Sarah Handzel, BSN, RN

As the economy recovers and new ways of working start to replace traditional avenues of employment, employees have more options than ever for finding work they deem meaningful and fulfilling. In recent years, the 

United States has seen an annual resignation rate around 8%

 that younger employees entering the workforce won’t stay at any one job for too long. For a small business like your dental practice, this means that you’ll sometimes lose key team members to other opportunities.

It could be anyone in your office, from your best hygienist to your office manager. The fact that someone will leave your team is something every small practice owner needs to be prepared for. So what do you do when a valued team member hands you their resignation?

 It doesn’t matter who decides to leave--for practice owners, it might feel like the end of the world when someone resigns. It’s not. Yes, there’s going to be some work involved in finding a replacement, and everyone in your practice might have to help pick up some of the slack. But keep in mind that the longer your practice stays open, the more people you might have that move on to other things. It’s important to adopt an attitude of resilience, not defeat. One person leaving will not cause your practice to crumble down around you.

 We’ve all heard stories of bosses that start screaming when an employee turns in their notice. Maybe you’ve even been on the receiving end of such a spectacle at some point in your dental career. Keep that in mind, and whatever you do, don’t become this scary person. Think about it—would you appreciate it if someone started demanding information out of you or accusing you of ruining their life or business if you decided to move on? You wouldn’t, and you might be setting yourself up for 

 against you if you turn into a screaming banshee. Just don’t do it.

As a practice owner, you have legal obligations to your employees even when they turn in their notice. This is an area that can also lead to legal trouble if you’re not careful, so you want be sure to protect yourself and your practice. The rules vary by state, so 

 to make sure you’re in compliance with all rules and regulations required by the government. You’ll still need to pay all the employee’s accrued wages and disburse any benefit payments that might be applicable to the employee. If you’re paying bonuses or other commission-type benefits, schedule these payments out, if necessary, after the employee’s last day. You also need to provide your departing employee with legal notices as required by law, like documentation explaining COBRA benefit continuation. If any nondisclosure or confidentiality agreements were signed upon hiring, review them with your employee to make sure both parties are clear on expectations for maintaining confidential information once the employee is gone.

Wish the employee well, and conduct an exit interview. 

Parting on good terms can mean that your employee leaves with good things to say about you and your practice. They might even come back and looking for employment from you again in the future! Showing your support for the employee keeps the lines of communication open, and could result in your former employee advocating for your practice or even sending referrals your way. Conducting an 

 is one way to encourage honest, frank communication with your employee that’s leaving. It’s a great way to learn about any aspects of your practice that could use improvement, and to get feedback on how to implement positive changes. During the interview, you want to be sure to let your departing employee know why you’re conducting the interview and what knowledge you hope to gain. Be sure to keep questions short and to the point so that you can better understand their reasoning for leaving and what you could do to make the workplace better. Take what they say to heart—after all, what’s the point of conducting an exit interview if you’re not going to use the information at all? Above all else, don’t get defensive. At this point, all you can do is accept what your former employee says without confronting them on any of the negative points they might bring up.

Ask your other employees for help, and come up with a plan.

 Once you’ve announced that an employee is leaving (and you should let your other employees know this when appropriate), it’s a good idea to ask the entire team for help. You can take this opportunity to bring your practice team together to meet the challenge of being an employee short, and you’ll probably find that your people want to help you anyway. Plus, asking your team for ideas increases their sense of value and will probably make them feel more involved in the practice’s continued success. Take the ideas you gathered from the exit interview and from your team to develop a plan for dealing with the resignation. Instead of allowing a resignation to turn into a depressing, paralyzing event, take the opportunity to plan for ways to improve the quality of your practice for all your remaining employees. Remember, people leave for all sorts of reasons, and you can use the transition as a time to move your entire practice in a more positive direction.

Articles

The fact that someone will leave your team is something every small practice owner needs to be prepared for. So what do you do when a valued team member hands you their resignation?

Your Best Employee Quit Now What?

Fluoridation--to date, there isn’t a clear consensus regarding the real benefits or dangers of this intervention among dental professionals and members of the public. This issue appeared in the news again after 

several communities across the United States

 began debating, again, whether fluoride should continue to be added to public drinking water systems. While it’s certainly not the first time this debate has occurred, recent research is fueling the argument that the benefits of fluoridation don’t outweigh the risks.

 began in 1901, when a dentist in Colorado discovered that many patients living in the area around his practice had prominent brown stains on their teeth that could not be removed. Through collaborative efforts, dental researchers discovered that the stains were caused by excessive exposure to fluoride in the area’s water supply. It was also discovered that patients with the prominent stains also had teeth that were remarkably resistant to decay.

After more research, cities and towns started adding fluoride to drinking water supplies in 1945. Scientists measured rates of tooth decay among populations with access to fluoridated water, and they noted that these populations had a lower incidence of decay compared to people with no access to fluoride treatment. This was a great scientific breakthrough, and the results compelled dental organizations to recommend exposure to fluoride through drinking water and additives in oral health products, like toothpaste.

Thanks to the Internet, the public has more access to medical and scientific information than ever before. Certain interest groups have formed, sharing the opinion that fluoridation is not a necessary or even beneficial treatment. In fact, they claim that the treatment does more harm than good, and that efforts to expose the American public to fluoride should be stopped.

, questions the need for the public to be exposed to continued fluoridation, especially since fluoride is available in multiple products, from toothpaste to mouth rinses. On their website, the group claims that, as of September 2016, 50 out of 57 separate studies conducted in China, India, Iran, and Mexico have shown a relationship in humans between elevated fluoride exposure and a reduced intelligence quotient (IQ). The human studies were based on IQ examinations in more than 12,000 children, but it was also noted that many of the studies failed to control for other key factors that could be relevant, including parental education level, socioeconomic status, and exposure to other environmental contaminants like lead or arsenic.

 that exposure to fluoride contributes to increases in hip and other non-vertebral fracture rates. 

 that fluoride has potent effects on bone cell function, bone structure, and bone strength--in quantities that far exceed those found in drinking water.

Some dental practitioners say fluoride actually causes more harm to teeth than benefit. David Kennedy, DDS, notes that “fluoride is harmful to teeth. It does not make the enamel more resistant to decay. Any dentist that’s looked at dental fluorosis finds that it crumbles off--it’s weak, crumbly enamel that causes teeth to chip and break.”

Proponents of the treatment argue that one of the main benefits of fluoridation is the positive impact it has on the oral health of low-income children and adults who might not otherwise have access to dental interventions. In a report by 

, Katherine Weno, oral health director at the Centers for Disease Control and Prevention (CDC) said that “a big thing about community water fluoridation is that it’s a passive intervention … you don’t have to buy a product or access to a dental professional. It benefits people who don’t have money to go to a dentist or don’t have any insurance.”

However, according to 2011/2012 statistics provided by the CDC, the rate of tooth decay in low-income and minority children actually increased substantially despite record numbers of Americans being exposed to fluoride in water, foods, and other dental products. Kennedy notes that “problems caused by fluoridation disproportionately affect African-Americans and Hispanics.” According to the 

, up to 58% of all children have fluorosis, with African-American children being more affected. “The argument that’s made is that this is for the greater good. But more damage is caused by putting a chemical in the water that African-American children are particularly sensitive to” said Kennedy.

Fluoridation efforts continue today and are touted as a cornerstone treatment in the prevention of tooth decay. About 74% of the population of the United States receives fluoridated water from community water systems. The CDC has named fluoridated water as one of the 10 greatest public health achievements of the 20

 by the American Dental Association, about 214.2 million people in the United States received the benefit of fluoridated water in 2014. Statistics on the ADA’s 

 claim that fluoridation in community drinking water has been effective in preventing tooth decay by at least 25% in children and in adults, and there is a tremendous amount of information related to fluoride that is available to the public through the ADA and the CDC.

The debate over the benefits of fluoridation is far from over, and it’s likely that research into fluoridation will continue on both sides of the argument. What is clear is that this passive public health intervention is going to continue in communities across the US, at least for now. Decisions on the continued use of fluoridation have to be made on the basis of scientific merit, not popular opinion and, in order to do so, research must continue.

Recent research is fueling the argument that the benefits of fluoridation don't outweigh the risks.


Fluoridation Debate Rages On Across US

 identifying stem cells in the temporomandibular joint (TMJ) that, when transplanted into a mouse, spontaneously grew cartilage and bone. The transplanted stem cells also began to form a bone marrow niche. The researchers hope that these stem cells could be used to help make new cartilage and repair damaged joints in humans.

All the stem cells in the study were harvested from inside the TMJ, the joint that moves the jaw bone independently of the skull. Once transplanted into a mouse, only one stem cell was needed to start forming new bone and cartilage. Since scientists have been working for years to try to regenerate cartilage using stem cells, this discovery is particularly important for the world of healthcare.

The lead author of the study, Mildred C. Embree, DMD, PhD explained that “this is very exciting for the field because patients who have problems with their jaws and TMJs are very limited in terms of clinical treatments available.” Since the transplantation of stem cells always carries the risk of rejection by the body, researchers are hopeful that this new finding will allow patients to use stem cells from their own bodies to aid in their restorative process.

Along with their findings on the stem cells, the scientists were also able to identify a molecular signal, Wnt, that causes the depletion of fibrocartilage stem cells. The research team was able to stimulate cartilage growth and promote healing of the joint by injecting a Wnt-blocking solution directly into degenerated TMJs in animals. The team is now searching for similar drugs that could be injected into the joint with minimal to no side effects.

In the United States, up to 10 million people, mostly women, have TMJ disorders. The only options for treatment currently include surgery or palliative care. While both options address the symptoms of the disorders, neither choice can ever regenerate damaged tissue within TMJs. With this new research, it’s hoped that stem cells already within the joint could be used to repair it. Further, the research team is hopeful that, in the future, the research they’ve completed here could be used to help repair fibrocartilage in other joints, like knees and vertebral discs.

Scientists at the Columbia College of Dental Medicine have completed research identifying stem cells in the temporomandibular joint (TMJ) that, when transplanted into a mouse, spontaneously grew cartilage and bone.

TMJ Stem Cells Used to Repair Damaged Cartilage

the College of Public Health at the University of Georgia

 is the first to analyze existing research and report that there is a relationship between dental surface restorations composed of dental amalgam and mercury exposure in a population of individuals from various backgrounds across the United States. These restorations, typically composed of a mixture of mercury, silver, tin, and other metals significantly contribute to prolonged mercury levels in the body, 

 reviewed data from almost 15,000 people, with data capture methods controlling for age, education, ethnicity, race, gender, smoking, and seafood consumption, which is known to contribute to mercury levels in the body. The specific type of mercury involved in the exposure was also analyzed, with a significant increase in methyl mercury being found related to dental fillings. This is the most toxic form of mercury.

One of the study co-authors, Xiaozhong “John” Yu, said that “we know that mercury is poison, but it all depends on the dose. So, if you have one dental filling, maybe it’s OK. But if you have more than eight dental filings, the potential risk for adverse effect is higher.” The study concluded that people who have multiple dental fillings and who are also exposed to other environmental sources of mercury are at highest risk for elevated mercury levels in the body.

In response to this new research, the American Dental Association (ADA) released its own findings after examining the study results. 

, dental amalgam is a durable, safe, and effective option for filling dental caries. The ADA also noted that mercury levels cited in the study did not exceed levels that are known to cause adverse health effects according to research from the National Academy of Sciences. Additionally, the study examined data including two different types of dental materials, including composite that does not contain mercury at all. Thus, the ADA stressed that the study’s findings might be subject to over-interpretation of the results.

 has been used as a filling material in more than 100 million Americans. Used for more than 150 years, it is affordable and durable, with its safety and effectiveness having been studied and reviewed extensively.

The study’s lead author, Lei Yin, said that “it’s important for doctors and patients to be informed in their selections…(and) we now have an excellent starting point to evaluate the potential risk of dental material on human health.” The ADA determined that there can be no conclusions drawn about the safety of dental amalgam simply based off the results of the study.

A division of the College of Public Health at the University of Georgia is the first to analyze existing research and report that there is a relationship between dental surface restorations composed of dental amalgam and mercury exposure in a population of individuals from various backgrounds across the United States.

Controversy Surrounds Dental Fillings and Mercury Exposure

You’ve gotten to the point where you need some extra help in your practice. You sit through interviews, or you let your office management team handle the interviewing and hiring of your new talent. But it seems like you keep winding up with people who aren’t a good fit for your practice—they don’t pitch in to help your other team members, they don’t follow the rules, and it seems like they always have a bad attitude.

You’ve got a problem with toxic employees. How do you avoid all this in the first place?

Toxic employees do more than bring down the mood in your practice. They can also seriously hurt your bottom line. According to a 

 on toxic workers, even modest levels of toxic behavior can cost organizations big time in the form of unhappy patients, decreased morale in your practice, increased turnover, and damage to your reputation.

From a financial standpoint, even one toxic employee can cost you the monetary gains you make from your superstar employees. For example, the HBS study found that a superstar employee-a person in the top 1% of workers in terms of productivity-can add about $5,000 each year to your profit margin. Your toxic employee? They’re actually costing you about $12,000 every single year you keep them on the payroll.

You want to avoid this entire situation, and no one blames you. After all, if your toxic employee does something like steal from you, or forges patient records, the financial penalties you could face are going to be a lot more than $12,000.

There are certain things you can look for during the interview process that can help you identify people that might turn toxic so you don’t bring them into your practice in the first place. As the HBS report explained, toxic employees seem to share common traits. You can look for these traits to screen toxic people during your hiring process, but keep in mind that not all toxic employees will show all of them.

: If a person is overconfident, they’re more likely to overestimate their abilities to complete tasks correctly and within desired time frames. They automatically believe they can handle whatever your practice throws at them … but they also automatically believe that they can get away with doing something they know they shouldn’t. Hypothetically, if someone believes they can get away with doing something, they are more likely to do it. Even if they know they shouldn’t.

They Say the Rules Should Always be Followed

: This is counterintuitive. It seems like someone who believes the rules were made to be followed would, in fact, follow them. The HBS study found just the opposite--it showed that people who said the rules always had to be followed were actually 25% more likely to be fired … for 

 be followed during interviews were saying that just to secure a job--they said it because it’s what they thought prospective employers wanted to hear. They didn’t necessarily believe it themselves.

: Toxic employees tend to be faster when it comes to working. It typically takes them less time to complete tasks compared to their non-toxic coworkers. Even so, they’re not likely to help your practice in the long run. They might be faster, but they also don’t necessarily produce higher quality work.

: Did your interviewee treat your receptionist like trash? Maybe they were rude to your other patients? It’s a good idea to check with everyone your interviewee came in contact with while they were waiting to interview. Toxic people typically have little regard for others, believing themselves to be above everyone else on some level. They don’t care about other people’s interests and don’t understand the consequences of their behaviors on the people around them.

They Say They Came from Another Toxic Workplace

: Toxic environments breed toxic people. It’s like a sickness in the workplace--once it starts, it spreads around and infects everyone. Constant negativity, employee favoritism, narcissistic leaders, and major communication problems are all problems in the workplace that can influence people to develop toxic attitudes about work. As the HBS report found, a person who was exposed to a toxic work environment was 46% more likely to be fired for misconduct. It says a lot about just how damaging toxic attitudes can be.

It takes more time and effort to weed through your interview pool to find the best talent for your team, but the benefits of doing so far outweigh the risks of not pursing better people. You don’t have to shoot for only hiring the top 1% superstar employees either. Even average workers with positive attitudes can save you cash and make you more money in the long run compared to a toxic individual, and they save you the headache of having to deal with daily negativity, lower employee morale in your practice, upset patients, and even potential litigation. Screening for toxic people should be a part of every interview you conduct, since such signs are a good indication of likely problems you’ll have in the future.

If you keep winding up with employees who aren't a good fit for your practice, a new report from Harvard Business School sheds some light on how to avoid the problem.

Tired of Hiring Toxic Employees? Screen Them Out Early

Just ahead of the American Dental Association’s (ADA) annual meeting, a group representing healthcare providers have issued a report estimating that more than 10,000 general dentists will discontinue their ADA memberships if the convention’s 

This controversial resolution is a continuation of Resolution 77, which was deferred by the ADA at its 2015 annual meeting. Resolution 37 will revise guidelines for the use of sedation and general anesthesia in dental practices. Additionally, educational guidelines for both dentists and dental students regarding pain control and the use of sedation in dentistry could also come under revision. The economic impact study cited by TEAM 1500 concluded that the financial impact to both patients and dental providers will be substantial. Data for the study was gathered from a variety of practicing dental health professionals, dental school academics, regulatory experts, and financial forecasters. 

, the consequences of the passage of Resolution 37 include higher fees, fewer dentists qualified to administer sedation, and increased difficulty for patients in accessing safe, affordable oral sedation treatments. They also noted that patients who require sedation for dental treatments will have to pay as much as twice the current fees as a result of the new guidelines, with the average cost of a standard teeth cleaning under sedation exceeding $500 per treatment.

In addition, the study found that higher dental fees to cover the increased cost of providing sedation dentistry, together with longer wait times to see a qualified dentist, will drive patients away from dental practices. T1EIS estimated that as many as 50.000 patients will stop getting routine dental treatment within two years of the passage of the resolution. Most of these patients will come from lower-income and minority communities.

The independent study forecast that many general dental practitioners will be driven out of practice altogether as a result of the dramatic increase in cost. 

 revised guidelines would double the amount of training that is currently recommended, with the cost of additional training potentially reaching $50,000 per dentist. As it was noted in the study, many dentists and dental students might not be willing to spend so much extra money and defer time treating patients in favor of extended education.

 was held earlier this month to address dental provider concerns regarding Resolution 37. 

A new report claims thousands of dentists will leave the American Dental Association if a resolution related to sedation dentistry is enacted.

Study Predicts ADA Exodus if Controversial Resolution Passes

In the aftermath of extensive surgical procedures, like the removal of impacted wisdom teeth, many patients want pain medication to adequately treat their pain and allow them to more pleasant recovery. Recent research has found that more than half of the opioids prescribed to patients after these kind of procedures go unused. 

Researchers at the University of Pennsylvania’s Perelman School of Medicine and School of Dental Medicine conducted the 

, which examined prescription opioid use in 79 patients after dental impaction surgery. In addition to looking specifically at opioid use, the researchers also wanted to see if a financial incentive, coupled with information about a pharmacy-based drug disposal program, would inspire patients to properly dispose of their unused medications. 

Ninety-four percent of the study participants received a prescription for opioid pain medication following their dental surgeries. The participants in the study received a pre-loaded debit card containing $10, and text-based surveys assessing patients’ pain level and opioid use were sent to patients daily for the first week after surgery. After the first week, participants received surveys on post-op days 14 and 21. Each survey completed resulted in an additional $3 loaded onto the debit card, for a total of $27 available to earn. An additional $10 was awarded after completion of a voluntary follow-up health interview.

The results of the study showed that, within five days of the surgery, most patients experienced relatively little pain. Most of the patients also still had over half of their prescribed opioid medications. Patients received an average of 28 pills when they received their prescriptions and the majority had 15 pills remaining that went unused. In total, 1,010 prescribed opioid pills were unused among the study participants.

Additional results showed there was a 22% increase in the number of patients who planned to properly dispose of their unused medications or planned to, based off the availability of information regarding the pharmacy-based drug disposal program. 

The results are significant for dentists because of the rates of prescription opioid abuse in the United States. As researchers hypothesized, opioid medications that are left over from surgeries might contribute to drug diversion in individuals that abuse prescription opioids. Dentists and other healthcare providers might be able to help reduce opioid diversion by reducing the amount of opioids prescribed after surgery. One of the co-authors on the study, Elliot V. Hersh, DMD, MS, PhD, 

while opioids can play a role in acute pain management after surgery, they should only be added in limited quantities for more severe pain.”

In a recent study, most patients who underwent dental surgeries no longer had pain after five days. However, most had plenty of opioid pills leftover.

New Research Examines Unused Opioid Medications Following Dental Surgery

Third molars, commonly referred to as wisdom teeth, typically erupt either fully or partially in patients between the ages of 17 and 26. Dentists know that many patients have multiple problems when this occurs — wisdom teeth can become wedged against second molars, with symptoms ranging from swelling to tooth decay. In these cases, wisdom teeth are promptly removed.

If a patient has wisdom teeth, but are not experiencing any adverse effects related to them, should the third molars still be removed? A 

recent review of previously published research

 explored this question and came to the conclusion that there was no benefit to patients in removal of wisdom teeth, unless they are explicitly causing pain or other problems. 

 comparing outcomes, such as the likelihood of various dental problems, after disease-free, impacted wisdom teeth were either removed or retained. Only two studies were found that met this criteria, and neither study measured outcomes like cost, cyst or tumor formation, bleeding, nerve damage, or infection. One of the studies showed that men who still had impacted wisdom teeth may have had a higher risk for gum disease around the adjacent molar compared to men who had their wisdom teeth removed. Another study found no evidence of any notable differences between people that had impacted wisdom teeth removed compared to people who did not. 

If third molar extraction is not performed because a patient is asymptomatic, the patient might have to have surgery later on when the teeth do become symptomatic. This might lead to more surgical complications due to the older age of the patient. One of the review study authors, Hossein Ghaeminia, said, “on the other hand, preventive removal of all asymptomatic wisdom teeth is also undesirable: if the tooth would stay asymptomatic and disease free during lifetime, the patient might have been exposed to an unnecessary risk of complications and costs.”

Wisdom teeth removal is still very common in the United States and across the world. This surgical procedure is covered by most dental insurance plans but is usually not covered by medical insurance. Infection, inflammation of the tooth socket and temporary nerve injury causing impaired sensation of the lip and chin are the most common risks of the procedure.

The review study authors acknowledge that the lack of evidence indicating the benefit of asymptomatic third molar removal in patients should lead to greater discussion of both options with dentists. Ghaeminia noted that, “in the absence of evidence, orthodontists, dentists and oral surgeons should discuss the pros and cons of wisdom teeth removal in each case individually."

A recent research review looked at the benefits of removing asymptomatic wisdom teeth. The results might surprise some dentists.

Dentists Still Lack Evidence for Asymptomatic Third Molar Removal

Depression isn’t just a case of the blues, and it’s not possible to simply “snap out of it.”

, otherwise known as major depressive disorder, is a mood disorder characterized by persistent feelings of sadness and a loss of interest in things once found pleasurable. There are many 

 that could indicate a problem with depression, including but not limited to:

Angry outbursts, irritability, or frequent frustration

Trouble thinking, concentrating, making decisions, or remembering things

Unexplained physical problems, like backaches or headaches

Frequent or recurrent thoughts of death or suicidal thoughts

Depression isn’t just a case of the blues, and it’s not possible to simply “snap out of it.” Many people that are affected by depression have symptoms that are severe enough to cause noticeable problems in day-to-day activities. In fact, depression is a condition that might take extended treatment under the guidance of a mental health professional. What’s important is that treatment is sought before the condition progresses too far.

Many factors influence whether a person develops depression in their lifetime. The exact cause of depression isn’t known, but it’s currently thought that people with the disorder have biological differences in the structure and chemistry of their brains compared to individuals that are not depressed. Hormones are also thought to play a role in the development of depression. It could be that depression is an inherited condition — research indicates that it’s more common in people who also have relatives that were diagnosed with the condition, suggesting that certain genes might be involved.

Some people are exposed to more external influences that make the possibility of having the disorder more likely. For dentists, the nature of the profession could be a significant factor in the development of depression. Dentistry is a high-stress profession — the demands of dentistry start in dental school, and once a dentist enters clinical practice, they find that they’re exposed to a greater number and variety of stressors than ever before. 

Journal of the American Dental Association

 examined more than 3,500 dentists. Thirty-eight percent reported feeling worried or anxious constantly or frequently. In the same study, 34% of respondents said they always or frequently felt physically or emotionally exhausted, and 26% reported continuous or frequent backaches and headaches. 

Stress-related problems, like depression, result from both the work environment and what is thought to be the typical personality type of people entering the dental profession. Isolation, confinement to small, usually windowless spaces, and continuous intricate, meticulous work are all factors that might contribute to the development of depression. There is usually tremendous economic pressure on dentists, with many practitioners facing huge loans for both school and the cost of opening a practice. 

 that dentists also have a tendency toward perfectionism driven personalities, which can lead to frequent disappointment both in life and in practice regardless of the effort to succeed.

What Can Dentists Do If They Think They Are Depressed?

First, it’s important to realize that there is no shame in admitting you might need help. Depression is not a weakness. It is an indiscriminate condition, affecting people from all walks of life. 

There are multiple resources available to help treat depression, but the first step is typically an evaluation by a physician to rule out any physical causes for your condition. Provided there is no evidence of any physical problems, your physician will refer you to a mental health provider for further treatment. 

The treatment path will be discussed and will depend on the severity of your symptoms and goals for treatment. In cases of more mild depression, it might be possible to address the symptoms and stop the progression of the condition through frequent, in-depth psychotherapy alone. 

 is used to help replace negative thoughts and unproductive thought patterns, and treatment focuses on taking specific steps toward overcoming depression. 

If depression is more severe, an antidepressant medication might be prescribed. Although recent research indicates that 

dentists might not be as responsive to these medications

 when taken alone, they might still be useful in dealing with severe symptoms for brief periods of time when coupled with other forms of treatment, like psychotherapy.

 include joining support groups, practicing relaxation techniques, meditation, talking with friends and family about your condition, and getting regular exercise. While you probably won’t notice instantaneous change — treatment for depression takes time to work – you should notice a reduction in your depressive symptoms over time. Try to set realistic goals for treatment, and let your friends and loved ones help you. Just as you help your patients maintain their healthy smiles, it’s important to let trained professionals, family and friends help you maintain and improve your own mental health. 

Addressing Suicidal Tendencies in the Healthcare Population

Dentists, and others with high-stress job, can be particularly susceptible to depression.

Depression Among Dentists, A Silent Epidemic

It’s not easy to be a dentist. Years of schooling (often resulting in high student loan debt), the pressure of starting and maintaining your own practice, dealing with team member and patient demands, uncooperative or difficult patients, and the need for high levels of focus and concentration can all make dentistry an extremely stressful career choice. It’s the same in any high-level career (with perhaps a few minor differences), and it can lead to an unintended side effect: depression. 

Unfortunately, many people don’t respond to standard treatment with medications for depression. Is it possible that a high-status job, such as dentistry, can contribute to this non-responsiveness? Researchers wanted to find out, and in a 

 they examined patients with high-status jobs and their responses to standard treatments using medications for depression. 

A group of international researchers selected 654 working adults to participate in the study, classifying each participant’s work in terms of occupational level: high (such as dentistry), medium, and low. Most patients in the study were treated with serotonin reuptake inhibitors (SRIs), but other medications were also used along with psychotherapy. People with higher-status jobs were found to have taken fewer SRIs and received more psychotherapy than people in medium or lower status jobs. 

The researchers found that 55.9% of study participants in higher occupational level jobs were more resistant to treatment. In contrast, 40.2% of medium-level and 44.3% of low-level workers remained resistant to treatment with medication. 

As one of the researchers, Siegfried Kaspar, MD, noted

, “though these findings should be considered preliminarily, they indicate that high occupational levels may be a risk factor for poor response to treatment. A number of variables may explain these findings. For example, there may be specific working environment demands and stressors; people may find it difficult to accept or cope with illness, or to continue with medication; or there may be other factors, related for example to cognitive, personality and behavioral differences”.

The study implies that clinicians might be able to better help patients with depression by recognizing their occupational level and relating it to treatments that might be more effective than standard treatments with medications, like psychotherapy. Another possible explanation is that patients in high occupational jobs might be more willing to try treatments for depression that do not include pharmacotherapy. While further study is needed, it might be advantageous for clinicians to look at the entire patient picture, including job status, when deciding on an effective treatment plan in order to have as positive an outcome as possible.

A new study suggests people with high-stress careers might be poorer candidates for drug-based depression treatments.