Apopular Chinese proverb states that “a toothache is worse than a serious illness”. The Hong Kong Special Administrative Region government, therefore, cannot relegate the shortage of dentists to the backwaters of its healthcare agenda. By the end of 2021, there were 2,706 registered dentists in Hong Kong, and the shortage is more serious in public practice. At present, the ratio of dentists in public to private practice in the city is 1-to-3. To get around this problem, some local people choose Shenzhen as their dental tourism destination.
Instead of taking a piecemeal approach, the Health Bureau recently conducted a comprehensive review of the major problems confronting the dental sector in the city. First, the Health Bureau deserves a pat on the back for making feasible plans to amend the Dentists Registration Ordinance (DRO) so as to provide new pathways for admitting qualified nonlocally trained dentists to practice in specified institutions.
Second, the proposed pre-registration internships for local dental graduates, or the period of assessment requirement for nonlocally trained dentists, could also work to the benefit of the public healthcare sector.
Last, the proposal to modernize the regulatory framework for dentists and ancillary dental workers, including dental hygienists and dental therapists, could benefit patients as well as the entire dental profession.
Implementing such reforms requires amending the DRO.
The proposal to provide new pathways for the admission of qualified nonlocally trained dentists is a timely solution to alleviate the shortage. What the government has tried to do is to drastically increase the number of undergraduate dental education places in the city, which, unfortunately, has not been successful. The number of places allocated by the bureau to Hong Kong University increased from 50 in 2009 to 90 in 2023. Such an increase, however, is still insufficient to alleviate the shortage of public dental services. Merely increasing the number of HKU graduates is not enough for the government to respond quickly to the increasing demand for dental services.
The proposal to provide new pathways for nonlocally trained dentists seems to have borrowed a leaf from Singapore, which launched its Conditional Registration program — an employment-tied registration mechanism — to meet public expectations and address a shortage of dentists. Under the program, a nonlocally trained dentist is required to work as a dentist in any hospital or other institution for a specified period (usually two years) under the supervision of a fully registered dentist. Dentists under the program may apply for conversion after two years but this is subject to the approval of the Singapore Dental Council.
Like Hong Kong, Singapore suffers from a shortage of dentists, with only 0.41 dentists per 1,000 people. According to Patrick Tseng, chief dental officer for Singapore, the demand for dental services is changing due to the more complex dental needs of the growing number of geriatric patients. As a result, allowing nonlocally trained dentists to practice in Singapore has become a matter of public concern.
The mismatch between supply and demand for dental services has also raised concerns in Hong Kong. In his maiden policy address, Chief Executive John Lee Ka-chiu stated that the government will explore various options to ensure sufficient healthcare personnel for the public health system. One of the options is to admit qualified nonlocally trained dentists and nurses. In line with the above policy, the Health Bureau’s employment-based proposal requires the dentists to secure employment with a specified institution before submitting their application for limited registration.
With regard to the one-year mandatory internship proposal, I believe that such a proposal may provide more clinical experience for the fresh graduates of HKU, while to a certain extent helping to ease the manpower shortage in the public healthcare sector. But nonlocally trained dentists, who have passed the licensing examination but are not admitted by limited registration or special registration, may find the one-year internship unfair. It is worth noting that the licensing examination is very demanding.
Finally, we strongly support the proposal to modernize the regulatory framework for dentists and ancillary dental professionals. The proposals include the imposition of a mandatory continuing professional education requirement, the revamp of the composition and structure of the Dental Council of Hong Kong (DCHK), the tightening of regulatory control over ancillary dental workers, and the need to keep up with the latest trends in dental practice.
Dental hygienists do not exist in every country but they are part of a growing trend in dentistry around the world because of their specialized services. For instance, they provide patients with thorough cleaning and polishing of teeth. They also provide health advice to patients. Both dental hygienists and dental therapists can help relieve the burden on dentists by providing the basic preventive and primary dental care services, freeing up dental resources for more-complex dental treatments. Because of their important roles in the dental sector, these ancillary dental workers should be subject to more formalized regulatory control.
The proposal to empower the DCHK to accredit a local training program for ancillary dental programs and to benchmark qualifications for the purpose of registration is fair. It deserves the support of local dentists to embrace the introduction of a statutory registration system for ancillary dental workers. To enhance their professionalism, they must obtain practice certificates. The government will go in the right direction by providing dental hygienists with a certain degree of independent practice in public dental services or government outreach programs.
The author is a dental services senior consultant of Chinese Dream Think Tank, and was previously the assistant dean and clinical associate professor of the faculty of dentistry of the University of Hong Kong.
The views do not necessarily reflect those of China Daily.
