The burden of debt for Canadian dental students: part 4. The influence of debt on program and career decisions.

In the 3 previous papers of this 4-part series, we explored the issue of debt among dental students in Canada to analyze the factors influencing levels of debt. The information was obtained from a national survey of all dental students enrolled in Canadian dental schools during the 2003-2004 academic year. The aims of this fourth paper were to investigate the influence of debt upon career decisions after graduation and to comment on future directions for research into the impact of the rising costs of dental education and dental students' increasing debt levels. The results show that almost half of respondents found the costs of dental programs significantly higher than they anticipated. One-third of the respondents indicated that their anticipated debt level upon graduation had influenced their choice of career path within dentistry. Although this study provides baseline information about the degree of and influences on the indebtedness of students currently enrolled in dental programs across Canada, much remains to be learned about the impact of the higher costs of dental education on potential applicants to dental school and the effect of increased educational debt on practising dentists.

The burden of debt for Canadian dental students: part 3. Student indebtedness, sources of funding and the influence of socioeconomic status on debt.

In recent years, tuition fees at most universities across Canada have increased substantially, particularly in professional programs such as dentistry. Anecdotal evidence suggests that these increases have a significant adverse impact on the educational experience of dental students. In January 2004, students at Canada's 10 dental schools were invited to participate in a survey on costs, debt and other factors related to attending dental school in Canada. This third article in a series of 4 examines the effects of funding sources and socioeconomic status (SES) on dental students' debt. The survey provided key information about the costs of attending dental school and the levels of debt among dental students across Canada. Choice of school and year of study had a significant effect on the overall costs of attending dental school, and dental students' costs were largely financed by private loans or other forms of debt. Canadian dental students' average debt varied between 24,000 to 26,000 dollars per annum, depending on their year of study. Key determinants of borrowing included type of residence, SES, total costs, and number of dependents. Students who lived at home or with relatives borrowed significantly less than those who were renting. Parents' SES was related to students' access to forms of educational funding that result in no debt burden. SES also played a role in determining the likelihood of a student pursuing further professional education.

The burden of debt for Canadian dental students: part 1. Review of the literature.

Debt among Canadian university graduates is increasing, while money apportioned to federal and provincial needs-based student assistance programs has been decreasing since the 1990s. Dental students have had to absorb increased tuition fees at both the undergraduate and post-baccalaureate levels. Existing debt and high tuition fees may adversely influence a potential candidate"s decision to enroll in dental school. Likewise, debt incurred during the minimum 2 years of pre-dental education adds to the future debt load of dental graduates. It seems that few dental students can remain debt-free during their dental education, although data are lacking about the extent of debt among dental students and its impact on their career decisions. Government statistics focus primarily on tuition costs for baccalaureate-degree students. Tuition and clinic-related fees constitute a significant proportion of costs for dental students; moreover, university administrations perceive dentistry as an expensive curriculum. This first article of a 4-part series examines debt among dental students, both nationally and internationally.

The burden of debt for Canadian dental students: part 2. A report on survey participants and an analysis of dental education costs.

There are many anecdotes, but few facts about the issue of dental students' debt in Canada. This second of a 4-part series about dental students' debt attempts to remedy this situation. In January 2004, students at Canada's 10 dental schools were invited to participate in a survey on costs, debt and other factors related to attending dental school in Canada. The survey provided previously inaccessible demographic information about levels of debt amongst dental students. A typical dental student respondent had completed 4 years of post-secondary education, was in first year of dental school, was single with no dependents, did not work outside of classes, lived in rented accommodation and walked to school. Reported costs to attend dental school varied widely among Canadian dental schools. Choice of school and year of study had a significant effect on overall costs of attending dental school.

Tophaceous calcium pyrophosphate dihydrate deposition disease of the temporomandibular joint.

Tophaceous pseudogout is a rare manifestation of calcium pyrophosphate dihydrate (CPPD) deposition disease that particularly affects the temporomandibular joint (TMJ). We describe a case of tophaceous pseudogout and review the literature. Thirty-four cases of chronic CPPD deposition disease affecting the TMJ are described. Symptoms usually included pain and swelling. Most patients required surgery because of extensive crystal deposits, usually localized to the joint and adjacent structures but occasionally invasive. For many patients, malignancy was the preoperative diagnosis. Although patients with acute pseudogout of the TMJ may have involvement of other joints, tophaceous pseudogout was predominantly isolated to the TMJ.

Use of oral bisphosphonates and the risk of aseptic osteonecrosis: a nested case-control study.

OBJECTIVE: To determine whether use of oral bisphosphonates is associated with an increased risk of aseptic osteonecrosis (AON) among a cohort of elderly cardiovascular patients. METHODS: We conducted a nested case-control study within a previously defined cardiovascular cohort of elderly Quebec patients using linked administrative health databases. Cases were defined as those with the diagnosis of hospitalization secondary to AON at a nonspecified site. For each case, 10 controls were randomly selected and matched to the cases by age, calendar time, and length of followup. The main outcome measure was the risk ratio (RR) of AON among ever-users of oral bisphosphonates compared to that among nonusers. As a quality measure, RR for AON among users of statin and angiotensin-converting enzyme inhibitors (ACE-I) compared to nonusers were also calculated. RESULTS: The initial cohort consisted of 87,837 subjects. In the primary analysis, the adjusted RR for AON among bisphosphonate users was 2.87 (95% CI 1.71-5.05). The adjusted RR for alendronate, etidronate, and risedronate were 2.87 (95% CI 1.46-5.67), 2.43 (95% CI 1.05-5.62), and 3.34 (95% CI 1.04-10.67), respectively. There were no significant differences in RR for AON among current users (most recent drug exposure within 90 days of diagnosis) and past users (drug exposure between 91 and 365 days before diagnosis) of bisphosphonates. The adjusted RR for both statins and ACE-I were 0.79 (95% CI 0.49-1.07) and 1.16 (95% CI 0.79-1.70), respectively. CONCLUSION: In this cohort of elderly cardiovascular patients, an association was observed between oral bisphosphonate use and aseptic osteonecrosis. Further research into this putative association is required.