Twenty-two-year-old Hillary Chua, who has quadriplegic cerebral palsy and uses a wheelchair, depends entirely on her 57-year-old mother, Ms Cindy Wong, for daily care, including oral hygiene. The search for a dentist trained to manage her daughter’s complex condition had long been a challenge. During the Covid-19 pandemic, dental visits stopped completely. In 2024, when Ms Wong noticed a strong odour from her daughter’s mouth, they were referred to the National University Centre for Oral Health Singapore (NUCOHS).
There, Dr Tay Chong Meng, division head of advanced general dental practice, assessed Ms Chua and developed a personalised treatment plan focused on her comfort and safety. This included working with Ms Wong to support her daughter’s head during treatment and testing different approaches to access her inner teeth, given her limited ability to open her mouth.
Dr Tay is part of Singapore’s growing group of special care dentists – a field that gained official recognition in July when the Ministry of Health (MOH) confirmed that the Dental Specialists Accreditation Board (DSAB) would designate special care dentistry as the country’s eighth dental speciality.
MOH noted that the decision reflects a growing demand for specialist dental care, particularly with Singapore’s ageing population. Special care dentistry serves adults who cannot undergo routine dental procedures due to physical, developmental or cognitive conditions.
Such individuals are more vulnerable to oral diseases like caries and periodontal disease, which can severely affect their oral function, general health and quality of life. According to MOH, recognising this speciality supports professional development and encourages dentists to undertake advanced training.
DSAB will be responsible for setting standards and strengthening training to ensure high-quality care. Special care dentistry is also recognised in other countries, including Australia, Malaysia and the UK.
While the field is not defined by specific procedures, its practitioners are trained to understand the interplay between medical conditions and oral health, along with behavioural management strategies. For instance, patients with autism spectrum disorder or Down syndrome may become anxious during dental procedures.
“Careful use of suction, with a lot of reassurance and distraction, will help reduce the anxiety triggered by involuntary salivary flow whenever the mouth is stretched for dental assessment and treatment,” said Dr Tay.
NUCOHS and the National Dental Centre Singapore (NDCS) are equipped with tools like wheelchair-tilters, allowing patients to remain in their chairs during treatment.
Dr Tay highlighted that people with special needs and their caregivers often struggle to find dental practitioners confident in managing complex cases. “This recognition is also an acknowledgement of the work and efforts by our colleagues to manage the oral health challenges of people with special needs,” he said.
Dr Yang Jingrong, head of the Geriatric and Special Care Dentistry Clinic at NDCS, described the move as a validation of the “unique skill set and expertise required in treating patients with special needs.” She added that it provides “an improved professional identity and better defined scope of practice.”
Dr Tay noted a rise in visits by special needs patients to NUCOHS, increasing from about 1,200 in 2022 to approximately 1,500 in 2023. This could be due to increased awareness and the availability of government subsidies for special needs outpatients.
He explained that while basic procedures typically take only slightly more time for special needs patients, some cases require significantly longer – potentially spread over multiple appointments. For example, patients with substantial tartar under the gums may need several visits to build confidence for scaling procedures.
The dental team also collaborates with caregivers to establish manageable home oral care routines, such as using water picks for patients uncomfortable with flossing. Targeted dental products can also play a role.
“Improved access to certain therapeutic products, such as high-strength fluoride toothpaste, can allow the caries – or tooth decay – risk to be controlled more appropriately, enhancing the preventive benefits of these products to persons with special healthcare needs,” said Dr Yang.
She also emphasised the importance of educating caregivers on oral care techniques and necessary modifications for individuals with swallowing difficulties or cognitive impairment.
For Ms Wong, the support from NUCOHS has made a significant difference. Despite living in Punggol, she continues to bring her daughter to Kent Ridge for treatment. Dr Tay helped ease Ms Chua’s fear of doctors – a result of previous surgeries – by calling himself “uncle” and adopting a friendly approach.
“It was the first time I met a doctor who called himself ‘uncle’,” Ms Wong said.
Source: Straits Times
