Chief Psycho

Dentistry’s Silent Emergency: Rethinking Suicide Awareness

Sep 15, 2025By Jonathan Bonanno

Every September, timelines fill with reminders to “check on your friends.” The intention is good, but in dentistry it is not nearly enough. Elevated suicide risk in our profession isn’t a mystery of individual weakness. It is the predictable byproduct of how the work is designed, how practices are led, and how silence is rewarded.

We know the contours of the risk. Dentists report high rates of anxiety and depressive symptoms, staggering educational debt, chronic musculoskeletal pain, and professional isolation. International studies have long noted suicide rates in dentistry exceeding those of the general population. None of this will change until leaders treat suicide prevention as an organizational mandate rather than a private struggle.

This article moves beyond awareness to operational change. It borrows from the Interpersonal-Psychological Theory of Suicide, the Job Demands–Resources model, the World Health Organization’s classification of burnout as an occupational phenomenon, and contemporary work on psychological safety by scholars like Amy Edmondson and Timothy Clark. Then it translates those frameworks into a concrete action plan for dental organizations.

Why dentistry is structurally vulnerable

  1. Interpersonal-Psychological Theory of Suicide (Joiner). Risk spikes when people experience perceived burdensomeness, thwarted belongingness, and acquired capability. Dentistry intersects with all three through debt and production pressure, solo practice isolation, frequent exposure to pain and pharmacologic agents, and a culture that normalizes suppressing distress.
  2. Job Demands–Resources (Bakker and Demerouti). When precision, time pressure, patient anxiety, and administrative hassles outstrip resources like autonomy, peer connection, fair rewards, and supportive leadership, burnout becomes a system output, not a personal failing.
  3. WHO on burnout. Burnout is classified as an occupational phenomenon, which squarely places responsibility on work design, staffing, and leadership norms rather than on the “grit” of individual clinicians.
  4. Psychological Safety (Edmondson; Clark). Without inclusion, learner, contributor, and challenger safety, people hide errors and pain. In dentistry, that silence isn’t just costly; it can be lethal.

If you run a practice or a DSO and your policies, cadence, and incentives aren’t aligned with these realities, you are leaving risk on the table.

The leadership playbook: nine levers you can implement now

1) Publish a no-reprisal mental health policy
Make it explicit that seeking help will not jeopardize status, pay, scheduling, or licensure disclosures beyond what law requires. Put it in your handbook. Reference how information will be handled, who has access, and what confidentiality looks like in your context. Ambiguity breeds fear; fear breeds silence.

2) Install a predictable 1:1 architecture

  • Weekly 20-minute 1:1s between each leader and each direct report
  • Agenda: wins, workload heat map, one friction point, one wellbeing check
  • Scripted opener: “On a scale of 1–10, how sustainable did this week feel, and what would move it one point higher next week?” Normalize the conversation so support isn’t a special event reserved for crises.

3) Redesign workload using JD-R

Audit job demands and resources line by line:

  • Demands to dial down: chaotic scheduling, unrealistic chair-time density, after-hours charting, solo coverage on high-acuity blocks, opaque production targets
  • Resources to dial up: admin buffers daily, cross-coverage, autonomy over scheduling templates, transparent metrics, protected learning time, ergonomic upgrades Treat this like infection control: non-negotiable and audited.

4) Build belonging on purpose

Isolation is a risk factor. Create durable peer structures:

  • Pod model: 4–6 teammates meet biweekly for consults and debriefs
  • Monthly “case plus coping” rounds where clinical learning and emotional processing share equal time
  • Mentorship pairings that rotate every 6 months so belonging isn’t accidental

5) Train gatekeepers and practice the drill

Use evidence-based gatekeeper training adapted to dentistry. Then run scenarios quarterly like you would a medical emergency:

  • “A hygienist texts ‘I can’t do this anymore’ and doesn’t show for first patient”
  • “An associate has escalating errors and withdraws from team banter”
  • “A practice owner hints at ‘everyone would be better off without me’ after a financial setback” Rehearsal makes response faster, calmer, and safer.

6) Make access effortless

  • Share a living, curated list of local and telehealth therapists who understand healthcare
  • Cover at least two initial sessions through your benefits or a discretionary fund
  • Put 988 and emergency steps on the back of ID badges and in the staff portal
  • Offer quiet rooms and same-day coverage swaps without penalty when someone signals distress

7) Establish a four-step crisis protocol

  1. Stay with the person or keep them on the line, and move to privacy
  2. Ask directly: “Are you thinking about killing yourself?”
  3. Activate 988 or local crisis services and your internal escalation tree
  4. Remove access to means where possible, and never promise secrecy Document, debrief with the team, and schedule follow-ups. Compassion without structure is fragile.

8) Measure like you mean it

Track leading and lagging indicators on a simple monthly dashboard:

  • Leading: 1:1 completion rate, schedule predictability, overtime hours, ergonomic issues resolved, EAP utilization, training completion
  • Lagging: absenteeism spikes, turnover, incident reports related to fatigue, near-miss counts Share trends. What leaders measure, teams take seriously.

9) Roll out with a 30-60-90 plan

  • Days 1–30: announce policy, launch 1:1s, publish the provider list, schedule training
  • Days 31–60: complete JD-R audit, adjust templates and staffing, start peer pods
  • Days 61–90: run first crisis drill, publish dashboard, fix two systemic friction points the team identified Momentum matters more than perfection.

Language that helps instead of harms

Leaders often want to help but choose words that shut people down. Use these scripts to move the conversation forward.

  1. Say: “You’re important here, and I want to understand what would make next week more sustainable” Not: “Everyone’s stressed; it’ll pass”
  2. Say: “I’m hearing you feel stuck and alone; let’s map options together and loop in support” Not: “Have you tried taking a day off?”
  3. Say: “Thank you for telling me. You won’t be penalized for asking for help” Not: “Keep this between us”
  4. Say: “Are you thinking about killing yourself?” Not: “You’re not going to do something silly, right?”


Directness signals safety and competence. Euphemisms telegraph avoidance.

A brief self-audit for owners and executives

Score each item 0–2 and total out of 10:

  1. We have a written, visible no-reprisal mental health policy
  2. Managers complete scheduled 1:1s at least 80 percent of the time
  3. Our schedule includes protected admin buffers every day for each clinician
  4. We run at least two crisis simulations per year and debrief them
  5. Our monthly dashboard includes at least three leading indicators tied to wellbeing


If you scored 6 or below, you have structural work to do. If you scored 8 or above, share your model with colleagues. Hoarding good practice design helps no one.

What this looks like in real life

A startup group asked for “communication training” because meetings were tense and production had plateaued. A quick JD-R scan showed overloaded hygiene columns, no admin buffers, and managers canceling 1:1s during busy weeks. We replaced the meeting ritual with 15-minute daily huddles, hard-locked buffers into templates, and instituted a strict 1:1 cadence with the wellbeing check. Within six weeks, error reports dropped, same-day cancellations stabilized, and two team members who had been withdrawing accepted referrals to counseling. No one gave a motivational speech. The system changed, so the outcomes changed.

The pledge

If you lead in dentistry, adopt this simple pledge and mean it:

  • I will make vulnerability safe and expected
  • I will design the work so sustainability is the default, not the exception
  • I will measure what matters and act on what I learn
  • I will treat suicide prevention as a core element of clinical quality and patient safety

Behind every restored smile is a professional whose wellbeing is not optional. Suicide Awareness Month is a reminder, not an endpoint. The work is to change conditions so fewer people need to be “checked on” in the first place.

If you or someone you know is struggling, call or text 988 for the Suicide & Crisis Lifeline.

References:

  • Myers, H. L., & Myers, L. B. (2004). “It’s difficult being a dentist”: Stress and health in the general dental practitioner. British Dental Journal, 197(2), 89–93.
  • American Dental Association (2023). Dentist health and wellbeing survey.
  • American Dental Education Association (2022). Educational debt data.
  • Kopecky, K., Kopeckova, J., & Machova, R. (2017). Stress, burnout syndrome, and depression among dentists. Neuro Endocrinology Letters, 38(Suppl 1), 49–56.
  • Hayes, M., Cockrell, D., & Smith, D. R. (2013). A systematic review of musculoskeletal disorders among dental professionals. International Journal of Dental Hygiene, 7(3), 159–165.
  • Joiner, T. E. (2005). Why people die by suicide. Harvard University Press.
  • Bakker, A. B., & Demerouti, E. (2007). The Job Demands–Resources model:
  • State of the art. Journal of Managerial Psychology, 22(3), 309–328.
  • World Health Organization (2019). Burn-out an occupational phenomenon: International Classification of Diseases.
  • Edmondson, A. C. (2019). The fearless organization: Creating psychological safety in the workplace for learning, innovation, and growth. Wiley.
  • Clark, T. R. (2020). The 4 stages of psychological safety: Defining the path to inclusion and innovation. Berrett-Koe