SINGAPORE — A proposal that could mean dentists in general practice will require further training and certification for “higher risk” procedures such as implants and wisdom teeth surgery has left some of them up in arms.

While the proposal aims to enhance safety for patients, among other things, some dentists believed that if implemented, it could restrict them from performing procedures that they have done for decades such as wisdom teeth surgery — resulting in patients shouldering higher costs by driving them to see specialist dentists instead.

In response to TODAY’s queries, the Ministry of Health (MOH) said in a joint statement with the Singapore Dental Council (SDC) that they are working to review “where dental procedures may be of higher risk and dental competencies need to be enhanced, such as for implants and wisdom teeth surgery”. The SDC is the self-regulatory body for the dental profession.

“This is to allow dentists to be further trained in these specific dental procedures and to be able to practise safely and competently without having to undergo specialist training,” the statement said.

A committee in the SDC has been set up, comprising general and specialist dentists from both the private and public sectors, to seek feedback on the proposal from the dental fraternity “over the next few months”.

The SDC is aiming to identify dental procedures where general dentists may be required to attain certificates of competency. This is to ensure that they have the required skills to carry them out, MOH and SDC said.

Such an arrangement is not new, they noted. Similar frameworks have been put in place for both the medical and dentistry professions for aesthetic practices.

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In coming up with the proposal, MOH and SDC said that they took account of factors such as “comparisons with international benchmarks, and patient concerns and complaints in recent years”. No details were provided on the number and nature of complaints against dentists here.

“As the practice of dentistry evolves with advances in dental science and technology, changes in population demographics and rising patient expectations, the demands on our dentists will rise,” MOH and SDC said.

“It is important that our dentists acquire and update their knowledge and skills to maintain high standards of professionalism and competency. The safety and quality of the dental care provided to Singaporeans must continue to be of utmost priority.”

Within the dental fraternity, however, confusion and anger has set in. Five dentists in general practice, some of whom spoke to TODAY on the condition of anonymity, complained of a lack of transparency on the proposal and viewed it as an attempt to protect specialists.

They warned that patients could lose out.

Dr Melvin Chia, 44, pointed out that figures provided by the Singapore Dental Association (SDA) — the professional body for dentists — showed that dentists in general practice comprise 85 per cent of the dentist community, with specialists forming the other 15 per cent.

The proposal could drive patients away to specialists. “The restriction of supply will lead to a corresponding increase in price,” said Dr Chia. 

A 37-year-old dentist, who declined to be named, said that if certain procedures were limited to just specialists, patients would likely feel the brunt of such a move in their wallets, as specialists tend to “charge higher per procedure”.

As most private clinics have a mix of general practitioners and specialists, he also foresees a situation where the specialists might become so overwhelmed with patients that the delivery of treatment gets delayed.

“This increases the risk of patients’ problems worsening as they wait for the specialist (in my clinic). Even though I might be able to help them, some person in an ivory tower arbitrarily says I can’t.”

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He said that if a patient has a wisdom tooth infection, for example, he could surgically remove it on the spot.

“But if I have to prescribe antibiotics to hold the situation and then refer it to a specialist... It might be weeks before it is managed and this may become a bigger problem along the way.”

Former SDA president, Dr Eugene Tang, 62, said that since some dentists have to fork out their own money to undergo certifications, some could pass the cost on to patients.

Dentists said that they have yet to get any information on why the proposed certifications touch on procedures “commonly carried out by dentists” in the general practice and specialist areas.

One dentist, who is in his 60s and requested anonymity, said: “I’ve been doing this for more than three decades, and now you say I need a certificate to perform the procedure?”

Dr Tang, a dentist at Aesthetic Dental Care, said that in fairness, certificates of competencies have their benefits. In 2015, a similar framework was put in place for dentists performing facial aesthetic procedures such as using botox to treat dental and jaw problems such as teeth grinding.

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“We were not taught about that in school, so those who want to perform the procedures have to undergo training and certification. That’s fine and dentists accepted that,” Dr Tang said.

“But if you are talking about the procedures you do day in and day out for years, it’s quite laughable.”

CALLING FOR A MEETING

Given the unhappiness in some quarters in the dentist fraternity, 50 dentists submitted a requisition letter to the SDA on April 18 demanding that a special general meeting be held to allow members to elect a standing committee so that it could gather more information on the authorities’ proposed plan.

The letter proposed three resolutions. One is that the standing committee is to represent the association “on matters related to the freedom of dentists and specialists to practise all aspects of the practice of dentistry as defined in the Dental Registration Act”.

Dentists have since been informed that no special general meeting will be called on the matter. In an email which was sent on Friday evening to dentists — and seen by TODAY — SDA president Lim Lii said that under the advice of its lawyers, it declined to hold the meeting "at this time" as the proposed resolutions deal with matters that "are not within the power and/ or competence" of a special general meeting under the SDA. 

Separately, in response to TODAY's queries, Dr Lim said it is "holding dialogues and is actively in consultation across a broad spectrum of its membership" on the proposals by MOH and SDC. 

She said: "As only preliminary details about the proposed plans have been made available, we are currently fact finding and ascertaining the impact that these proposals would have on the clinical practice of our general dental community." 

Adding that the SDA seeks to "thoroughly and comprehensively engage" with its members and the SDC together, she stressed that the association takes its members' concerns seriously but it will "work within the law and its constitution".

Dr Phua Tin Cock, the president of the College of General Dental Practitioners Singapore (CGDP), said that it is in touch with the SDC over the proposal but declined to elaborate. The CGDP is a non-profit, non-political organisation for general dental practitioners.

In its joint response, the MOH and SDC reiterated that the “views of dentists are important to us”.  

“As part of the review, SDC has been engaging them to share with them the objectives and scope of the review, and to seek their views and feedback,” the statement said.

“We hope to reach out to as many within the dentist fraternity as we can over the next few months. We look forward to their inputs and will incorporate them into the review where appropriate, so that we can co-develop the new competency, assessment and training and competency frameworks together.”