Issues to review in new Dental Bill

THE 2017 Dental Bill was tabled for first reading in Parliament on Nov 28, 2017. It is a total revamp of the current 1971 Dental Act with major changes in the following areas:

I. Introduction of a “Specialist Division” in the Dental Register and Dental Therapist (School Dental Nurse) in a new Dental Therapist Register;

II. Introduction of various offences relating to a dental practice; and

III. Empowerment of enforcement officers from the Health Ministry (MOH) where the authorised officers will possess all powers of a police officer in addition to the powers provided under the new Dental Act.

Regarding the introduction of the words “Dental Specialist” in the Bill, there is an ambiguous clause embedded under the title of “Registration as Dental Specialist”. Clause 34 (1) of the Bill states that “A practitioner whose name does not appear in the Specialist Division of the Dental Register shall not practice as a Dental Specialist in that specialty”. The clause “practice as a Dental Specialist” is not clearly defined and is open to interpretation, which may lead to grave consequences.

Drafters of any bill are not merely putting words to proposed government policy, they are also giving a legal opinion based on the application of the principles of interpretation, and this should never be left in ambiguity. So what does this ambiguity in the Dental Bill entail for the rakyat?

It is clear that the original intent of this clause was to prevent the general dental practitioner, also known as the dental GP, from advertising himself as a “specialist” when he or she is not one. However, this ambiguity could mean that once the Bill is passed and enforced, a dental GP would no longer be able to carry out certain dental procedures which may be classified as a specialist procedure. This would mean that even if a dental GP has 10, 20 or 30 years’ experience in the required field, and has invested considerable time and money to acquire the requisite skills, knowledge and certifications to do so, he would no longer be able to carry out that dental procedure.

This restriction is also not found in other countries and would only deprive the rakyat of many experienced and skilled dental GPs who are not only accomplished in what they do but have also, over the years, developed skills and techniques that have contributed to the dental industry.

According to the National Specialist Register (NSR), there are only 500 dental specialists from 10 specialties in Malaysia. From this small number, there are only 374 dental specialists from seven specialties who are clinicians providing dental care to patients.

The remaining 126 dental specialists are either laboratory-based or management-based. These 374 clinical dental specialists constitute less than 5% of the 8,736 active dentists in Malaysia and most practise in cities. Should dental GPs be restricted to only carrying out non-dental specialist procedures, it is the rakyat who would be severely deprived of the much needed specialised dental care.

There is currently a huge shortage of dental specialists in both the private and public sectors. For instance, the waiting period to get dental braces in a government orthodontic clinic can be up to several years. There is also a policy where clinics would usually only provide such treatments for teenagers aged 18 and below, and these treatments are usually only provided to patients with moderate to severe misalignment of teeth.

Currently, dental GPs can provide such services with a shorter waiting period and exceptional quality. If the “specialised” restriction comes into play, the general public would be forced to pay higher prices and face longer waiting times as there would only be so many private dental specialists who would be able to provide such care. Worse still, some might resort to seeing bogus dentists for fake braces, teeth whitening and other procedures.

As such, the Malaysian Dental Association (MDA), the national association for Malaysian dentists, convened an extraordinary general meeting on Feb 11, 2018 and unanimously adopted the resolution: “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 in the memorandum was to urge the MOH to amend the ambiguous clause 34(1) and word it in a more defined manner where it prohibits a general dentist from making a false claim or advertising himself as a “dental specialist” when he is not registered as a dental specialist under the Act. This was the original intention of the clause.

Dental therapists, formerly known as school dental nurses, have existed since before the independence of Malaysia. The programme was originally intended to transform medical nurses into school dental nurses to provide basic dental care to school children aged 12 years and below and to cope with the shortage of dentists during the 1950s. It was later transformed into a threeyear diploma programme where a candidate, after SPM, could enrol at the Children’s Dental Centre and Dental Training College Malaysia in Penang.

Currently, a dental therapist exclusively practises in the public sector, serving its original intent of school dental services, and is fully regulated by the MOH. However, once the new Dental Bill is passed and enforced, the dental therapist would be allowed to practise in the private sector and their scope would be increased to treating teenagers aged 18 years and below.

Is this beneficial to the public and should these dental therapists be subject to the same laws that regulate dental GPs who treat the public at large?

On the second issue, the new Dental Bill also listed several punishments for offences related to the practice of dentistry. While severe punishments could act as a deterrent, the punishment prescribed must be proportional 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. If a dentist fails to do this, he is committing a crime and faces a fine not exceeding RM50,000 or imprisonment for a term not exceeding one year or to both upon conviction.

Failure to notify the registrar on a change of address within 30 days is a procedural/ technical mistake by a dentist; the severity of the punishment, particularly the one-year jail term, is definitely not proportional to the gravity of the mistake especially where it is not related to the public’s safety.

Last but not least, the enforcement officers/authorised officers are seen to have enormous powers. Not only do they posses all the powers of a police officer of whatever rank in relation to the investigation, they also hold any extra power provided under this new Dental 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 to provide the authorised officer with any assistance that the authorised officer may reasonably require.

This may encompass giving the authorised officer all reasonable information related to the matter and producing 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 undertaken 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. One may say that it is important to empower the ministry’s officers with the necessary powers to carry out their duty and protect the public. However, empowering them with the powers of a police officer and more could lead to abuse of power and lack of accountability.

I sincerely appeal to the MOH and all members of Parliament to consider the above amendments during the second reading of the 2017 Dental Bill for the benefit of the profession and, more importantly, the rakyat.

DR SIOW ANG YEN Johor Baru