SINGAPORE — Strict regulations imposed on dental clinics during the two-month circuit breaker to control social and business activities have left some patients coping with pain for a prolonged period. They have been unable to get the treatments they need when they have toothaches and other oral pains.

Dentists told TODAY that they have had to turn away many patients or give them temporary patch-up jobs to tide them over until the restrictions are lifted. The circuit breaker, which began on April 7, is scheduled to end on June 1, pending the rate of community transmission of Covid-19.

Some patients who have serious tooth infections have been sent home with pain medication and antibiotics because dentists cannot perform the necessary procedures that are deemed non-essential.

Although their dental issues are not serious enough to warrant immediate medical treatment, the patients said that bearing with toothaches have led to sleepless nights and there are difficulties with eating.

Dental services are essential and clinics remain open, but some procedures such as surgery for tooth extractions, making dentures and putting in tooth fillings are deemed as non-essential dental services that have to be deferred. These can be done only if the patient is in severe pain. 

Some patients who do not know this have gone to see their dentists, only to be turned away or told during consultation that nothing much can be done to fix the problem.

In a circular dated April 12 and issued by MOH to dental clinics and registered dental practitioners, which was seen by TODAY, only essential procedures can be performed during the circuit-breaker period. These are for patients who need immediate attention or those with conditions that are potentially life threatening.

Examples of urgent dental care listed by MOH include tooth fractures which result in pain or cause soft tissue trauma, and dental treatment that is needed before critical medical procedures and suture removal.

Another group impacted by the containment measures are those who have pre-existing health conditions and are deemed “high-risk patients” by the Ministry of Health (MOH). They are diabetic, have high blood pressure or have compromised immune systems.

Yet, these patients are often unaware that they have to go directly to public clinics such as those at the National Dental Centre Singapore or the National University Centre for Oral Health and they cannot seek dental treatment at private clinics during this period. The private practitioner can only stabilise the condition before referring the patient to the two public institutions. 

Dr Anna Seow, 29, who is in private practice, recently turned away a mother-son pair who both have pre-existing medical conditions.

They did not know that they have to go designated public clinics and ended up making an extra trip. 

‘CAUGHT BETWEEN A ROCK AND HARD PLACE’

While dentists interviewed by TODAY agreed with and understood the need for safe distancing measures to curb the spread of Covid-19, they feared that delaying treatment for some patients would result in more severe and even permanent dental issues down the road.

Dr Ronnie Yap, 51, a dentist in private practice, said: “The thing about dental pain is that even if it is mild, it is not a good sign. Usually if the patient is experiencing pain, it is already a sign that (the infection) is quite advanced.

“Prevention is definitely better than cure and early treatment is more economical for the patient… If you delay (treatment), it will just get worse eventually.”

The dentists feel like they are in a bind when frustrated patients cannot get immediate medical attention.

Dr Raymond Ang, chief operating officer of Q&M Dental Group, which runs over 70 clinics in Singapore, said: “We are caught between a rock and hard place. On the one hand, we support MOH’s restrictions and guidelines, but we also have to face patients who are upset they cannot get their dental treatment.”

He also said that private clinics, like other businesses, have to deal with landlords not passing on rental relief and a drop in customers. 

PATIENTS PAYING MORE

Aside from not receiving the medical care they need, some patients have to spend more when they make frequent trips to the dentist to get temporary stop-gap treatments.

One dentist who spoke on the condition of anonymity said: “When patients come in, I always tell them there is only so much I can do for them and I seek their understanding. They would then ask, ‘Does that mean I have to pay again when I come back?’”

The 40-year-old, who is in private practice, explained that these temporary procedures are not made to last and they are usually carried out with the expectation that something more permanent can be done in the near future.

NOT SERIOUS, BUT PAIN PERSISTS    

One patient who had to delay getting dental treatment during this period is Mr Mohd Suhood.

The 60-year-old signage installer experienced a tooth fracture late last month and for three days, he had trouble sleeping and eating because he could not chew his food properly. 

However, since he was not in extreme pain, the treatment he needed would be considered non-essential, so he decided not to see a dentist. 

The pain and discomfort grew unbearable, though, and unable to withstand it any longer, he used a small nail file to file down the crack until he can get proper medical treatment.

Another patient, who wanted to be known only as Mr Chan, had a toothache for a week. The 32-year-old went to a clinic near his home to book an appointment to get the tooth removed, but was turned away because his issue was not considered serious enough.

Later, when he was in much pain, he told the dentist and the extraction was done on Wednesday (May 6).

PROCEDURES CAN BE CARRIED OUT SAFELY

Dr Yap said that as medical professionals, dentists have been used to wearing personal protective equipment such as gowns and masks.

“Most patients are healthy and we disinfect and sterilise our equipment and the area after each patient.

“With the number of community infections plateauing, and because we know dental clinics are safe for patients since few cases have spread in this context, we think some restrictions should be eased so that patients can see dentists for any pain or discomfort.”

Dr Ang of Q&M Dental Group said that it would be helpful if procedures such as making dentures and installing permanent tooth fillings could be made available to patients who need them.

“These issues are real for these patients… If the circuit-breaker extends or the restrictions are not eased, (these problems) could get worse and lead to long-term issues,” he said.

Dr Lim Lii, president of the Singapore Dental Association (SDA), said it is aware of the difficulties that dentists face this period.

“During this time, dentists have been informed by MOH to defer all new and ongoing elective procedures or surgeries and to provide only essential and emergency dental care. 

“This is to help in the fight against Covid-19, to flatten the curve, by reducing the number of patient visits and interactions where possible,” Dr Lim said.

“SDA understands that it is a challenging time for the dental fraternity and is exploring various ways to help clinics tide over this difficult period, both financially and professionally.”

MOH RESPONDS

In an email to TODAY on Saturday (May 9), MOH said it would continue to study the “gradual resumption of dental services, taking into account the needs of patients and feedback from dental practitioners, and adjust as necessary”.

The ministry reiterated that essential dental services are those which, if not provided, “would result in significant or rapid deterioration of the patient’s condition, and would potentially threaten their health and wellbeing”.

These include medications, interim fillings when possible, pulpectomies, localised debridement, simple extraction of symptomatic teeth and denture repairs.

During this period, patients should be managed for the primary purpose of maintaining their oral condition from deteriorating for “up to three months”.

“Dental practitioners will exercise clinical judgement in determining the patient’s need for urgent or emergency care, which should be carried out as minimally invasive as possible, with minimal or no aerosol generation,” added MOH.

“All non-essential elective dental services and procedures should be deferred.”