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SINGAPORE \u2013 Newly issued guidelines for wisdom tooth surgery have drawn pushback from the Singapore Dental Association (SDA), which contends that recommending general dental practitioners to undergo training for certificates of competency (COCs) could impose an artificial ceiling on their career growth.<\/p>\n
This is particularly so for dentists who have safely performed such surgery for years, the SDA said.<\/p>\n
Under the new guidelines, surgery of an intermediate level of difficulty is covered by the COC course, while highly complex extractions, such as those involving a tooth deeply trapped in bone, are beyond the scope of the COC and should be referred to oral and maxillofacial surgeons (OMS).<\/p>\n
The Singapore Dental Council, the profession\u2019s watchdog, sent out a July 29 circular informing dentists of the introduction of the COC for wisdom tooth surgery.<\/p>\n
To obtain the wisdom tooth surgery COC, general dentists have to undergo at least eight hours of didactic training taught by OMS, observe at least one operation done by an OMS and complete a minimum of five hands-on cases, with a treatment plan pre-approved by their supervisor.<\/p>\n
These steps have to be completed within six months.<\/p>\n
As the first surgery in a phased implementation of COCs for dental procedures starting in 2026, the framework aims to connect undergraduate dental education with practical surgical techniques for a common procedure that varies considerably in complexity.<\/p>\n
A COC is neither mandatory nor a displayable qualification, the circular said.<\/p>\n
Dental practitioners must limit their scope of work to areas in which they are competent, it added.<\/p>\n
SDA, which counts about 2,000 general dental practitioners and specialists here as members, said in an Aug 4 Forum letter that a general dentist who becomes proficient in the types of wisdom tooth surgery covered by the COC has no defined pathway within the framework for progressing to cases of greater complexity.<\/p>\n
\u201cThe sentiment we are hearing is not so much about, \u2018Why can\u2019t I do this procedure?\u2019 and more about, \u2018How will the experience I have built over many years be recognised, and how can I continue to progress?\u2019\u201d SDA president Eugene Tang told The Straits Times.<\/p>\n
Singapore had 2,358 general dental practitioners and 454 dental specialists in 2024.<\/p>\n
SDA also criticised the requirement to log at least 30 cases of wisdom tooth surgery over three years after completing the COC course to obtain lifelong accreditation.<\/p>\n
Dentists who do not meet the 30-case target will see their initial COC accreditation lapse at the end of the three years.<\/p>\n
It said volume-based targets could inadvertently incentivise unnecessary surgery over clinical judgment.<\/p>\n
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.<\/p>\n
\u201cLearning on the job without any formal structure sounds reasonable, but it relies entirely on individual dentists judging their own abilities,\u201d he said.<\/p>\n
\u201cThat 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.\u201d<\/p>\n
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.<\/p>\n
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.<\/p>\n
\u201cIt 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,\u201d said Peck.<\/p>\n
\u201cPatient 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.\u201d<\/p>\n
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.<\/p>\n
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.\u00a0<\/p>\n
Newly registered dental practitioners are encouraged to obtain the COC to gain new competencies as part of good clinical practice, said a ministry spokesman.<\/p>\n
\u201cExisting practitioners are likewise encouraged to participate in the COC framework in order to strengthen and maintain their competencies through lifelong learning,\u201d he said.<\/p>\n
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.<\/p>\n
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.<\/p>\n
Royce\u2019s seven surgeons are insufficient to meet demand from its 48 clinics across its three brands.<\/p>\n
\u201cIn 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,\u201d he said.<\/p>\n
\u201cOur OMS want to decant the \u2018complex wisdom tooth surgeries\u2019 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.\u201d<\/p>\n
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.<\/p>\n
These dentists graduated from Singapore, the UK, the US, Hong Kong, Australia and New Zealand, among other places, and have differing standards of care.<\/p>\n
\u201cDentistry, 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,\u201d Peck said.<\/p>\n
\u201cWhat 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.\u201d<\/p>\n
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.<\/p>\n
The Health Ministry said the COC framework will be reviewed from time to time.\u00a0<\/p>\n<\/div>\n
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SINGAPORE \u2013 Newly issued guidelines for wisdom tooth surgery have drawn pushback from the Singapore Dental Association (SDA), which contends that recommending general dental practitioners…<\/p>\n","protected":false},"author":1,"featured_media":78643,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"fifu_image_url":"","fifu_image_alt":"","footnotes":""},"categories":[2611],"tags":[],"class_list":["post-78642","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-buzz-headlines","wpcat-2611-id"],"brizy_media":[],"_links":{"self":[{"href":"https:\/\/sgbuzz.com\/index.php?rest_route=\/wp\/v2\/posts\/78642","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sgbuzz.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/sgbuzz.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/sgbuzz.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/sgbuzz.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=78642"}],"version-history":[{"count":0,"href":"https:\/\/sgbuzz.com\/index.php?rest_route=\/wp\/v2\/posts\/78642\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/sgbuzz.com\/index.php?rest_route=\/wp\/v2\/media\/78643"}],"wp:attachment":[{"href":"https:\/\/sgbuzz.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=78642"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/sgbuzz.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=78642"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/sgbuzz.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=78642"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}