Practice purchase and private employment options for the new graduate with student debt: A projected scenario analysis for loan repayment.

BACKGROUND: When attracting talent to dentistry, graduates need educational costs justified by future financial outcomes. The authors provide insights into how career choices (employee versus practice owner) and student loan repayment plans (principal-based versus income-driven) can be made to work. METHODS: Five loan repayment and career choice combinations were assessed using spreadsheets (Microsoft Excel) to rationally model monthly budgets and financial decisions during a projected 40-year work life. RESULTS: Even with high levels of student loan debt ($292,169 average for new graduates), it is still possible, but increasingly difficult, to achieve desirable career, lifestyle, and financial outcomes. Outcomes are highly sensitive to rates of investment returns and inflation. On the basis of the 5 scenarios of projections of debt and income levels to 2060, assuming reasonable levels of investment return and stable inflation, career and repayment choices can make a difference of more than $5 million in lifetime earnings and more than $3 million in retirement savings (2020 dollars). CONCLUSIONS: The new reality of high educational debt requires graduates to budget and plan before beginning their careers. Use of loan servicers, consultants, brokers, attorneys, certified public accountants, and financial advisors is needed. Working for a dental service organization is a valid option for developing dental and practice management skills. Owning a practice is still a viable career path. PRACTICAL IMPLICATIONS: Dental graduates should choose a student loan repayment that minimizes the size of monthly payments, balance budgets, practice frugality, obtain a practice purchase loan at lowest rates, and heed financial advisors.

A consideration of factors affecting palliative oral appliance effectiveness for obstructive sleep apnea: a scoping review.

STUDY OBJECTIVES: This scoping review allows physicians, researchers, and others interested in obstructive sleep apnea to consider effectiveness of oral appliances (OAs). The intent is to improve understanding of OA effectiveness by considering morphologic interaction in patients with obstructive sleep apnea. METHODS: Morphologic and biomechanical criteria for positional alterations of the mandible assessed success rates of OA appliances. Searches of databases (Medline, PubMed, The Cochrane Library, EBSCO) using terms: OA treatment effectiveness and positive and/or negative outcome predictors. Craniofacial predictors of OAs and obstructive sleep apnea biomechanical factors of anatomical traits associated with OA effectiveness were included. Databases searched radiographic cephalometric imaging for morphology/phenotypes and apnea-hypopnea index responses. Articles were excluded if title or abstract was not relevant or a case report. If the analysis did not report mean or standard deviation for apnea-hypoxia index, it was excluded. No language, age, or sex restrictions were applied. RESULTS: Analysis of 135 articles included in searched literature indicated alterations in musculature and pharyngeal airway structure through OA use. These alterations were individually unpredictable with wide variability 61.81% ± 12.29 (apnea-hypoxia index mean ± standard deviation). Morphologic variations as predictors were typically weak and idiosyncratic. Biomechanical factors and wide variations in the metrics of appliance application were unclear, identifying gaps in knowledge and practice of OAs. CONCLUSIONS: An integrated basis to identify morphologic and biomechanical elements of phenotypic expressions of sleep-disordered breathing in the design and application of OAs is needed. Current knowledge is heterogeneous and shows high variability. Identification of subgroups of patients with obstructive sleep apnea responding to OAs is needed.

Accuracy of cone-beam computed tomography imaging of the temporomandibular joint: comparisons with panoramic radiology and linear tomography.

INTRODUCTION: Cone-beam computed tomography (CBCT) is increasingly being used as an imaging modality, particularly in the assessment of the temporomandibular joint (TMJ). A blinded observational cross-sectional in-vitro study was conducted to compare the diagnostic accuracy of observers viewing images made with CBCT, panoramic radiography, and linear tomography. The task was to detect cortical erosions affecting the mandibular condylar head. METHODS: The sample consisted of 37 TMJ articulations from 30 skulls with either normal condylar morphology (n = 19) or erosion of the lateral pole (n = 18). The articulations were imaged by using corrected angle linear tomography (TOMO), normal (Pan-N) and TMJ-specific (Pan-TM) panoramic radiography, and CBCT. Digital images were obtained with photostimulable phosphor plates for all modalities except CBCT. The CBCT detector used an amorphous silicon flat-panel array combined with cesium iodide. Images and 10 rereads were presented to 10 observers on a flat-panel display at a pixel-to-monitor ratio of 1:1. CBCT multi-planar images were presented both statically (CBCT-S) and interactively (CBCT-I). The observers were permitted to scroll through axial (0.4 mm) and para-sagittal (1 mm) sections and then independently rate their confidence about the presence or absence of cortical erosion. Intraobserver reliability was determined by weighted kappa and diagnostic accuracy by the fitted area under the ROC curve. Means were compared by using ANOVA (P < or =.05). RESULTS: Intraobserver reliability was moderate (0.57 +/- 0.22; range, 0.34-0.78). Pan-N (0.72 +/- 0.15), CBCT-I (0.65 +/- 0.21), and CBCT-S (0.65 +/- 0.17) reliability was significantly greater than TOMO (0.44 +/- 0.25). The diagnostic accuracy of CBCT-I (0.95 +/- 0.05) and CBCT-S (0.77 +/- 0.17) was significantly greater than all other modalities (Pan-N [0.64 +/- 0.11], Pan-TM [0.55 +/- 0.11], TOMO [0.58 +/- 0.15]). CBCT-I was also more accurate than CBCT-S, and Pan-N was more accurate than Pan-TM and TOMO. CONCLUSIONS: CBCT images provide superior reliability and greater accuracy than TOMO and TMJ panoramic projections in the detection of condylar cortical erosion.

The relationship of vertical skeletofacial morphology to oropharyngeal airway shape using cone beam computed tomography: possible implications for airway restriction.

OBJECTIVE: To determine if the shape of the oropharyngeal airway is related to the vertical morphology of the skeletofacial complex, including the hyoid bone. MATERIALS AND METHODS: Cone beam computed tomography scans from 50 pretreatment adult orthodontic records were used to obtain skeletal and airway measurements. Linear regression statistics were used to compare soft tissue variables to hard tissue predictor variables. RESULTS: Transverse airway widening was significantly increased when the distance between the hyoid and vertebrae was reduced; when the three-dimensional (3D) facial axis angle decreased (became more vertical); when the 3D mandibular plane angle increased; when the width of the hyoid increased, or when the calculated length of the geniohyoid decreased. CONCLUSIONS: A laterally elliptical airway-found when the face is more vertical and when the hyoid is closer to the cervical vertebrae-is hypothetically more resistant to collapse. Patients with a retrognathic, skeletal deep bite and a rounded oropharynx should be identified and corrected early to prevent potential airway problems.