Perspectives on Debt, Crazy Cases and More

Happy New Year, fellow residents and new practitioners! The AAE and the Resident and New Practitioner Committee would like to wish you and yours a very healthy, productive and successful 2013.

In this edition of The Paper Point, we will continue our latest feature, Crazy Cases (please send a case you think can top ours to, highlight a new tool within the Professional Outreach Toolkit and will focus on the more personal side of student debt by providing insight on how debt is handled by various members of the committee. We will also give you a behind-the-scenes report on a resident's recent visit to an endodontic office via the AAE's Open House program.

We continue to try and provide a wide range of subjects and areas of interest to the resident and new practitioner and we hope that you continue to enjoy our newsletter. If there is a topic you would like us to focus on in the upcoming Paper Point, feel free to contact us. Until then, have a blessed 2013!

Dr. Cameron Howard


Cameron M. Howard, D.M.D., Msc.D
Chair, Resident and New Practitioner Committee

Managing Student Debt: Two Perspectives

Piggy BankThinking about student debt can make entering a career in endodontics a bit daunting. Both residents and new practitioners alike should be considering how debt can be managed post-graduation. In an effort to help the younger demographic of AAE membership, two members of the Resident and New Practitioner Committee—one resident, Dr. Manpreet Singh Sarao and one new practitioner, Dr. Justin R. McAbee—discuss how they plan and manage their student debt on a day-to-day basis.

Resident: Manpreet Singh Sarao, D.D.S.
Debt, a word no one wants to have anything to do with, and yet most of us accumulate quite a bit as we stride the path of higher education. In my case, it was even more compelling as I came from another country to upgrade my skills to become an endodontist here in the United States. I had the dual responsibility of supporting not just myself, but also my family.

Now, as I think about managing this debt, two things cross my mind. The first one is to start furnishing the installments as soon as I begin to practice after graduation. The second one is to keep those installments low by stretching them over for as many years as allowed, so that I can enjoy a decent lifestyle as time goes by. This implies being able to set up a practice or buy a house with an affordable mortgage. The key here will be to be able to maintain regularity in payments above anything else.

Just as important as it was for me to indulge in debt to achieve a career of choice, I believe a well-managed repayment schedule is equally important, and I should be working at it in the near future. I strongly believe that professional advice can prove to be a good guide in that direction. A rational debt payback plan is as critical as any other major decisions in my life, for I understand that it has the potential to make or break me!

CalculatorNew Practitioner: Justin R. McAbee, D.M.D., M.S.D.
Along with dental school and my endodontic program came a massive pile of student loan debt. I’ll be honest, I was worried. I needed to be proactive and realistic about spending and saving right from the start in order to have a more comfortable, less stressful lifestyle.

First and foremost, was to save for an emergency fund. Whether for an unpredictable event like job loss, medical emergency or other unexpected expenses, I wanted to have the security and backing for at least six months. Saving for the emergency fund and future loan payments meant setting a monthly budget and sticking to it. No unnecessary spending, such as buying lavish gifts, going out to dinner multiple times a week or vacations.

I also keep a constant eye on where we are spending our money and how we can cut costs on various items, whether it is groceries, gas or the cable bill. We decided not to rush in to large purchases, for example buying a house or new car until we feel comfortable with our loan payments. I will make minimum payments for the time being until I can get some money stashed away. After I’ve established my practice and income grows, I plan to increase the amount that I contribute to loan payments so that I can pay them off faster than the 10-year length of time and not drag them out for eternity paying interest.

Yes, I was extremely nervous about being able to pay these loans off in a reasonable amount of time, but as I get through my first year of practice I worry less and less. Endodontists are fortunate to make a very good living even if they're not incredibly busy. So, my advice would be to work hard, pay attention to your patients and referring dentists and not to worry about loan payments because the money will come.

Crazy Cases

Do you have a case that took you by surprise or was just inexplicable? Submit it to be featured in The Paper Point! Send your Crazy Case to

Crazy Case 149-year-old male presents for evaluation of #19 referred by his periodontist. This tooth had a history of periodontal treatment and a sinus tract was noted at a follow-up visit. The patient was asymptomatic; he was in good health and not taking any medications. Intraoral examination findings included: non-functional #19 with a sinus tract observed buccally between #18-19. This sinus tract was located approximately 6 mm from the DB gingival of #19 and about 4 mm from the MB gingival of #18. Pulp testing revealed necrotic pulp #19; #18 tested vital with 1,1,1,2 tetrafluoroethane refrigerant spray. There was significant recession along the buccal surfaces of the mesial and distal roots of #19. A Class II buccal furcation defect was noted a well as Class 2 mobility. Radiographic examination revealed periapical pathosis along M- and D-roots. Treatment options were discussed with the patient, including the risks/benefits of these options. This patient elected to attempt to save #19 with endodontic treatment The patient understood that the long-term prognosis for this case was guarded, and that after endodontic treatment, further periodontal procedures may be necessary.

Crazy Case 2He returned about four months later for treatment, and he had recently seen his periodontist for another follow-up and was told to get #19 endodontically treated or removed. Informed consent was discussed and patient consented to endodontic treatment of #19. Local anesthetic was administered, rubber dam placed and the tooth accessed. While cleaning and shaping with NaOCl and instrumentation, the patient complained about some burning pain and some bleeding was noted from the M-root. Calcium hydroxide medicament was placed and the tooth temporized. Upon rubber dam removal, it was apparent that the NaOCl irrigation solution had been introduced into the gingival tissues in the area of #19. The irrigant was flushed out with additional local anesthetic administration to the area as well as sterile saline lavage of the area. Calcium hydroxide paste was noted on the gingival tissues along the mesial root, and upon further evaluation a buccal inflammatory resorptive defect was noted in this area (see intraoral images). The patient was informed of the NaOCl accident and was placed on antibiotics, anti-inflammatories and analgesics. Care calls were completed that evening and the next day, and the patient was doing well.

Crazy Case 3He returned two weeks later for completion of endodontic treatment. I had discussed my findings with the periodontist, and the plan included completing endodontic treatment and restoration of the defect on the mesial root after treatment was completed. Local anesthetic was administered and it was noted that the previous sinus tract had resolved. Also, there was no evidence of bruising or swelling in the area of #19. Temporary restorative material was placed into the B defect on the M-root to prevent further irrigation accidents. Endodontic treatment was completed without further incidence. After completion of treatment, a bonded resin core was placed into #19. Any further coronal restoration was deferred until healing could be assessed. The patient was referred back to the periodontist to repair the B defect on the M-root and for possible surgical intervention in the area.

Recently, this patient returned for his six month follow-up and I was amazed to see significant radiographic and intraoral evidence of healing. The previous B defect on the M-root had been repaired with alloy. The radiographs showed evidence of bony trabeculation around both roots. The periodontist also continues to follow this case.

Bring Your Practice to Life With Messaging

In last quarter’s issue of The Paper Point, we talked about how to market your practice using the FREE Professional Outreach Toolkit, brought to you by the AAE Awareness Campaign and based on research from the AAE’s GP Referrals Study.

Today we are going to look at the Messaging section of the Toolkit. This area will help you create a personalized message by including key points that come directly from the AAE message map. It is important to develop key messages to ensure that every time you promote yourself or your practice, your message is consistent. Key messages tell referring dentists who you are and what you stand for, no matter where you say it. What you say on your website should deliver the same messages as what you say in a practice brochure and in a conversation with a dentist.

There are three core areas to consider when creating your messaging:
1. Expertise; 2. Patient Satisfaction; and 3. Partnership.

The Messaging Worksheet will help you identify messages that will resonate with referring dentists and patients based on the key drivers of expertise, patient satisfaction and partnership. The worksheet will help you simplify a volume of complex information into a concise, shareable story that helps guide content of your marketing efforts.

As a recent graduate or resident, you have a great deal of training in endodontics that you can use to convey your expertise. Look for examples you have had during training and clinic work. Have patients thanked you for the treatment you provided? Have you worked with others to develop treatment plans? Use all of your experiences, education and facts to help create your messages.

Dentists are looking for better communication from and stronger relationships with endodontists. Taking the time to develop your unique messaging will give you a foundation for all of your communication and outreach to referring dentists and potential referrers. Practice promotion and success starts with you! To learn how to better use the Professional Outreach Toolkit, watch this free on-demand webcast. Also, visit the Practice Management Toolbox for other FREE resources. If you have questions or would like assistance with your practice marketing, contact the AAE at

Messaging Map
This message map can help you develop key messages for referring dentists.

Virginia Residents Spend a Day in the Life of an Endodontist

Seven residents from the Virginia Commonwealth University School of Dentistry spent a day learning about the technicalities of running an endodontic practice from a seasoned endodontist. Dr. C. Vaughn Mayo, a Virginia Beach, Va.-area endodontist who has been practicing for more than 25 years, opened his practice to the residents on October 31, 2012 through the AAE’s Open House program. A well-connected member of the community, Dr. Mayo understands the benefits of the program.

Dr. Mayo demonstrated electronic patient management software, made residents aware of the different aspects of the operatory equipment setup and pros and cons of the office floor plan. Office manager Jill Mayo was helpful in explaining differences in insurance companies, including their plans, benefits and disadvantages. The residents were pleased to learn from Mrs. Mayo how to step-by-step manage a patient visit from the patient’s first phone call to collecting insurance information, contacting the insurance company and through the treatment process. The residents had a great experience.

This opportunity took residents out of the clinic for an afternoon and put them in a real endodontic office. The lessons learned in these hands-on visits are invaluable and can’t be learned in a clinic. One of the program goals is to foster a level of camaraderie between residents nearing graduation and practicing endodontists. It is a wonderful opportunity for seasoned practitioners to share information and be mentors to the AAE’s newest member.

Open House Visit
Residents from Virginia Commonwealth University School of Dentistry spent a day with Dr. C. Vaughn Mayo, far left, through the AAE's Open House program.

Want to learn more about the Open House program? Visit for details.

Resident News

If you have news about your endodontic residency program to share, please email Alyson Hall at

Naval Postgraduate Dental School Endodontic Lecture Series

The Naval Postgraduate Dental School Department of Endodontics in Bethesda, Maryland hosted a presentation by Dr. Ove A. Peters entitled “A Review of Cleaning and Shaping Devices” on November 30, 2012. This was the second of four presentations arranged by the NPDS Department of Endodontics. This annual endodontic lecture series provides residents with valuable, high-quality endodontic presentations from world-renowned experts in their fields. Residents from the University of Maryland, Albert Einstein University, Virginia Commonwealth University and West Virginia University attended. Dr. Peters provided aninteractive and informative six-hour presentation. Dr. Peters is the co-chair of the Department of Endodontics at University of Pacific. The next presentation is scheduled for February 8, 2013 by Dr. Gerald N. Glickman on "Contemporary Strategies in Endodontic Retreatment."

Dr. Ove A. Peters with residents at the Naval Postgraduate Dental School Endodontic Lecture Series. Residents from the University of Maryland, Albert Einstein University, Virginia Commonwealth University and West Virginia University attended the November 30, 2012 lecture.

Do You Have News to Share?

The Resident and New Practitioner Committee is looking for fun news about your program to include in the next issue of The Paper Point, the quarterly e-newsletter sent to all residents and new practitioners.

  • Have any exciting happenings in your program?
  • What were your residents up to this fall and winter?
  • What types of groundbreaking research are happening at your institution?
  • Any famous alumni?

Please direct all questions or send any news items to Alyson Hall, AAE development coordinator, at, or by calling 800/872-3636 (U.S., Canada, Mexico) or 312/266-7255 ext. 3008.

© 2013 American Association of Endodontists. All Rights Reserved.
American Association of Endodontists
211 E. Chicago Ave., Suite 1100
Chicago, IL 60611-2691
Phone: 800/872-3636 (U.S., Canada, Mexico) or 312/266-7255
Fax: 866/451-9020 (U.S., Canada, Mexico) or 312/266-9867