By Frederick Chu

Apopular Chinese proverb states that “a toothache is worse than a serious illness”. The Hong Kong Special Administrative Region government, therefore, cannot relegate the shortage of dentists to the backwaters of its healthcare agenda. By the end of 2021, there were 2,706 registered dentists in Hong Kong, and the shortage is more serious in public practice. At present, the ratio of dentists in public to private practice in the city is 1-to-3. To get around this problem, some local people choose Shenzhen as their dental tourism destination.

Instead of taking a piecemeal approach, the Health Bureau recently conducted a comprehensive review of the major problems confronting the dental sector in the city. First, the Health Bureau deserves a pat on the back for making feasible plans to amend the Dentists Registration Ordinance (DRO) so as to provide new pathways for admitting qualified nonlocally trained dentists to practice in specified institutions.

Second, the proposed pre-registration internships for local dental graduates, or the period of assessment requirement for nonlocally trained dentists, could also work to the benefit of the public healthcare sector. 

Last, the proposal to modernize the regulatory framework for dentists and ancillary dental workers, including dental hygienists and dental therapists, could benefit patients as well as the entire dental profession. 

Implementing such reforms requires amending the DRO.

The proposal to provide new pathways for the admission of qualified nonlocally trained dentists is a timely solution to alleviate the shortage. What the government has tried to do is to drastically increase the number of undergraduate dental education places in the city, which, unfortunately, has not been successful. The number of places allocated by the bureau to Hong Kong University increased from 50 in 2009 to 90 in 2023. Such an increase, however, is still insufficient to alleviate the shortage of public dental services. Merely increasing the number of HKU graduates is not enough for the government to respond quickly to the increasing demand for dental services.

The proposal to provide new pathways for nonlocally trained dentists seems to have borrowed a leaf from Singapore, which launched its Conditional Registration program — an employment-tied registration mechanism — to meet public expectations and address a shortage of dentists. Under the program, a nonlocally trained dentist is required to work as a dentist in any hospital or other institution for a specified period (usually two years) under the supervision of a fully registered dentist. Dentists under the program may apply for conversion after two years but this is subject to the approval of the Singapore Dental Council.

Like Hong Kong, Singapore suffers from a shortage of dentists, with only 0.41 dentists per 1,000 people. According to Patrick Tseng, chief dental officer for Singapore, the demand for dental services is changing due to the more complex dental needs of the growing number of geriatric patients. As a result, allowing nonlocally trained dentists to practice in Singapore has become a matter of public concern.

The mismatch between supply and demand for dental services has also raised concerns in Hong Kong. In his maiden policy address, Chief Executive John Lee Ka-chiu stated that the government will explore various options to ensure sufficient healthcare personnel for the public health system. One of the options is to admit qualified nonlocally trained dentists and nurses. In line with the above policy, the Health Bureau’s employment-based proposal requires the dentists to secure employment with a specified institution before submitting their application for limited registration.

With regard to the one-year mandatory internship proposal, I believe that such a proposal may provide more clinical experience for the fresh graduates of HKU, while to a certain extent helping to ease the manpower shortage in the public healthcare sector. But nonlocally trained dentists, who have passed the licensing examination but are not admitted by limited registration or special registration, may find the one-year internship unfair. It is worth noting that the licensing examination is very demanding. 

Finally, we strongly support the proposal to modernize the regulatory framework for dentists and ancillary dental professionals. The proposals include the imposition of a mandatory continuing professional education requirement, the revamp of the composition and structure of the Dental Council of Hong Kong (DCHK), the tightening of regulatory control over ancillary dental workers, and the need to keep up with the latest trends in dental practice.

Dental hygienists do not exist in every country but they are part of a growing trend in dentistry around the world because of their specialized services. For instance, they provide patients with thorough cleaning and polishing of teeth. They also provide health advice to patients. Both dental hygienists and dental therapists can help relieve the burden on dentists by providing the basic preventive and primary dental care services, freeing up dental resources for more-complex dental treatments. Because of their important roles in the dental sector, these ancillary dental workers should be subject to more formalized regulatory control.

The proposal to empower the DCHK to accredit a local training program for ancillary dental programs and to benchmark qualifications for the purpose of registration is fair. It deserves the support of local dentists to embrace the introduction of a statutory registration system for ancillary dental workers. To enhance their professionalism, they must obtain practice certificates. The government will go in the right direction by providing dental hygienists with a certain degree of independent practice in public dental services or government outreach programs.

The author is a dental services senior consultant of Chinese Dream Think Tank, and was previously the assistant dean and clinical associate professor of the faculty of dentistry of the University of Hong Kong.

The views do not necessarily reflect those of China Daily.

【CDTT Newspaper Article】Frederick Chu：A smiling HK needs nonlocal dentists for better dental care (China Daily HK Edition, Page 8, 19 June 2023)

https://www.chinadailyhk.com/epaper/pubs//chinadaily/2023/06/19/08.pdf

https://www.chinadailyhk.com/article/336577#A-smiling-HK-needs-nonlocal-dentists-for-better-dental-care

This article is reproduced by Kwun Media with the consent of China Daily.

Chinese Dream Think Tank is a non-profit Hong Kong-based organization working with skilled volunteers, experts and professionals who are passionate about telling the China story well.

中國夢智庫｜牙醫

牙痛不是病，痛起來要人命。特區牙醫短缺問題是政府管理本地醫療保健議程中不可忽略的一個重點。至2021年底，本港共有2,706名註冊牙醫，公營醫療體系中的牙醫短缺問題一直處於令人關注的狀態。至今為止，特區公營及私人執業的牙醫比例為1:3(註1)。面對這個問題，許多特區本地人選擇深圳一日遊，北上找牙醫。

「醫務衞生局」最近採取整體性方案，全面檢討本港牙科事務，著手處理當前面臨的牙醫難求的主要問題根源。筆者撰文，集中討論「醫務衞生局」提出的三項建議。首先，「醫務衞生局」有擔當，就修訂《牙醫註冊條例》(DRO)制定切實可行的計劃，為接納合資格的非本地訓練牙醫入住特區本地指定機構執業提供新的途徑。

其次，建議為本地牙科畢業生提供預先註冊實習或為非本地訓練牙醫設定的評估期新規定，這些提議可大大惠及公營醫療界。第三，現代化牙醫與輔助性牙科工作人員(牙齒衛生員與牙齒治療師)監管框架的建議可以使求醫者與整個牙科行業受益。為確保上述改革的正確實施，政府有必要修訂DRO。

首先，筆者討論一下為符合資格的非本地培訓牙醫提供的新途徑建議。政府在這方面做得非常事倍功半，多年來嘗試大幅增加本地牙科培訓名額的數量。由2009/10學年起，學額由50個增至53個，其後由2016/17學年起增至73個，由2019/20學年起增至80個，最近由2022/23學年起增至90個(註2)。但是，僅僅擴加香港大學牙科培訓名額未能使政府以合理的速度緩解公營牙科診所出現的人手短缺問題。

「醫務衞生局」為非本地培訓牙醫所提供的新途徑似乎與新加坡有條件註冊牙醫計劃(該計劃)類似。這種新途徑將就業與註冊機制挂鉤，新加坡的相關計劃在實踐上已達到滿足公眾期望與解決新加坡牙醫短缺的成果。根據該計劃，非本地培訓牙醫須在完全註冊牙醫監督下，在任何醫院或其他相關機構擔任牙醫，為期2年。該計劃下的牙醫可在兩年期滿，需要新加坡牙科委員會核准後，申請轉正(註3)。
新加坡與特區面對的同一樣問題是缺乏牙醫，平均每1000人中只有0.41名牙醫。新加坡首席牙科醫生 Patrick Tseng表示，社會對牙科需求隨着老年病患者數量增加的趨勢變得更加複雜化(註4)。越來越多非本地培訓的牙醫入境工作所產生的問題已經引發新加坡社會的關切。

牙科服務的供需錯配也引起了特區社會的憂慮。特首李生在首份施政報告中表示，政府會研究不同的方案，以確保公共醫療系統有足夠的醫療人手。其中一個選項是接納合資格的非本地訓練牙醫與護士(註5)。根據此項政策，「醫務衞生局」的就業與註冊挂鉤機制規定非本地培訓牙醫在提交有限度註冊申請前，必須獲指定機構的聘用書。

「醫務衞生局」建議將有限度註冊的有效期定為三年及須經「香港牙醫管理委員會」批准才能續期。任何非本地訓練牙醫於一間或多於一間指定機構工作，並獲限制註冊合共五年，可獲豁免執照考試「第一部分-筆試」與「第二部分-實踐測試」。這項建議具吸引力能夠鼓勵更多海外牙醫來港工作。

至於為期一年的牙醫強制性實習建議，筆者認為此建議可為港大應屆畢業生提供更多的臨床工作經驗，同時在一定程度上有助於緩解公營醫療界的人手短缺問題。但對於已通過執業資格考試但未獲有限註冊或特別註冊錄取的非本地牙醫來說，他(她)們可能會認為一年強制性實習期不公平。值得注意，執照考試的難度很高，通過考試的非本地培訓牙醫人數僅為每年10至30人(註6)。

最後，筆者全力支持特區政府現代化牙醫與牙科輔助性工作人員的監管框架建議。有關建議包括：對在業持續性專業進修的正式規定、改革「香港牙醫管理委員會」組織與架構、加強對牙科輔助性工作人員的監管管制，與時並進。

並非每個國家都設有牙齒衛生員，但由於牙齒衛生員所能夠提供的專業服務，全球各地對他(她)們服務的需求呈上升趨勢。例如洗牙服務、提供護牙意見等等。牙齒衛生員與牙科治療師都可以減輕牙醫在提供基本預防性牙科護理與初級牙科護理服務方面的負擔。牙醫可以騰出手來，處理更複雜的牙科治療。由於輔助性牙科工作人員在牙科領域可以發揮重要作用，他(她)們應接受更嚴謹的監管機制。

授權「醫務衞生局」管理本地輔助性牙科工作人員培訓計劃與基準資格註冊的建議是公平的。為這批人士引入法定註冊制度，本地牙醫們應該支持。為提高與保持專業水準，發牌制度是應該的。

賦予一定程度的就業自由度，牙齒衛生員可在公共牙科服務或政府外展計劃中執業，特區政府正沿著正確的政策起草方向努力不懈。
註 1: 醫務衞生局「修訂《牙醫註冊條例》的立法建議 諮詢文件」2023年2月，第1.1及1.5段
註 2: 同前，第7頁
註 3: Dentalorg「Dentistry in Singapore

available at: https://www.dentalorg.com/dentistry-in-singapore.html
註 4: The Straits Times「Ministry of Health recognizes the lack of locally trained Singapore Dentists
11.02.2017 available at: https://adda.sg/ministry-of-health-recognises-the-lack-of-locally-trained-singapore-dentists/#:~:text=A%20report%20from%20the%20Straits,are%20Singaporean%20but%20trained%20overseas.
註 5: 行政長官2022年施政報告19.10.2022，第84段 available at: https://www.policyaddress.gov.hk/2022/public/pdf/policy/policy-full_tc.pdf
註 6: 同上，註 1 第3.5段

文：朱祖順
「中國夢智庫」醫療牙齒健康事務高級顧問
修復齒科專科醫生
香港大學牙醫學院前助理院長兼臨床副教授

文：丁煌
深圳大學基本法研究中心兼職研究員
經民聯港島支部主席，「中國夢智庫」主席
城市智庫成員，刑事辯護大律師
國際公益法律服務協會顧問委員會成員
香港法學交流基金會副主席
全國港澳研究會會員

《中國夢智庫》是一間扎根特區的非牟利團體；與心存熱誠的資深義工、專家與職業專業人士們合作，攜手「說好中國故事」。

*作者文章觀點，不代表《觀新聞》立場