This interview was originally taken from Coffee Break With Coachman, a series of interviews with the best dental brains and the best personalities, in short, the most influential people in our dental industry today. From business to marketing to clinical to research, academics, laboratory technology and digital, each of the interviews is a conversation with a thought leader in their field, sharing their knowledge and experiences.

What follows is the second of two interviews with my dear friend Dr. Kyle Stanley, one of the new members of the team of young dental celebrities, he’s a super-successful dentist from Beverly Hills, and with a bunch of great new ideas -  a breath of fresh air into the lecturing circuit. We talk about Kyle’s career and a very serious subject that Kyle brought to our attention.

We have this group of opinion leaders in dentistry that we are part of, and you brought this topic and people really got involved and started to comment. Mental health, dealing with stress, a huge rate of depression in our profession. Actually dentistry is known as one of the most stressful professions on earth, and the rate of depression among our colleagues is huge. It's curious also to know that the highest rate of suicides among professionals is among dentists as well.  

CHRISTIAN: When we last spoke, Kyle, you talked about having a midlife crisis of sorts. We all go through that, it's amazing because I went through that too, at a similar age.

KYLE: 35? That's how old I am.

CHRISTIAN: 32. I got depressed, had panic attacks, I didn't sleep.

KYLE: You graduated a few years before me probably because you guys go directly to dental school, right? Oh, but you were a technician first though.

CHRISTIAN: So I was later, but I started to work as a technician earlier, so that's probably why my crisis started earlier, but it's amazing what your brain can do to you. People look at you and say, “you're completely, fine, don't worry.” And you are in your bed saying, “I'm going to die.” Everything is wrong. Nothing makes sense, and that brings us to the topic about stress and mental health, and I want you to introduce this topic with the information you shared with our group of friends that day.

KYLE: My crisis was maybe six months, where I actually considered, “Have I been wasting my time since I was 18 years old thinking about being a dentist? Am I not as good as I thought I was? What am I doing wrong?”

At the time, I was in a happy state, so I re-posted that and I said, “oh, look at how cool it is that my profession is one of the top jobs in America.” And then when I was at my low point, I was looking at it and saying how is this possible? And when I was in dental school, I'd be going out and I'd be going to clubs or bars or whatever, and talking to people, and they were like, “oh, you're a dentist? Oh, yeah, dentists all kill themselves.” And I was like, “oh, no, that's like in the past.” That must have been in the '50s when there was no anaesthesia and we didn't do aesthetic work, and that kind of stuff. So I started looking more and looking at scientific research on this and saying, are we the best job? What is the suicide rate?

So of the best jobs in America, one, two, three, four, five out of the top 17 are dentists. So it is dentist, orthodontist, maxillofacial surgeon, prosthodontist, dental hygienist. Top jobs in America. But then when I looked at it, it would say that our stress was minor or maybe moderate. Mostly because dentists work three to four days a week, they can take vacation when they want to.

And I was thinking, is something wrong with me? Why do I have a hundred percent stress and they're saying that the stress is low?

So I started looking at suicide rates in dentistry, and one article I found, dentists are 1.67 times more likely to commit suicide. Then another one I found, being a dentist increases your risk of suicide by 564%. And I was like, holy shit, 564% just by being a dentist? Let alone being a dentist and managing other things or whatever. So I got like, how could this be possible? How could we have the best job in America and have one of the highest suicide rates? We have to figure out what's happening here. Why are people killing themselves? When I speak about this, I always say, anybody here know a dentist who's committed suicide?

Let's say I'm speaking to a hundred people and there's a normal, steady club of a hundred people. 70% of them raise their hand. I know someone. My dad knows someone, my brother knows someone. My mother-in-law, who works in an orthodontist's office, she knows an oral surgeon that has. And the first time I gave this lecture and I asked, and this was this hundred people, 70 people raised their hand. I started crying. This is also when I was just getting over my midlife crisis, too, so I was maybe a little emotional. I was like, okay, there's something wrong here. We have to figure out what's going wrong. So I started to think about what are the different reasons why we may be stressed. So the first one is an environment of fear. We live in an environment where patients don't want to come see us. They may hate us, too. So I started looking up research and there's research that shows some of the top fears for people. Number one is public speaking, which is kind of interesting for you and I. Public speaking. People are very scared. Number one fear. Number two is usually the dentist. Number three is death. They're more afraid to come see us than they are to die. They would rather die than come and see us.

CHRISTIAN: Every single day you're generating this fear. You're generating pain, and when you are dealing with pain, it's like torturing people. People that are tortured for years, others, they usually kill themselves at the end of their lives because they feel like shit. Generating pain. And then when you're a dentist, you're chronically, every single day, generating that little pain, and you can see that in people's faces and that bounces back as not a good energy.

KYLE: One of my friends, Victor, told me they did a study on when dentists are giving injections, our blood pressure goes up 20 points or something like that. It's because people think we like to hurt people. It's insane to think that, but we never want to hurt anybody. And so when we do, when it's part of the process, or they have pain after surgery or something, we take it on ourselves. It's very difficult emotionally.

So I was thinking about why is there this emotion of fear. Are we teaching this to people, or is it after they have bad experiences? And I started looking at things and a lot of it comes from the media. So there's very rarely a good portrayal of a dentist. Which is why I love the makeover shows that you're doing in Brazil. Every time a dentist is portrayed in the media, it's always like this bumbling idiot who likes to hurt people.

So I think that what you're doing with DSD really helps this in the media, and Invisalign has helped with this, and I think in America one of the last things that was good press was these makeover shows like The Swan and Extreme Makeover. They maybe went a little too extreme with it, but it was a good portrayal. It showed how you can change someone's smile. They feel better about themselves, they start dating again. So, that was one of the first things. The first thing was environment of fear.

The next thing I started looking at was litigation. So, I know that this is more prominent in the United States than it is in other countries, but it definitely happens in other countries. So in the US, 5% of all malpractice suits are related to dentists, and the median price tag for a dental malpractice suit is about $53,000, which is a ton of money. I don't know who has $53,000 just to throw around, and this, of course, doesn't include legal fees, things like that.There's another study that says, 72% of dentist are actively fearful of being sued.

So, every day we go to work, we're worried about when we touch this patient, are we gonna be sued? And this has to do with the media as well. So we have the media always showing whenever a doctor, a dentist, an optometrist, any doctor that does something wrong there's media about it. We always have high workloads, we see a lot of patients, and to be afraid every day of being sued, that can influence what treatment you do, which shouldn't. You should do the best treatment for patients, but you may think that one's more risky, this one. I'm going to do this one because of that.There was a dental survey of about 700 participants. 42% of dentists have received a claim for clinical negligence during their career. So almost half have received a claim. I've never been sued, but I know many who have. I know people that have got letters saying I want to sue you. They don't end up doing it, or something happens, but this can affect your life. This affects your self-esteem.

This affects your relationships. This affects your health. The stress of this on your body affects you personally.

CHRISTIAN: Just to complement this, I believe that we definitely need to change the perception of the public, in general, related to dentistry, and that dentistry is seen as something boring, a waste of time, painful, and something that is aggressive. People still have in mind dentistry from a hundred years ago, like the barber extracting teeth with no anesthesia. I usually compare it to the medical field, a hundred, 200, 500 years ago, the medical field comes from the science world from sophistication, and the dentist comes from the backyard barber extracting teeth.

So today we have dentistry in one of the most exciting moments in the history of dentistry where procedures are so sophisticated. Technology is beyond crazy sophisticated. Precision, delicateness, the chair for creating comfortable procedures. And adding to that the fact that today we have so many beautiful researchers showing the importance of having an oral health environment and smiling with confidence.  

So research is not just about dentistry, but we dentists should be speaking to the whole world. The importance of smiling with confidence - how the smile affects your biology, your body, your health, smiling with confidence every day, 30 to 40 days, is one of the best medicines in the world compared to healthy diet and sleeping well and smiling with confidence. The three. They are as important.

KYLE: The oral health is related to the medical health and a little bit going back to the AI that we were talking about in our last interview, one thing that's cool about that is we're able to connect. You take this x-ray, and we connect it to the patient's chart anonymously, so we know this x-ray is related to a 53-year-old female that smokes or whatever. Now when we take all of that together, and we have millions of patients, x-rays, and patient charts, we can then predict when we take an X-ray, you're 72% more likely to have a stroke, heart disease, whatever, based on looking at all of these charts. That's that connection with the oral cavity that we've learned in maybe the last 10 years. That's really starting to become important now. Patients need to understand this.

CHRISTIAN: But again we need to look back at us. If community is not giving the value we deserve, it's our fault it's not their fault, right? We need to know how to create perceived benefit. We need to tell the story about the beauty of dentistry, about how deep the impact is of what we do, how sophisticated, how important, how difficult it is to be a good dentist. Patients suing dentists, they need to look to their dentist in the eyes and understand the intentions. If the intention was the best, do you want to sue your dentist just to get his money and ruin his life even though he's trying to do his best for the last 20 years? It’s about understanding that being a great dentist is very difficult. It's the amount of investment for a dentist to become very good, it's more than any other profession. The amount of financial investment you have to invest in yourself on technology, equipment, training, courses, reading, articles, and continuing education. No other professional does as much as a dentist.

Then you have this professional that changed people's lives deeply. That is so stressful because of this profession, that needs to invest so much money to become so good, giving his best because we are passionate. Dentists are, in general, passionate about what they do. We give our best to patients, and that's the reason why I'm really proud of being part of this moment through DSD of changing the perception of society about what our profession does for them. And that ties perfectly to what you were talking about, and I think you need to speak much more about it. You need, as you said, and I wanted you to mention that as well, you were suggesting in our group a channel of communication for dentists that are going through stress and depression.

KYLE: We're working on that. After I started giving these stress lectures, another dentist contacted me and said, “I had this idea of making an anonymous forum for dentists to have, and maybe all doctors to have, a way of talking about their stress because talking about mental health is a taboo subject, especially in the United States.”

But I think everywhere around the world, because we see it as a weakness, and I used to be one of these people that said, oh, yeah, they're just weak. I just hadn't gone through it yet. So, having this area where we can talk about this openly, in person would be fantastic, but maybe not everyone's ready for that. So, we're working on something right now which will be an outlet to where doctors can talk about stress with like-minded people, people that understand their problems. People that understand the things we've been talking about, like the debt, which is one of the next big problems. Should I talk about debt?

Okay, so I went to what I think is the most expensive dental school in the world, USC. I got out of school with $425,000 in debt. That was before going to my residency program, taking out more money. That was before buying a practice. That was before buying a house. That's the beginning, $425,000. And when I started looking at these studies and researching things on debt, the average dental student gets out of school at $287,000 in debt. 80% of dental students have over $100,000 in debt, and since 1990, the cost of dental school has quadrupled. It's gone up four times, so people are coming out of school, and they just have to do whatever they can. And often times it forces people to do sub-par dentistry because they just have to work. They just have to pay the bills. And I don't care if I see 40 patients a day. I just have to pay my bills.

One thing that's interesting that I just read this week, I don't know if you saw this, but there's been two grants given to NYU Medical School and Columbia Medical School. NYU Medical School is paying for all of their students' tuition. All of their current students and all of their future students. So these people have given a ton of money to pay for medical students to go to school. And I was like, this is crazy. This is awesome to see that, because those students will come out of this any they may still have the clinical stresses, but they may not have the financial stresses as much. I don't say this as like, oh, they can come out and be rich. But they may not think, well, gosh, I went to school for 20 years and now I'm struggling to pay my mortgage. So there's the debt portion.

One of the biggest things that's very specific to dentistry is revisions. And you may be saying, what are revisions, because this is a medical term. Revisions are like I get in a car accident, and I break my ankle in 30 pieces, afterwards I still limp. Do I see the doctor? No, of course not. If I need to get a revision surgery, does a doctor do it for free? Of course not. But in dentistry, this is what's expected.

And the thing is that everybody makes mistakes no matter how good you are, no matter how long you've been practicing.  But with dentistry, we have this very dynamic part of the body. We're working with one of the dirtiest parts of the body and one of the most mobile parts of the body, and we're expected to do things that are super predictable. 

CHRISTIAN: Very interesting, I never thought about it. You're totally right. The example of the car accident and people come to the dentist, the same car accident, the same patient. But he lost the teeth on the same car accident, and now the doctor is rehabilitating his smile and then his bite is limping. What does he do? He sues the dentist, and he expects perfection. And the dentist needs to redo for free. An excellent example. Amazing, and maybe we need to look at the way we explain things in dentistry because we do have the tendency to say, oh, I'm gonna make your smile perfect.

KYLE: I have learned this the hard way by saying, this is the most predictable way of doing it, which is true, but what I wasn't saying the first five years of my practice was, it can still fail. No matter what I do, it can still fail because biology happens. Do you want to treat your mouth with me knowing that I may make a mistake? I'm human.

CHRISTIAN: Do you as a patient expect that I'm perfect? Do you expect that? Because I'm not perfect, and I may make a mistake in your mouth. So if you have any intention to sue me because I'm not perfect, you tell me right now. So then the patient thinks, well, how can I trust you? The same way you can trust your lawyer, you trust your engineer, you trust your physician. You trust they are doing the best they can. That's what you need to trust. You need to trust that I'm doing the best I can. Not that I'm perfect. And we should make people understand that it's not only things that we can’t control, because dentists say there are things that I cannot control. I am not talking about that. I'm talking about things that you can control, and you make a mistake.

KYLE: It's true. We're human. So I guess you have the patient, what they do after you do the treatment or before, and you have the dentist’s human-ality, I don't know if that's even a word, and then you have biology. So I talk to my patients and say, for an implant, I'm doing guided surgery, I'm doing facially-driven treatment, I'm using some of the best implant companies. I can do everything right. You cannot chew on that side, not smoke, all this stuff, and guess what? The implant can still fail. On the lower jaw, we have a 97% success rate, let's say. What does that mean? 3% still fail, and this is what I tell my patients.

So I learned in my first five years that I definitely don't talk patients into doing treatment. I let them make the decision that this is what they want to do, and I almost try to talk them out of it a little bit, so that they understand that nothing is this predictable.

One of my good friends who is a foot and ankle surgeon, and so imagine when he does surgery. He puts a tourniquet around the patient's leg, bloodless surgery. Sterile procedure, truly sterile, and then afterwards he puts the patient on a crutch for months. We can't put a tourniquet around the patient's neck. We can never make it sterile, and we can't say don't eat for the next three months.

CHRISTIAN: That's true. It has to be perfect right out of the box and function immediately. The emotional, social, aesthetic impacts, of the smile has a huge impact as well, but going back to your point, how do you call it, revision, right? I love that term. We need to write more about that because many people come to us to learn how to simulate smiles, to do the motivational mock-ups, to plan digitally and show to the patient in 3D the treatment, and many dentists, they say, but Christian this is very dangerous because you're committing to this. How can you guarantee that the final result will look like that? So I will not use this. I will not do a simulation. I will not do a mock-up, and I will not show these great 3D simulations because I cannot promise that the final result will be like that. My answer is, that's not the point.

You cannot stop using this, not give this benefit to your patients. But how do I explain this to my patient? This is what you need to tell your patient, look, this technology, I'm simulating your smile. I'm simulating the plan in 3D. This helps me to increase the chances of a better final result. I cannot guarantee perfection between the project and the final result. There's many factors that I don't control including a few mistakes that I can make myself in the middle of the pack, right? So what I can tell you is, with this technology, because of the simulation, and because of the 3D simulations that I do, the chances are that my result is better. Now I tell you, patient, that you prefer for me to use this technology and increase the chances even though I cannot promise and cannot guarantee, or you prefer me not to use anything because I don't want to commit with that possibility. How crazy. So we need to stop with this.

We need to be sincere about the distance between a simulation and a final result. We need to be clear that we are not seeking perfect smiles, that we want to give the best we can. There are unpredictable factors, things we cannot control, and above all, I'm a human and I can make mistakes, and you shouldn't sue me because I made mistakes. If the mistake is related to me not following the ethics or basic principles of my profession, you should sue me, but the mistake is incorporated on the process, even if I'm the best. So we need to change the way people perceive what we do.

KYLE: It's how we talk to our patients. It's how we explain this to our patients and setting the expectations correctly at the beginning. So there's a few other topics with this. One is isolation. Many people, like my father, works alone in a windowless office for 40 years. So, that can be a big problem. I'm lucky that I have two great partners that I work with that we bounce ideas off each other, and we can just sit and talk about our families, or our cars, or whatever. Just to have that interaction with people, I think is a big thing.

Another thing is professional jealousy. You look at Instagram accounts that every single post they post is the most amazing picture and I've been guilty of this. Of course, I'll post when I feel like it's good, right? But now, in my lectures, a case that I showed five years, showing look how good I am, now I show and say, look at all the stuff I did wrong. And I think that's what we need to see more of, because the young generation gets out of school and they think, oh my gosh, these guys from Japan and from Brazil, and all this stuff they're doing. Everything they do is amazing. Every margin is perfect. Everything blends with the face. But they're not showing the ones that don't blend with the face. They're not showing the ones where the bite is off, or the patient is pissed at them, or the patient comes back at 9:00 PM because they're bleeding. So it's that reality.

CHRISTIAN: That brings back to the ego factor. I don't know exactly why, the average ego amount, in good dentists is usually high and we like to impress each other, sometimes when impressing our own clients. We want to impress other doctors. And the bad thing about it is, besides all the problems with the ego, is the fact that we generate pressure. We cannot fail, because we are trying to impress the others. We try to create this persona of perfection, of artistic perfection and precision that when we fail, and we will... everyone's been telling you for the last year you're the best thing since sliced bread, and then something fails and you're like, wait, I thought I was the best.

How did this happen? I thought I was so good. I went to school for so long. I'm going around teaching people how to do this. That's why I love Joseph Kahn so much. Joe Kahn, all his lectures now are just look at all the stuff I thought I was doing right and let's see how we can learn from this.

But in an honest way. A professor can't teach his shows on dentistry in an honest way because there's a lot of fake humbleness. People pretending they're humble or creating a story, but at the end, they're still trying to show off, right? People are using humbleness to show off even more.

“I'm so humble. I'm so cool because I'm so humble”, and at the end you're showing off. It's tough to control the ego.

KYLE: I remember when we were walking to the Joseph Kahn, you said, "Kyle, be careful because I see your career taking off, and I see you getting invitations, but be careful because you feel great all the time, but you're away from your family a lot and it can get your ego out of control." I always remember that, it will always stick in my brain, so thank you for that.

CHRISTIAN: We need to go out and try every single day. You say, oh, I don't have an ego. You're already lost. It's there. You need to pay attention and control it, and actually having an ego, it's a drive, it's a push. It makes you want to do better, but it can never be the main force guiding your decisions beyond ethics and moral, and being a good person. My ego is there. I know, every day in the morning, my ego's going to try to take over and I can't allow this. Control the ego. Be a good person, and that's the way to move forward, understanding that. So if you can just summarize. You mentioned, I don't know, six, seven, eight factors. Can you summarize what are the factors that make dentistry so stressful and create this huge amount of dental professionals with mental issues and depression and stress?

KYLE: Yeah, it's debt, professional jealousy, isolation, living in an environment of fear. There's a lung cancer that's happening only to dentists right now that we can talk about another time. Litigation, physical and mental stress. More than 90% of practicing dentists experience musculoskeletal pain. Working in one of the most difficult parts of the mouth. Revisions is a huge one. And then the last one is emotional stress. I'm just gonna rattle off some numbers from the American Dental Association, okay? 11% of dentists have depression. Only 6.7% of the general population have depression. Same thing, in the general population anxiety disorder, dentists are double. Panic disorder, dentists are double. 3,500 dentists were surveyed, 38% are frequently or always worried. 34% are frequently or always physically or emotionally exhausted. And it says always. Frequently or always worried or emotionally exhausted, and five years ago you'd ask me this and I would say, these people are weak. Maybe they can't handle it. I can handle it. I just wasn't there yet. I have seen this in very close family members of mine where I may have even judged them as being weak and now I'm the hypocrite, and I relate this a lot to celebrities. Okay, we see celebrities, and we say, Justin Bieber, how can he be going through a mental crisis? He's worth $300 million. He's one of the most famous guys in the world. We don't give someone any empathy if they're successful.

I started realizing why this is why dentists don't get empathy because let's say, Christian, you go to one of your friends who, I don't know whatever their profession is, and you say, you know what? I am struggling right now. I've got so much on my plate, and with my family, and I have this patient that's in pain, and I'm stressed about this. They'll say, what do you have to worry about? You're successful. You have a beautiful family, you drive a nice car, you're well-respected in the community.

So it's the same thing with these celebrities. People don't really get any sympathy if you're successful and this is why I think it's nice if we can talk about it amongst ourselves. And when I speak about this, I told you this, but I'll give a full-day lecture, and I'll be talking about smile design and implants, and facially-guided treatment, oral-facial treatment. I'll talk for 45 minutes about stress. When we take a lunch break, you know what everyone comes up and talks to me about? Stress. They don't care about implants. They don't care about smile design. They don't care about anything. They come up to me and say, thank you so much for bringing this because I've been struggling with it, or my husband has been struggling with it, or my friend. I'm so glad that you've brought this into the air, and I'm getting emotional talking about it, but that's been so important to me. I hope that people will invite me for this topic, and I think that's the hard part with a lot of things is getting the invitation for it.

CHRISTIAN: The lip lift will be a detail close to this topic. So when you have somebody with the communication skills as you have really identifying these topics because that's what we need. We need people talking about it, and I'm sure as soon as you have this project ready on opening this channel of communication, I don't know, but this can become something huge and help so many people. So let me know when this is up and running.

KYLE: My idea with this is if I can prevent one dentist from committing suicide over the next 10 years, I mean, that would be everything for me. It's close to my heart.

CHRISTIAN: It's important to understand that you have the extreme and we need to help and have the channel for these people to be able to share, but as you saw the numbers, it's the slightly depressed, the slightly stressed, the chronic ones. There's millions of professionals out there at that level. First, making people talking about it will make people realize. I actually have some level of issue. It's not as obvious. I'm feeling this, and we know that sometimes we talk about these things, people recognize that we are suffering. They respect what we're feeling, and we get better immediately or we see the light at the end of the tunnel. So move on with this project. This is amazing. You will help a lot of people that are at the end, not normal, but general people at the chronic level of stress. That we need help to just have a slightly better life. I think that's beautiful.

KYLE: To summarize that point, I always like to have, is there an answer to this? Is there a way? I think number one is this, you allowing me to talk about this and spread the word. Maybe if we could have some kind of debt reform for professionals of some way.

CHRISTIAN: Debt, those solutions will come. You just need to place yourself at the center of the movement. Make yourself available.

KYLE: You always said when people would ask you on a plane, what do you do? And you would say, I'm a smile designer. And it's like, well, what is that? We always talk about ourselves as our profession, and then I think that's dangerous because then if something goes wrong in our profession, we lose our personal identity. So that's why I think we need to think of our profession as part of our identity, but like for me, number one, I'm a father, I'm a husband. And I happen to be a dentist, that's what I do for my job. So excuse me, I'm getting a little emotional here.

CHRISTIAN: This topic deserves the emotion, only because of the emotion, people do things about it. So, you have to be. If you weren't emotion, you wouldn't be the right person to bring this topic and discuss and start this, so keep the emotion, keep moving in that direction, and count on me because I think we're gonna have a lot of people coming on board and you're gonna get so much positive energy from people being grateful. It's an amazing process.

Every time you have a great idea or you start doing something really good for others, not thinking about yourself, you start to find other people all over the world doing the same. You know? So you've been talking about the lip lift and that was the topic that brought you to the world, and you definitely found amazing people that were working with the face, the synchronicity, right?

This new wave will connect you with even more amazing people that are worried about other people. Be ready because it's going to be a beautiful adventure, I'm sure.

KYLE: Thank you very much. I owe a lot of my career to you, so thanks for bringing me under your wing before I was anybody, and believing in me. I've told you this in person, I've told you this over WhatsApp before, but thanks again, I really appreciate it. It means a lot to me.

I hope you enjoyed this interview with Dr Kyle Stanley and on such an important and special topic. Do share this interview with our profession. Do this for our colleagues that are going and struggling, and do this for ourselves because if we haven't been through something like this, we will probably go through something like or, or maybe we are going through something like this right now and we don't see it from inside.

If you would like to know more about Digital Smile Design, the DSD Planning Center and the courses we offer, including our four day residency to take the first step to becoming a DSD Master, find out more here: