Dentistry Under the Influence

Lifeline Liability

According to the American Dental Association’s 2021 Dentist Health and Well-Being Survey, most dentists are reporting moderate or severe stress at work. Dental professionals at every stage of practice as well as dental students are dealing with burnout, substance use disorders (SUDs) and other conditions that may impair their abilities to practice competent dentistry.

SUDs can affect anyone. Matthew Korn, DDS, chairs the California Dental Association’s Wellness Program, a source of support to the association’s members who are facing physical and/ or mental ailments, including anxiety, depression and substance dependence. Dr. Korn himself battled alcohol dependency from his college years and into his early years practicing dentistry, although by his own words he was “born an alcoholic.” He later developed prescription-opioid dependency.

“It got worse and worse over the course of 15 to 20 years, so it wasn’t a single event — it wasn’t a one-time lightbulb that came on where I realized I needed help,” he said. “And for years I remember thinking I was too smart to succumb to this disease. Obviously, I was proven wrong.”

Eventually, enforcement officers with the Dental Board of California’s Diversion Program showed up at his dental practice with badges and guns.

“I thought my life was over,” Dr. Korn said.

Fortunately, that was not the case. Intervention led to recovery. Korn was able to maintain his license, continued practicing dentistry and emerge from recovery with new insights, tools and confidence.

Substance abuse and dentists

The risk factors that contribute to SUD are complex. They include genetic and environmental influences, personality, social pressure, availability of drugs and coexisting mental health problems. It is estimated that 10-15% of healthcare experience SUDs, and that 1 out of 10 dentists will suffer from alcohol or drug abuse at some point in their lifetime.

Dental professionals at every stage of practice as well as dental students are dealing with burnout, substance use disorders (SUDs) and other conditions that may impair their abilities to practice competent dentistry.

The most obvious impact of substance abuse in the dental profession is the direct risk to dentists and their patients. Impaired dentists are more likely to make mistakes or harm patients. They cannot deliver the best care to their patients and pose a real danger to themselves and others. Practicing dentistry under the influence of alcohol or drugs is a violation of the

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ADA’s Principles of Ethics and Code of Professional Conduct, which states that, “The dentist has a duty to refrain from harming the patient.”

Early identification of the signs and behaviors associated with substance use disorder and drug diversion reduces the risk of harm to patients and providers. Staff play an important role by reporting any concerning behaviors witnessed within the office to a supervisor or their local dental board. Some signs of that indicate potential alcoholism or chemical dependency include: • Frequent tardiness or unexplained absence • Difficulty meeting scheduled appointments and/or deadlines • Impaired motor coordination • Prescribes large doses of controlled substances • Frequent and prolonged bathroom breaks • Obvious physical changes; lack of attention to hygiene/appearance • Dramatic mood swings • Periods of isolation • Unexplained family and/or financial difficulties • Decline in quality of care or exercising poor judgment with treatment plans

It is an extremely uncomfortable experience for a dentist to discover they have a colleague who may be abusing drugs or alcohol. However, the ethical duty is clear. The American Dental Association’s Principles of Ethics and Code of Professional Conduct states, “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.” When there is a need to report, ensure confidentiality and maintain an atmosphere of mutual respect and accountability.

Staff play an important role by reporting any concerning behaviors witnessed within the office to a supervisor or their local dental board.

Getting confidential support

If you believe a colleague has an alcohol or chemical dependency problem, the American Dental Association offers resources to seek help. You can download its directory of well-being programs offered nationwide or email dentalpractice@ada.org for confidential assistance.

Dr. Korn offers hope and encouragement that there is support and help available to other dentists struggling with SUD. “They’re going to get the help they need,” he assured. “Dependence is treatable.”

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