Planning Helps New Dentists Handle High Debt
By Debra Belt
Copyright 2001 Journal of the California Dental Association
The challenges facing recent dental school graduates is a hot topic of conversation among those in the dental profession. Foremost in these discussions is the subject of debt, and the $121,500 average student debt figure is bandied about like a shuttlecock at a badminton tournament.
The ADA 1999 Survey of Dental Graduates reports a student debt increase of 33 percent from the $93,172 reported by the class of 1993. Of the survey respondents, 89 percent had debt from student loans upon graduation. More than half of the nation’s 4,041 dental school graduates responded to the annual survey and offered insight to the professional and financial challenges of newly minted dentists.
To connect with some of the young dentists making up these statistics, the CDA Journal talked to a sampling of recent California dental school graduates to find out how they are managing student loans while progressing in their careers. In spite of cumbersome loans they must begin paying six months after graduation, new dental professionals are making payments, forging ahead professionally, and enjoying a variety of experiences. Those reporting the most success say they planned ahead, live within their means, and keep expenses to a minimum.
"I am managing pretty well," said Stuart Yoon, DDS, a 1998 graduate of Loma Linda University. "I was fortunate to be able to buy a practice that is doing well. I think a lot of people worry about student loans and then the additional debt to purchase a practice. But when I talked to the bank and they looked at the practice and saw that it was solid, I was able to get a practice loan."
According to the ADA survey, Yoon is among 25 percent of 1998 dental school graduates nationwide who have purchased their own practices.
In finding a practice to purchase, Yoon networked with alumni and fellow dentists and worked closely with a financial adviser. He found a practice in Riverside and worked for 18 months before buying it. "When you purchase a practice, the first six months can be difficult, but working in the practice and getting to know the patients really helped. I lost very few patients when I took over," he said. "The practice is doing well, and I’m on a graduated payment plan with the students loans. I will pay more as I earn more."
Also, Yoon lives within his means. "Some people earn a lot and spend a lot. There is a need for balance between earning and spending."
Damani Mitchell, DDS, a graduate of the University of California at San Francisco class of 1999, said he also worked to avoid excess expenses and was able to start his own practice with careful planning. "I started making decisions early on in dental school about what I wanted to do when I graduated. I knew that I would return to Oakland. I knew that I didn’t want to be an associate and that I didn’t want to work for a large clinic."
Mitchell spent time talking to other dentists about how they got started. "In my junior year of dental school, I met another dentist, James Sweeney, DDS, and we knew a lot of the same people. I knew the children of many of his patients. When I graduated, I worked out an arrangement to share a building with him. We have two separate practices, but share office space."
Mitchell said the arrangement offers several benefits including keeping start-up costs to a minimum as well as consultation with an experienced practitioner.
"Upon start-up, business was a little slow, but grew tremendously in the first year," Mitchell said. "This opportunity also allowed me to develop speed at my own rate."
Mitchell said he is managing monthly loan payments. "I have to remember that the loan is an investment in myself. Without the loans, I wouldn’t have been able to attend school and increase my earning potential. Sometimes, I’m not able to purchase something I want, but everything will come in time."
Student loans are also on the minds of nearly one-quarter of the graduate population who make the decision to become a resident, intern, or graduate student. According to ADA’s survey, 22 percent of 1998 graduates chose to further their education.
"When you are a resident, there is a deferment on student loans, but as you can imagine, the interest and accumulation of debt is steep," said Paul Lund, DDS, a University of the Pacific graduate of the class of 2000 who is in his first year of UOP’s orthodontic program. "I trust that I will be able to set up a practice in a community that will allow me to pay off accumulated debt. Admittedly, this may be at the expense of practicing in a more underserved area."
Lund said he is encouraged by the success of his colleagues who are managing loan payments and have still been able to buy homes and practices. "Many of my colleagues are doing very well in just a few years out of college, and this gives me an optimistic outlook. When I get out of school, balancing payments on student loans with building clinical expertise will be the biggest challenge."
Nicole Nalchajian, DDS, a 1999 graduate of UOP’s orthodontic program, is currently facing this challenge. She is making monthly payments on student loans while buying into an orthodontic practice in Fresno. "Financially, I still have to budget, but my student debt was less than many grads’ since my dad, who is also a dentist, helped me through school. I’m hoping to be able to pay off student loans in five years."
In five years Nalchajian also plans to own 50 percent of the practice she is working in. "I’m spending the time and money now, building a practice, and financially things will be better in the future. Demographically, other orthodontists are retiring and there is plenty of work to do."
ER Becoming Primary Source for Pediatric Care
In the last half of the 20th century, the number of emergency room visits dramatically increased in the United States with evidence strongly attributing this increase to dental visits.
According to a recent article in the journal Pediatric Dentistry, a Dallas study indicates parents are using the ER for their child’s nonemergency, primary dental care that can be more appropriately and economically treated in an office setting.
Traditionally, dental services provided in an ER setting were primarily for oral trauma to the mouth and its associated soft tissues. However, recent studies suggest an increasing pattern of nontraumatic dental treatment is occurring in the ER. One 10-year study in Seattle evaluating trends in patients seeking emergency dental care showed more than a 10 percent increase in two simultaneous five-year intervals. Tooth decay was responsible for the increase in visits, despite an overall decrease in cavity rates for U.S. children.
In the study conducted at the Children’s Medical Center of Dallas, researchers investigated its outpatient ER population. During a two-year period, 61 percent of the patients were age 6 or younger -- 25 percent were age 3 or younger. The most common dental treatments provided were for cavities (48 percent) and periapical abscess (47 percent).
Although most of the recorded visits could have been prevented with regular dental care, a need clearly existed by the time the patient’s parents sought treatment.
U.S. Sets Plan to Combat Antimicrobial Resistance
The federal government, through the Department of Health and Human Services, has unveiled an action plan that provides a comprehensive national approach to combating antimicrobial resistance.
In the 1940s, the widespread availability of newly discovered antibiotics led to a dramatic reduction in illness and death from infectious diseases. However, bacteria and other disease-causing organisms have been able to develop resistance to existing antimicrobial drugs. Many scientists and public health specialists expect this resistance problem to worsen.
The Health and Human Services plan has four major components: surveillance, prevention and control, research, and product development. Within those four components are 84 action items, including 13 priority action steps considered essential to addressing antimicrobial resistance. Of these 13 initiatives, seven are already under way, and six are planned to begin within the next two years.
* Surveillance. The Centers for Disease Control and Prevention will work with state health departments and other task force members to design and implement a plan that will define national, regional, state, and local antimicrobial resistance surveillance responsibilities so that these entities are coordinated and use similar methodology. Additionally, the Food and Drug Administration, the Department of Agriculture, and the CDC plan to develop systems that can monitor patterns of antimicrobial drug use in medicine, agriculture, and consumer products.
* Prevention and control. HHS and partners will launch a national public education campaign to reduce the overuse and misuse of antimicrobial drugs and to improve antibiotic use in health care systems. Along with professional societies and other interested parties, CDC has already started to prepare clinical guidelines for health professionals on how best to use antimicrobials.
* Research. NIH will lead a team of agencies that will provide the research community with new information and technologies, including genetic blueprints for various microbes, to identify targets for desperately needed new diagnostics, treatments, and vaccines that could assist in preventing the emergence and spread of resistant pathogens.
* Product Development. To identify and publicize priority health needs for new products that prevent resistance or treat resistant infections, HHS plans to create an interagency antimicrobial product development working group. Once formed, this group will also identify incentives that encourage this kind of product development.
The Public Health Action Plan to Combat Antimicrobial Resistance is available online at CDC’s antimicrobial resistance Web site, http://www.cdc.gov/drugresistance/.
Researchers Genetically Modify Primate
Researchers have completed the first successful effort to introduce a new gene into the unfertilized eggs of rhesus monkeys, a member of the family of mammals that includes human beings.
After the gene was introduced, the eggs were fertilized, resulting in several pregnancies and the birth of three live monkeys. The gene was successfully incorporated into one monkey’s DNA, making it the first genetically modified nonhuman primate. Previous gene transfer attempts in animals have been confined largely to rodents and agricultural animals.
The technology could lead to the development of a variety of animal models of diseases having a greater resemblance to the corresponding human conditions than do any animal models now in existence. The new accomplishment could also provide insights into human diseases and techniques for treating a variety of human disorders, from cancer, to cystic fibrosis, Alzheimer’s disease, birth defects, heart disease, and AIDS. The research appears in the journal Science.
National Conference to Explore Caries
An independent panel will draft a statement on dental caries prevention and treatment as part of the National Institutes of Health’s Consensus Development Conference on Diagnosis and Management of Dental Caries Throughout Life to be held March 26-28.
This NIH Consensus Development Conference has been convened to examine the current state of dental caries research so that health care providers and the general public can make informed decisions.
During the first day and a half of the conference, experts will present the latest dental caries research findings to an independent, non-Federal consensus development panel. After weighing all of the scientific evidence, the panel will draft a statement that will be presented to the conference audience on the third day. The consensus development panel’s statement will address the following key questions:
* What are the best methods for detecting early-stage and late-stage dental caries?
* What are the best indicators for an increased risk of dental caries infection?
* What are the best methods available for the primary prevention of dental caries initiation throughout life?
* What are the best treatments available for reversing and stopping the progression of early dental caries?
* How should clinical decisions regarding prevention and/or treatment be affected by detection methods and risk assessment?
* What are promising new research directions for the diagnosis of dental caries?
Saliva Can Promote Skin Healing
Scientists have discovered that a multipurpose protein found in several bodily fluids, including saliva, has another important function -- it can promote the healing of abnormal skin wounds, which are a significant problem in the elderly.
Working with a new animal model for delayed wound healing that they produced, researchers at the National Institute of Dental and Craniofacial Research demonstrated that the protein, called secretory leukocyte protease inhibitor, or SLPI (pronounced slippy), plays a critical role in normal wound healing. When SLPI was applied topically to nonhealing wounds, it reversed tissue destruction and hastened healing.
Each year, more than 4 million older people suffer from chronic, nonhealing wounds such as diabetic ulcers, bedsores, and venous ulcers. Inflammation and bacterial infection are two of the major problems that often contribute to delayed healing. Even acute wounds sometimes fail to heal properly in the elderly. Not only are nonhealing wounds painful, but they are expensive to treat. The cost of wound care is more than $3 billion a year.
Previous laboratory studies have suggested that SLPI is involved in the wound healing process. The protein, which is also found in fluids that bathe mucosal surfaces such as bronchial fluids and cervical fluids, in addition to saliva, is a versatile substance. It has anti-inflammatory, antiviral, antifungal, and antibacterial properties. In recent years, NIDCR investigators demonstrated that SLPI found in saliva blocks HIV-1 infection.
Reporting in the October issue of Nature Medicine, the scientists noted that the fact that animals tend to lick their wounds may be nature’s way of delivering SLPI to the wound site via saliva.
Plans are under way for a clinical trial to test SLPI as a treatment for delayed healing of skin wounds in the elderly. The researchers also suggest that findings from their current study may be extended to other conditions that involve excessive elastase activity, such as gingivitis and bullous pemphigoid.
Cigar and Pipe Smoking Match Cigarettes in Danger to Perio Health
A slew of celebrities have appeared on covers of cigar magazines sending the message that cigar smoking, a growing habit among the young and affluent, is sophisticated. What the covers don’t show are models with missing teeth.
Yet, according to a study published in the Journal of Periodontology, cigar and pipe smoking may have nearly the same adverse effects on periodontal health and tooth loss as cigarette smoking.
Researchers analyzed 705 individuals ranging in age from 21 to 92 years old, and found that 17.6 percent of current or former cigar or pipe smokers had moderate to severe periodontitis -- nearly three times the rate of nonsmokers. In addition, they averaged four missing teeth.
For each given tobacco product, current smokers were defined as individuals who smoke daily. Former heavy smokers were defined as individuals who had smoked daily for 10 or more years, but had quit. The nonsmoker group included individuals who had quit smoking cigarettes after smoking for less than 10 years and those with no history of smoking.
"Cigarette, cigar, and pipe smokers all head a much higher prevalence of moderate and severe periodontitis compared to former smokers and nonsmokers," said Jasim Albandar, DDS, PhD, professor of periodontology at Temple University School of Dentistry and lead researcher of the study. "Research also indicated that there was a correlation with the number of missing teeth with the current, former, and nonsmokers having 5.1, 3.9 and 2.8 missing teeth, respectively."
Cigar smokers are at a higher risk of alveolar bone loss than nonsmokers. "The increase in risk is similar in magnitude to that of cigarette smokers," Albandar said.
Upcoming Meetings
2001
March 4-10 U.S. Dental Tennis Association Spring Meeting, Longboat Key, Fla., (800) 445-2524
March 21-24 Academy of Laser Dentistry 8th Annual Conference & Exhibition, (954) 346-3776, www.laserdentistry.org
April 18-20 The Periodontal-Systemic Connection: A State-of-the-Science Symposium, Bethesda, Md., (312) 787-5518, www.perio.org
April 19-22 CDA Scientific Session, Anaheim, (916) 443-3382, Ext. 4470
May 4-8 Australian Dental Congress, Brisbane, +61 (0) 7 3369 0477
May 18-20 California Society of Periodontists, San Francisco, (805) 962-7144
July 19-21 Forensic Dentistry 2001: A Symposium With Workshops, Chicago, (312) 440-2895
Sept. 14-16 CDA Scientific Session, San Francisco, (916) 443-3382, Ext. 4470
To have a meeting included on this list, please send the information to Upcoming Meetings, CDA Journal, P.O. Box 13749, Sacramento, CA 95853 or fax the information to (916) 443-2943.
