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THE NEXTDDS Student Ambassador Blogs

Financial considerations after dental school

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 Frequently, there is one thing on the back of my mind while in Dental School. Fellow classmates suffer from the same thought, while others choose willful ignorance, as ignorance is truly bliss, right?

What I’m referring to is the scary “F” word.

Finances, and of course the associated, necessary, and painful loans.

Most might put it off, saying that it is something to think about or consider upon graduation, that it is too stressful thinking about it now – but looking at the figures, I know I need to be proactive in securing a future where I don’t have to constantly worry about each loan payment. Some may relish in receiving their loan package each semester, fortunate to have more spending money, while I dread it, as I know that each dollar I spend, is truly more than that dollar appears.

I was fortunate enough to have chosen to attend the cheapest state school I applied to, however after graduation I know I’ll still be looking forward to paying back nearly $250,000.

Most of my classmates would consider that $250,000 not nearly as daunting as most have optimistically stated that they expect a 6 figure salary right out of school. Unfortunately, this is the kind of thinking that can limit not only earning potential but also one’s ability to save and prepare for financial decisions in the future.

With the current Grad Plus Loan rate at 7.21%, the loan amount you take out effectively doubles in a 20 year span. Imagine spending 500k for a dental degree, especially after all the work and stress already put into it.

“But, I’ll pay that off in 3 years so I won’t have to worry about 500k”

Unfortunately, many of us are still in the “student mindset” where we unintentionally underestimate what our living expenses will be. We think, “Wow I mean even if we made 100k, that is a ton of money!” However, reality will show us that through federal and state taxes, we can automatically subtract nearly 30%, and then with housing, food, clothing, car payments, etc… the working capital dramatically decreases. Now to have 250k in loans on top of it, it quickly becomes obvious how expensive the route to become a dentist is. Throw in a few more expenses such as wanting to start a family, children, and buying a house, and before you know it, you realize that maybe you’ll need more than 3 years to pay off all your loans. Maybe 10 or more.

Another concept that directly ties in with paying back our loans is the concept of “opportunity cost”.  A concept where you spend your time, energy, and money into one thing but because you are, you may be missing out on other items of interest or as the term suggests, opportunities. A mentor of mine brought this concept to light. Instead of paying his loans off immediately, he opted for more time as if he paid them back rapidly, he would miss out on having the capital to directly invest into the practice he was an associate for. While extending loan payments and thereby increasing the total may seem counterintuitive, what he did made so much sense. As an associate he was making 95k a year, but since he saved and made only the minimal amount per loan payment, he was able to reach his goal of co-ownership of his practice quicker allowing him to buy in and bump his salary from $95k to $195k far quicker than if he paid of his loans immediately. It was because of this savviness, that he was able to secure a higher salary and in turn pay of his loans much easier than if he scrounged to pay them off immediately.

These are the things that we must take into consideration now so that we can prepare for what is to come later. If your school estimates $250k, $300k, or even $400k, make it a point to challenge yourself to save as much as you can. Find ways to shop smarter, save better, and be resourceful in a way that you can be proud of the financial decisions you’ve made and which allow you to make decisions that will pay dividends later. You may not really realize how detrimental some habits are until loan payments begin to be made, but I promise you that you’ll appreciate being proactive. So put down that $6 dollar sandwich, save those $4 dollar beers, and instead invest in yourself to make your financial future brighter.

Mission Trip: "Jamaican" more smiles

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One aspect about dentistry that attracts people who decide to join the field is the ability to give back and help those in need. Many schools offer students opportunities to give back via mission trips. SIU-SDM organizes a mission trip to Jamaica every summer which gives the dental students a chance to practice dentistry in a different, and often more challenging, setting, as well as helps the people of the Jamaican community improve their oral health. The students who go on the mission trip are typically third and fourth year dental students. The third year dental students learn quite a bit from this mission trip since this is often the first time they are practicing dentistry on people instead of mannequins. They come back from the mission trip more confident in their skills and ready to start their journey in the clinic. The main procedure performed on the trip is extractions which can be very nerve-wrecking for a student who has never extracted teeth before. However, since the people of Jamaica are very friendly and desperate of healthcare, they are less fearful of this procedure than people you will encounter in the clinic. Thus, it is less stressful on the dental student. Also, for the fourth year students, this mission trip is a great way to expand your skills by performing procedures in a different setting where there isn’t much technology. Let’s not forget, participating on a mission trip is a great résumé builder too. 

The dental mission trip is organized by Dr. McLeod who is from Jamaica and is a professor at SIU-SDM. There is an annual fundraiser held in St. Louis which helps raise funds for the trip and for the construction of the dental/healthcare facility in Kew Park, Jamaica which will serve that population in need. The mission trip started in 2000, and as of 2014, the trip has helped improve the oral health of 14,000+ adults and children. I look forward to attending this trip and getting the opportunity to travel to a different country and broadening my skills as a future dentist. Having the opportunity to give back to others in need is one of the main reasons I chose to join the dental field, and when I graduate from dental school, I plan on attending other mission trips all over the world. I encourage everyone to attend at least one mission trip in their life. 

First Job: Corporate Dentistry or Private Practice?

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As I’m nearing the end of the final semester of my dental education, I’m faced with the daunting prospect of being released into the real world and needing to pay back six figures of debt. Since I’m not going into a residency or specialty program I’m faced with having to find a job. This task comes with a lot of questions and considerations. Should I stay in California near my family or pick a state that is less saturated? Should I work for corporate dentistry or private practice? 

Many classmates have been interviewing for corporations in states all across the nation including New Mexico, Texas, Alaska, and Oklahoma. Many have chosen to go with corporate dentistry because in general, many have found that they are able to offer higher salaries and full time employment compared to private practices. Most available positions are also outside of California and often in non-metropolitan cities where the need is greater and the area is less saturated with dentists.       

Several corporations have come to visit our school and tell us about their available opportunities. From their presentations it seems there are several pros and cons to working for corporate dentistry. Some positives include significant steady income, steady inflow of patients, opportunity to gain plenty of experience, benefits, and free continuing education courses. However, some downsides could include extremely full schedules that could leave a new graduate overwhelmed and feeling like a dental restoration mill. This could lead to compromises in quality of care for the patient. Some corporations also limit the amount of autonomy a new graduate has in treatment planning for their patients. This could leave the new dentist with a treatment plan they don’t agree with and possibly performing procedures they don’t feel are in the best interests of the patient.

When considering working for a private practice there are pros and cons to evaluate as well. A private practice may not be able to offer full-time employment or compensation as high as a corporation. There may not be a steady influx of patients, which would also affect the amount of income one takes home at the end of the day if compensation is based on production. Many students have also found that it can be difficult to find a private practice that is a good fit because many owners are looking for associates who are willing to do molar endo, a procedure most new dentists are not comfortable or well-trained to do. Furthermore, benefits may not be offered and continuing education courses usually come at the expense of the new dentist.

Thus, the question becomes which opportunity will give me plenty of experience, compensate well so that I can pay down my debt, offer opportunities to learn and grow, not force me to compromise the quality of my work or principles, and put me in a city/state I’m comfortable living in? I like the idea of working for a private practice since that’s what I ultimately want to do but would working in a corporate environment give me more experience and help me evolve into a better clinician faster? Or would I get burned out by the full schedule and frustrated with wanting more autonomy and less oversight? 

Biologic Width

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As a 4th year dental student I have done a number of crowns and bridges. Most of my margins have been supra gingival, but a handful have been sub gingival. Last week I did a preparation on tooth #5 and was forced to take my margin sub gingival due to a facially inclined #6. The inclination made it so that the contact between #5 and #6 was sub gingival. The patient complained of sensitivity and soreness after the preparation. Hemostasis was difficult to control. 


My supervising faculty at the time told me that, because of the tight/ broad contact, the patient had been unable to floss and adequately clean the area. He explained that, his poor hygiene in this area caused the interdental papilla to be chronically inflamed. Because of the heme, I decided a definitive impression would not be possible at that appointment and that he should come back after a week with a temporary bridge. 


When the patient presented this week for removal of the temporary and a definitive impression, the patient complained of increased soreness, sensitivity and discomfort. The sensitivity increased when I removed the temporary. I asked out periodontist for a consult and the first thing he asked me was, "is your margin sub gingival?" Immediatley I knew what he was implying…the potential violation of the biologic width. Without him even looking, I took a vertical bitewing image and discovered, sure enough, the margin was less than 1mm from the crestal bone.


I have know the definition of the biologic width: the dimension of space that the healthy gingival tissues occupy between the base of the sulcus and the underlying alveolar bone is comprised of the junctional epithelial attachment and the connective tissue attachment

(Newman, Michael, Henry Takei, Perry Klokkevold, Fermin Carranza. Carranza's Clinical Periodontology, 12th Edition. W.B. Saunders Company, 2015. VitalBook file.) This means that, on average, the margin of a restoration should be at least 3mm above the crestal bone to account for 1mm connective tissue, 1mm junctional epithelium and 1 mm sulcus depth.  If this depth is encoarched upon, gingival recession, bone loss and/or gingival inflammation can occur.


Even though I have know the definition for a few years, I had not been keeping it in mind while performing crown preparations in clinic. Although the patient will have crown lengthening surgery and the outcome will remain the same, I wished I had warned the patient of the potential need for crown lengthening before treatment began. Additionally, I wish I had not followed the assumption that his bleeding and sensitivity was due to poor hygiene. From now on when I am performing crown preparations, I will keep in mind that if I need to go sub gingival, I should monitor my proximity to bone with radiographic images. 



How big is “too big?”

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 It seems as though I keep running into people who say “I need veneers” or “I want veneers because I want to have a Hollywood smile.” I must admit that I feel like the hype around veneers is rather large because of the popularity they have among entertainers. When a large population of famous actors and musicians has veneers placed there is no doubt that the desire to want to look perfect will be further infused into the general population, however clinical judgement should never be negated. 


My question is “how big is too big?” A number of times these veneers do not look natural. They are too white. They are too big. They do not match the set contours of the individual’s face. Cosmetic Dentistry is a million dollar industry and many dentists definitely know how to do it right. My concern is that restorative dentistry is intended to restore the natural esthetics and function of the dentition. Toilet bowl white color and huge veneers placed canine to canine may not always support that charge.

What it comes down to is having set color match and veneer selection standards that dentists adhere to in an attempt to better achieve a natural look with veneers. The choice of material whether dental laminate or porcelain should be based on a number of factors and should be what is best for the patient. Ultimately customer satisfaction is extremely important but as a clinician you should always offer information to the patient explaining what you feel is best based upon the evidence available. Once the patient is properly educated, the final decision should be one where the patient is properly informed and the clinician is comfortable offers the best standard of care.

Zoom! Whitening… Good or Bad?

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      There is no question that we are in exciting times where we are seeing  many innovative advancements in dental technology entice the masses to head to the dentist and inquire about what’s new! Unfortunately, dental healthcare providers may not be the one’s maximizing profits on such trends. Zoom Whitening is a relatively new technique used to whiten teeth. The procedure involves the active ingredient hydrogen peroxide. “As the hydrogen peroxide is broken down, oxygen enters the enamel and dentin, bleaching colored substances white, leaving the structure of the tooth unchanged. The Zoom lamp aids in activating the hydrogen peroxide and helps it penetrate the surface of the tooth.1” The manufacturer markets it as a product that allows you to get your teeth “8 shades lighter” with an average time frame of 45 minutes. This is a great selling point, however the question still stands. Is it worth it? 


                As with any dental procedure there are side effects that may occur. The side effects seen with Zoom Whitening are synonymous with those known of many other tooth bleaching agents to include but not limited to tooth pain, gum irritation, sensitivity to hot and cold, and discomfort when eating hard foods.  As long as the procedure is done under the control of a dentist, the situation can be managed properly. The concern arises when individual entities that have no dental background begin offering the service at beauty spas, etc. This product is not intended for use on individuals who have not had a comprehensive oral evaluation and have arrested any active lesions occurring in their oral cavity. The cosmetic effects only mask rather than treat the true underlying problems. When patients inquire about Zoom Whitening it is important to make them aware of all consequences of treatment, have them sign a consent form consenting to the treatment, and encourage them to get it done from a licensed dental provider.









Philips Zoom! Whitening, http://www.zoomwhitening.com/en_us/teeth_whitening