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Proposal for further certification could lead to higher costs, longer waits for patients: Dentists’ group

SINGAPORE — The Health Ministry and Singapore Dental Council’s (SDC) proposal that may require dentists to receive further training for “higher risk” procedures could raise costs for patients and compromise their treatment, said a non-profit organisation for Singapore dentists in general practice.

Dentists in general practice could be required to undergo further training and certification for “higher risk” procedures with the proposal by the MOH and Singapore Dental Council.

Dentists in general practice could be required to undergo further training and certification for “higher risk” procedures with the proposal by the MOH and Singapore Dental Council.

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SINGAPORE — The Health Ministry and Singapore Dental Council’s (SDC) proposal that may require dentists to receive further training for “higher risk” procedures could raise costs for patients and compromise their treatment, said a non-profit organisation for Singapore dentists in general practice.

The College of General Dental Practitioners Singapore (CGDP) on Saturday (May 4) also blamed the fraternity’s “general anxiety and confusion” over the proposal on the “lack of clarity and detail on the proposed policy and the absence of any compelling reasons for it”.

“No official consultation paper has been issued, and the discussions of the Ministry of Health (MOH) or SDC committee on the proposed policy have not been made available to the profession generally,” said the college.

The CGDP counts over 600 dentists in general practice as members, and such dentists form 85 per cent of the profession in Singapore.

On Friday, TODAY reported that some dentists were up in arms over the proposal which they believed, if rolled out, could restrict them from carrying out procedures they have done for decades, such as wisdom teeth surgery.

The MOH and SDC — the self-regulatory body for the dental profession — said that they were reviewing the areas where dental procedures might be of higher risk and dental competencies needed to be improved, such as for implants and wisdom teeth surgery.

This review would allow dentists to be trained further in these procedures and practise safely and competently without undergoing specialist training, said both parties. A committee in the SDC will seek the dental fraternity’s feedback on the proposal over the next few months.

In a press statement on Saturday, CGDP’s president, Dr Phua Tin Cock, said the college was concerned because it understood that the MOH’s proposed policy sought to exclude general dentists from procedures that the ministry classifies as “specialist-level” and reserve these only for specialists.

It understood that the exclusion may be in spite of dentists’ training, expertise and experience, certificate of competency, or patients’ informed consent.

“In other words, this part of dental practice will be completely off limits to general dentists unless they become specialists,” said Dr Phua.

“The college does not think that such a framework, if indeed intended by the MOH and SDC, is necessary, effective or in the interests of the profession or dental patients.”

TODAY has approached the MOH and SDC for comment on the college’s concerns.

COST CONCERNS FOR PATIENTS

Dr Phua, a general dental surgeon in a group practice with both general and specialist dentists, said that the college was worried about significant increases to the costs borne by patients if general dentists are prohibited from carrying out advanced procedures.

Patients would have to visit specialists to receive treatment, he said.

There could also be bottlenecks and longer waits to see specialists, thereby compromising patient treatment, he added.

For many years, numerous general dentists have undergone extra training of their own accord to perform various advanced procedures safely and competently, said Dr Phua.

He pointed out 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 to offer better and safer care, he said.

“Many dentists also travel overseas at their own expense to further themselves. Hence, the spirit of continual improvement is strong among dentists who undergo further training voluntarily and willingly.”

NO CONSULTATION PAPER, DATA ON COMPLAINTS

Some of the anxiety and confusion felt by general dentists were attributed to the lack of clarity and details about the proposal and the absence of compelling reasons for it, said the CGDP.

The MOH and SDC had told TODAY that they were considering factors such as comparisons with global benchmarks and patient concerns and complaints in recent years in their review. However, they did not provide the number or nature of complaints against dentists here.

This was also a bone of contention for the CGDP, with Dr Phua saying that the relevant data is not available “on complaints or disciplinary cases… involving general dentists attempting procedures outside their sphere of competence”.

“All this could have led to misinformation, misunderstanding and speculation,” he said.

Dr Phua called on the MOH and SDC to clear the air and explain their justifications for the proposal, as well as provide detailed supporting data.

He also asked them to set out the key features of the proposed policy and how it will impact general dentists.

In addition, he urged them to lay out the possible solutions or measures to tackle the likely cost increases for patients and compliance costs for dentists, as well as the alternatives that are being or have been considered.

Dr Phua added that the CGDP shares the MOH’s priority to ensure that dentists are properly trained to perform procedures safely and competently.

As such, the college has set up a committee to explore alternative proposals that can strike a balance between patients' need for safety, affordability and access to care, and allowing general dentists to carry out procedures within their training, expertise and experience.

The committee is exploring options such as mentoring, supervision of procedures and clinical guidelines that would “provide a well-balanced solution”, said Dr Phua.

Ultimately, he said that using a “blunt and mechanistic classification” to exclude general dentists from what has for many years been an important part of their professional practice — when they can obtain the appropriate training, expertise and experience to perform those procedures — will be “detrimental to our patients and unfair to general dentists”.

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