Promotion and Subsidy of Dental Care

Mrs Lina Chiam asked the Minister for Health (a) whether there are sufficient programmes in place to promote dental care; and (b) what dental procedures are subsidised at the National Dental Centre and what procedures are not.

Minister of State for Health (Dr Amy Khor Lean Suan) (for the Minister for Health): Mr Speaker, Sir, in Singapore, we place a strong emphasis on prevention and inculcating good oral hygiene practices from young. The Health Promotion Board's (HPB) School Dental Service provides free basic dental care for all Singaporean children aged seven to 18 years old, within the school dental clinics. This includes cleaning, screening and fillings, as well as dental health education, to promote good oral hygiene amongst our students. Subsidised treatment is also available for pre-schoolers at HPB's School Dental Centre.

As a result, the oral health status of our 12-year-olds, measured by the DMFT index – that is, a common measure of the number of decayed, missing or filled teeth – is among the best in the world. At 0.6, it is much better than in most OECD countries, including Japan and South Korea – which are at 1.3 and 2.1 respectively.

For adults, HPB works with professional groups and industry partners to promote good oral hygiene through events, such as the annual Oral Health Month. HPB has also started a Community Functional Screening Programme for seniors 60 years old and above, to detect early signs of functional decline, including poor oral health, and to institute the appropriate follow-up measures.

Mrs Chiam also asked about subsidised dental procedures at the National Dental Centre (NDC). NDC provides the full range of subsidised dental treatment – such as for crowns, bridges, dentures and root canal treatment – to meet the needs of all patients referred to NDC for management. Only procedures deemed cosmetic in nature, such as dental laminates and bleaching services, are not subsidised. Eligible patients who require root canal treatment, crowns and dentures can also receive subsidies for treatment at private dental clinics under the Community Health Assist Scheme (CHAS). Subsidised basic dental care is also available at the polyclinics and at private dental clinics under CHAS.

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Mrs Lina Chiam (Non-Constituency Member): Sir, I thank Minister of State Amy Khor for her reply. I would like to ask two supplementary questions. Can MOH provide the exact breakdown of what is being subsidised at NDC and what treatments are not subsidised? What is the rationale for not providing subsidy for some treatments and what if they were necessary? Can MOH update the House on what is being done to shorten waiting time for dental appointments for fresh or new cases at polyclinics?

Dr Amy Khor Lean Suan: Sir, with regards to the first question on the types of subsidised dental procedures at the National Dental Centre (NDC): firstly, in fiscal year 2010, the subventions that were given for subsidised dental treatments at the various centres amounted to $23 million. At the NDC, various procedures are subsidised – from basic dental services to more complex dental procedures like crowning, root canal treatment and dentures. The subsidy rates can vary from 20% to 76%, depending on the type of treatment or procedure. Please allow me to list some of the procedures where subsidies are available. The basic dental procedures will be scaling, polishing, fillings and extractions. The more complex ones would be crowning, root canal treatment, dental treatment related to traumatised teeth and non-vital teeth, dental treatment for patients who are under rehabilitation following cancer surgery and so on. Most of these procedures which are required medically are subsidised.

The procedures which are not subsidised by National Dental Centre are basically procedures which are cosmetic. For example, dental laminates and veneers, bleaching, orthodontic treatment for cosmetic purposes. If orthodontic treatment is required for medical purposes, there will then be subsidy.

Sir, I am not too clear about the Member's second question, so perhaps the Member could repeat it.

Mrs Lina Chiam: Sir, I would like MOH to update the House on what is being done on the NDC front. A lot of people have been complaining about long waiting times to see a dentist or dental surgeon. By the time they are ready, the teeth would have fallen out, or the dental problems would have grown worse. Can the NDC do something about that to shorten waiting times for fresh cases and for cases referred by the polyclinics?

Dr Amy Khor Lean Suan: Sir, I thank the Member for the question. Let me say that we are aware of some of these feedback and concerns. In general, for emergency cases or where severe pain is experienced, these are treated as urgent cases and will be prioritised. They will be treated immediately, say, the day itself, or within the week, depending on the level of urgency. Another example would be the elderly who need urgent denture replacements. These cases would be prioritised and they would be treated.

For those on the waiting list, generally, they would have been assessed by the dentists as stable or pain-free cases. We would then put them on the waiting list. The waiting time would depend on the level of complexity of the procedures. In fact, for the NDC, the median waiting time for first appointment, where the dentists will make the assessment, for non-emergency, non-urgent cases, is 18 days. And depending on the type of treatment that they need, if it is urgent, they will be sent almost immediately. As I said, if they call up and it is an urgent case, they will also be treated on an urgent basis.

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On 15 January, we implemented the expanded PCPS, which is now called the Community Health Assist Scheme (CHAS). Eligible patients who have the CHAS card can also have access to subsidised dental treatment at participating dental clinics. There are 218 such participating dental clinics around the island now. They can get subsidised dental treatment for crowning, root canal work, dentures and basic dental services. For this group of people, it would offer convenience and, of course, waiting times would be much shorter. In the longer term, we are also increasing our intake of dentistry students at the National University of Singapore, to increase capacity in our healthcare system.