Singapore wisdom tooth surgery rules and dental competency framework

Dentists who do not meet the 30-case target will see their initial COC accreditation lapse at the end of the three years.

It said volume-based targets could inadvertently incentivise unnecessary surgery over clinical judgment.

Verifying skills development

Singapore Dental Council member Chris Peck, who is dean of the Faculty of Dentistry at the National University of Singapore and a senior consultant at the National University Centre for Oral Health Singapore, said accreditation establishes a baseline standard rather than a restriction.

“Learning on the job without any formal structure sounds reasonable, but it relies entirely on individual dentists judging their own abilities,” he said.

“That is risky, especially when there is a financial incentive to take on procedures and charge for them. Without structured training and assessment, there is no way to verify that the right skills are actually being developed.”

For experienced general dental practitioners, there is a one-off grandfathering exercise that exempts them from the training and allows them to become clinical supervisors for COC training, he said.

These are general dental practitioners who graduated in 2005 or earlier, have at least 20 years of clinical experience and have performed a minimum of 100 cases.

“It is worth noting that in no other part of the body are general practitioners allowed to perform all types of surgery with so little formal training,” said Peck.

“Patient safety is not just about counting how often things go wrong. It is about making sure we have done everything reasonable to prevent problems in the first place.”

Wisdom tooth surgery carries real risks, including permanent nerve damage that can affect sensation in the lip, chin and tongue, as well as serious infections and bleeding, he added.

When asked about the rationale for introducing the framework, the Ministry of Health said it provides a structured pathway for dentists to acquire and maintain the knowledge, skills and experience needed to undertake these more complex procedures beyond what is covered in undergraduate training. 

Newly registered dental practitioners are encouraged to obtain the COC to gain new competencies as part of good clinical practice, said a ministry spokesman.

“Existing practitioners are likewise encouraged to participate in the COC framework in order to strengthen and maintain their competencies through lifelong learning,” he said.

Yeo Kok Beng, chief executive of Royce Dental Group, which has more than 150 general dental practitioners, said he plans to send all of them for COC training.

The framework will give them greater confidence to perform more complex procedures safely, which will translate to more general dentists being empowered to take on complex cases they currently refer to OMS, he said.

Royce’s seven surgeons are insufficient to meet demand from its 48 clinics across its three brands.

“In fact, some of our OMS have commented that the cases referred by the younger dentists are quite manageable and could have been done by the young dentists,” he said.

“Our OMS want to decant the ‘complex wisdom tooth surgeries’ to our general dentists, so that the OMS can do more challenging work like sinus lifts, bone grafts, tissue grafts and even biopsies for cancerous-looking lesions.”

Yeo said he and his peers, many of whom are clinic owners, are glad the COC framework can align standards among the many dentists working in their clinics.

These dentists graduated from Singapore, the UK, the US, Hong Kong, Australia and New Zealand, among other places, and have differing standards of care.

“Dentistry, like all healthcare professions, demands a commitment to lifelong learning. With approximately one million new scientific publications in the biomedical and dental sciences each year, the knowledge base of the profession is constantly evolving,” Peck said.

“What a practitioner learnt at university, even five or 10 years ago, may no longer reflect current best practice. Structured postgraduate training pathways like the COC are one way to ensure that practitioners keep pace with advances in knowledge and technique throughout their careers.”

The development of new training courses leading to COCs in higher-risk procedures like wisdom tooth surgery and implant surgery was first proposed in 2019; it also met with resistance from the SDA then.

The Health Ministry said the COC framework will be reviewed from time to time.