Fine tune Dental Bill

THE Dental Bill 2017 was tabled for first reading in the Dewan Rakyat on Nov 28, 2017. It is a revamp of the Dental Act 1971 and the major changes are as follows:-
» The introduction of Specialist Division in the Dental Register and dental therapist (school dental nurse) to the new Dental Therapist Register
» The introduction of various offences relating to dental practice
» The empowerment of enforcement officers from the Ministry of Health where the authorised officer will have all powers of a police officer in addition to the powers provided under the bill.
Clause 34 (1) states that "A practitioner whose name does not appear in the Specialist Division of the Dental Register shall not practise as a dental specialist in that speciality". The clause is open to interpretation as "practise as a dental specialist" is not defined in the bill.
This could mean a general dentist can no longer carry out certain procedures which may be classified as a specialist procedure even if the dentist has the knowledge and skill. According to the National Specialist Register (NSR), there are only 500 dental specialists from 10 specialities, out of which, only 374 dental specialists from seven specialities are the clinicians who directly provide dental care to the patient while another 126 dental specialists are either laboratory-based or management-based. These 374 clinical dental specialists are less than 5% of the 8,736 active dentists. Most dental specialists are in urban areas. Should the general dentist be restricted, the "specialised" dental care would be less accessible to the public.
There is huge shortage of dental specialists. The waiting period to get braces in a government orthodontic clinic can be up to several years, this is on top of the policy that the clinic usually only provide this for teenagers 18 and below and only to patients with moderate or severe misalignment of teeth. Patients may need to pay a higher price with a longer waiting time with a private dental specialist for these dental care compared to when a general dentist can provide such services too. Some may resort to consulting a bogus dentist.
The Malaysian Dental Association (MDA) had convened an EGM on Feb 11 and unanimously adopted the resolution "that the house resolves to reach a consensus on a Memorandum to the Dental Bill 2017 and approve it as the official position statement of the Malaysian Dental Association". The main issue was to urge the ministry to amend clause 34(1) and make it clear that a general dentist is prohibited from making a false claim or advertising as a dental specialist when he is not registered as such.
The bill also lists severe punishment for offences. While severe punishment could act as a deterrent, the punishment must be commensurate to the severity of an offence.
For example, Clause 44 states that a dentist/dental therapist shall notify the registrar of any change in home address or clinic address within 30 days of such change. Should a dentist fail to do so within 30 days, he is committing an offence which on conviction, be liable to a fine not exceeding RM50,000 or to imprisonment for a term not exceeding one year or both. Failure to notify the registrar on change of address is a procedural/technical mistake, the severe penalty especially the one year jail term is not commensurate to the gravity of the mistake, where this mistake is not related to public safety in practice of dentistry.
Dental therapists, formerly known as school dental nurses, have been around before independence. The programme was intended to transform medical nurse to school dental nurse to provide basic dental care to schoolchildren 12 years old and below to fill the shortage of dentists during 1950s. It later became a three-year diploma programme where a candidate after SPM enrols into Pusat Pergigian Kanak - Kanak & Institut Latihan Kementerian Kesihatan Malaysia (Pergigian) George Town. The dental therapists are now exclusively in the public sector, providing school dental services and are fully regulated by the ministry. However, once the bill is passed and enforced, the dental therapist will be allowed to practise in the private sector.
Last but not least, the enforcement officer/ authorised officer prescribed under this act has an enormous power. Not only does he have all the powers of a police officer in relation to police investigations in seizable cases as provided under the Criminal Procedure Code, he also has additional powers provided under this bill. It is the duty of any owner or occupier of any premises used or believed to be used as a place to practise dentistry and any person found in that premises shall provide the authorised officer with the assistance as the authorised officer may reasonably require, give the authorised officer all reasonable information related matter; and produce to the authorised officer any book, record or document in his possession or custody or under his control or within his power to furnish, relating to the affairs of the place of practice. While some of these requirements can only be enforced by a police officer with a warrant, it is not necessary for the authorised officer to obtain or produce a warrant when he is performing his duty.
I urge the Ministry of Health and all members of Parliament to consider the above amendments during the second reading of the bill for the benefit of the general public and the profession.
Dr Siow Ang Yen
Johor Baru