SINGAPORE: In February, an oral health therapist from Pristine Dentalworks was fined and suspended for performing dental procedures beyond her scope of work.
On Oct 19, a general dentist from Advanced Dental Surgery at Tampines was suspended and fined for performing dental treatment on a patient even though he did not have the appropriate skills or knowledge.
The Singapore Dental Association has said that it received more than 270 such complaints against dental practitioners in the last four years.
The complaints ranged from long waiting times and appointment mix-ups, to inappropriate fees and poor treatment outcome. However, the bulk of them were over poor communication between patients and dentists, resulting in unmet expectations from the treatment.
“The complaints were mainly due to misunderstanding on both the part of the patient and dentist about the treatment rendered,” said Singapore Dental Association president, Dr Lim Lii.
“Due to a lack of proper communication, patients may not fully comprehend the advice like the limitations of treatment procedures given by the dentists.
“Similarly, the patients may not have adequately expressed their expectations to the dentists, resulting in apparent unmet expectations from the treatment,” Dr Lim added.
LACK OF AWARENESS
Orthodontists told Channel NewsAsia that this discontent among patients can also stem from a general lack of awareness among Singaporeans on the differences in services provided by a dentist and an orthodontist.
The job of a dentist typically includes diagnosis, prevention and treatment of oral diseases. An orthodontist, on the other hand, is a specialist who is trained to deal with more complex cases such as braces treatment and fixing malpositioned teeth and jaws.
A certified orthodontist has to complete a three-year postgraduate degree and have at least two years of work experience followed by a certifying exam. A general dentist in Singapore undergoes four years of undergraduate university education.
According to the Association of Orthodontists, the Faculty of Dentistry undergraduate course at the National University of Singapore does not have hands-on clinical sessions involving orthodontic treatment of patients.
Dr Elaine Tan, a consultant in clinical-orthodontics at the National Dental Centre Singapore, said: “In the first two years of (training), anybody will stick the braces wrongly. And it’s only with supervision, correction and following through with the patient that we know where and how to stick the brackets, and learn from our mistakes. When a general dentist does braces, they lack in examination and diagnosis.”
Dr Tan added: “I think people have been thinking that all dentists are the same and that their job is just to extract or fill teeth. But in dentistry, we have different specialties.
“For example, an orthodontist does braces, but after the treatment is completed, the patient can go back to a general dentist for their maintenance or routine six-month scaling, polishing, fillings and even to maintain their retainers as well.
“Oral surgeons do more complicated wisdom teeth surgery. Prosthodontists do complicated crowns and bridges implants and we also have endodontists, who do complicated root canal treatment.”
There are currently no restrictions in Singapore on the range of treatment that a dentist can provide. But the Singapore Dental Council stressed that all dentists are expected to practise within their competence and refer patients appropriately as indicated in the Singapore Dental Council Ethical Code and Guidelines.
The council added that a dentist should only carry out procedures which they have appropriate knowledge, skill or required experience for. It is also illegal for a dentist to state that he is a specialist when he is not registered as a dental specialist with the Singapore Dental Council.
However, the Singapore Dental Association said that in some cases an adverse treatment outcome is not due to incompetence or negligence by the dentist, because sometimes treatment – even in the best of hands – do not go as expected.
Medical experts also said that one reason why people choose a dentist over an orthodontist is cost. For example, a dentist could charge about S$3,000 for a braces treatment, while it would cost about S$800 more to see a specialist. A wisdom tooth surgery could be priced as low as S$535 by a general dentist, while a specialist can charge up to $2,100.
Dr Lim said: “The public can seek advice from any dentist of their choice. Dentists are trained to provide a wide range of treatment for their patients. Ultimately, it’s the patient who decides who they want to go to for treatment based on factors like fees, convenience and the personal relationship they have with the dental practitioner.”
Meanwhile, the National Dental Centre of Singapore will be launching a campaign next March aimed at stepping up awareness on dental health and informing the public about the services provided by dentists and orthodontists.