Impaired Dentists Have New Place to Find Help
By David G. Jones
If a tree fell in a forest with nobody nearby to hear it, would it make a sound? While
philosophers continue to ponder that question, some dentists wonder if their darkest secrets will
be noticed in the confines of their solo practices.
Private practice by its nature isolates dentists. Coupled with anxious patients, tedious and
exacting procedures, and easy access to drugs, the combination can lead to substance abuse,
addiction, and emotional disorder problems for some dentists.
In an effort to help dentists who have different impairment issues than physicians, the
nationally
recognized Talbott Recovery Campus in Atlanta. has established the Talbott National Dentist
Treatment Center. It is the first program of its kind in the nation specifically committed to the
recovery of dentists.
"Many centers treat doctors, but there is often a blank expression on the faces of
treatment center
staffs when a dentist's family asks where dentists are treated," said G. Douglas Talbott, MD, a
national expert on physician impairment, treatment, and recovery. "Our program has been
intricately designed to address the specific challenges faced by dentists."
Jerome M. Gropper, DDS, MS, co-developed the program with Talbott. The 1958
graduate of
the New York University Dental School is the executive director of the Talbott Recovery
Campus and director of the national dental program.
Gropper retired from active dentistry in 1983, and two years later was treated for chemical
dependency at the Talbott program, as it existed at that time. After getting his masters degree in
community counseling at Georgia State, Gropper started working with Talbott as a therapist in
1988.
"I had been practicing dentistry for 25 years and had experienced problems with depression and
anxiety, and wasn't very happy in the practice of dentistry, but didn't know why," Gropper said.
"My addiction forced me to get treatment. I took great solace from realizing I wasn't alone."
The Talbott National Dentist Treatment Center treats dentists with diseases of psychiatric illness,
addiction, and behavioral problems leading to impairment. Patients are treated by dentists and
behavioral health specialists who have personal experience in dealing with the particular issues
of dental impairment.
In developing the National Dentist Treatment Center, the Talbott Recovery Campus has
assessed, evaluated, and treated 400 dentists during the past decade. The research findings
characterized dentists as being more likely to develop elevated levels of fear, dissatisfaction with
career choice, obsessive/compulsive behavior, perfectionist personalities, interpersonal
sensitivity and depression.
Gropper said they've actually been treating dentists differently for about three years as the
program evolved.
"New techniques and procedures have been added to give dentists the added attention they need
to do well in recovery," he said. "And we are very gratified with the numbers. We had 65
dentists admitted during the calender year 1997-1998, and I find it amazing that we had close to
a 98 percent success rate."
Gropper said that about half of the dentists who come to Talbott have already been in treatment
elsewhere.
"Also, about half come to us with some cognitive impairment," he said. "Usually that will clear
prior to their return to practice."
To help in that process, Gropper said he felt it necessary for patients to experience dental
procedures while still in treatment.
"As a result, we have a relationship with the dental school, and our patients perform procedures
in a lab setting. Their level of ability, skill and comfort are graded," he said. "If you send them
back into a stressful office without all of their skills, that will be a trigger for relapse. We
immerse them in the environment before they go home, and that's a major reason for our
success."
When Gropper came to treatment back in 1985, he was one of only three dentists out of about
100 patients.
"Today we have an average of between 12 and 20 dentists in the 120-day program," he said.
"We give them extra attention, and being treated together as a group gives them a feeling of
importance. Dentists frequently feel they don't receive equal respect as physicians do. They
bring that low sense of self-esteem with them."
In what is perhaps the most novel part of the program, the junior class of the Augusta dental
school unanimously voted to spend a day with the patients. It is there that they learn about the
isolation in the office, and of the booby traps such as drug samples and nitrous oxide.
"It's powerful for the students, and for the dentist patients who get tremendous gratification
helping the students in their education process," Gropper said.
Talbott says he feels very good about what is being accomplished.
"What you find is that there is a ripple effect, sort of like throwing a stone into a pond, and you
find dentists who learn about addiction through peers or people close to them, and they begin to
recognize the signs in their own practice. I feel very enthusiastic and positive about this center
for dentists."
Families, friends, or associates of dentists suspected of having impairment problems should call
(800) 807-3268 to get in touch with the Bay Area Well-Being Committee, and (619) 275-7180
(San Diego) or (213) 969-1393 (southern California) for the Southern California Well-Being
Committee.]
Teaching vs.Training
Incompetency occurs in two forms.One form is a deficiency in knowledge: The person doesn't know what to do. Teach this person the steps required to do the task and the reasons for them.
The other form of incompetency is a deficiency in skill: The person knows what to do but can't do it well. Train this person how to do the task, when to do it, and if possible to mimic others who do the task well.
Training is a longer-term process than teaching and requires refresher courses along the way. You might have the employee:
* Observe others doing the task correctly.
* Participate with someone who knows the job.
* Perform the task alone, with an experienced person watching.
Be sure to accurately identify the employee's type of deficiency and use the appropriate corrective measures.
Lighten Up
Laughter is one guaranteed way to help a person feel better instantly.An individual might feel silly doing it, but laughing at oneself -- or just laughter and humor in general -- is a healthy creative stimulant.
How best to use it? A dentist can think about her or his practice, envisioning the whole place rolling with laughter. It probably isn't a very realistic picture, considering the underlying seriousness and responsibility of running a business. But by taking a step back and looking beyond the surface, one may find the everyday humor of the office environment.
That's why humor is an effective way to help diffuse job stress. Studies at Cornell University show that exposure to humor acutely enhances creative problem-solving ability and allows individuals to better see the consequences of their decisions.
What are the real effects? Comedy can be a cure. The human body loves laughter. The act of laughing increases a virus fighter in the body, suggesting that the more humor in one's life, the better able one will be to fight infection.
The physical benefits of laughter are great. Internal organs get a workout, then muscles relax and blood pressure decreases below pre-laughter levels. Laughter may reduce the risk of heart attack.
Here are some ways to bring humor and laughter in the practice:
* Be imaginative when faced with a particularly daunting task. Pretend the assignment is the plot of a television comedy: How would the character find a way out?
* Keep a file of cartoons or funny quotes with personal meaning. Post them around the office.
* Don't take oneself too seriously. Acknowledge faults in a humorous way and laughing will replace stressing.
Combating Some Milk Myths
Many people mistakenly believe they have trouble digesting lactose, leading them o
unnecessarily cut milk and other dairy products from their diets, thereby eliminating a major
source of calcium.
Lactose is the main sugar in milk and other dairy foods. Some people are lactose
maldigesters -- those who have true problems breaking down lactose. However, few people
are truly incapable of handling lactose.
"There have been numerous news reports that suggest we don't need milk and other dairy
products after our bones and teeth have formed," says Alvin Atlas, DDS, a general dentist
who practices in Evanston, Ill. "Also, many nutrition students have been taught for years that
certain groups of people lack an enzyme in their digestive tracts to handle milk's lactose. For
example, some Asians, Africans and Middle Eastern peoples, including Jews, have been
placed in this category, and as a result, have lower milk consumption. However, there is
little science to prove they are lactose intolerant."
Other people simply diagnose themselves as lactose intolerant because they have stomach
aches or other related symptoms.
Nine out of 10 women, and almost two-thirds of men, do not get the calcium amounts
recommended by the National Academy of Sciences, which increased recommended intakes
last year. Low calcium intake can increase risk of osteoporosis and high blood pressure, two
serious chronic diseases.
New research published in the Journal of the American Dietetic Association suggests that
most people who have trouble digesting lactose can have as much as two cups of milk a day
if it is consumed with meals. In fact, eating and drinking products that contain lactose may
improve a person's digestive abilities. Atlas makes the following suggestions for people who
believe they may have lactose intolerance problems:
* Consider special milk products such as acidophilus milk or other pharmaceutical products
to take with dairy products.
* Chocolate milk may be handled better than white milk by some.
* Start small. Increase milk portions over a period of time, a strategy similar to eating more
beans in order to help eliminate the gas problems they cause.
* Consume milk with meals to aid in digestion. Most cheeses have very low levels of lactose
and are easier to digest.
* Yogurt and ice cream are more easily tolerated by lactose-avoiders. Ice cream simply has
less lactose, and the cultures in yogurt are helpful in digestion of lactose.
It is not a good idea to simply stop eating products that contain lactose because there is a
danger of not getting the calcium a body needs.
Health Information on the Internet
Type in the words "dental health"on any Internet search engine, or a specific condition such
as "root canals," and one can come up with hundreds or even thousands of links, or pages of
information.
But when a dentist has a patient who is interested in researching particular dental health
issues, or if one needs to research resources for specific information, where can they look?
And what information can be trusted?
Here are some ways to determine the quality of online dental health information:
* Check the web site's source and funding. Be cautious of sites with information that comes
from a single source, that primarily promote a product or position, that tout "miracle cures,"
or that push treatments that sound too good to be true. Also be wary of information posted
anonymously.
* Check how often the information is updated, when it was last updated, and who reviews
the information. Authors' affiliations and credentials should be provided.
* The sources of the information and proper attribution should be provided.
Following are select sites recommended by CDA that provide reliable consumer dental health
information resources:
* National Oral Health Information Center - a resource for patients with special needs.
aerie.com/nohicweb/ohmap.html
* American Dental Association - Patients & Consumers page.
www.ada.org/tc-cons.html
* American Academy of Pediatric Dentistry. www.aapd.org/
* American Academy of Periodontology. www.perio.org/
* American Association of Oral and Maxillofacial Surgeons -- patient information page.
www.aaoms.org/patient3.html
* American Association of Endodontists -- patient information page, root canals, cracked
teeth (there's a nice tooth picture). www.aae.org/patient/index.html
* American College of Prosthodontists -- patient information page.
www.prosthodontics.org/indexabout.htm
For those who are searching for general health-related information, the following sites are
helpful:
*American Medical Association -- Provides consumer health information that has been
reviewed by medical experts and also links to other reliable health information.
www.ama-assn.org
* Healthfinder -- U.S. Department of Health and Human Services-sponsored gateway to
reviewed resources available on consumer health and human services information.
www.healthfinder.org
* Tufts University Nutrition Navigator -- Provides links to nutrition information that has
been reviewed by a team of nutrition experts. www.navigator.tufts.edu
* U.S. Centers for Disease Control and Prevention (CDC) -- Provides health information on
diseases, health risks, and prevention guidelines. www.cdc.gov
* U.S. Food and Drug Administration (FDA) -- Latest information on foods, human and
animal drugs, cosmetics and related issues. www.fda.gov
From Blue to Pink
Rising numbers of men are moving into "pink-collar" professions as wages improve, demand
grows and stigmas fade. According to Trend Letter, 4 percent of registered nurses in
Canada
are males, twice as many as 10 years ago. Similar patterns are emerging among dental
hygienists and flight attendants throughout North America, especially in regions buffeted by
declining blue-collar professions such as manufacturing.
Reinventing PE
Educators are abandoning physical education as we know it, replacing sit-ups and running
laps with less-punishing activities meant to foster lifelong fitness habits. The trend, reported
by the The Global Network, stems from alarm over skyrocketing numbers of overweight
kids
who "hate" exercise. What's new: power walking, heart-rate basketball, TVs in front of
treadmills.
Honors
The FDI World Dental Federation elected Arthur A. Dugoni, DDS, dean of the Unviersity of the Pacific School of Dentistry, to the prestigious List of Honour at the World Dental Parliament meeting on in Barcelona. The List of Honour is the highest award the FDI World Dental Federation can bestow upon a member and is limited to 30 living members throughout the world who have made distinguished contributuions to international dentistry and the federation.Dugoni, former preisdent of CDA and ADA, served six years as treasurer and member of the executive committee and three years as a member of the organization's council. His contributions have resulted in many innovative and important changes in the structure of the federation, including the creation of four subsidiary companies, an internationally recognized world dental congress, and an increase in revenue tenfold over the decade, including the establishment of substantial reserves for future expansion of programs and facilities.
Anthony H.L. Tjan, DDS, an Emeritus Professor of Loma Linda University has received the 1998 Michinosuke Nakayama Memorial Award from the Pierre Fauchard Academy, Japanese Section on October 17, 1998, in Kobe, Japan. This prestigious award is the highest honor bestowed by the academy and recognizes individuals who have made outstanding contributions to dental materials research and development.
Upcoming Meetings
1999
Jan. 14-16 Denver Midwinter Dental Convention (800) 637-6337
Feb. 3-6 Academy of Laser Dentistry's Sixth Annual Conference and Exhibition, Palm
Springs, Calif. (248) 548-7171
Feb. 11-13 East Coast District Dental Society Miami Winter Meeting and Dental Expo,
Miami (800) 344-5860 or (305) 667-3647
April 8-11 CDA Scientific Session, Anaheim (916) 443-3382, Ext. 4470
April 13-17 International Dental Show, Cologne, Germany, http://www.koelnmesse.de/ids
April 23-26 UOP/ADA Second National Conference on Over-the-Counter Dental Drugs and
Products, San Francisco (415) 929-6486
April 27-May 1 The American Academy of Oral Medicine 53rd Annual Scientific Session
(410) 602-8585
April 29 - May 1 British Dental Association National Dental Conference, Torquay, England
0971 935 0875
Sept. 16-18 CDA Scientific Session, San Francisco (916) 443-3382, Ext. 4470
Sept. 17-18 Society for Advanced Dentistry Annual Meeting, New Orleans (317) 290-2613
To have a meeting included on this list, please send the information to Upcoming Meetings,
CDA Journal, P.O. Box 13749, Sacramento, CA 95853 or fax the information to (916)
443-2943.
