According to the Institute of Medicine and National Research Council (2011), the evolution of dental education and training has progressed from apprenticeships to formalized programs in dental schools as well as in a variety of off-campus locations. The Commission on Dental Accreditation (CODA) is recognized by the U.S. Department of Education as the accrediting agency for all undergraduate and advanced dental educational programs.

Between 1960 and 1980, federal support for dental education allowed dental schools to expand significantly, but this support has fallen behind in recent years. Title VII training grants for dentistry includes two forms: (a) grants to increase the workforce for vulnerable populations and (b) grants to diversify the workforce.

The rising cost of dental education has been a barrier to many middle-income students and, especially, low-income students. In 2008–2009, the average annual tuition for dental schools was $27,961 for state residents and $41,561 for nonresidents (ADA, 2010a). Considering many states do not have a single dental school, the difference is significant.

Among registered dental students, 61 percent were male, and the racial and ethnic diversity mirrored their proportion in dental schools (see Table 3-4) (ADA, 2010b). Currently, two states require a residency as a requirement for licensure: New York and Delaware. As a result, the Western Interstate Commission for Higher Education created the Professional Student Exchange Program, in which students from certain states may receive assistance to attend dental schools in other states.

According to Okwuje et al. (2010), in 2009, the average dental education debt was $164,000, ranging from $141,000 for public school graduates to $195,000 for private school graduates. In general, 77 percent of dental graduates had a debt of at least $100,000, and 62 percent had a debt of at least $150,000. This debt differs significantly between graduates and often affects future career choices. While 10 percent of graduates reported having no debt, 20 percent reported graduating with more than $250,000 in debt. Among all graduates, 33 percent said that their educational debt had a large influence on plans after graduation.

In order to alleviate the student debt problem, financial incentives have been created to care for vulnerable and underserved populations. Started in the 1970s, the National Health Service Corps offers scholarships and loan repayment to dental clinicians who agree to serve for two to four years in a Health Resources and Services Administration facility (HRSA, 2010b). In 2009, 464 dentists served in the National Health Service Corps (Anderson, 2010).

Upon graduating from dental school, many students have few opportunities to incorporate their skills and knowledge with hands-on practical experience and often feel inadequately prepared for private practice. Dental residencies provide further training in general dentistry or specialization. In 2008–2009, 5,864 total dentists enrolled in 723 advanced dental education programs in the United States, with 3,009 first-year students residency and fellowship programs; approximately one half of these programs were sponsored by dental schools.

A survey of deans of dental schools found three-quarters of the deans agreed that building or sustaining a strong postdoctoral general dentistry program was a priority, and slightly more than 60 percent agreed that a year of postgraduate training should be required within 10 years (ADA, 2010a).

I remain optimistic that new opportunities will be created for meaningful reform as well as for the incorporation of new oral health proposals to provide financial help to incoming dental students. I am convinced this will be accomplished through our membership, which will have an enormous impact in this arena in the near future.

Although the American Dental Education Association stands for a majority of our voices, we must show our ability to work in concert with each other and express a common voice for our advocacy efforts. I urge everyone to make your voice heard within our association.

References

• ADA. (2010a). 2008-09 survey of dental education: Academic programs, enrollment, and graduates — volume 1. Chicago, IL: American Dental Association.
• ADA. (2010b). 2008-2009 survey of advanced dental education. Chicago, IL: American Dental Association.
• Anderson, J. R. (2010). HRSA oral health programs. Paper presented at 2010 Dental Management Coalition, Annapolis, MD.
• HRSA. (2010b). NHSC loan repayment. nhsc.hrsa.gov/loanrepay ment (accessed Dec. 22, 2010).
• Institute of Medicine and (NRC) National Research Council. (2011).
• Okwuje, I., E. Anderson, and R. W. Valachovic. (2010). Annual ADEA survey of dental school seniors: 2009 graduating class. Journal of Dental Education 74(9):1024–1045.