Preventing professional discrimination

Dentists should not be penalized for seeking counseling, mental health treatment

The ADA is taking action in 2024 to prevent discrimination in licensing and credentialing against dentists who have received counseling, therapy or treatment for mental, behavioral or physical health issues.

In 2024, the ADA will create a pilot project to assist states in developing and advocating for legislation or regulations in licensing and credentialing that is not punitive toward dentists who have received or want treatment for mental health issues.

The ADA will also develop resources — including the different pathways states could follow — to go into a toolkit for state associations to use in their advocacy efforts.

“Licensure applications with questions on previous impairment or mental health conditions act as barriers for a dental professional to self-report and seek appropriate care,” said Jeffrey Ottley, D.M.D., chair of the Council on Dental Practice. “It is important to recognize the barriers, such as intrusive or stigmatizing language on licensure applications, that may reduce the likelihood of dentists seeking help when experiencing negative effects from mental health issues. Addressing these barriers remains vital to optimizing dentists’ health and ultimately, improving patient care.”

The project, which the ADA Council on Dental Practice and the State Government Affairs team will develop, is in response to Resolution 517, passed by the 2023 ADA House of Delegates.

In 2023, two state dental boards — Texas and Virginia — changed the language on initial and renewal licensure applications to remove the stigma associated with seeking help for a mental health condition. 

A bill enacting that change was signed into law by Virginia’s governor in 2023 and immediately went into effect. 

Virginia is taking additional steps this year by including dentists and dental hygienists in a “Safe Haven” model. Based on a 2020 program authorized by the Virginia legislature, Safe Haven allows health care providers — initially physicians, but now also nurses, pharmacists and medical students — to seek resources to help them with burnout and other mental health issues as well as legal protection ensuring confidentiality.

The Virginia Dental Association is working to include dentists and dental hygienists within the ambit of this legislation in 2024.

“The Safe Haven legislation is an important fatigue and wellness program to allow health care providers to seek mental health treatment without fear of losing their license and their ability to practice,” said Ralph Howell, D.D.S., Virginia dentist and former member of the ADA Council on Dental Practice.

Dr. Howell said a similar program has been proven successful for physicians, nurses and pharmacists, with the use rates for those eligible for Safe Haven approaching 20% in Virginia. 

He added that the profession as a whole would benefit from advocacy nationwide that could emulate what Virginia has done.

“There needs to be a priority on removing barriers, stigmas and unwarranted professional repercussions for dentists and dental hygienists trying to receive help with career fatigue and other mental health issues,” he said.  

In 2023, the Texas State Board of Dental Examiners moved away from "have you ever" questions dealing with treatment for depression and substance use disorder, said Robert G. McNeill, D.D.S., M.D., chair of licensing and board secretary. Dr. McNeill is also a member of ADA’s Dental Team Wellness Advisory Committee.

“Our new question requires an attestation about a current ability to be able to practice in a competent, ethical, and professional manner,” he said. “I realized that there is convincing evidence that we can [make an] impact on whether our colleagues will seek mental health care by how we ask questions on licensing applications and renewals. Mental health and well-being also give us a unique opportunity for regulators, dental organizations and other stakeholders to work together to make change happen.”

Dr. McNeill added that practitioner safety issue is a direct patient safety issue.

“All stakeholders can work together to help with challenges of mental health issues,” he said. “State dental board examiners can learn from the Federation of State Medical Boards, American Medical Association, ADA, and the Dr. Lorna Breen Heroes' Foundation.”

Dr. Breen was an emergency room doctor from Virginia who practiced in New York City during the height of the pandemic and died by suicide in 2020. New York is a state where she could have sought mental health support without punitive damage, but she did not know that. Her sister and brother-in-law, both attorneys, founded the foundation in her memory and have been champions leading the effort of licensure reform and credentialing for physicians.

Changes are also afoot in North Dakota.

“Partnering with state dental boards of examiners is an important step a state dental association can take”, said Kami Dornfeld, D.D.S., president of the North Dakota Dental Association and DWAC chair. “NDDA is working with the North Dakota Board of Dental Examiners to change … language to include dentists in physician assistance programs by 2025.”

After the rule changes are made, there will be an opportunity to review licensure application language, she said.

For resources on wellness, visit ADA.org/Wellness.