On May 4, a dental hygienist whom I had never met sent me an e-mail. I quickly read her note while I was on the road with three programs to present. It was clear that Jenny was in distress. Fully intending to get back to her, I marked her e-mail accordingly. Unfortunately, her note got buried in an avalanche of mail. Little did I know, any response from me would have been too late.
In her e-mail, Jenny asked me to inform the dental hygiene community about the overwhelming issues of chronic pain. Her exact words were: “Please warn other hygienists by your publication. Hygienists don’t have a chance. I could have avoided this by preventing my pains, it is all so complicated now after 3 years of stress. Having personal insurance, WC and SSDI was horrible. I have been in fight or flight for 3 steady years. I did my best……I can’t believe I am doing this, I don’t want to. I am forced.”
On June 27, Jenny’s husband contacted me. His note said, “Last month, on May 4, Jenny sent you an e-mail. I would like to reach out to you for a short talk. Please let me know when you have a few minutes.” Before responding, I searched for Jenny’s e-mail. My heart sank when I reread her entire note. It was clear that something terrible had taken place. I left a message for John to call me.
Within an hour, my suspicions were verified. Immediately after sending e-mail notes to her sisters-in-law and three dental hygienists, Jenny attempted to kill herself. She had spent years working left-handed in a right-handed dental world. The years of chronic musculoskeletal pain in her neck, back, shoulders, arm, and hand laid the foundation for grief, depression, anxiety, and despair, resulting in horrific injuries that ultimately led to her death.
A personal transformation
When her husband shared her story with me, he asked repeatedly that I share her story with the dental hygiene community. They had been very happily married for 35 years and raised three children to adulthood. Jenny loved clinical dental hygiene, practiced for more than 30 years, helping more than 40,000 patients. She was a passionate dental hygiene volunteer in the local grade schools, and was also a gifted dental hygiene educator. But the pain she endured during the last three years of her life made her fragile. John and the family saw changes in Jenny’s emotional stability.
Jenny sought help from a variety of sources, including massage therapy, physical therapy, acupuncture and cupping, yoga, relaxation therapy, and traditional medicine, including multiple visits with a psychologist. John’s wife was turning into a different person, consumed with what had happened to her. Living with chronic pain and the loss of her professional career now had an added layer - a form of insidious mental illness that went undiagnosed.
For decades, I’ve written about workplace injuries and connected with thousands of dental professionals whose careers are on the brink or totally shattered. Every contact with a colleague in pain wounds my soul, but every conversation steels my resolve to continue to speak out about needless damage to our bodies and our minds.
A growing number of dental professionals are now physically and mentally broken. Countless have suffered through multiple surgeries or live with chronic pain 24 hours a day. Others spend hours fighting for fair treatment from state workers’ compensation plans, private disability policies, or to be granted federal social security disability coverage. Our legacy should not include losing our professional careers or emotional well-being to a cumulative trauma disorder or a workplace-related musculoskeletal disorder.
We are not human scaling machines. Our most precious possession is a heathy body, and it’s hard to provide care when our bodies are screaming in pain. Sadly, there are dental professionals who have never realized or acknowledged the toll clinical practice can take on our bodies. Others clearly understand, but for one reason or another are reluctant to act to combat or reverse the physical demands.
Injured hygienists often pose the question: “Why didn’t my dental hygiene program tell me about the risks?” For starters, the risk for injuries was not recognized until the last couple of decades. Injured workers just faded away. The academic community has begun to make changes in our education over the last 15 years. Publications such as RDH have devoted much space to articles about preventing needless musculoskeletal issues, and online forums are loaded with discussions every day. But the reality is, there are way too many hygienists experiencing physical and emotional pain. A lot of work still needs to be done.
Chronic pain is deceptive. The impact is cumulative over time. It gets old. Unless you live in that world, people around those suffering from chronic pain can become numb to the conversation. Imagine being told over and over that your symptoms are all in your head, when you know internally that something is wrong. Chronic pain fuels depression, anxiety, anger, and fear.
Colene House, RDH, has gone down this pathway. After years of increasing hand pain and several surgeries, she finally retired from clinical practice due to carpometacarpal (CMC) arthritis. She was angry and frustrated. She felt like her body had betrayed her. After 41 years of service, she had ceased to be a valued team member. Her income was gone, her professional social identity altered. The worker’s compensation process was draining and rather than living with constant stress every day, she finally agreed to a settlement.
Colene felt like an outcast, lonely and isolated. She never heard from her former teammates, people she had worked with for years. As her life continued to morph, she realized that she, too, had neglected another dental professional who had been sidelined. Years earlier, she had worked with a very talented dentist, who was forced to quit practice because of unbearable neck pain. After he left the practice, she never took the time to just say hello or see how he was doing. This realization struck her deeply, and she called her former employer and apologized for abandoning him.
Eight years ago, she started an Internet group called Hygienists’ Hands. She wanted to create a safe, nonjudgmental space where dental professionals could share information about treatments, symptoms, and coping with daily life. Members share strategies on how to file a workers’ compensation claim, strategies to use when applying for social security disability, and ways to deal with pain and discomfort. They openly discuss frustration, depression, feeling powerless, or judged by others.
It is common to read, “All I tried to do was take care of patients as best as I could. Now I am being treated like I did something wrong.” The emotions in the group run high. Participants express anger, denial, grief, loss, and joy when a colleague reports a victory of any kind. This group has provided amazing support and collective wisdom to countless members. Apparently, Jenny was a member of Hygienists’ Hands, but like some, she saw the conversations but never shared her thoughts with others in the group.
Many of us have friends, family members, and coworkers who struggle with numerous mental health issues. The short list includes depression, anxiety, obsessive-compulsive behaviors, bipolar disorder, and post-traumatic stress disorder (PTSD) - situations that cause inexplicable disruptions in one’s personal life and to those close by. Over time, it can become easier and easier to turn a blind eye or deaf ear to the chaos.
The statistics are staggering—one out of five adults in the United States experiences mental illness in a given year.1 Four percent of the adult population has a serious mental illness that substantially interferes with, or limits, one or more major life activities.2 Individuals living with serious mental illness face an increased risk of having chronic medical conditions.3 Suicide is the 10th leading cause of death in the United States.4
Washington State has taken an active position on mental health issues. The state website states that less than 50% of those who attempt suicide have a mental health diagnosis, but most see a health-care professional within a year of their attempt and a recent study found that 40% have a health-care visit within a week prior to their suicide attempt. While dental professionals are not mandated to take suicide prevention training in the state at this time, it is required for college and university faculty.
We’re not social workers or counselors. We’re not equipped to fix a broken life. But we can lend a hand and perhaps offer a measure of compassion or point a friend or colleague to a resource that can provide positive direction. Two good places to start are the National Alliance of Mental Illness (nami.org) and Mental Health America (mentalhealthamerica.net). Both groups offer extensive information about common warning signs of mental health issues, as well as advice on where and how to seek help. MHA has online screening tools that can help determine the risk for mental health problems.
One never knows the impact our words or actions will have on another human being. Clearly, Jenny wanted to warn other dental hygienists to take care of their bodies. She asked me to deliver her message. Even if you dread the inevitable conversation or phone call that recounts the latest event, if you, one of your friends, or a family member are suffering, please reach out.
Mental illness is not a crime; it is a disease. RDH
ANNE NUGENT GUIGNON, RDH, MPH, CSP, provides popular programs, including topics on biofilms, power driven scaling, ergonomics, hypersensitivity, and remineralization. Recipient of the 2004 Mentor of the Year Award and the 2009 ADHA Irene Newman Award, Anne has practiced clinical dental hygiene in Houston since 1971, and can be contacted at [email protected].
1. Any mental illness (AMI) among adults. National Institute of Mental Health. National Institutes of Health website. U.S. Department of Health and Human Services. www.nimh.nih.gov/health/statistics/prevalence/any-mental-illness-ami-among-us-adults.shtml. Accessed October 23, 2015.
2. Serious mental illness (SMI) among U.S. Adults. National Institute of Mental Health. National Institutes of Health website. U.S. Department of Health and Human Services. www.nimh.nih.gov/health/statistics/prevalence/serious-mental-illness-smi-among-us-adults.shtml. Accessed October 23, 2015.
3. Colton CW, Manderscheid RW. Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Preventing Chronic Disease. 2006;3(2):A42. www.ncbi.nlm.nih.gov/pmc/articles/PMC1563985/. Accessed January 16, 2015.
4. Suicide facts at a glance 2015. Centers for Disease Control and Prevention. www.cdc.gov/violenceprevention/pdf/suicide-datasheet-a.pdf. Accessed October 23, 2015.