2 days ago
More support for special needs patients as Singapore recognises special care dentistry
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Cerebral palsy patient Hillary Chua with her mother, Ms Cindy Wong, and Dr Tay Chong Meng, division head of advanced general dental practice at the National University Centre for Oral Health Singapore.
SINGAPORE – Born with quadriplegic cerebral palsy, 22-year-old Hillary Chua uses a wheelchair and cannot perform daily functions independently.
Her 57-year-old mother, Ms Cindy Wong, has been taking care of her full-time, including diligently cleaning her teeth.
Finding a dentist who is trained to treat special needs patients was challenging. Then, during the Covid-19 pandemic, Ms Wong stopped dentist visits altogether because of restrictions.
In 2024, she noticed a bad odour from her daughter's mouth. They were referred to the National University Centre for Oral Health Singapore (Nucohs), where Ms Chua was treated by Dr Tay Chong Meng, division head of advanced general dental practice.
Dr Tay and his team carefully assessed her needs, as well as the unique challenges posed by her condition, and put together a tailored treatment plan prioritising her safety and comfort.
They worked with her mother in providing head support for Ms Chua – who occasionally has sudden head movements due to her lack of muscle control – and trying out various positions to reach her inner teeth, which is challenging as she has difficulty opening her mouth.
Dr Tay is among Singapore's growing cohort of special care dentists, an area of specialisation that was officially recognised in July.
The Ministry of Health (MOH) announced that the Dental Specialists Accreditation Board (DSAB) will recognise special care dentistry as the eighth dental speciality, joining others such as oral and maxillofacial surgery, orthodontics and paediatric dentistry.
'The new dental speciality addresses the growing need for specialised dental care, particularly in the light of Singapore's ageing population,' MOH had said.
Specialists in the field look after the oral healthcare of adults with complex needs, such as those with physical, developmental or cognitive conditions that prevent them from receiving routine dental care.
The ministry noted that difficulties in getting appropriate dental care could mean that such individuals face an increased risk of oral diseases, such as dental caries or tooth decay and periodontal disease.
This, in turn, could significantly impact their oral function, general health and quality of life, it said.
'The recognition of special care dentistry as a dental speciality will support professional development and encourage more dental practitioners to pursue advanced training in this field,' it added.
The DSAB will establish professional standards, as well as enhance training competencies, to ensure dental specialists meet quality care standards.
Special care dentistry is also recognised as a speciality in several other countries, such as Australia, Malaysia and Britain.
While this field does not have a set of specialised procedures, its practitioners have a better understanding of the relationship between patients' medical condition and their oral health, and are trained in behavioural management.
For example, patients with conditions such as autism spectrum disorder or Down syndrome may face anxiety when undergoing dental procedures.
'Careful use of suction, with a lot of reassurance and distraction, will help reduce the anxiety triggered by involuntary salivary flow whenever the mouth is stretched for dental assessment and treatment,' Dr Tay said.
Both Nucohs and NDCS have special equipment for those with special needs, such as a wheelchair-tilter, which allows patients with mobility issues to remain in their wheelchairs during treatment.
Noting that people with special needs and their caregivers may face difficulty in finding dental practitioners confident in managing challenging cases, Dr Tay said the recognition of the field as a speciality raises awareness that additional help is available for such patients.
'This recognition is also an acknowledgement of the work and efforts by our colleagues to manage the oral health challenges of people with special needs,' he said.
Dr Yang Jingrong, who heads the Geriatric and Special Care Dentistry Clinic at the National Dental Centre Singapore (NDCS), said the recognition validates the 'unique skill set and expertise required in treating patients with special needs'.
'This leads to an improved professional identity and better defined scope of practice,' she added.
Dr Tay told The Straits Times that visits by special needs patients to Nucohs have been increasing, from about 1,200 in 2022 to about 1,500 in 2023.
This could be due to a number of reasons, he said, including greater awareness of the importance of oral health and the extension of government subsidies for special needs outpatients at Nucohs.
Dr Tay noted that carrying out simple procedures takes only slightly longer for patients with special needs in most cases.
However, there are cases who need a 'significantly longer' time, even taking several visits, depending on the individual.
One example is a patient with dental tartar that is significantly bulky or under the gums.
'Then we might need a few visits to build their confidence with under-the gums-scaling,' Dr Tay said, referring to a procedure to remove plaque and tartar build-up below the gum line.
He added that the dental team works with caregivers to help introduce patients to a 'realistic and sustainable oral care regime' at home, such as the use of a water pick for those uncomfortable with flossing.
Patients can also benefit from targeted dental products that further protect their oral health.
'Improved access to certain therapeutic products, such as high-strength fluoride toothpaste, can allow the caries, or tooth decay, risk to be controlled more appropriately, enhancing the preventive benefits of these products to persons with special healthcare needs,' said Dr Yang.
'Additionally, there can be more education as a whole for caregivers on how to perform oral care for patients with special care needs, as well as modifications to be aware of, such as for persons with swallowing difficulties or with cognitive impairment.'
For Ms Wong, the special care services at Nucohs are a major reason why she is willing to take her daughter all the way to the centre in Kent Ridge from their home in Punggol.
Aware that her daughter had developed a phobia of doctors after previously undergoing surgery, Dr Tay put her at ease by referring to himself as 'uncle' and being friendly towards her.
'It was the first time I met a doctor who called himself uncle,' said Ms Wong.
