Your Wellness Committee was recognized as the best in the nation by American Association of Dental Boards. In 2019 the TDA’s Wellness Committee was dissolved and its responsibilities were transfer to the Tennessee Dental Wellness Foundation (TDWF). The TDWF is a nonprofit, 501c3 that works with dental professionals like the Wellness Committee did in the past. It is supported and promoted by the TDA but operates independently of the TDA. Simply stated, the mission of the Foundation is: “Restoring lives to a life worth living, saving careers, and thereby serving the dental patients of Tennessee.”
Introduction
Working in the dental profession can be emotionally stressful, physically demanding, and mentally exhausting. As dental professionals, we are only human, but many times feel the pressure to perform with superhuman perfection and at an unrealistic pace. Recognizing this potential problem, the Tennessee Dental Association (TDA) established the Wellness Committee in 1981. Since that time it has discretely assisted hundreds of our dentists, dental hygienists, and dental assistants practicing in the State of Tennessee when they might succumb to difficulties that are capable of affecting their performance.
For example, we have assisted in situations where age-related decline in performance is cause for the staff and/or family to be concerned. This decline in performance may be physical, emotional, and/or mental. Sometimes our loved ones spot this decline in performance before we do. It is sad to see a dental professional who has dedicated his life to his profession and patients decline to the point that he needs to be encouraged to retire, seek medical help, or seek other opportunities. What would be worse is if the Tennessee Board of Dentistry needed to take action. Dealing with these difficult situations is what we do.
There are many chronic diseases that can cause a decline in performance long before age is an issue. Diabetics need to be aware of their disease’s effect on their eyes and peripheral neurological function. Hypertension, which may lead to strokes, might affect performance. Arthritis, back and neck dysfunction, and pain can hinder the ability to function optimally. It is not uncommon for our colleagues to become dependent on opioids while attempting to manage pain that might be secondary to practicing our dental profession. It would be sad to see the Tennessee Board of Dentistry take punitive action against a colleague who is struggling with a chronic disease that might affect his professional performance. Again, dealing with these challenging circumstances, hopefully, before the Board becomes involved and dental professionals and patients suffer, is what we do.
By far, the most common condition we assist in is what is now termed substance use disorder (SUD). The Centers for Disease Control (CDC) has called the opioid dependency in our country an “epidemic”.1 Drug overdoses accounted for 52,404 deaths in the United States in 2015 and approximately 63% involved an opioid.2 Of the overdose deaths, approximately half involved an opioid obtained from a prescription.3 Each year in the United States it is estimated that prescription opioid overdose, abuse, and dependence cost approximately $79 billion.4 These facts should call our attention for the necessity of prudent prescription writing.
This epidemic affects the public at large but also takes a toll on our colleagues, patients and families as well. This is even more reason to understand this disease and how the TDWF can benefit you.
Substance use disorder is classified as a chronic disease much like diabetes, hypertension, obesity, and rheumatoid arthritis. Studies have shown that at least 10% of the general population will have a SUD at some point in their life. Many assume it is higher among health care professionals due to a plethora of reasons such as easy access to prescription medication and the stress associated with our profession. Much like other chronic diseases, studies have led experts to report that at least 40% (and some report as high as 60%) of SUD is due to genetic factors.5
By definition, chronic diseases are multifactorial in nature, leading to multifactorial control of the disease. There is no “one size fits all” cure nor is there one treatment to cure a chronic disease. Therefore, most chronic diseases tend to be hard to manage. Some authors report only 30% of the population that have a chronic disease have it maintained well at any one time. Long-term follow-up and support are key to keeping any chronic condition at bay.6
TDWF being recognized as one of the top organizations in the United States did not happen by accident. It is the long-term follow up and support that has afforded us an approximately 90% success rate. Like most successful endeavors, a well-thought-out system or approach that is developed, instituted, and followed are the keys to success. This approach has been proven to “restore lives, save careers, and thereby serve dental patients of Tennessee.”
The System (See Fig. 1)
Identification
Normally, the first step in assisting a colleague is having the individual identified as having some difficulty that may be interfering with their professional performance. These leads can come from many different sources including patients, staff members, colleagues, friends, and family members. Also, a colleague may self-report, asking for help, direction, and support. Many times the identification process is when you, as a member of our profession, have an important role to play. This is an ethical obligation which we all share. The ADA states, “All dentists have an ethical obligation to urge chemically impaired colleagues to seek treatment. Dentists with first-hand knowledge that a colleague is practicing dentistry when so impaired have an ethical responsibility to report such evidence to the professional assistance committee of a dental society.7 To know a problem exists and do nothing could cost a colleague, patient, or family member their life.
You can feel absolutely safe when reporting information to us. Your identity will not be shared with anyone, without your permission. This information is absolutely confidential and it cannot even be subpoenaed. While your name will never be revealed, if our recommendations are not followed and we think patients are in danger, we are ethically required to inform the State Board of Dentistry of our concerns involving the practitioner in question. We will not report who informed us; we only report the dental professional that seems to have a problem along with our concerns.
Each lead has to be evaluated. Some leads are really domestic disputes, and some maybe disgruntled employees or disgruntled employers, and some might even be a jealous colleague. All of these situations and factors have to be taken into consideration, research has to be done, and a decision has to be made whether an intervention is indicated.
Intervention
A professional intervention is not like an intervention that you may have seen on television or YouTube. A professional intervention is simply colleagues sharing their concern with another colleague. The goal of an intervention is for the person in question to obtain an evaluation. We are not physicians. We do not diagnose or treat SUD. There are trained addiction medical professionals that are approved by the Board of Dentistry that can and will give a medical diagnosis and treatment plan, if it is indicated.
Treatment
Treatment for SUD can be delivered in many forms, such as: residential, outpatient, intensive outpatient, medicines, psychological, psychiatric or a combination of any of the above. Historically, high-risk professionals, such as physicians, dentists, and airline pilots, have received long-term residential treatment for three months or more. Often hygienists and dental assistants may receive shorter, less intense treatment but follow up and accountability normally remain the same.
Remember, SUD is a chronic condition. It cannot be treated like an acute illness that is cured. When formal treatment is completed the patient is normally released with a recommended plan to follow to continue his recovery in a healthy way. These recommendations are critical for long-term success and this is where the TDWF lends its support, guidance, and experience.
After Treatment Contract
The post-treatment recommendation of the treatment center and recommendations which we have found helpful are gathered in the form of a contract. This contact is between the treated individual and the TDWF. It basically states if the individual will follow the guidelines laid out by the treatment facility and the TDWF, the individual will receive our advocacy whenever and wherever needed.
This advocacy is sometimes needed with the State Board of Dentistry, with insurance companies, employers, and occasionally with other forms of local, state, and federal law enforcement. Our advocacy comes in the form of stating the individual has a disease, it has been successfully treated, and the disease is under control. Furthermore, our advocacy informs the concerned institution that the individual is fit and able to practice dentistry in a safe and competent manner. Historically, because of the reputation of the TDWF, our advocacy carries substantial weight with institutions that might be concerned. This is becoming more and more important as nicotine, alcohol, and drug screening become a part of hiring practices and other employment decisions as well as the ability to become medically insured.
On Contract
Most contracts cover a five-year period following successful treatment. While there are a number of phases involved, accountability and documentation are the hallmark of this period of recovery. As the TDWF, we want to be able to substantiate sobriety and recovery so our advocacy can be trusted.
Most contacts include requirements such as: random drug test, daily or weekly support meetings (like Alcoholics Anonymous), weekly professional support meetings, annual retreats, and professional counseling. A primary care physician is required, which the TDWF can communicate with, so any physical complication can be treated successfully and/or monitored. Many of the requirements tend to grow less frequent over the five-year period. Most of the above requirements can be met near the individual’s home and around the work schedule.
The goal of the contract period is not only for documentation so advocacy can be supplied, it is really designed so the individual learns what is necessary to keep this chronic, deadly disease in remission.
Conclusion
If we can help keep this chronic, deadly disease in remission then we have fulfilled our mission to restore a life worth living, save a career and thereby serve the dental patients of Tennessee.
References:
- Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015 Weekly/ December 30, 2016 / 65(50-51);1445–1452. https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm
- Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid-involved overdose deaths – United States, 2010-2015. MMjWR Morb Mortal Wkly Rep 2016;65:1445-52.
- Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2017.
- Florence CS, Zhou C, Luo F, Xu L. The economic burden of prescription opioid overdose, abuse and dependence in the United States, 2013 Med Care 2016;54:901-6.
- Sain David, et al. Genetics and the Disease of Chemical. J Tenn Dent Assoc 86 (4), 26-29. Fall 2006
- Barnes, Henrietta Robin. Hijacked Brains: The Experience and Science of Chronic Addiction. Dartmouth College Press, Hanover, New Hampshire, 2015
- American Dental Association, Council on Ethics, Bylaws and Judicial Affairs, Principles of Ethics. http://www.ada.org/~/media/ADA/Publications/Files/ADA_Code_of_Ethics_2016.pdf?la=en
Authors:
David R. Sain, D.D.S, M.S., Director, Tennessee Dental Wellness Foundation
Nancy J. Williams, R.D.H., Ed.D., Board Member, Tennessee Dental Wellness Foundation
Dale Kennedy, D.D.S. President of Board of Directors, Tennessee Dental Wellness Foundation