SINGAPORE — The gnashing of teeth continues over a proposed framework that may require more training for general dental practitioners and which, they say, would drive up dental costs for patients.

On Tuesday (May 28), a group representing general dentists said that there was no meaningful discussion on the recommendations put up for consultation last weekend by the Singapore Dental Council and Ministry of Health (MOH).

The College of General Dental Practitioners Singapore, which has more than 600 members, said that it would be coming up with alternative recommendations for the council and ministry to consider.

Its recommendations will “improve patient care and safety, ensure our general dentists are well trained to carry out dental procedures, and without adversely affecting cost and access to care for our patients”, the college said in a statement.

The college’s president, Dr Phua Tin Cock, is a working committee member on the framework but did not receive any document setting out the committee’s recommendations, it said.

It is inaccurate for the council to state that the framework was proposed by the working committee — which did not deliberate on alternative options, or whether the framework was necessary or appropriate, the college said.

“In fact, from the very first meeting of the working committee, the Framework for Competencies was already set and the working committee’s task was simply to categorise dental procedures under the three classifications in the framework,” the spokesperson said.

The framework classifies competencies for basic, intermediate and specialist dental care.

When contacted, Dr Phua reiterated that the committee did not have a hand in drafting the framework.

The college stated that some dental procedures would be restricted to specialists under the draft framework.

“General dentists would not be allowed to perform these procedures, regardless of their training, expertise and experience,” the spokesperson said.

The college also noted the disproportionately small representation of general dentists on the working committee. Of more than 2,100 dentists in Singapore, 85 per cent are in general practice while the rest are specialists. Yet, only two of the seven working committee members are general practitioners, it said.

The remaining members are a medical doctor and four specialists.

SIMMERING UNHAPPINESS, CALL FOR MORE DATA

Confusion and anger have simmered among some dentists in recent weeks, even before the recommendations were put up for feedback. TODAY reported that some dentists opposed a requirement for general dentists to undergo more training for procedures such as wisdom-tooth surgery and implants.

On Tuesday, the college also questioned a point raised by the Singapore Dental Council on an increase in complaints against dental practitioners.

The Singapore Dental Association has received more than 100 complaints annually in recent years, some of which were escalated to the council when mediation failed, the council said. Statutory complaints seen by the council have increased from six in 2014, to 21 in 2018, it said.

But the college said that there was “no indication” of complaints related to general practitioners attempting dental procedures that were beyond their expertise, experience or training, to the detriment of their patients.

“Without this data, the number of complaints in itself is not helpful,” it said.

While the college agreed that continuing education is needed to “improve the competencies” of dentists in Singapore, there is “no compelling reason” to define a specialist-level competency exclusively for specialists.

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“Many general dental practitioners have been performing these procedures successfully for many years and without incident,” said the college.

Dr Phua previously told TODAY that dentists have to fulfil at least 70 hours of continuing professional education every two years to renew their practising certificate.

Many far exceed the required hours, he said.

“With the right training, but without having to go through a three- to four-year specialty course, more (general dentists) can be taught to perform (these specialist-level procedures), for the benefit for our patients,” said the college.

The college said its recommendations will cover the mentorship of young dentists, structured supervision of dentists under training, clinical guidelines and modular, structured courses with practical training for dentists.

In response to queries from TODAY, the Standing Committee for Dental Classification and Dental Procedures Accreditation for the Singapore Dental Association (SDA) said it shares the SDC’s concerns on patient safety and the importance of continued education for dental procedures.

However, SDA’s committee said in a late Tuesday night statement that it believes that placing restrictions on what procedures dentists can carry out will similarly compromise access to care and escalate healthcare cost for Singaporeans.

One suggestion proposed by the SDA committee is improving the access for dental professionals to “high quality, affordable training programs”.

The standing committee was elected on May 26 during a Special General Meeting to study the current issues dentists are facing, and to work with the relevant authorities.