Pursuing a career in dentistry is a noble and rewarding endeavor, but it often comes with an eye-popping price tag, and new dentists are left wondering how they should repay a mountain of debt. This month, AGD Impact presents “The Do’s and Don’ts of Dental School Loan Repayment” along with three testimonials from AGD members who share their strategies for paying off debt.
Restoring Heroes: The Legacy of the Air Force Maxillofacial Prosthetics Fellowship Program
By Col. Joshua A. Vess, USAF, DC, and MAJ Patricia M. Walworth, USA, DC
The Air Force Maxillofacial Prosthetics Fellowship Program restores not just faces but also lives, blending advanced dental care with compassion. For AGD members, this program exemplifies dentistry’s power to heal, inspiring dentists to approach their practice with renewed purpose.
Honoring
Don’t Put Off to Tomorrow…
Time is a most precious gift, and we all have it in an unknown quantity. Our lives can change for better or worse instantaneously. Some issues are minor, but others can be intense or life-altering. But one of the most important lessons I’ve learned is that, because time is so unpredictable, we should not put off important tasks. Like the old proverb goes: “Don’t put off to tomorrow what can be done today.”
Procrastination at any level is a crime, shortening the gift of time by leading us to do nothing or to prioritize less important topics. To be successful, we need clear and concise priorities. The challenge is to use our time wisely. The more demands we face, whether personal or financial, the more crucial it becomes to determine what truly matters to you as well as to your family, friends and dental practice.
You may think that procrastination is simply being idle, but it can be disguised by constant activity. Being perpetually busy does not necessarily mean that you are focusing on what truly matters; what is most critical is that your time is being used efficiently. If we let busy work overshadow other more important tasks, we are procrastinating on meaningful priorities. Setting goals is a good way to establish considerable success. Working toward those goals, whether they need to be met immediately or broken down over time, ensures a balance. When life feels chaotic due to numerous demands, the lack of time to think and reflect can lead us to prioritize tasks that can be completed quickly or those shouted by the loudest voices. These may not be true priorities. Long-term goals, deeper needs and tasks with the potential for beneficial change often get neglected both in our personal and professional lives. That must change.
Take time each day to consider what matters most on a personal level. Meeting demands we face daily creates a powerful tool for readiness. It can bring order to chaos and reduce procrastination on important matters. It can provide a calm and assertive approach to overwhelming demands. Most importantly, it brings the question of readiness back to the forefront.
How do we keep from procrastinating? Many tools exist to help. The software we use daily has integrated functions to keep us on track. Microsoft Outlook allows you to “follow up” on important emails and keeps them in a separate pane, sorted by what’s most urgent. Microsoft also has a program, OneNote, that allows you to keep all your notes sorted and prioritized (Google Keep serves a similar function). All of the latest artificial intelligence applications — ChatGPT and Apple Intelligence, for example — are excellent at summarizing long messages to keep you on point. Or, if you work better not staring at a screen, making lists with a good old-fashioned paper and pencil can do wonders.
Professionally, AGD can help you avoid procrastinating in areas of professional and personal development that can be vital to success in your career. Achieving your AGD Fellowship is a wonderful journey that I hope all AGD members at least consider (if you haven’t already earned your FAGD or MAGD). The track that the organization lays out ensures you gain knowledge in the most critical areas of dentistry. AGD Fellows must complete 500 continuing education hours in a prescribed number of subject areas. Masters take it one step further — they must complete 1,100 hours, 400 of which must be from hands-on courses, and local MasterTrack cohorts connect you with educational opportunities and fellow colleagues who will help keep you on task. Visit agd.org/fellowship for more information. Sometimes we need a little help to keep from procrastinating, and I can tell you that AGD will always be there to help keep you inspired.
I wish you the best on your journey to productivity. Find a method that works for you, and stick with it. The feeling of accomplishment once you’ve tackled your goals is worth every bit of effort.
Timothy F. Kosinski, DDS, MAGD Editor
DISCLAIMER: The Academy of General Dentistry does not necessarily endorse opinions or statements contained in essays or editorials published in AGD Impact. The publication of advertisements in AGD Impact does not indicate endorsement for products and services. AGD approval for continuing education courses or course sponsors will be clearly stated. AGD Impact (ISSN 0194-729X) is published monthly by the Academy of General Dentistry, 560 W. Lake St., Sixth Floor, Chicago, IL 60661-6600. Canadian Mailing Information: IPM Agreement number 40047941. Change of address or undeliverable copies should be sent to: Station A, P.O. Box 54, Windsor, Ontario, N9A 6J5, Canada. Email: impact@agd.org. Periodical postage paid at Chicago, IL and additional mailing office.
AGD members receive AGD Impact as part of membership; annual subscription rates for nonmembers are $80 for individuals and $120 for institutions. Online-only subscriptions are $85 for individuals and $110 for institutions. All orders must be prepaid in U.S. dollars. Single copies are available upon request. Please contact our Membership Services Center at 888.243.3368 for more information.
Leading from the Front: Leadership Lessons from the Army Dental Corps
By LTC Michael A. Mooney, DMD, MS, MS, ABGD, FICD, MAGD
As a leader, you are the final decision-maker, problem-solver and motivator. In a dental clinic, your role extends beyond clinical expertise — you must inspire your assistants, hygienists, front desk personnel and associate dentists. But what happens when motivators like salary increases or bonuses are out of your control? What if your clinic increases production by 20% year over year, your patient population increases 20%, and 100% of dental treatments are covered without insurance or co-pay, but your budget remains the same? Welcome to leadership in the U.S. Army Dental Corps — where responsibility is high, control is limited, and impact is immeasurable.
Building Trust: The Foundation of Leadership Leadership expert Simon Sinek emphasizes the importance of explaining the “why” to uncover intrinsic motivation. But before you can inspire, you must first earn trust. A practical starting point is asking engaging questions and actively listening. Why did your team members choose dentistry? What drives them to put in extra effort? When you ask questions, you gain trust — and also a list of problems to solve. However, just asking is not enough. You must make measurable progress on these problems within the first 90 days or that trust begins to deteriorate quickly. As one team member once put it: “If you ask about our problems, you have to start solving them.”
Prioritize and Execute: Turning Problems into Solutions
How do you begin solving your team’s challenges? Where do you start — staffing shortages or toxic culture? The principle from “Extreme Ownership,” by Jocko Willink and Leif Babin, provides guidance: prioritize and execute. Here are some ways you can start to do just that:
• Make a list of clinic challenges.
• Identify high-impact, quick-win solutions.
• Execute methodically, keeping your team informed.
Updating your team is crucial: “Problem A is solved. Problem B is in progress. Problem C is on hold for now.” If your team doesn’t see progress or hear updates, you’re failing them. No one remembers the wheel that squeaked last week but is quiet today.
Creating a Unified Mission: ‘Patients First’
To synchronize your team, establish a clear mission statement. A great framework for this is the Kotter 8-Step Change Model, but, at its core, clarity is key. In my clinic, our guiding principle was “patients first.” This simple statement dictated how each role functioned:
• Front desk: Be kind, and schedule efficiently to minimize delays.
• Sterilization team: Ensure instruments are processed correctly and not contaminated.
• Dentists and assistants: Provide the same care we would give our own families with comfort and empathy.
A unified goal eliminates confusion, aligns responsibilities and ensures everyone is working toward the same objective.
Empowering the Experts on Your Team
One of the most humbling lessons in leadership is realizing that expertise exists at all levels. As dentists, we might excel clinically, but we are not the best at scheduling, assisting or sterilization. Instead of assuming you have all the answers, ask your team: How can we improve scheduling efficiency? What’s the best way to streamline patient flow? By listening to their insights and implementing their ideas, you demonstrate trust. An engaged team member who feels valued will go the extra mile.
Delegation and Decision-Making
Trusting your team isn’t just about listening — it’s about action. Empower your team members to execute their plans. Micromanaging stifles initiative, while real delegation fosters ownership. However, decision-making must have boundaries: Staff cannot increase the supply budget. They can optimize patient flow and streamline clinic efficiency.
By shifting decision-making to those with firsthand knowledge, you save time and create a more efficient team. An empowered team member will carry through their own plan with more conviction and problem-solving brainpower than they will a plan that was emailed by a supervisor.
Extreme Ownership: The Mark of a True Leader
A final, crucial lesson: Take full responsibility. It’s easy to shift blame — traffic made you late; the assistant forgot an instrument; the lab messed up the crown. But extreme ownership means acknowledging that there is always something more you could have done. Late? You should have planned for traffic. Missing instrument? You should have created a checklist. Lab mistake? You should have communicated better and ensured quality impressions.
Blaming others erodes trust. Owning mistakes builds respect and creates a culture of accountability. If something goes wrong, the leader is responsible — always.
Final Thoughts: Stand Up and Lead
Leadership is not easy. It requires extra effort, humility and dedication. But it also offers the power to create a positive impact. You can transform your clinic’s culture, boost morale and improve patient experiences. Many people complain about what they would do if they were in charge. Now, you are in charge. It’s your responsibility to make things better. Stand up, look around, prioritize and execute. Your team is counting on you. ♦
Note: The views expressed herein are those of the author and do not reflect the official policy or position of Brooke Army Medical Center, the Department of Defense or any agencies under the U.S. government.
LTC Michael A. Mooney, DMD, MS, MS, ABGD, FICD, MAGD, graduated from Tufts School of Dental Medicine in 2013 on the Health Professions Scholarship Program with the U.S. Army. He has previously served as officer in charge of McClung Dental Clinic; Joint Base Lewis-McChord, Washington; and executive officer of 673rd Dental Company (Area Support) Forward. He currently serves as the U.S. Army General Dentistry (63A) consultant to the surgeon general and as a comprehensive dentist at Fort Sam Houston, Texas.
Awards
Nominate a Colleague for the 2027
Thaddus V. Weclew Award
AGD is now taking nominations for the 2025 Dr. Thaddeus V. Weclew Award. This prestigious award is given to an individual who has made outstanding contributions to the art and science of dentistry or has enhanced the principles and goals of AGD and has made exceptional efforts in promoting these ideals.
Named for founder Thaddeus V. Weclew, it is one of the oldest and most prestigious awards given by AGD. Recent recipients include Jane F. Martone, DDS, MAGD (2025); Charles Goodacre, DDS, MSD (2024); and Kimberly R. Wright, DMD, MAGD (2023).
To nominate a deserving colleague or educator, request a nomination form from education@agd.org. The nomination deadline is Dec. 1, 2025, to be considered for the 2027 award.
Be a Part of Convocation at AGD2026
Apply to receive your Fellowship, Mastership, or Lifelong Learning and Service Recognition at AGD2026 in Las Vegas! Complete all requirements and apply online by Dec. 31, 2025. Show your dedication to enhancing your clinical knowledge, and apply at agd.org/education/awards-recognition. If you need help achieving the required continuing education (CE), search the AGD CE Directory (agd.org/education/learn/ce-directory) or browse the Online Learning Center (agdonlinelearningcenter.org).
Advocacy
AGD Attends 2025 ALEC and NCSL Meetings
By Jay Fisher, JD, AGD manager, Government Relations
State policy directly affects the practice of general dentistry. AGD recognizes the importance of state legislative advocacy and exhibited this summer at the annual meetings of the American Legislative Exchange Council (ALEC) and the National Conference of State Legislatures (NCSL).
At ALEC, Gordon Isbell III, DMD, MAGD, and AGD staff spoke with legislators about the importance of community water fluoridation (CWF) and dental insurance reform. ALEC brings together conservative legislators from across the country.
At NCSL, Richard Huot, DDS, FAGD, chair of the AGD Legislative & Governmental Affairs Council, and AGD staff spoke to a bipartisan group of legislators about CWF and dental insurance reform. This year at NCSL, our “dental row” only included AGD and the American Academy of Pediatric Dentistry, but legislators appreciated being able to speak with both organizations about policy and the importance of oral health.
AGD will continue to raise the profile of the organization and dentistry as a whole by attending these meetings and speaking with legislators and other major stakeholders. AGD’s state-level advocacy will increase this year, as the Board has approved AGD’s sponsorship of the National Conference of Insurance Legislators (NCOIL), an extremely influential organization whose model bills carry great weight in the state capitals. NCOIL is currently considering amending its model dental insurance contracting bill to switch the virtual credit card and third-party network leasing provisions from “opt-out” to “opt-in.”
Education
This Month’s CE Opportunities
Nov. 4: “Occlusal Medicine: Why Haven’t You Been Taught this Stuff?” with Ian W. Tester, DDS, MSc
Nov. 6: “Chronic Pain Management: What Do I Need to Know?” with Aviv Ouanounou, BSc, MSc, DDS, FACD, FICO, FICD
Nov. 11: “HIPAA Compliance Simplified” with Matt DiBlasi
Nov. 13: “Alter the Tooth Life Cycle” with Troy Schmedding, DDS, AAACD
Nov. 21–22: 2025 Virtual Advocacy Conference
Register for these webinars and more at agd.org/education/learn.
AGD Manager Jay Fisher, JD, with Kansas State Rep. Dr. Allen Reavis and Dr. Gordon Isbell III at the ALEC meeting.
Dr. Steven Bradley Broadens His Impact on Oral Healthcare as a State Representative
As both a practicing dentist and a Republican state representative in Iowa, Rep. Steven P. Bradley, DDS, has spent his career balancing two forms of service: caring for patients in his practice and advocating for them through organized dentistry. With more than 40 years in dentistry and nearly two decades shaping policy through leadership roles with the Iowa Dental Association and the Iowa Dental Board, Bradley brought his expertise to the Iowa House of Representatives in 2021, where he works on issues ranging from workforce shortages to Medicaid reimbursement. In this interview, he reflects on the parallels between dentistry and public service, the importance of dental advocacy, and why he believes more dentists should consider stepping into public office.
the public, my patients and dentistry. Serving in the Iowa House of Representatives allows me to advocate directly for our profession and our patients. I work to keep costs down and dentistry strong.
Can you share some of your passion-project bills or exciting achievements?
AGD Impact : What inspired you to become a dentist?
Bradley: I was a chemistry major in college, so I was already in science. Several of my friends were headed to dental school, and I had a great-uncle who was a dentist, so I was considering either medicine or dentistry. While working at Finley Hospital in Dubuque, Iowa, an oral surgeon sat me down and walked me through the pros and cons of both careers, and that conversation is why I chose dentistry.
What was your path from dentist to state representative?
I spent nine years with the Iowa Dental Association, working my way up from trustee to vice president, president-elect and, ultimately, president. The day after my term as Iowa Dental Association president ended, I joined the Iowa Dental Board and served there for nine years, seven as chair. In total, I spent 18 years going down to Des Moines, working with legislators and four different governors on dental policy and trying to get certain bills passed and other bills killed. Running for office felt like a natural extension of that work. When my state representative switched parties for his 2020 re-election, I decided to run for his seat against him — and I won.
How are the calls to serve people through dentistry and through public office similar?
Both are about service. Dentistry is part of healthcare — some people may think we’re just a small part of healthcare, but I think we’re a large part — and healthcare is fundamentally about helping people. Serving in a public office greatly multiplies the number of people I am able to help with my dental knowledge. In public office, I’ve sponsored several dental- and other health-related bills, but sometimes the most important victories are the bills we kill. For example, I helped stop a proposal that would have charged dentists 2% on gross production in Iowa. When evaluating or developing legislature, my focus is always on what will most help
One of my upcoming bills would allow nurse anesthetists, dental anesthesiologists and physician anesthesiologists to provide anesthesia in dental offices without requiring dentists to hold a moderate sedation permit as long as an advanced cardiac life support certification is maintained. Recently, I introduced bills to increase Medicaid reimbursement and to address workforce shortages. In Iowa, dental assistants are required to be registered in the state to work, which was creating shortages in parts of the state. To address those underserved areas, I proposed allowing dentists to train dental assistants directly in the office without requiring state registration while still requiring registration for expanded-function dental assistants. This flexibility helps practices fill critical roles and continue serving patients. On a personal note, when I semi-retired from private practice to serve in public office, I sold my practice to a dentist who got her start in the profession as my dental assistant, and I now work for her part time as well as at my daughter’s dental practice. Dentists play an important role in developing the workforce, and this bill keeps us at the steering wheel and allows us to more directly address oral healthcare workforce shortage issues to better serve our patients in rural areas.
What are some current issues at the state or federal levels that dentists should watch closely?
Dental licensure is a major one. I believe that if a dentist is licensed in one state and has no disciplinary actions against their license, they should be able to practice in another state — similar to how physicians are licensed. If you pass your boards, you should be able to practice in all 50 states. Greater mobility would benefit both dentists and the patients they serve.
Do you have advice for members interested in running for public office?
I recommend it, especially for dentists who are retired or semiretired. I’ve practiced for 40 years and am now semi-retired, but serving in the legislature keeps me connected to dentistry. I love our profession and want to make it better every day. I urge dentists to run for office because, without our voices, dentistry can be overlooked, and we need people at the forefront to protect our interests and those of our patients.
We currently have two dentists in the Iowa legislature, Rep. Tom Jeneary, DDS, who also served with me on the Iowa Dental Board, and me. We need more dentists to get involved, whether by running themselves or by supporting dentists who are running or who are already in office. Campaigning isn’t easy. I’ve been substantially outspent in three out of four of my races but still won. But having “Dr.” in front of your name lends credibility, especially when you speak on healthcare issues. ♦
The Dance of Time, Purpose and Money: Finding Balance in Life and Dentistry
By Maggie Augustyn, DDS, FAGD
In the tapestry of life, three threads — time, purpose and money — intertwine to shape our existence. These elements seldom come into harmony, leading us on a perpetual quest to balance them. When we stand at the cusp of adulthood, time stretches before us, vast and unmarked, yet our pockets are light, and our purpose remains a silhouette on the horizon, undefined and elusive. It is a period saturated with potential, where dreams are born and the future is an open road.
As the wheel of time turns, ushering us into the realms of middle age, the scales tip. Our once-boundless reservoirs of time now ebb under the weight of responsibilities, yet it is during these years that our coffers begin to swell. The purpose that once eluded us starts to crystallize, shaped by the experiences and challenges we have weathered. But the irony of life becomes apparent — we find ourselves with more means and a clearer direction, yet with significantly less time to enjoy and explore these newfound horizons.
This paradox extends beyond personal experience, touching every profession and walk of life. We witness it in the ambitious young professional who works endless hours building a career, sacrificing present moments for future security. We see it in the parent juggling multiple responsibilities, finding that, as financial stability grows, the precious hours with loved ones seem to diminish. The pursuit of one element often demands the temporary sacrifice of another, creating an endless cycle of trade-offs.
The wisdom lies not in achieving perfect balance — an impossible feat — but in recognizing which thread deserves priority at each life stage. Sometimes we must invest our abundant time to build skills and relationships that will later yield both purpose and financial rewards. Other times, we leverage our money to create unforgettable memories or to support causes that align with our deepest values. The key is conscious choice rather than passive drift.
Advancing further into the golden years, we stand at the precipice where time has become a precious commodity. The wealth we have amassed, both tangible and intangible, now holds a bittersweet touch, for our moments to indulge are numbered. However, it is also in this twilight that our purpose shines brightest, forged in the fires of a lifetime’s worth of experiences, failures and triumphs. It is a profound irony of our existence that only when time begins its final countdown do we truly comprehend the magnitude of our purpose and the true value of our treasures.
Yet this understanding need not wait for our final chapters. The most fulfilled individuals learn to recognize the shifting nature of these three elements and adapt accordingly: They understand that money without purpose leads to emptiness, that time without direction breeds restlessness, and that purpose without resources often results in frustration. The art lies in the dance between these forces, sometimes leading with one, sometimes following another, but always maintaining awareness of the choreography.
The essence of life, then, is not merely to have time, purpose and money in equal measure; it is to understand that the pursuit and balance of these elements is what gives our lives depth, color and meaning. It teaches us that the richness of our days is not measured in hours, wealth or achievements, but in how we choose to fill them, whom we share them with, and the legacy we leave behind. This realization invites us to reflect on the beauty of life’s impermanence and the wisdom in cherishing every moment, for, in the end, it is the harmony between time, purpose and money that orchestrates the symphony of a life well lived.
Perhaps nowhere is this delicate balance more evident than in the field of dentistry, where practitioners navigate a unique intersection of healing, business and personal fulfillment. The journey begins in dental school, where young students invest enormous amounts of time and money — often accumulating substantial debt — while their purpose crystallizes around the noble goal of improving oral health and transforming lives
“It is a profound irony of our existence that only when time begins its final countdown do we truly comprehend the magnitude of our purpose and the true value of our treasures.”
through beautiful smiles. These formative years demand sacrifice — countless hours of study, clinical practice and examination, all while financial resources dwindle and social time becomes a luxury.
As new graduates enter practice, the pendulum swings dramatically. The pressure to establish a patient base, pay off educational loans and build a sustainable business often creates a whirlwind where time becomes consumed by the relentless demands of patient care, administrative duties and practice management. The idealistic purpose that once burned brightly may flicker under the weight of insurance battles, difficult cases and the business realities of running a healthcare practice. Money, once scarce, may begin to flow, but often at the cost of work-life balance and personal relationships.
Yet dentistry offers a unique opportunity to witness the profound impact of aligning these three elements harmoniously. When dental professionals find their rhythm — managing their time efficiently, maintaining their sense of purpose in patient care and achieving financial stability — they create something beautiful. They become healers who not only restore teeth but rebuild confidence, alleviate pain and sometimes even save lives through early detection of serious conditions. The elderly patient who can eat comfortably again, the teenager whose corrected smile opens doors to new opportunities, the anxious patient who learns to trust again — these moments illuminate why the struggle to balance time, purpose and money is worthwhile.
In dentistry, as in life, the wisdom lies in understanding that these elements will never exist in perfect equilibrium. There will be seasons of intense focus on building the practice, periods dedicated to advanced education and skill development, and times when family and personal health must take precedence. The most successful and fulfilled dental professionals learn to view their careers as a long-term symphony rather than a daily performance, allowing for movements of different tempo and intensity while never losing sight of the underlying melody of service to others. ♦
Maggie Augustyn, DDS, FAGD, is a practicing general dentist, owner of Happy Tooth, faculty member at Productive Dentist Academy, author and inspirational speaker. To comment on this article, email impact@agd.org
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Practice Management
Help More Patients Accept Your Treatment Recommendations
By Roger P. Levin, DDS
Ijust returned from speaking at a dental conference. I was there to talk about increasing practice production, and my co-presenters (all extremely accomplished clinicians) were invited to present on new clinical advancements. As I sat through the other speakers’ presentations, I was impressed with the level of advanced technology that now exists in dental practices. I was familiar with individual technologies, but to see it all presented in one place was exciting. As dentists, we can do things we’ve never done before, and this adds to confidence, quality and excellent results. But there is one thing the technology alone cannot do, and that is increase case acceptance.
Case Acceptance: Science or Art?
A great deal of what we do in management consulting to increase practice production for our clients is science-based. We can mathematically analyze a schedule. We can take that data and apply formulas to increase the schedule capacity by 30%. We have specific proven processes to collect 98% of all money owed to the office in under 30 days. Many aspects of running a dental practice have scientific step-by-step approaches to make it all work. If you follow the steps, you will get the same result almost every time. Even highly face-to-face interactions associated with customer service can be systemized and taught in a step-by-step method (e.g., greet every patient, smile, make eye contact, tell the patient how glad you are to see them, ask them if they have any questions or concerns, and ask them to write a review).
All of that sounds wonderful, and it is, but case acceptance is a completely different type of system. It is both science and art. Case acceptance cannot simply be broken into a number of steps and repeated the same way for every patient every time. Different patients will react differently to the same information. The enthusiasm, energy and excitement of the team go a long way toward increasing case acceptance. Body language is a critical component in case acceptance and is very difficult to master. For these and many other reasons, case presentation might be the hardest system to master and the one that most holds practices back. No matter how well run all the other systems of the practice are, if patients don’t accept treatment, then the practice will struggle to increase production and succeed.
Here are four recommendations to increase case acceptance:
1. Raise your enthusiasm. Enthusiasm is hard to measure, but it is critical. Enthusiasm creates credibility and trust. The more enthusiastic you are about the patient and the case being presented, the more likely it will be accepted. But the need for enthusiasm doesn’t end with the dentist. Whether or not they accept treatment during the consultation with the dentist, every patient will arrive back at the front desk, and most of them will have more questions or ask for another opinion from the front desk team. If the front desk person is focused more on completing
“Case acceptance cannot simply be broken into a number of steps and repeated the same way for every patient every time.”
paperwork, answering another call or shuffling the patient out the front door to make room for another patient, case acceptance will suffer. Enthusiasm from the dentist alone is not enough; you need it from the entire team.
2. Use power words. Power words create positive energy. They are more impactful than you might think. Words such as “great,”
“wonderful,” “terrific,” “unbelievable,” “awesome,” “fantastic” and “beautiful” are all power words. Examples of statements that you should constantly use with patients are:
• “You will love your new veneers.”
• “Your smile will be beautiful when we finish this case.”
• “The results will be wonderful.”
Dentists don’t generally talk this way. We give detailed clinical explanations that no one really wants to hear instead of providing motivational descriptions of how the treatment will help the patient. Patients do not care about how a veneer is made or what an implant is made of. They care about the benefits to them. Speaking of benefits…
3. Spend most of your time talking about the benefits. Many dentists spend a lot of time talking about clinical technique, quality of materials or new technologies. Dentists find all of that exciting. Patients appreciate knowing a bit of information — and it is impressive — but they also really want to know what it will do for them. Concepts such as looking younger, feeling better, being more comfortable and keeping teeth for a lifetime are all examples of the benefits that patients understand and desire. You should establish at least three benefits for every type of case you present and share them with the patient, repeating them at least twice. Most patients are not fully comfortable in a dental office and don’t always catch things the first time you mention them.
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4. It is not how much it costs; it is how they have to pay for it. America runs on debt and payment plans. Credit cards and payment options allow people to afford things they want. Even when you are successful at persuading them to consider treatment, patients still want to know how they’re going to pay for it. Informing patients at the start of each consult that the practice has several financial options available will immediately overcome the primary obstacle in many patient’s minds — the fee. Patient financing, especially interest-free financing, is amazing. Those words excite patients just as much as the benefits of treatment. It means they really can afford it, even if their credit cards are maxed out. You want patient financing that can be accessed very quickly so the patient can decide while they are excited and feel positive about treatment. The longer it takes to access patient financing, the more likely it is that the case will not be accepted. Patient financing is one of the most powerful ways to increase case acceptance. Keep in mind that, in the end, it always comes down to money.
Summary
We live in an era where most patients will accept single-tooth recommendations, but not necessarily anything more. If we add the four recommendations above, we have a wonderful opportunity to increase case acceptance. And yes, wonderful is a power word. ♦
Roger P. Levin, DDS, is the founder and CEO of Levin Group, a dental management consulting firm. To receive his Practice Production Tip of the Day, visit levingroup.com. To comment on this article, email impact@agd.org
Leadership Beyond the Drill: Smart Money Moves for New Dentists
By Amrita Feiock, DDS, FPFA, FICD, FACD
Graduating from dental school is both a monumental achievement and a financial awakening. Most new dentists leave school carrying a substantial amount of student loan debt, sometimes exceeding $300,000. At the same time, they are entering a profession that offers strong income potential, and many aspire to own their own practices. Balancing the weight of educational loans with the desire to build a thriving career and secure longterm financial stability requires a deliberate, structured approach. Before creating a strategy, it is essential to understand the nature of your debt. Dental school loans often come with a mix of federal and private components, each with different terms, interest rates and repayment options. Federal loans may offer income-driven repayment plans or forgiveness programs, but they accrue interest over time. Private loans typically offer fewer protections but can sometimes be refinanced at lower rates. An early and accurate assessment of the types of loans and their balances and interest rates is foundational to building a sustainable repayment strategy.
As a new associate, your income will likely vary based on geography, patient flow and compensation structure. Early budgeting must emphasize cash flow management. Rent, licensure fees, continuing education and insurance premiums can quickly absorb your income. To avoid unnecessary stress, create a detailed monthly budget that includes all fixed expenses, estimated taxes, and loan payments, along with modest personal spending. Living below your means during the first few years out of school is one of the most powerful ways to gain financial traction. Rather than aiming to eliminate debt immediately, it is more prudent to focus on regular, consistent payments that fit comfortably within your monthly budget. Prepayment can wait until you are financially stable. Your goal early on should be to avoid missed payments, prevent delinquencies and protect your credit score, which will be vital when financing a practice in the future.
Start Small
Begin with establishing small, achievable milestones. One may be to save your first $10,000 in an emergency fund. Another might be to pay down a specific high-interest loan by a target date. Avoid the temptation to compare your progress to peers’. Everyone’s financial journey is different, and comparison can distract from your own priorities. Make time to learn the basics of financial planning. Understand compound interest, amortization and how different repayment structures affect your total financial picture. Resources like AGD, dental finance advisers or credible personal finance books offer valuable insights. Financial literacy is not often part of the dental curriculum, but gaining this knowledge is critical to professional success.
One of the most common misconceptions is that student loans must be entirely repaid before considering practice ownership. This is rarely necessary. In fact, ownership can accelerate wealth-
“Each payment made, dollar saved and skill learned contributes to a more secure and independent future.”
building and provide better financial control than remaining an associate indefinitely. When considering ownership, lenders will evaluate your credit score, income history and existing debt obligations. A strong repayment record on student loans can be a positive sign to banks. What matters more than your loan balance is the ability to demonstrate responsible money management and a steady stream of income.
The Path to Ownership
While preparing for ownership, continue making regular payments on your loans, but shift focus to saving for a down payment and securing the financial documents typically required for practice financing. These include recent tax returns, associate contracts and monthly expense records. Building a relationship with a dentalspecific lender early on can also be helpful. They understand the nuances of dental practice financing and can offer realistic advice based on your situation. Even while managing debt, it is important not to postpone all long-term financial goals. Retirement planning should begin early, even if contributions are modest. If your employer offers a 401(k) with matching, contribute at least enough to capture the full match. Consider opening a Roth IRA while you are still in a lower tax bracket. Time in the market is more important
than timing the market. Early investing, even in small amounts, allows you to take advantage of compound interest over decades. Another often-overlooked area is insurance. Disability and life insurance are crucial for protecting your income and dependents. As a dentist, your ability to work is your most valuable asset. These protections, while not glamorous, are foundational elements of a stable financial future. As your income increases, the temptation to upgrade your lifestyle is strong. Buying a luxury car, moving to a high-end apartment or planning elaborate vacations may feel like rewards for your hard work, but they can easily derail your financial momentum. Lifestyle inflation can quickly consume cash that would otherwise be used for loan repayment, savings or investments. Practicing discipline early on ensures flexibility and financial freedom later. Set aside a portion of every raise or bonus before adjusting your spending. Automating savings and investment contributions can help remove emotion from financial decisions. Develop the habit of paying yourself first, and you will rarely find yourself unprepared for opportunities or emergencies.
Seek Help When You Need It
No dentist should try to navigate these decisions alone. A team of trusted professionals, including a certified public accountant, financial adviser and attorney, can provide guidance and help you avoid costly mistakes. Ideally, these professionals will have experience working with dentists and understand the challenges that are unique to the profession. They can help structure contracts, minimize taxes
Shape the Future of Dentistry
2025 Virtual Advocacy Conference
Nov. 21: Noon to 4 p.m. CST Nov. 22: 9 a.m. to 1 p.m. CST Earn 8 CE credits, free for AGD members!
AGD works every day to ensure your voice as a general dentist is heard, when and where it matters most. Join us for a free, two half-day virtual event designed to keep you informed on the latest legislative and regulatory developments impacting general dentistry, and gain valuable insights into current and emerging issues that could affect your practice.
Register at: agd.org/vac2025
Speakers include:
and guide you toward achieving both short- and long-term financial goals. At the same time, be cautious of advisers who overpromise or sell high-commission products. Always ask how your advisers are compensated, and prioritize those who are fiduciaries, meaning they are legally obligated to act in your best interest.
It is easy to feel overwhelmed by debt and the weight of financial responsibilities. However, it is important to remember that dental professionals have access to a reliable and lucrative career path. Debt is not a permanent burden, but rather a temporary challenge that can be managed with discipline and a long-term view. Celebrate the progress you make, no matter how small. Each payment made, dollar saved and skill learned contributes to a more secure and independent future. Remain patient, stay informed, and keep your long-term goals in sight. Ownership, financial security and personal satisfaction are all attainable with careful planning and consistent effort.
Ultimately, managing debt while planning for your future is not about perfection, but progress. It is about making thoughtful choices, staying flexible and recognizing that financial well-being is a lifelong journey. The habits and decisions formed in the early stages of your career will lay the groundwork for decades of success to come. ♦
Amrita Feiock, DDS, FPFA, FICD, FACD, is in private practice with her father, endodontist Rohit Z. Patel, DDS, PC, in Westchester County, New York. To comment on this article, email impact@agd.org
Marc J. Worob, DDS, FAGD, AGD President (2025–26) Rep. Steven Bradley, DDS, Iowa State Representative Johnny Johnson, DMD, MS, President, American Fluoridation Society
SUCCESS STORIES STUDENT
Super Tips
The Do’s and Don’ts
of Dental School Loan Repayment
By Andrew Paulson, CSLP
Pursuing a career in dentistry is a noble and rewarding endeavor, but it often comes with an eye-popping price tag. According to the American Dental Education Association, the average student loan debt for the dental Class of 2024 was $312,700.1 Those who choose to specialize will usually end up borrowing even more to fund further postgraduate education. Navigating this financial burden requires careful planning and strategic decision-making. In this article, we’ll explore the do’s and don’ts of borrowing for dental school and how to pay down dental school loans.
Borrowing for Dental School
The Do’s
1. Borrow only what you need. Dental school is expensive, but avoid the temptation to borrow more than necessary. Create a detailed budget that accounts for tuition, fees, books, equipment and reasonable living expenses. Work with federal loans first, as they often have lower interest rates and more flexible repayment options compared with private loans. As part of the One Big Beautiful Bill Act, federal student loan limits are changing in 2026, with a new borrowing cap of $200,000 for
dental school ($50,000 per year) for those who begin borrowing July 1, 2026, or later.
2. Explore scholarships and grants. Before taking out loans, research scholarships, grants and work-study opportunities. Organizations like the American Dental Association and state dental associations offer financial aid for dental students. Even small awards can reduce your borrowing needs.
3. Understand loan terms. Familiarize yourself with the terms of federal and private loans. Federal loans typically offer fixed interest rates and benefits like loan forgiveness, while private loans may have variable rates and stricter repayment terms.
4. Consider loan repayment assistance programs. Look into programs like Public Service Loan Forgiveness (PSLF), the National Health Service Corps (NHSC) Loan Repayment Program or Income-Driven Repayment Forgiveness. Please note, PSLF is not a common track for most dentists who work for private practices or dental services organizations (DSOs).
The Don’ts
1. Don’t ignore interest rates. High interest rates can significantly increase the total cost of your loans and accrue daily. When borrowing privately, avoid borrowing from lenders with unfavorable terms. Shop around if you are borrowing privately or refinancing.
2. Don’t overlook federal benefits. Federal loans come with protections like income-driven repayment and forbearance options. Avoid relying solely on private loans, which have less flexible terms.
3. Don’t skip financial counseling. Many dental schools offer financial aid counseling. They may also invite a student loan counselor to meet with you one-on-one. Having a student loan plan is critical when paying down mortgage-sized dental school loans.
Repaying Dental School Loans
After you graduate dental school, it’s time to start paying your loans down. Below are the primary repayment options for dental school loans.
Standard Repayment Plan
This is the default plan for federal loans, with fixed monthly payments over 10, 15, 20 or 25 years depending on balance amount. Most dentists will have a 25-year term. Here is the term breakdown, which takes effect in 2026:
• 10-year payoff for balances of $1–$24,999.
• 15-year payoff for balances of $25,000–$49,999.
• 20-year payoff for balances of $50,000–$99,999.
• 25-year payoff for balances of $100,000 or greater.
The standard repayment plan is a nice option if you prefer paying down the loans at a slower pace. However, it doesn’t qualify for any loan forgiveness programs. Moreover, federal rates are fixed, and, if interest rates drop, your rates don’t readjust. To lower the interest rates on your loans, you should consider privately refinancing. More on that later.
"By creating a student loan plan to crush your loans, you will have less stress and burnout and will be happier — and you will provide better patient care."
Income-Driven Repayment Plans
Income-driven repayment (IDR) plans are federal loan repayment options that adjust your monthly payments based on your income and family size, typically capping payments at 10%–20% of your discretionary income. After 20 to 30 years, any remaining balance may be forgiven (though forgiveness may be taxable). IDR payments can also qualify for PSLF after 10 years of full-time employment in public service.
Eligibility for IDR plans depends on when you borrow. For those who finished borrowing prior to July 1, 2026, you are eligible for either a repayment assistance plan (RAP) or income-based repayment (IBR).
Payments in the RAP plan are 10% of adjusted gross income (AGI). During times of negative amortization (monthly payment is less than monthly interest charge), unpaid interest is waived.
RAP has an IDR forgiveness track over 30 years if not working in public service.
The IBR plan has two versions:
• Pre-2014: Loan origination date prior to July 1, 2014 (15% of discretionary income), 25-year IDR forgiveness.
• Post-2014: Loan origination date from July 1, 2014, to June 30, 2026 (10% of discretionary income), 20-year IDR forgiveness.
Generally, the pre-2014 IBR plan is more expensive than a RAP, and the post-2014 IBR plan is cheaper than a RAP. The IBR plan also has a capped payment based on what you would owe under a standard 10-year repayment plan.
If you disburse a loan on July 1, 2026, or later, you’re only eligible for the RAP IDR plan.
The One Big Beautiful Bill Act has consolidated repayment options down to IBR or RAP. Currently, three additional IDR plans will be phased out by July 1, 2028:
• Pay as You Earn (PAYE)
• Income-Contingent Repayment (ICR)
• Savings on a Valuable Education (SAVE)
Borrowers will need to leave these IDR plans for IBR or RAP no later than July 1, 2028.
IDR plans are a great option if you’re considering a federal loan forgiveness program such as IDR forgiveness (20 to 30 years) or PSLF (10 years). Associates or part-timers will typically benefit more than practice owners pursuing a federal forgiveness track.
Refinancing
Refinancing involves taking out a new private loan to pay off your existing federal or private loans, ideally at a lower interest rate or with better terms. You can choose a new repayment term (e.g., five to 20 years).
Refinancing is a great option if you already have private student loans. There’s a good chance those private loans were obtained when your financial situation wasn’t as strong, and refinancing now would improve your terms.
Refinancing federal loans to private is common to lower the interest rate. However, once federal loans are refinanced to private loans, it eliminates access to federal benefits like IDR and PSLF.
Final Thoughts
Paying off dental school loans is a marathon, not a sprint. Taking time on the front end to borrow wisely and choose the right repayment strategy can make a world of difference paying down your student debt. I am 100% convinced that financially secure doctors are better partners, parents and dentists. By creating a student loan plan to crush your loans, you will have less stress and burnout and will be happier — and you will provide better patient care. Take action today to defeat your student loans! ♦
Andrew Paulson, CSLP, is lead student loan consultant and co-founder of StudentLoanAdvice.com. He has advised more than $1 billion in student debt for 2,900 borrowers, mostly doctors, dentists and other higher earning professionals, across the country on how to best manage their student loan debt. Additionally, he is a Certified Student Loan Professional (CSLP).
“Student Debt.” Academy of General Dentistry, agd.org/advocacy/agd-priorities/keyissues/student-debt. Accessed 11 Sept. 2025.
ADA Office of Student Affairs. “Dental Student Loan Repayment Programs & Resources.” American Dental Association, 2022, ada.org/-/media/project/ada-organization/ada/ ada-org/files/resources/students/dental-student-loan-repayment-resource.pdf.
Yale, Aly J. “How to Pay for Dental School in 2025: 6 Strategies to Use.” Credible, 30 July 2025, credible.com/student-loans/how-to-pay-for-dental-school.
And Now... the Stories!
From Debt to Discipline: Owning My Financial Future as a New Dentist
By Akanksha Baheti, DDS
Two years into practice, I still remember the gut-punch feeling of logging into my student loan portal for the first time after graduation: Six figures stared back at me, numbers that didn’t feel real until I saw them on that screen. As a first-generation dentist, I had no financial roadmap to follow, but I knew one thing — ignoring the debt wouldn’t make it disappear. If I wanted to build a meaningful, balanced career, I had to take control early. That became my starting point.
A Strategy that Matched My Career Vision
I graduated with approximately $260,000 in federal student loans. I wasn’t looking for quick fixes or forgiveness programs that didn’t align with my long-term goals. I also wasn’t in a position to make giant lump-sum payments. So, instead of trying to be debt-free as fast as possible, I focused on building a plan that was efficient and realistic.
I chose the standard 10-year repayment plan (the default option before the One Big Beautiful Bill changed the repayment timetables) and added a rule of my own: Every quarter, I’d make an extra principal-only payment equal to at least half a monthly installment. My living expenses stayed modest, and I made sure my loan payment never felt overwhelming, even as my income grew.
Leveraging Knowledge as a First-Year Associate
Early on, I committed to building my financial literacy. I listened to podcasts tailored to dentists, followed vetted financial professionals and read about behavioral finance. That helped me avoid common traps, like overfinancing a car or rushing into ownership without savings.
One of the most empowering decisions I made was negotiating my associate contract with an eye toward financial flexibility. I chose a practice that offered a reasonable base salary with a clear production-based incentive. That extra income didn’t go toward lifestyle upgrades — it went straight to loans.
Conscious Trade-Offs, Not Sacrifices
People often associate student debt with painful sacrifices. I tried to reframe it as a temporary reordering of priorities. Did I delay things? Yes. I skipped new furniture, stuck with an older car and avoided unnecessary subscriptions. But I didn’t feel deprived; I felt focused.
One helpful move: I created a “freedom fund” in parallel with loan payments. I allocated 5% of every paycheck into a separate savings account for life goals. That fund allowed me to enjoy small moments like weekend getaways or continuing education without derailing my repayment progress.
From Burden to Leverage
Around my second year, my mindset started to shift. I stopped seeing my loans as a mistake or burden. Instead, I began to treat them as an investment, an entry ticket to a career I love.
Not only was I making payments, but I was also learning how to build a financially resilient life. And that confidence made my experience whole; I became more comfortable talking about money, began exploring ownership and took control of my longterm goals.
Advice I Wish I'd Heard Sooner
To new grads feeling the pressure of their debt: Don’t wait for the perfect plan — just start with a clear one. Be honest with yourself. Know your numbers. Set up systems to reduce emotional spending, and, most importantly, stay consistent.
You don’t have to give up your life to pay off your loans, but you do have to be intentional. If you’re working hard, your money should work just as hard for you.
Final Thoughts
For me, debt repayment hasn’t just been a summit to conquer — it’s been a mindset shift. Two years ago, I saw my loans as a looming mountain. Now, I see them as a challenge I’m steadily conquering, one payment at a time.
There’s freedom in being proactive. There’s strength in knowing you’re not avoiding the problem, you’re tackling it. And the habits I’ve built during this journey? They’ll serve me for the rest of my career, far beyond the day I make my final payment. ♦
Akanksha Baheti, BDS, DDS, is an internationally trained dentist specializing in esthetic and restorative dentistry, recognized for advancing excellence in both clinical care and academic scholarship. She practices in Chicago.
Conquering Student Debt: Why Peace of Mind Was Worth More than Higher Returns
By Clayton Sorrells, DDS
Student loan debt was something I thought about long before I ever graduated high school. I never wanted to have any of it because I had heard so many horror stories and because I watched my mom pay off hers for years. With that in mind, I chose a smaller, more affordable college in Arkansas, where scholarships covered tuition and more. Unfortunately, professional school is different. Scholarships are scarce, and costs are high. To attend dental school, I had to face my fears and take out loans.
At the Louisiana State University School of Dentistry, the fouryear cost was around $180,000. I had done my research and knew I wanted to avoid the high-interest Direct PLUS loans (often considered a “last resort” because they’re always available but carry a higher interest rate) for graduate or professional students if possible. Before dental school, I had worked for three years as a registered nurse, which not only provided me with a stable income but also gave me a flexible skill set I could rely on during breaks and weekends. For anyone considering dentistry, I encourage you to think strategically about your undergraduate degree — a field like nursing can provide both real-world experience and a well-paying fallback job, which can make a huge difference when managing expenses in professional school. My plan was to borrow just enough in federal unsubsidized loans to cover tuition while living off savings and income from nursing side jobs and even semiprofessionally walking dogs. With careful planning (and some stress), I was able to do exactly that — graduating with $180,000 in loans and no Direct PLUS debt.
While in dental school, I made it a point to pay the accruing interest each month as long as my basic expenses were covered. Then came the COVID-19 pandemic. Nine months into my D1 year, interest was paused, and, for the first time, I wasn’t fighting against a growing balance. It felt like I had caught a huge break. My wife, Emily, and I planned to stockpile cash in a high-yield savings
account for when interest resumed, but discipline slipped, and we didn’t save as much as we’d intended.
Still, when I graduated in May 2023, we committed to an aggressive plan. We set up an automatic draft from our checking account into a high-yield savings earmarked for student loans. Starting at $2,500 a month, we later increased it to $4,600. And then we did something that felt crazy: We pushed it to $7,100. Emily and I had lived on just $30,000 a year while I was in dental school, and we decided we could keep living lean for a few more years if it meant freedom from debt.
By the time interest began again in August 2025, we had saved $90,000. On the very first day after interest resumed, I paid off the loans with the highest rates — 6.3% and 5.8%. Seeing $90,000 leave our account was painful, but I reminded myself it was buying us freedom. Since then, we’ve already made another $30,000 in payments. Today, I’m down to just two loans: one at $45,000 with a 4.3% rate and the other at $15,000 with a 5.1% rate. Our new goal is to finish paying everything off by the end of this year — just two and a half years after graduation, and a year and a half ahead of schedule.
Another factor that shaped my repayment journey was going into private practice right away. As an owner, I had more control over my income and financial decisions than I would have as an associate or working for a DSO. At the same time, ownership brought its own risks and responsibilities. Balancing payroll, overhead and loan repayment wasn’t easy, but the trade-off was worth it — that flexibility gave Emily and me the chance to be aggressive in paying down my loans.
Some of my friends took a different approach. Thanks to the SAVE (Saving on a Valuable Education) plan, an IDR plan that caps federal student loan payments at a portion of income that will be phased out in 2028, many friends have $0 monthly payments, and they are choosing to let their balances ride while investing the money in the stock market. Financially, they may come out ahead.
But, for me, the “aha” moment was realizing that peace of mind was worth more than the possibility of a slightly higher return. I had spent too much mental energy thinking about my loans — I wanted them gone.
My advice for anyone starting their repayment journey is simple: Have an honest conversation with your spouse or partner, decide when you want the debt gone, and work backward from there. If the monthly number feels overwhelming, extend the timeline. But automate your plan, stick to it, and increase contributions whenever possible.
For us, the automatic draft was the single most important tool. It forced discipline and made progress feel inevitable. I’ll admit I was fortunate to catch some breaks along the way — the pause on interest during the COVID-19 pandemic, the SAVE plan delaying
required payments and a supportive spouse who was equally determined to be debt-free. But discipline was what turned those breaks into progress. By saving aggressively — already making more than $120,000 in payments — and choosing peace of mind over chasing higher returns, we’ve put ourselves in a position to eliminate this debt faster than we ever imagined. And while our story isn’t finished yet, I can promise that by the end of this year, our student debt will be gone. The weight lifted from both Emily’s and my shoulders will be worth every sacrifice. ♦
Utilize Discipline and All Available Resources to Pay Off Debt
By Helena Soomer Lincoln, DDS, PhD
Iwas able to pay my University of Michigan Dental School student debt off in one year after graduation. During that year, I was a hospital resident in the Department of Oral and Maxillofacial Surgery/ Hospital Dentistry with a very good salary as a first-year dentist.
I decided to channel all my salary and bonuses into paying off the student debt. I was lucky in that my husband’s salary could cover our household expenses. And then I saved money everywhere I could. While others went to Starbucks for morning coffee, I drank the drip coffee that the assistants made in the break room of our department. I always brought my own sandwich from home and never bought food from the cafeteria. I was very disciplined and focused because I had a dream of starting my own practice and solving big problems for my patients, so paying off the debt was an easy decision for me. All I did was create an autopay and channel my salary to pay off the debt each month.
In the meantime, I was able to score a dental chair and some lab equipment that the department was replacing to start my own
practice from scratch with very low startup costs. My dream was to perform transformative dentistry and full-mouth reconstructions.
My residency also allowed me to zoom in and learn all I could about maxillofacial prosthodontics and oral surgery without paying the high tuition of a postgraduate program. I really took advantage of my time there, spending long days and nights learning all I could.
With this knowledge, I was able to create and patent a full-arch restoration called the TruBridge that helps millions of Americans without teeth. Because I know how to control cash flow and how to create things from scratch, I have been able to start a charitable foundation, the TruBridge Foundation, which helps those in need. It all starts with a decision and then daily discipline to carry it out. You start small, but, if followed precisely, your plan will have a snowball effect! ♦
Helena Soomer Lincoln, DDS, PhD, is the founder of TruBridge Dental and the TruBridge Dental Foundation. She maintains a private practice in Bainbridge Island, Washington. To comment on this article, email impact@agd.org
Clayton Sorrells, DDS, is a new dentist and previous AGD chapter president at Louisiana State University School of Dentistry. His is the AGD Impact New Dentists columnist.
Self-Instruction
Practice Management and Human Relations
(Subject Code: 550)
The 10 questions for this exercise are based on information presented in the article, “Student Debt Success Stories,” by various authors, on pages 12–17. This exercise was developed by members of the AGD editorial team.
1. According to the American Dental Education Association, the average student loan debt for the dental Class of 2024 was $_____.
A. 212,700
B. 262,700
C. 312,700
D. 362,700
2. According to Andrew Paulson, CSLP, which of the following is the main reason dental students should prioritize federal loans over private loans?
A. They are easier to obtain.
B. They have lower application fees.
C. They are forgiven automatically after graduation.
D. They often have lower interest rates and more flexible repayment options.
3. As part of the One Big Beautiful Bill Act, federal student loan limits are changing in 2026, with a new borrowing cap of $_____ for dental school for those who begin borrowing July 1, 2026, or later.
A. 150,000
B. 200,000
C. 250,000
D. 300,000
4. All of the following loan repayment assistance programs are available to dentists except one. Which is the exception?
A. Income-Driven Repayment (IDR) Forgiveness
B. Public Service Loan Forgiveness (PSLF)
Reading the article and successfully completing the exercise will enable you to:
• identify key strategies for minimizing the burden of dental school student loan borrowing;
• differentiate among federal loan repayment options; and
• evaluate the advantages and limitations of refinancing federal and private student loans.
This exercise can be purchased and answers submitted online at agd.org/self-instruction Answers for this exercise must be received by Oct. 31, 2028.
C. Community Dental Relief Loan Support (CDRLS)
D. National Health Service Corps (NHSC) Loan Repayment Program
5. Federal loans come with protections like income-driven repayment and forbearance options. Avoid relying solely on private loans, which have less flexible terms.
A. Both statements are true.
B. The first statement is true; the second is false.
C. The first statement is false; the second is true.
D. Both statements are false.
6. Starting in 2026, most dentists will have a _____-year payoff term under the standard repayment plan for federal loans.
A. 10
B. 15
C. 20
D. 25
7. Income-driven repayment (IDR) plans adjust monthly payments based on income and family size, capping payments at _____ of discretionary income.
A. 5%–15%
B. 10%–20%
C. 15%–25%
D. 20%–30%
8. Payments in the repayment assistance plan (RAP) are _____ of adjusted gross income.
A. 10%
B. 15%
C. 20%
D. 25%
9. What percentage of discretionary income is required under the post-2014 income-based repayment (IBR) plan (loan origination date from July 1, 2014, to June 30, 2026)?
A. 10%
B. 15%
C. 20%
D. 25%
10. Refinancing private student loans can result in improved terms if those private loans were obtained when your financial situation wasn’t as strong. Refinancing federal loans to private is common to lower the interest rate, but it eliminates access to federal benefits like IDR and PSLF.
A. Both statements are true.
B. The first statement is true; the second is false.
C. The first statement is false; the second is true.
D. Both statements are false.
Restoring Heroes The Legacy of the Air Force Maxillofacial Prosthetics Fellowship Program
By Col. Joshua A. Vess, USAF, DC, and MAJ Patricia M. Walworth, USA, DC
Amassive Air Force plane lumbers across the sky above Joint Base San Antonio-Lackland in Texas, its aircrew practicing touch-and-goes to maintain mission readiness. Inside the Air Force Postgraduate Dental School’s second-floor Prosthodontic Clinic, a different kind of resilience unfolds. As an alginate impression sets for an ocular prosthetic, a provider and patient share a lighthearted exchange about the aircraft’s size and speed. The patient, a colonel who lost his left eye and arm to an improvised explosive device in Afghanistan in 2006, laughs as he recounts jumping from similar planes. This Veterans Day, we honor such heroes through the Air Force Maxillofacial Prosthetics Fellowship Program, which restores not just faces but lives, blending advanced dental care with compassion. For AGD members, this program exemplifies dentistry’s power to heal, inspiring us to approach our practice with renewed purpose.
The colonel is back at the clinic for a new ocular prosthetic and is currently seated in the spacious anaplastology treatment room flooded with natural light (anaplastology is the field of medicine that deals with prosthetic rehabilitation). He tells his provider, “I know you guys can paint it to look like my other eye, but I want you to put this in it instead,” and hands over a metal lapel pin with the insignia of his current unit. Still on active duty and now a full-bird colonel, he custom orders these pins every time he’s assigned to a new unit, then calls the clinic for a new eye. When Dr. Walworth discusses extraoral prosthetic options with a patient.
Dr. Vess processes and characterizes a silicone auricular.
asked why he continues to serve after giving so much, he responds, “Every day I get to come to work and be with people who not only make sacrifices daily, but who are willing to die for what they believe in. What could be better than that?”
Stories like his are the heart of the U.S. Air Force Maxillofacial Prosthetics Fellowship Program — a beacon of hope for veterans and service members who have sacrificed so much. Established in 1984, this pioneering program has transformed the landscape of specialized dental care within the military, blending cutting-edge technology with compassionate expertise to restore not only function, but also dignity and confidence.
This Veterans Day, as we honor those who have served, it’s fitting to spotlight the unsung heroes we treat in military medicine. For AGD dentists, understanding the program’s history, purpose and impact can deepen our appreciation for the Armed Forces’ commitment to holistic care. It reminds us that our profession extends beyond routine procedures — it’s about healing the human spirit. In this article, we’ll explore why this fellowship program exists, delve into some of the innovative treatments it provides and share inspiring patient examples that highlight its profound effects. Our hope is to cultivate a shared sense of gratitude for our veterans and awareness of these specialized services,
“Embodying the military ethos nemo residit — ‘no one left behind’ — it is our hope that this program serves to inspire other dental professionals to continue their efforts to approach patient care with the same holistic dedication, ensuring every patient feels whole.”
inspiring us all to approach our practices with renewed purpose.
Why Does the Military Have Maxillofacial Programs?
The Air Force Maxillofacial Prosthetics Fellowship Program was born out of necessity — a response to the challenges faced by military personnel and veterans. Service members face unique risks — combat injuries, high-impact training accidents and environmental hazards — that civilians rarely encounter. These can lead to devastating facial trauma or conditions like head and neck cancers, requiring specialized lifelong care through both active duty and Department of Veterans Affairs (VA) systems. The Air Force Maxillofacial Prosthetics Fellowship Program trains specialists to bridge dentistry and medicine, crafting lifelike prostheses for eyes, ears and noses, far beyond the crowns and dentures of general prosthodontics. This ensures a cadre of experts ready to restore function and dignity, maintain operational readiness, and support veterans’ reintegration into civilian life.
“‘Whole’ signifies more than physical restoration — it’s about renewing confidence, dignity and purpose.”
In the broader context of military dentistry, the fellowship underscores the armed forces’ dedication to comprehensive health. The U.S. Air Force Dental Service, established in 1949, has long prioritized advanced training to meet the demands of a global force. By investing in maxillofacial prosthetics, the Air Force not only treats physical wounds but also addresses the psychological toll of disfigurement, helping veterans reintegrate into civilian life. Embodying the military ethos nemo residit — “no one left behind” — it is our hope that this program serves to inspire other dental professionals to continue their efforts to approach patient care with the same holistic dedication, ensuring every patient feels whole.
Fellowship History: From Inception to Excellence
The Air Force’s commitment to prosthodontics began in the 1950s, with graduate programs elevating care standards for a global force. In 1984, the Maxillofacial Prosthetics Fellowship was established at Wilford Hall Medical Center (now part of Joint Base San Antonio-Lackland), training board-certified prosthodontists in complex reconstructions. The program embraced innovation early, adopting stereolithography — a 3D-modeling technique — in the 1990s to craft precise prostheses. Today, at the state-of-the-art Air Force Postgraduate Dental School, fellows use advanced tools like cone beam computed tomography, stereophotogrammetry and jaw-motion tracking (digitizing the complete patient), along with CAD/ CAM for custom devices, ensuring unparalleled accuracy. Accredited by the American Dental Association’s Commission on Dental Accreditation,
Examples of eye prostheses.
Drs. Vess and Walworth discuss a mandibular fibula free flap reconstruction plan.
the program has trained 38 fellows across the Air Force, Army and Navy, adapting to an increased need for maxillofacial prosthetics due to better survival rates from improved body armor — and restoring heroes’ quality of life in the process. At the same time, advances in weaponry have increased the number of warfighters sustaining soft- and hard-tissue injuries to the head and neck. May this legacy serve to inspire AGD members to embrace innovation in their own practices.
The Ethos: Returning Warfighters Whole to the Fight
The Air Force Maxillofacial Prosthetics Fellowship Program embodies the motto: “Returning warfighters whole to the fight.” “Whole” signifies more than physical restoration — it’s about renewing confidence, dignity and purpose. Whether crafting an ocular prosthetic for a colonel who continues to serve or designing implants for a veteran reclaiming his ability to speak, the program ensures service members can return to their missions or civilian lives with resilience. For AGD members, this ethos inspires us to treat every patient holistically, addressing not just their dental needs but their human spirit, ensuring no one is left behind in their journey to healing.
Treatments that Transform
The fellowship equips specialists to restore both form and function through innovative treatments, collaborating with oral surgeons, oncologists and plastic surgeons to serve complex patient needs. Key interventions include:
• Intraoral prostheses: Obturators for palatal defects, mandibular resection prostheses and implant-borne prostheses, critical for trauma or cancer recovery.
• Extraoral prostheses: Lifelike silicone eyes, ears and noses, meticulously painted to match skin and eye tones, restoring confidence.
• Dental oncology support: Radiation shields and rehabilitative devices to aid speech and swallowing for head and neck cancer patients.
• Custom devices: Transparent pressure masks for burn patients, crafted using stereophotogrammetry (3D imaging) and 3D printing, alongside therapy aids and cleft palate molding devices. These treatments transcend esthetics, enabling patients to eat, speak and engage confidently.
For AGD members, these innovations highlight dentistry’s role in holistic healing, inspiring us to explore advanced techniques in our practices.
Patient Stories: Heroes Reborn
The program’s heart lies in its patients’ stories. One veteran, who was diagnosed with lower lip squamous cell carcinoma nearly a decade ago, sought dentures after extensive reconstruction. “I used to swing dance, but I don’t anymore,” he shared, describing years of limited eating and smiling due to an atrophic jaw and flap reconstruction. After months of planning with an ear, nose and throat doctor and oral surgery, specialists placed four mandibular and three zygomatic (cheekbone) implants. When he saw his interim prostheses, he teared up: “Doc, you did what others said couldn’t be done. I can’t wait to eat a steak.” His joy inspires AGD members to pursue creative solutions for complex cases.
Another active duty soldier lost much of his facial skin, including his nose and lips, due to an aberrant autoimmune reaction after being attacked with a knife. After spending months in the Army’s Burn Institute for Surgical Research rehabilitation clinic and being reconstructed with grafts, he received both a custom 3D-printed face mask and a silicone prosthesis for his nose and upper lip — both created from a 3D face model computed using a pre-injury video he provided. “I can go out in public without people seeing inside my body,” he said tearfully before traveling home to his family. Still serving, his resilience motivates us to connect patients with specialized care, such as through the American Academy of Maxillofacial Prosthetics (AAMP) or VA referrals.
Call to Gratitude
The Air Force Maxillofacial Prosthetics Fellowship Program embodies service beyond the battlefield, restoring heroes one prosthesis at a time. This Veterans Day, let’s honor veterans by cultivating awareness of these specialized services. AGD members can make a difference by partnering with local VA clinics, referring complex cases to maxillofacial prosthodontists (find AAMP specialists at maxillofacialprosthetics.org) or simply expressing gratitude to veteran patients. By embracing the ethos of “returning warfighters whole to the fight,” we strengthen the bond between civilian and military dentistry, ensuring no hero faces the world alone. ♦
Note: The appearance of U.S. Department of Defense (DoD) visual information does not imply or constitute DoD endorsement.
Col. Joshua A. Vess, USAF, DC, is program director of the Maxillofacial Prosthetics Fellowship Program at the Air Force Postgraduate Dental School, Joint Base San Antonio-Lackland, Texas. MAJ Patricia M. Walworth, USA, DC, is chief of maxillofacial prosthodontics at Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas. To comment on this article, email impact@agd.org
By Ross Isbell, DMD, MBA
In my practice, my usual plan is to extract a tooth as atraumatically as possible and allow the site to heal. This is the least expensive treatment, and we know the body will heal in time. However, I am not always fortunate enough to have patients or sites that heal perfectly — luckily, there are a variety of ways to help heal them. While postoperative management of surgical sites is a commonly encountered situation in practices that extract teeth, past solutions haven’t always been as predictable and easy to deliver.
Take the Guesswork out of Implant Integration
Osseosense Pro
Conmetior conmetior.com
For an implant surgeon, and especially for a restorative dentist, it is critical to know that your implants are integrated and have gained secondary stability. There are a few basic ways to test implant stability values after placement and prior to restoration. Manual options, such as reverse torque-testing with your hands or a driver, or percussion testing with a solid instrument like a mirror handle, can provide a reliable qualitative answer about integration — but not a quantitative one. It is more precise to utilize implant stability measuring technology such as resonance frequency analysis (RFA) with the Osstell® or Penguin, damping capacity assessment (DCA) with Anycheck® or Periotest®, or physical torque-testing with an implant driver. RFA technology yields a measurement called implant stability quotient (ISQ); DCA yields a measurement called implant stability test (IST) or perio test value (PTV); and reverse torque-testing with an appropriate handpiece or torque wrench can obviously yield a newtons per square centimeter (N/cm2) value.
I chose a device that uses DCA called the OsseoSense Pro from Conmetior. It uses physical tapping and DCA to provide an IST reading. With this tool, you can test directly onto crowns, abutments, or any other tightened and connected extension of the implant. Personally, I test implants prior to loading them. But if you are a fan of immediate temporization, I would recommend removing temporary cement and acrylic crowns for a more accurate measurement. The OsseoSense Pro does not require single patient–use tips or pegs, is a universal system and doesn’t need specific attachments, and can be sterilized between patients. It is composed of three pieces — the handpiece, the tapper and the tapper sheath. The tapper and sheath are autoclavable, and the handpiece is covered with a plastic cover during patient use but is also wipeable. To use, simply add the pieces, orient the handpiece to have a vertical positioning over the implant, press the power button, and read the value on the display. Like other DCA tools in its class, it is about one-third the price of RFA tools but gives me a reliable way to put a number on integration success rather than relying on a temporally decided healing window and my radiographic and manual opinion. The OsseoSense Pro has given me greater confidence in my timeline for implant loading after uncovering, and I definitely recommend it for ease of use and effectiveness.
A Rock-Solid Cement
Choice™ 2 Veneer Cement Bisco bisco.com
In my opinion, cementation of veneers is one of the more stressful procedures a general dentist can perform. It is a precision-based, minimal-error process that, from start to finish, requires attention to detail and quick hands. Identifying and reducing stress points should always be a part of your preprocedure planning process. For me, a simple stress reducer was finding a simple and reliable cementation kit. The Choice™ 2 starter kit from Bisco is a light-cured luting cement setup that has a range of available shades of cement and accompanying try-in pastes. It functions well with all ceramic materials, especially when coupled with Bisco’s cleaning and bonding agents (also included in the kit). One procedural recommendation I have that may seem obvious is that, if you use try-in pastes, you should choose a specific moment after you have completed using them to move all of them out of reach and only keep the one cement you plan to use on your tray. Ask me how I know to do this now. This cement is highly particle-filled and is therefore very dimensionally stable over its functional lifetime, but it also does not feel too “doughy” and allows for complete veneer seating without extreme force. With clear labeling, easy delivery and a top-notch bonding protocol, I think this is a worthwhile kit to have on hand.
Ross Isbell, DMD, MBA, currently practices in Gadsden, Alabama, with his father, Gordon Isbell, DMD, MAGD. He attended the University of Alabama at Birmingham (UAB) School of Dentistry and completed a general practice residency at UAB Hospital. Isbell has confirmed to AGD that he has not received any remuneration from the manufacturers of the products reviewed or their affiliates for the past three years. All reviews are the opinions of the author and are not shared or endorsed by AGD Impact or AGD. To comment on this article, email impact@agd.org
Testing the Tools
USPS STATEMENT OF OWNERSHIP, MANAGEMENT, AND CIRCULATION
As a 37-year-old man, I have finally begun to accept the truth that I snore, sometimes loudly and for a prolonged time. I have taken this acceptance as a reason to start learning about sleep, sleep dentistry and myofunctional therapy. I’m far from an expert, but I am starting to search for products and exercises that can improve my sleeping life and, correspondingly, my waking life. A product I recently started using is the REMplenish™ Myo-Nozzle by REMastered Sleep. By placing your lips around the wide base to create a seal, the extended length of the nozzle places the tip into the anterior area of the palate and requires strong suction forces to retrieve your drink (water). This placement also encourages an arched and tightened tongue positioning in the highest part of the palate and exercises the muscles of the tonsillar arch and upper oropharynx. The company claims that by drinking 30–60 ounces (one or two bottles) daily for six weeks, you can stop snoring. While I haven’t stopped snoring, I have noticed a significant change in my tongue positioning and swallowing. The Myo-Nozzle can be purchased as an add-on attachment to any sturdy straw you use already (like a metal Stanley), as a straw and nozzle combo, or built into a water bottle. The company offers adult- and child-sized nozzles as well as bottles. This product and others like it supposedly can cause airway improvements through muscular adaptation — I can tell you for sure that you will notice those muscles straining. The successful positive alteration of sleep quality scores in patients with sleep-disordered breathing patterns such as snoring or mild to moderate sleep apnea can be a major boon to body oxygenation. The REMPlenish Myo-Nozzle is an easy way to train yourself into better habits and possibly into more effective sleep.
Publication Title: AGD IMPACT Publication Number: 0194-729X Filing Date: 9-2625 Issue Frequency: Monthly Number of Issues Published Annually: 12 Annual Subscription Price: $70.00 Mailing Address of Known Office of Publication: 560 W. Lake St., Sixth Floor, Chicago, IL 60661-6600, Cook County Contact Person: Leland Humbertson Telephone: 312.440.4311 Mailing Address of Headquarters or General Business Office of Publisher: Same as above Names and Mailing Addresses of Publisher, Editor and Managing Editor: Same as above Publisher: Academy of General Dentistry, 560 W. Lake St., Sixth Floor, Chicago, IL 60661-6600 Editor: Timothy F. Kosinski, DDS, MAGD, address same as above Managing Editor: Leland Humbertson, address same as above Owner: Academy of General Dentistry, address same as above Known Bondholders, Mortgagees, and Other Security Holders: None Tax Status: Has not changed during preceding 12 months Issue Date for Circulation Data Below: October 2025
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Publication of Statement of Ownership: November 2025 issue
Signature and Title: Tiffany Slade, Executive Editor
Date: 9-23-25
Earn CE at Your Convenience with Self-Instruction
Now is the time to take advantage of AGD’s Self-Instruction program that includes exercises based on AGD Impact articles. These exercises contain 10 questions and are worth 1 CE credit. It’s the perfect complement to General Dentistry
