Dentistry’s Silent Epidemic.

Dentistry has always rewarded composure. Patients expect steadiness, teams look to the doctor for answers, and owners are expected to carry the responsibility, make the decisions, and keep moving when the pressure rises. That expectation becomes dangerous when composure turns into concealment.

For too many dentists, the same traits that built a successful practice make it harder to admit when life isn’t working anymore. We learn to endure. We keep the schedule moving and solve problems quickly and privately. Then one day the problem isn’t a broken system, a difficult employee, or a bad month. The problem is that we’re no longer okay, and we don’t know how to say it out loud. I know what that feels like because I lived it.

September 3, 2020

A 45-second recorded call destroyed what I had spent twenty-four years building. Fifteen million dollars disappeared, and twenty-four years of work felt like it had vanished in less than a minute. The financial loss was enormous, but it wasn’t the hardest part. The emotional collapse that followed was far more dangerous.

Within an hour of that call, I fell into the deepest depression of my life. I gained more than fifty pounds. I stopped taking care of myself, I hated what I saw in the mirror, and I felt like I had failed my family after doing what I thought responsible people were supposed to do. And I did what many dentists do when life gets ugly. I kept it mostly to myself.

I could still talk to people. I could still work and appear functional. From the outside, I looked like a dentist who had taken a hard hit and would eventually recover. Inside, I was disappearing, and that gap between appearance and reality is where this subject gets serious.

From the outside, I looked like a dentist who had taken a hard hit. Inside, I was disappearing.

The Problem Isn’t Pressure Alone

Dentistry is demanding. That isn’t new. Clinical responsibility is real, and ownership adds payroll, staffing, overhead, patient expectations, family obligations, and the constant awareness that a mistake can affect far more than one day’s production. Pressure alone doesn’t explain the problem, though. The deeper issue is what our profession teaches us to do with pressure.

We’re trained to be the person with the answer. We’re rewarded for control, and we learn that professionalism means staying composed. Somewhere along the way, many of us start confusing composure with silence, and that’s a costly mistake.

Research has documented serious levels of anxiety, depression, burnout, substance misuse, and suicide risk among dental professionals for years. A study published this fall in the Journal of the American Dental Association, using U.S. death records from 1979 through 2018, found that suicide accounted for roughly twice the expected share of deaths among dentists compared with the general population. The exact figures vary by study, population, and method, but the direction is consistent enough that we shouldn’t dismiss the problem as rare or isolated.

These aren’t abstract categories. They’re people we know. They’re dentists who show up every morning, greet patients, lead teams, pay bills, and quietly wonder how much longer they can keep doing it.

Dentistry is good at identifying silent disease in patients. We’re much less comfortable identifying silent suffering in ourselves.

What Dental School Never Taught Us

Dental school taught us how to diagnose pathology, manage difficult patients, prepare for complications, and make decisions under pressure. It didn’t teach us how to recognize despair in ourselves. It didn’t teach us what to do when the identity we built around being competent, reliable, and successful starts working against us, or how to say, “I don’t know what to do with my own life right now.”

That gap matters because the dentist is often the final stop. Patients ask us what to do. Team members bring us problems. Families depend on our income, and owners carry responsibility that rarely fits into a neat job description. When your identity is built around being the person who fixes things, asking for help can feel like evidence that you’ve failed. It isn’t.

Some problems can’t be solved by working harder, thinking longer, tightening a system, or pushing through another month. Some situations require another person in the room. Sometimes that person is a close friend, sometimes it’s a coach, and sometimes it needs to be a licensed mental health professional. The important part is that the problem is no longer being carried alone.

What Silence Cost Me

I lived in that gap for four years. Before the call, physical performance had been part of my identity. In my forties I had become a top 2% triathlete, reached roughly 7% body fat, and competed at a level I hadn’t touched since my twenties. After the collapse, I eventually reached 204 pounds at 5’8”, with body fat approaching 30%. The physical change was visible. The emotional one was harder to see.

I kept telling myself I’d figure it out because I always had. I kept assuming time would restore what discipline couldn’t. It didn’t. What made that period so difficult wasn’t only the loss. It was the meaning I attached to it. For more than twenty years, being a successful dentist had been part of how I understood myself, and admitting that I was struggling felt like admitting that the person I had worked so hard to become wasn’t who I thought he was. That belief kept me quiet longer than it should have.

Dentists don’t get a special exemption from grief, depression, fear, shame, or exhaustion. Competence doesn’t make us immune, and neither do financial success or a strong reputation.

When life hands you something that grit and intelligence can’t fix, silence can turn a hard season into a dangerous one.

The Warning Signs Usually Aren’t Dramatic

For many dentists, the warning doesn’t arrive in one catastrophic phone call. It can look ordinary: Sunday dread that begins on Saturday afternoon, the second drink poured before the first one is finished, another dinner declined because you’re too tired, a short temper at home, compulsive phone checking on vacation, or the strange inability to feel much of anything when something good happens.

None of those signs proves a diagnosis, but they do deserve attention. The important question isn’t whether your experience matches someone else’s perfectly. It’s whether the life you’re living feels increasingly different from the life you want, and whether you’re hiding that difference from everyone around you. That’s often the point where a conversation needs to happen.

Bermuda and the First Honest Step

In November 2023, I went to Bermuda for Dr. Len Tau’s Supercharge Your Dental Practice Conference. My friend Matthew invited me, and I almost didn’t go. The opening keynote speaker was Dr. Jeff Buske.

His circumstances were different from mine, but parts of his story felt painfully familiar: depression, wine at the end of the day, and a life unraveling quietly while success still looked fine from the outside. Jeff talked about rebuilding through what he calls the Core Four: Body, Being, Balance, and Business. Body meant rebuilding physical health as a foundation for resilience. Being meant reconnecting with an identity that wasn’t limited to “Dr.” Balance meant repairing the marriage and family relationships that get pushed aside when work consumes everything. Business meant building a practice that supports life instead of taking it over.

For the first time in years, I heard someone describe a structure that addressed the whole person, not just the practice. After his talk, I walked up to Jeff and told him I had been where he had been and that I was still climbing out. I told him I wanted to help spread that message for the rest of my career.

A few weeks later, Jeff took me on as a coaching client. That relationship mattered, but so did the decision underneath it. I finally admitted that I needed help.

Coaching became one important part of my recovery. It wasn’t a replacement for mental health care, and it shouldn’t be treated that way. Anyone dealing with depression, suicidal thoughts, substance misuse, or another mental health concern deserves support from a qualified licensed professional. The bigger lesson was simpler. Asking for help didn’t diminish me. It gave me a way forward.

What Changed in My Work

Foundation Dental Alliance began with a straightforward goal: help dentists build better practices. That goal still matters, but my definition of a better practice has changed.

A practice isn’t better if its owner is financially successful and personally miserable. More revenue doesn’t make up for a marriage that’s falling apart. Clinical excellence doesn’t mean much if you dread waking up. A strong EBITDA number can create options, but it can’t tell you whether you like the life you built. That’s why health, purpose, relationships, and personal freedom now belong in the same conversation as systems, leadership, practice value, and transitions.

At our retreats, I want dentists thinking about what they’re running toward, not only what they’re trying to escape. In the Foundation Dental Mastermind, I care about how the owner is doing, not only how the practice is performing. In transition work, the question isn’t only what the practice is worth. It’s what the next chapter of life is supposed to make possible.

A practice should support the person who owns it. It shouldn’t consume that person.

The Objection I Hear Most

Some dentists hear a message like this and think, “I’m fine. I just need to toughen up and get through the next season.” Sometimes that’s true. Not every hard month is a mental health crisis, and not every stressful period requires therapy. But “I can handle it” becomes dangerous when it turns into a rule that nobody is allowed to see what’s really happening.

Strong people ask for help. Good leaders let other people carry weight with them. Responsible owners know the difference between a difficult season and a pattern that’s starting to damage their health, marriage, relationships, judgment, or ability to function. The goal isn’t to turn every challenge into a diagnosis. The goal is to stop treating silence as proof of strength.

What You Can Do Today

If you’re struggling, tell one person the truth. Choose someone who can listen without minimizing it or turning the conversation back to business. If what you’re experiencing includes depression, thoughts of suicide, substance misuse, or the sense that you may not be safe, contact a licensed mental health professional or a crisis resource now.

If you’re doing well, look around. The dentist who needs help may not look distressed. They may still be producing, smiling, leading, and answering every question. Ask something better than “How’s business?” Ask, “How are you, really?” Then give the person enough time to answer. The profession doesn’t need more performance. It needs more places where honesty is allowed.

A Final Thought

I lost fifteen million dollars in forty-five seconds. That loss hurt, but it wasn’t the thing that nearly cost me everything. My health, my family, and my sense of purpose were worth far more. Money can be rebuilt, and so can a practice and a reputation. A life is different.

Your practice matters. Your patients matter. Your team matters. You matter more than any of them can ask you to carry alone. If we want healthier dentists, stronger leaders, and better practices, we have to stop treating silence as strength and make it normal to tell the truth sooner.

If You Need Help Now

If you or someone you know is in immediate danger or thinking about suicide, call or text 988 in the United States or contact local emergency services. For ongoing concerns, contact a licensed mental health professional, your physician, or a confidential wellness resource available through your state dental association.

Frequently Asked Questions About Mental Health in Dentistry

Is this newsletter saying every stressed dentist needs therapy?

No. Stress is part of ownership and clinical practice, and not every hard season signals a mental health disorder. The point is to pay attention when stress becomes persistent, starts changing how you function, damages relationships, increases substance use, or makes you feel unsafe. At that point, getting qualified help is a responsible decision.

Can a coach help with depression or suicidal thoughts?

A coach can be useful for accountability, perspective, habits, and business or life structure, but coaching isn’t a substitute for licensed mental health care. Depression, suicidal thoughts, substance misuse, or other significant mental health concerns should be addressed with an appropriate licensed professional.

What should I do if I’m worried about another dentist?

Start with a direct, private conversation. Ask how the person is doing and give them room to answer honestly. If you believe there’s an immediate safety risk or they’re talking about suicide, contact emergency services or the 988 Suicide & Crisis Lifeline in the United States. Don’t leave an immediate safety concern to a casual follow-up.

Where can a dentist find confidential support?

In an emergency, call or text 988 in the United States or contact local emergency services. For ongoing concerns, start with a licensed mental health professional or your physician. Many state dental associations also offer confidential wellness resources for their members.

Why connect mental health to leadership and practice ownership?

Owners make decisions that affect patients, teams, families, and the long-term health of the practice. Personal well-being affects judgment, patience, communication, relationships, and the ability to lead. A practice that performs well while its owner is falling apart isn’t a healthy practice.

What does freedom mean in this context?

Freedom isn’t simply working fewer days or reaching a financial target. It means building a practice and a life that leave room for health, relationships, purpose, and choice. Practice value matters because it creates options, and those options matter most when the person who owns the practice is healthy enough to use them.

The Foundation Dental Newsletter publishes every Tuesday. If this reached you through a colleague and you’d like to subscribe, the newsletter is available on LinkedIn or you can reach out directly.

About the Author

Dr. Jim Arnold, DDS is the Founder and CEO of Foundation Dental Alliance, a leadership and practice development organization serving dentists from graduation through retirement. He has 30 years of experience as a multi-practice owner and has been involved in more than 60 dental practice transitions. He leads the Foundation Dental Mastermind, Luxury Dental Retreats, co-founded Foundation Dental Transitions, and hosts the Foundation Dental Podcast. He also publishes the Foundation Dental Newsletter and Blog weekly, focused on leadership, practice design, and long-term sustainability in dentistry.

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