By 2030, one in four Singaporeans will be over 65 years of age, according to data from the Ministry of Health (MOH). With a booming ageing population due to increased life expectancy, there is rising demand for care for chronic dental conditions.

“Robust primary dental care support is important to ensure a strong and sustainable network where patients have easy access to affordable treatment across different healthcare settings. With an ageing population, close partnerships with primary care providers are more vital than ever,” said Dr Wu Siwen, Consultant, Department of Restorative Dentistry, and Head, Community Partnerships, National Dental Centre Singapore (NDCS).

Resource allocation

NDCS’ Care Partnership Programme (CaPP) was launched as a collaborative partnership with community dentists to support the co-management and right-siting of dental cases. Under this programme, NDCS patients with stable and low-risk dental conditions will have their care transited to General Dental Practitioners (GDPs) located within their community. These conditions include selected gum and root canal treatments, single crowns, and dentures. This allows patients to seek treatment at GDPs conveniently, with assurance that a specialist has assessed their condition as stable. Specialist resources at NDCS can then focus on managing complex dental conditions. Optimal care is thus ensured for every patient, explained Dr Wu. Patients who are at higher risk of disease deterioration will continue to receive care from both NDCS and community care partners under CaPP’s Shared Care model. This includes patients who suffer from medical conditions and have other risk factors, such as diabetes and smoking respectively, which may cause them to be more susceptible to certain gum diseases. Following visits with GDPs, these patients may be required to do follow-up consultations with NDCS specialists six months later to ensure careful assessment of recovery.

CaPP reflects MOH’s vision of extending care of patients beyond the hospital to the community. “As a national specialty centre, NDCS has to keep abreast of the changing needs of the population so that we can effectively serve our patients. Through this programme, we work closely with our community care partners and tap on available resources to ensure a continuum of care for our patients,” said Dr Wu.

<<Clinical Associate Professor Poon Choy Yoke, Director, NDCS; Dr Chng Chai Kiat, Chief Dental Officer, Ministry of Health; Clinical Associate Professor Teoh Khim Hean, Deputy Director (Clinical and Regional Health), NDCS, at the opening of the Care Transition Office at NDCS.>>

Benefits of right-siting

Patients can choose to visit their preferred dentist, or have NDCS match them with a dental partner located in their community.

There are multiple benefits in anchoring patients in their community. Keeping costs affordable is one tangible benefit, as treatment fees at participating GDP clinics are capped at a maximum amount for basic and intermediate dental care.

The convenience of receiving treatment closer to home is also important. “Patients have greater flexibility to visit their dentists after work and on weekends, without the hassle of travelling. Receiving long-term care for chronic dental conditions from a dedicated GDP also ensures that patients are well taken care of by a professional most familiar with their dental and medical history. A close-knit dentist-patient relationship can be established,” Dr Wu said.

Implementing this shift to community dental care is not without its challenges. “Some patients feel that all their dental needs should be addressed at NDCS and are unsure of the quality of care they would receive at GDP clinics,” explained Dr Wu.

To address this, NDCS has been educating patients, facilitating smooth transitions through assisting with dental appointments, and working to build patients’ trust in GDPs.

It is also working closely with GDPs to effectively transit the care of patients. A framework has been developed to evaluate the care delivered and to monitor patient outcomes. Dentists are also required to complete a series of workshops and lectures to upgrade their skills and align themselves with NDCS’ mission of championing joint care for patients.

Future of dental care

Since CaPP was launched in 2017, NDCS has successfully rightsited more than 600 patients to dentists within the community. The majority of patient feedback has been positive.

“Patients have found that the community dentists provide good services and are able to provide detailed explanations of their conditions. Their clinics are also closer to home, and hence more convenient,” Dr Wu said.

GDPs involved have also responded positively to the collaboration. “CaPP has allowed me to actively contribute to this national effort of improving dental care,” said Dr Hong Qixian, a GDP.

“Continual education by the specialist-led programme has also helped me align my skills to the expected standard of a public healthcare institution. I hope to see more cross-referral integrations in the future,” he added.

Such plans are already in the pipeline. NDCS intends to expand the programme to engage more dental partners and include other procedures, such as advanced root canal treatments.

“We hope to grow the current pool of 36 dental partners to 60 by 2022. Once the pool of dental partners is sizeable, they can even set up their own primary care network, which will enable a more seamless collaboration with NDCS,” said Dr Wu.

“Dental care is a responsibility that needs to be shared by every healthcare worker. We need to ensure that patients get the right care from the most suitable providers in the right setting and at the right time,” she said.