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How Not to Waste Your First Year Out of School by Richard Low

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As I enter my fourth year of dental school, I’m realizing how much I don’t know. Like many students I hope to someday place implants, do molar RCTs and remove impacted thirds. Unfortunately I haven’t had as many opportunities as I would like to practice these procedures while in school. While many CE courses teach these skills, the CE courses aren’t by your side when cases go wrong. If you don’t have someone to bail you out, these learning experiences can come at the expense of the patient. As new dentists, how can we safely expand our scope of practice without endangering our patients or getting in over our heads?

There are many general practice residencies (GPRs) and advanced education in general dentistry (AEGD) programs that promise to expand the skills and confidence of new grads. Yet some of these programs fail to deliver or end up being just a fifth year of dental school.

One Townie shared this horror story:
I attended a GPR where there was only a part-time director that made the program a nightmare. [I was one of] two residents and when we were on call in the ER, we would get called three to four times per day mostly for non-dental issues because the medical residents were “too busy.” The director would not go to bat for us on issues with staff or the abuse of our call schedule. In fact he rarely came out of his office. It was a miserable experience and I ended up leaving after 10 months and never looked back.

With rising student loan debt and interest rates, no one can afford to waste a year in a residency program that isn’t providing an advanced education. A Townie that goes by the username, “Knife,” on Dentaltown.com warns that, “There is a lot to gain by doing a residency, but there is also much more to lose if you choose a program that doesn’t fi t your needs or expectations.” How can you tell which programs are worth it? Their descriptions are similar and are required to maintain the same accreditation, so what makes some better than others? How can you know if it is worth giving up a year of earnings and experience in private practice to continue your education?

AEGD versus GPR — what’s the difference?
GPRs are typically hospital-based programs with the opportunity to treat medically compromised patients, see emergencies and rotate through other fields of medicine. For those who are looking to specialize, a GPR will set you apart and give you great experience. Many take this to mean that a GPR wouldn’t be a good fit for a general practitioner going into private practice. “Rod” on Dentaltown.com disagrees:

When a patient comes into the ER, an inch away from death, nearly unconscious, with an acute dental-related infection, and you’re looking around the ER and seeing that everyone is looking at you, you [get courageous] very quickly. When you handle 20 cases like that in your GPR, a little endo infection in your own practice is tame by comparison, and you don’t get all flustered wondering if you [should have referred].

[We did] all sorts of surgery — no endo, perio or oral surgery procedure will ever seem monumental. When you finish a residency like that, you walk out feeling like you can conquer the world, and nothing throws you. Not only does it allow you to do virtually 99 percent of your own specialty work yourself, but it gives you the knowledge base and confidence to learn anything quickly. How valuable is that when starting your own practice, with no other dentist there to go to for help?

 AEGD programs, on the other hand, are traditionally dental-school based and do fewer rotations through associated hospitals. The ADA website states, “The major distinction between the AEGD and GPR programs is the emphasis that the AEGD program places on clinical dentistry in contrast to the emphasis on medical management in the GPR program.” 1 However, in recent years the ADA has changed the certification requirements so that the differences between the two are shrinking. “RedHawkDent” shared this advice on the Dentaltown.com forums,

Don’t get too caught up in the type of program (AEGD versus GPR). As an applicant last year, had I focused on one or the other I would have missed out on many great programs. Yes it’s true that GPRs tend to be a bit more hospital-based and AEGDs more dental-school based, but that’s not always the case. There are many AEGDs I found that happened to be hospital-based and GPRs, oddly enough, at dental schools. Point being, don’t generalize the program based on it being a GPR or AEGD.

Research and visit
The only people who regret an AEGD or GPR are those who didn’t do their research. There are huge differences between the best programs and the worst. The first step in this process is to decide what kind of experiences you are looking for. If you’re looking to specialize in pediatric dentistry, a VA hospital will likely not meet your needs. “Knife” on Dentaltown advises students:

Research the living mess out of programs. Find out what you want to get out of residency, and make sure your program will offer that. Not just a general idea like “gain speed, confidence, etc.,” because private practice will do that for you. But actually write down what you want out of a program in concrete terms: being able to do complex perio surgeries or impacted third molar extractions or anterior/posterior, immediate/delayed implant surgeries, or even molar endos consistently in one-hour appointment intervals.

Next, ask for recommendations. Many dentists on Dentaltown.com have graduated from these programs, know the faculty, or are mentors themselves. Asking your questions on Dentaltown.com will give you much more information than reading the descriptions of the more than 200 AEGD and GPR programs.

Once you have a list of programs with good reputations, find the contact information of the program director from the ADA’s online database. Do as much research as you can and then reach out to the director and let her know that you are interested. Ask what she considers to be the strengths of her program and ask for the contact information of a few current or recently graduated residents. This is where the real work begins. Changes in program directors, funding, mentors and class size can turn a great program into a mediocre one overnight. You need current information and the best source of unbiased information is the residents in the program right now.

Before calling the residents, make a list of questions that are important to you. Ask how many of X, Y and Z procedures they have done personally and how many the average resident does. If implants, RCTs and third molar extractions are important to you, you need an objective number to be able to compare programs. Ask how many units of crown and bridge they do, if they do their own hygiene, and whether they do any sedation training. Ask if you share patients with other programs, like an associated endo or oral surgeon program in the same building. Find out if you will have a dedicated full-time assistant, how much administrative work you will have, how many weeks you are on-call and what kind of exams are involved. Ask them what their favorite and least favorite parts of the program are and what they wish they had known before they started. Lastly, and most importantly, ask about the mentors and the program director. They will make or break your experience. If the program director is about to retire or leave, that could change everything about the program and leave you out to dry.

After communicating with several residents, ask the directors of your favorite programs if you can come visit. Even if it’s only for a day or two, a visit will help finalize your decision. Try to shadow a couple of different residents, get to know the mentors, and if possible sit down with the program director one-on-one. Visiting will show your interest and dedication, and will likely increase your chances of getting in.

My journey
“I’ll definitely get pimped this morning. OS is notorious for doing it. As long as I review my cranial nerves, space infections and block grafting techniques, I should be good,” Major Simmons told me as he prepared for his maxillary tori removal and block graft that morning.

After several months of research and phone calls, I decided to shadow the residents of the Army’s two-year AEGD in Fort Hood, Texas. It turns out that “getting pimped” can be a daily ordeal. One resident explained,

At the start of any major procedure, your mentor will ask question after question about everything from materials, techniques and alternatives, to complications and how to handle them. They’ ll keep asking until you don’t know the answer. However, if you show that you’re prepared, you will be the lead on the procedure and they’ ll assist you. Otherwise you’re the assistant. It’s their way of testing you and pushing you to always learn more.

It turns out that the head oral surgeon was in a good mood and skipped the “pimping” altogether. Simmons took the lead as the large maxillary tori was removed and shaped into a black graft for the posterior mandible as site preparation for an implant. Residents at Fort Hood place implants, remove impacted third molars, are trained on CEREC’s Omnicam, perio surgery and use microscopes to do molar endo and retreats. This is exactly the type of experience I was hoping to fi nd in a residency. If I get in, this program will teach me to do the dentistry I enjoy for the rest of my career.

Whether an AEGD or GPR is right for you depends not only on the program itself but also on your interests, alternative opportunities and individual situation. By finding the best programs, you will have the confidence that you are not just doing a fifth year of dental school. Hopefully this investment in yourself will allow you to agree with Rod: “Without a doubt, [it was] the most learning and the most exciting year of my entire life.”

References
  1. http://www.ada.org/en/education-careers/dental-student-resources/career-options-after-dental-school/understanding-advanced-dentaleducation/ program-options-and-descriptions
Richard Low is a fourth-year dental student at Midwestern University in Glendale, Arizona. He received the four-year HPSP scholarship from the Army and is applying to their two year AEGD program. He and his wife, Kristine, are obsessed with their baby girl and will smother you with photos if you ask. Richard is passionate about dentaltown.com and is working to promote Dentaltown to students nationwide. If you have any suggestions about how Dentaltown.com can be improved for students, reach out to him at rlow04@gmail.com.

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September 2025
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