient experience and practice efficiency.

Conclusion: While the expiration of telehealth waivers poses challenges for dentists, it also presents an opportunity to evaluate and refine the role of telehealth in dental care. By staying informed, embracing hybrid models, and leveraging technology, dentists can continue to provide high-quality care while adapting to the evolving healthcare landscape.

Questions regarding HIPAA and OSHA Compliance, please email Abyde at info@abyde.com or call (800) 594-0883

A Brief History of Why Pediatric Dentistry Needs Pediatric Anesthesiology

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By: Dennis Stone M.D.

Anesthesiology in Great Britain and Europe developed during the Enlightenment almost exclusively as a medical subspecialty on equal footing with Surgery. American Anesthesiology has roots in three medical disciplines; Dentistry, Nursing and Medicine.  

In the 1840’s Dentists and others discovered anesthetic properties of N2O (Colton and Wells), Ether (Jackson, Long, Morton) and Chloroform (Simpson). It was the dentists who developed the first practical clinical applications when dentistry consisted mostly of extraction of painful, infected teeth. John Snow developed a directional valve apparatus for the administration of ether and became the first known full time medical anesthesiologist publishing a book on ether administration in 1847.     

The Civil War during the 1850’s spurred the advancement of trauma care.  Unfortunately, early in the war the skill of a surgeon was judged by 30 second amputations.  Later in the war, nurses were recruited to provide open drop ether allowing more skilled surgical treatment. Officers were given scarce anesthetics and the southern General Stonewall Jackson was an early victim of silent aspiration (Mendelson’s) syndrome during anesthesia. He died of aspiration pneumonia 3 days postop.

After the Civil War medical/surgical treatment advanced and intra thoracic and abdominal surgery became possible but with a high mortality.  Macewen in 1878 reported the first elective endotracheal intubation for anesthesia. Anesthesia care improved with the pioneering work of physicians and surgeons such as (Hewitt, Dragger, and Boyle) who developed safer anesthesia machines capable of titration of anesthetic gases.  Lewis Wright 1940 introduced curare for muscle relaxation and the era of modern anesthesia was begun.  Halothane (1954) was a significant improvement over ether and chloroform but there were problems with cardiac depression and rare instances of liver damage. Sevoflurane was introduced in 1971 replacing Halothane and Propofol in 1989 replaced Pentothal. Both agents were much safer than their predecessors.

Until the 1980’s there were incremental improvements in drugs supplies and equipment yet injury or death from anesthesia related causes remained high in the neighborhood of 1:10,000 anesthetics with anesthesiologists paying malpractice premiums similar to neurosurgeons , cardiovascular surgeons , general surgeons and obstetricians.

What happened in the 80’s? Three things; the invention and clinical use of pulse oximetry and capnography; and the establishment of the American Society of Anesthesiologists (ASA) Closed Claims Project (1984). The Anesthesia Closed Claims Project’s goal is to identify anesthesia-related major safety concerns, patterns of injury and prevention strategies in areas where anesthesiologists provide care. The idea of analyzing closed malpractice claims as a method of improving patient safety was that of Drs. Pierce (Chairman) and Richard J. Ward, M.D., (Professor Emeritus) , of Anesthesiology University of Washington in Seattle. Jeff Morray M.D. a pediatric anesthesiologist at the University of Washington in Seattle was one of the original committee members.

Lessons learned from the closed claims data were published in peer reviewed journals and incorporated into anesthesia training programs as well as Continuing Medical Education (CME) materials for practicing anesthesiologists. Patient safety became the central focus for the ASA leadership resulting in the eventual creation of subspecialty fellowship training and board certification of anesthesiologists in Critical Care Medicine (ICU), Obstetrical Anesthesia, Cardiovascular Anesthesia, Pain Management and Pediatric Anesthesia. Improved surgical and anesthesia care allowed some procedures to move from the hospital to more cost effective surgery centers and office based facilities. Safety Committees established by the ASA developed policies, procedures and guidelines to assist anesthesiologists in providing safe care in these new practice environments. Dr. Hector Vila (Cofounder of PDAA) was chairperson of the Office Based Safety committee and led the effort to provide practical safety guidelines.  Today thanks to these efforts injury or death from anesthesia related causes has improved 100 fold to 1:1,000,0000 anesthetics with anesthesiologists paying much lower malpractice premiums, similar to the low rates of pediatricians  and family practice.

Children sedated in dental offices by dentists have a higher risk of morbidity and mortality because of age (younger the patient the greater the risk), site of the procedure (dental care is in the patients airway), single operator model of dental sedation (dentist attention divided), and sedation effects are difficult to predict (some patients go completely to sleep others are not fazed). Pediatric sedation tragedies continue to occur, are highly publicized and someone on the news report will usually be quoted “No child should ever die in a dentist’s office”. Thus the community standard set by the media is a fantasy of PERFECTION.

Dentistry should consider a Closed Claims Project so that cases are analyzed, lessons are learned and deaths could be avoided. Closed claims analysis could lead to the adoption of Pediatric Dental Anesthesia Standards which are most likely to improve outcomes.                                  

I have been a pediatric anesthesiologist for over 40 years and I love to tell the story of my chosen profession’s journey of continuous improvement. Pediatric Dental Anesthesia Associates (PDAA) is a national leader; we have adapted our anesthesia medications, techniques and equipment to deliver advanced pediatric specialty care in the pediatric dental office. We gather outcomes on every one of over 30,000 cases performed each year and we review and compare outcomes to modify our practice protocols which are uniform across the 26 states and over 600 Pediatric Dental Practices served. The investment in quality improvement and safety has been the single most important factor in the success of our practice.

Today, pediatric dentists are able to provide excellent care to children using lasers, innovative materials and techniques. Yet, expert dental care is difficult to deliver because of high rates of dental decay, and changes in parenting and social norms. Modern restorative pediatric dental care means more young children than ever need sedation. 

Pediatric dentistry requires safe, humane and predictable anesthesia for short and longer dental procedures. Our patients deserve the highest standard of care when it matters most.

 Dennis Stone MD 8/23/2022