Removing Tuition Dependency From Dental Education: Consensus Recommendations on Student Debt, Sustainability, and Pathway Reform

BACKGROUND: The current financing model for US dental education is increasingly misaligned with the goals of sustainability, equity, and workforce design. Tuition has risen substantially over time, educational debt among dental graduates remains high, and evidence suggests that price affects enrollment decisions and student diversity. High debt may also constrain career choice, reducing graduates' flexibility to pursue academic, hospital-based, public-serving, and safety-net careers. At the same time, major reform reports across the past century have repeatedly argued that dental education must periodically redesign its structure, financing, and institutional role in response to changing social needs and health systems. These concerns informed the deliberations of Working Group 2 (WG2) at the Reimagining Dental Education Summit in June 2026. OBJECTIVE: To present a perspective with consensus recommendations from WG2: Student debt, sustainability, and pathway reform on structural reforms that could reduce tuition dependency in dental education while preserving educational quality, professional accountability, and public mission. CONSENSUS PROCESS: WG2 used a structured worksheet, facilitated discussion, and iterative review of background materials, including studies on price sensitivity, educational debt, return on investment, workforce trends, and healthcare educational debt, together with summit materials that articulated bold reform concepts. Recommendations were refined across working sessions and advanced through the final report-out process. RECOMMENDATIONS: The group reached consensus on four recommendations: (1) Shorten and restructure the dental education pathway around competency and a paid transition year; (2) create technology-enabled shared curricula and preclinical training models; (3) implement pledge-based and pay-it-forward financing models; and (4) modernize licensure, accreditation, and regulatory frameworks to support new educational pathways. CONCLUSIONS: Dental education's affordability challenge is not solely a debt problem as it is a structural design problem. Reducing tuition dependency will require redesign of educational pathways, institutional cost structures, and regulatory frameworks so that access to the profession is determined more by talent and commitment than by financial capacity.