The Road to Becoming a Dentist:
Exclusive Interview with Dr. Guido Sarnachiaro
Dr. Pola Rosen(PR): Dr. Guido is a dentist who does all kinds of treatments but I think particularly you specialize in implants—dental implants. Is that correct?
Dr. Guido Sarnachiaro (GS): Dental implants and the reconstructive portion, basically; the surgical aspect and the prosthetic aspect, which is the crowns that go on top of the implants.
PR: Tell us a little bit about your background. How did you prepare for this career?
GS: Well, this started actually—I come from Argentina, and so that was the background of my education. Back home in Argentina, I went to dental school and I got my dental degree with my regular degree and then I went into specialty training. First of all, you know my dad was the Dean of the dental school back home. So it’s a family event. It’s a tradition; my sister is a dentist, too. So, after I finished my regular dental degree, I had a talk with my father and said what would you like to do now, because there is always further education. I went into the prosthetics training, which is basically the crown and bridges that are on regular teeth. Then, after that I got even more motivated so I went into the surgical phase, which is doing all the foundation for the implants and I took specialty training for surgery. Then, I had the opportunity for a fellowship in dentistry.
PR: And this was all in Argentina?
GS: Yes, this was all in Argentina, until a point that I started lecturing at the very young portions of the dental meetings. I also met one of my father’s colleagues who was one of the founders of this practice. He saw me presenting and we were discussing at dinner back home in Argentina, because we had him as a guest lecturer for a meeting in our school, if I would consider a career abroad. In all fairness, I was doing great and I had my office hours. It was like a family practice because I was practicing with my dad and my sister. But that really started a new phase in my life because I thought that it was very challenging and it was I think at a great moment in my life to be able to try something like that. I was not married, so it was just a matter of a very personal project that I could take on.
PR: Right, you were in your twenties, I’m assuming.
GS: Late twenties. And so I said why not. So I came to the United States, finding out all that I had to do beforehand and I had to prepare for exams, like boards before you come, in order to be eligible to get into the dental school.
PR: So did you have to go to dental school all over again?
GS: So basically there is a program that they get you into, the dental school, called Advanced Standing. Instead of getting you in the first year of the dental school, they match you and that’s why you have to take those boards and you get into the second year of the dental school. Even though you are a specialist you have to basically go into undergrad, which is going back to dental school. And those were three tough long years, going back to the basics.
PR: Sure and they were expensive weren’t they?
GS: Still hurting, yes of course. Education has gotten really very expensive at the highest level.
PR: But they gave you some credit for your previous work in Argentina. But you know that was a very courageous thing to do because you left your entire family and your friends and started on a new path.
GS: It’s a very good point that you make because I have discussed this. You know there are a few things that are a very difficult decision in life. One is leaving your family, your friends and also your country. These are the three combined. So, basically you are leaving to start a life in a new place, a new culture and all that put together, they were very difficult moments I have to say, emotionally. You just question if it’s the right decision. I think that there is something inside us that guides us and gives you the strength that keeps you going and I thought that this was the right thing for me.
PR: Well, if you had a choice right now to have your old career back and be very successful in Argentina—let me rephrase that—what would you like to do in twenty years? Would you like to go back to Argentina? Or would you want to stay here?
GS: Probably retire in Argentina. At this point, I think that I have been able to develop a very nice and challenging and thriving career. And I am giving back to where I am at right now. I go back home every time I can and I still practice in Argentina. We have a running practice that my sister and my family have. You get to see old patients.
PR: That’s wonderful. You really made a bridge between the two countries.
GS: I did.
PR: You are a dentist in two worlds, in two separate hemispheres.
GS: Yes. There is also some interdisciplinary activities between practices because, for example: here we do research. So, we share knowledge and exchange data and information. We do multi-center studies. So, this really is something that has worked very, very well.
PR: Are you doing teaching now as well?
GS: Yes, the last two years, even though I finished and graduated at NYU, I was teaching at NYU after I graduated. Then two years ago, I moved all my teaching activities up to Columbia University. I am there on the faculty, part-time. I go there once a week. I love teaching, I love the students, I love the school but obviously I cannot dedicate more than a day a week. I am still growing my career, my private practice.
PR: What is your advice to young people today who are thinking about the dental profession as a career? Is it a good one to go into?
GS: Yes, but don’t get discouraged because of the tuitions. It’s a very big, it’s a huge burden that students start with and they are not getting any cheaper. Unfortunately, we are all struggling with problems with student loans. They are not all that student-friendly, in all fairness with rates that are high.
PR: But is it a good career?
GS: I think that if you love this career don’t get discouraged because of the burden of finances and tuitions. At the end of the road, it will just payoff.
PR: Is it cheaper to go to dental school in Argentina?
GS: When I went to school in Argentina, all my undergrad to become a dentist, I paid zero. It’s a public university, so it’s government funded.
PR: What was it?
GS: The University of Buenos Aires.
PR: What type of work do you do the most of? What’s the most popular thing people come in and want to have done?
GS: If I had to describe this practice, it’s like the end of the road in terms of complexity. Over 60 percent of the cases that we do in this office are redos of other work that was done before and unfortunately failed. Or just didn’t work the way that it was expected. Mainly, it is focused on implant dentistry and prosthetics, on one end. Also, anything that has to do with the esthetics components. We have been able to combine and fine-tune all the aspects that people in a very challenging and demanding society expect.
PR: Implants have become increasingly more popular in our society. I think that dentists like the fact of that also, because it affords them additional revenue. What should the average patient be careful about, beware of when seeking someone? I see signs all over the street, “we do implants.” And I am sure that some people don’t do them as well as others. Look at all the training that you have had in surgery and implants. Your office is a terrific place to come to. But what should the consumer do?
GS: There are a few things that are very important. Number one, we cannot just by the fact of people saying well an implant is just like putting a screw in the wall. We are not carpenters. So the understanding of the biology and the discipline of how our body heals is what makes a carpenter different than us. Always a point I make with my patient is there is no better implant than your natural tooth. We haven’t done anything better than nature or God yet. Having said that, there is one thing that is good about the implants. And interesting you brought a point about increasing revenue. Once you place an implant on a patient and you restore that implant and everything goes well, provided that the patient stays healthy and maintains it, the odds of you having to replace that implant or restoration are very slim. We have seen implants in the mouth for over thirty or forty years already.
PR: The patient is dead but the implant is still there?
PR: Okay, I got it.
GS: In all fairness, it’s more of a treatment that you will only have done. Unfortunately, it’s an expensive treatment but the dividends that it pays are high. Any crown, no matter who does it between ten to fifteen years starts to have some little problems, even with the best laboratory, the best technicians and the best fittings we can accomplish—you still can have problems. It’s called recurring decay, decay starts to happen around the crown. So, I say that one of the best things that happened in dentistry in the last thirty years is implants. Today, it’s very strange that we are going to find natural teeth to replace missing teeth, which is a blessing. It made dentistry much more conservative. Obviously, with more dental education, people are losing less teeth but we still have almost 40 or 50 million Americans that are wearing dentures. So, there is still a lot of room for a discipline that keeps growing and dental implant companies are growing at 18 to 20 percent a year, and that’s the reason why.
PR: So if a person theoretically has every tooth in their mouth removed and has an implant done, they will go to the grave with those wonderful implants. Is that right?
GS: The answer is yes, but as I said, no better implant than your natural tooth.
PR: Right, of course. I just wanted to know about your father because he was the Dean of the dental school. What influence did he play on your career?
GS: Huge. My mentor, my friend—my everything. Unfortunately, one of the most difficult things having emigrated was losing him while I was here. The only thing that I wanted was to be there when I had to and that’s when I was there. A few days ago, September 24th, it was already six years that he’s gone. But he’s around. I’m sure he’s very happy for me.
PR: I’m sure he is very proud of you.
GS: Proud, I’m sure. He’s very happy about how things are going.
PR: Let me ask you a question about your sister because you said she is a dentist, as well. We take a lot of pride in this nation that women are coming up in the ranks, that they are able to be professionals just the same as men. Was it a difficult thing though in Argentina to get to be a dentist?
PR: Is it unusual for a woman to be a dentist in Argentina?
GS: The answer is no. In my class, there were more women than men. It’s a very, very interesting profession for women. Because a lot of women work part-time and they can have a great profession, a great activity and a great living. It’s not necessarily having to spend five days a week in the office. For example, my sister was about to study medicine after high school and she had a talk with my uncle who is a cardiologist. That talk made a difference in her life because he told her about medicine, the rotations, the on-call services and if she really loved the biologic aspect of the healthcare professions and treating people, she could consider dentistry. That was something that she used to make her decision then, and she never regretted it.
PR: I just have one final question to ask you and that is—how does dentistry in the United States differ from dentistry in Argentina? And you can discuss this from the point of view of the education or the practice?
GS: There are a lot of myths out there that everywhere in the world is not as good. I think that in every place there is room for great dentistry. I go to some meetings in Latin America, Brazil—I am going to Brazil in November with one of my colleagues here. The level of dentistry today, once you find the right group, is outstanding everywhere. You are going to find great dentists everywhere. You are going to find pretty bad dentists here, too. So it’s a matter of really who wants to take it to the next level and give the best to our patients and to really invest in education. And we have to talk about the educational aspect; the only thing that I see is that here education is very expensive. It’s becoming a limiting factor and that’s not the best thing.
PR: How should a patient in New York City find the best person to do the best implant that they can? What questions should you ask?
GS: I think that the bottom line is: asking friends, asking family members and finding out in the academia. In the schools, which are the people that are really teaching and leading the pack, in terms of delivering the message of implant dentistry. It’s very strange that you are going to find the chairman of the department, the director of the department that is not really among the people that are knowledgeable and that are not just looking for money. They are just really into just putting things together properly. That’s basically how this practice has been built, thirty years ago until this day. I joined this practice seven years ago, but the core of this office has been education and research academia. That’s all accolades to the person who started this practice, which is Dennis Tarnow, he’s been chairman of the department. So it’s very difficult to find the right dental professional that’s going to place your implants or surgery—you’re not going to find him on TV. It’s more like, if I had to recommend people it’s just to really search and look for the prestigious, the most serious channels of education.
PR: Would you ask the question how many implants have you done in the past year? Would that be an important question to ask?
GS: Probably not. People feel comfortable if it’s not the first one you are doing. In all fairness, obviously experience is a factor. You want to make sure you are not having someone who basically just started or did a two-day course.
PR: One of the many interesting things about your office that I have discovered is that you have a laboratory and you make your own caps here.
GS: Yes, we do everything in-house. This is a unique setting of having ten dental technicians on staff full-time working for a group of us. We are seven dentists here. Not all full-time, but it’s a very unique setting. It was incredible when I joined the practice to see that.#