Cost of dental education, student indebtedness, and our social contract.

1479 One of the most pressing concerns for dental students today is educational debt. Dental school graduates have among the highest amounts of student debt in the nation. Over the last decade, student indebtedness has increased much more quickly than inflation, a rise that is directly related to higher tuition and fees. In 2013, dental students overall incurred an average debt of $241,000, according to the American Dental Education Association (ADEA). For students graduating from private dental schools, the figure was $283,000.1 The expense of running a dental school is also growing, with total expenditures for all schools reaching $3.3 billion in FY 2012.2 Unlike medical schools, where students in their clinical training mainly observe faculty work at hospitals—with minimal cost to the school—dental schools bear the overwhelming cost of operating patient clinics. Without a dramatic shift in how this country prepares dentists, the financial structure of dental school is not likely to change, nor is the four-year cost of attendance, which (excluding living expenses) has reached $264,810 for private and $159,460 for public schools.3 This issue of the Journal of Dental Education presents several articles on the costs of dental education and running a dental school (see Bertolami and Berne, Stafford et al., Makarem and Coe, and Spallek et al.); these include proposals on student indebtedness and loan repayment options. But as we consider the impact of decreasing public support, increasing education costs, and increasing student debt, we must also consider the influence of these changes on the profession’s social contract: our sense of responsibility to treat the underserved and provide service to those less fortunate. Our discussion must therefore include the role of dental schools in the oral health safety net and the willingness of our graduates to practice in underserved areas and volunteer their services. Dental graduates wishing to participate in the oral health safety net have several options. In 2005, Guest Editorial