Dental Registration (Amendment) Bill

5.27 pm

The Senior Minister of State for Health (Dr Koh Poh Koon) (for the Minister for Health): Mr Deputy Speaker, on behalf of the Minister for Health, I beg to move, "That the Bill be now read a second time".

Sir, the practice of dentistry constantly evolves with changes in population demographics as well as advancement in technology and materials associated with dental treatment. With Singapore having one of the world's fastest ageing populations, one of its challenges is ensuring that the needs of a growing ageing population, including dental care needs, are well provided for.

The Singapore Dental Council (SDC) ensures that there is a steady supply of dentists each year to meet the expected demand for dental services. In addition to local graduates from the Faculty of Dentistry of the National University of Singapore, the SDC also registers dental graduates from foreign universities.

The proportion of foreign-trained dentists in Singapore has risen steadily from 20%, or about 302 out of 1,484 dentists in 2008, to 36%, or 900 out of 2,475 dentists in 2019. Against this backdrop, SDC undertook a review of the process for foreign-trained dental graduates to practise in Singapore, to ensure that they meet the same high competency standards as locally trained dental graduates.

SDC assessed that two measures are needed to achieve this objective. First, the Dental Registration Act (DRA) will be amended by this Bill to require that foreign-trained dental graduates must pass a qualifying examination to be eligible for conditional registration; and second, the DRA Schedule will be revised to list the foreign universities whose dental degree holders are automatically eligible to take the qualifying examination.

This Bill gives effect to the first measure, relating to the qualifying examination, which I will explain in more detail now. The second measure, which I will touch on briefly later, will be affected by way of subsidiary legislation.

Under the current DRA, dental graduates from foreign universities looking to practise in Singapore will, typically, have to apply for conditional registration first. This means that they have to complete a period of supervised work, usually around two years, and be assessed to be competent, before they can apply to be fully registered dentists.

For the purposes of an application for conditional registration, the SDC recognises dental degrees from universities in Australia, Canada, the Hong Kong Special Administrative Region, New Zealand, the Republic of Ireland, the United Kingdom and the United States of America, which are listed in the Schedule of the DRA. If an applicant has a degree in dentistry from a foreign university listed in the Schedule and also meets the other prevailing criteria for conditional registration, the SDC may grant the applicant conditional registration.

These criteria do not currently include a requirement to pass a qualifying examination.

The SDC may also grant conditional registration to applicants who have degrees in dentistry from other foreign universities that are not listed in the Schedule. The SDC evaluates such applications on a case-by-case basis and may require that such applicants pass an examination, to ascertain that they have the minimum skills and knowledge to practise and treat patients safely and competently in our local context.

Clause 4 of the Bill amends section 14A of the DRA to introduce a requirement that foreign-trained dental graduates must take and pass a qualifying examination to be eligible for conditional registration.

This qualifying examination, which is currently already taken by foreign-trained dental graduates who do not have dentistry degrees in the Schedule, is administered by the National University of Singapore (NUS) Faculty of Dentistry and overseen by SDC. It assesses a dental graduate’s clinical knowledge and procedural skills which are fundamental to the practice of dentistry. This is similar in scope and benchmarked to the standards of the final-year examination of the NUS Faculty of Dentistry.

Section 14A, when amended, will make it a requirement for foreign dental graduates, regardless of whether their qualifications are contained in the DRA Schedule, to pass a qualifying examination to be eligible for conditional registration.

Foreign graduates who have a degree in dentistry listed in the DRA Schedule will automatically be eligible to take the qualifying examination.

Those not listed in the DRA Schedule are not automatically eligible to take the qualifying examination, but the SDC may permit them to do so on a case-by-case basis if the circumstances set out in section 14A(2) apply. The treatment of foreign graduates with degrees in dentistry not listed in the DRA Schedule will not be so different from that under the current DRA in that they already have to pass an examination to be eligible for conditional registration.

This amendment will ensure that the competency standards of foreign dental graduates who are granted conditional registration in Singapore, whether or not their degrees are listed in the DRA Schedule, are aligned with those of dental graduates who have a Singapore degree, which means someone who has obtained a degree in dentistry from NUS.

This new requirement of a qualifying examination will also ensure that foreign dental graduates are familiar with the requirements for clinical practice here in Singapore. For example, the local dental curriculum has, in recent times, sharpened its focus on core clinical general dentistry skills and more emphasis has been placed on geriatric dentistry, considering the trends in Singapore’s demographics.

Under the current DRA, any foreign dental graduate with a degree listed in the Schedule is entitled to be registered as a dentist with conditional registration, if he has secured employment with a local dental practice. With the proposed amendment, the qualifying examination will be applicable to graduates with degrees listed in the Schedule as well.

To be clear, there is no change to the regime for dental graduates with a Singapore degree. They continue to be eligible to apply for full registration directly. There is no requirement of a qualifying examination for locally trained dental graduates.

I now move on to the second measure which we will be implementing to ensure the continued quality of foreign-trained dental graduates who practise in Singapore.

This will be a revision of the DRA Schedule, which contains the list of foreign degrees in dentistry that are recognised by the Singapore Dental Council (SDC) for the purposes of conditional registration. This list is curated based on a review of dentistry degrees from foreign universities which the SDC deems prima facie to meet the standards for practice in Singapore, subject to the individual dental graduate’s proof of his skills, knowledge and competencies through the qualifying examination.

As mentioned earlier, foreign dental graduates who have a degree listed in the DRA Schedule will automatically be eligible to take the qualifying examination, unlike the foreign graduates with degrees not listed in the Schedule. Alongside these amendments introduced by the Bill, we will be revising the Schedule to ensure that the list continues to reflect degrees in dentistry from foreign universities that give their holders this automatic eligibility to take the qualifying examination. The last revision of the Schedule was in 2008 and a review is timely to ensure the continued quality of foreign-trained dental graduates who practise as dentists in Singapore.

This revision will be done by way of subsidiary legislation and is actually not part of the Bill per se. But I have highlighted this as it complements the introduction of the mandatory qualifying examination that foreign-trained dental graduates must pass to be eligible for conditional registration.

There will be a transitional period after the revision of the Schedule, where qualifications in the current Schedule will continue to be recognised and, their holders, as well as students who are already enrolled or have secured places in courses leading to such qualifications, may apply for conditional registration under the DRA.

The Bill also makes a number of miscellaneous amendments, which are to provide for payment of penalties and composition sums into the Consolidated Fund, as well as for better administration of the Act.

Mr Deputy Speaker, this Bill will ensure the continued quality of foreign-trained dental graduates and that their clinical skills and competencies are aligned with those of locally trained dental graduates, so that they can effectively meet the dental needs of our population.

Once passed, the Ministry of Health (MOH) and SDC will work closely with the dental community and other stakeholders to implement and operationalise these requirements. At present, the introduction of the requirement for the qualifying examination is planned for 1 January 2029. In the coming months, SDC will engage dental students who will be affected by these changes, to ensure that they understand the new requirements and to address any concerns that they may have. I seek Members’ support for this Bill. Mr Deputy Speaker, I beg to move.

Question proposed.

Mr Deputy Speaker: Mr Louis Ng.

5.37 pm

Mr Louis Ng Kok Kwang (Nee Soon): Sir, we are facing a supply crunch in dental care. It has become necessary for Singapore to open its doors to graduates with foreign degrees in dentistry to supplement our locally trained dentists.

As early as 2017, the Ministry recognised that there were not enough locally trained dentists to handle all the demands for dental care and set the goal of achieving a ratio of one dentist to 2,200 people. In doing so, it is also important to ensure that there is some standardisation in the dentistry care that is provided in the industry.

This Bill helps to ensure that we strike the right balance between opening our doors and ensuring consistency in the profession.

I have three points of clarification.

My first point is on the implementation of the qualifying examination for foreign degree holders. Currently, SDC already administers a qualifying examination for graduates with foreign dentistry degrees from universities not specified in the Schedule to the Dentistry Act. The amendment to section 14A will expand this requirement to all graduates with foreign dentistry degrees, whether specified in the Schedule or not.

The SDC’s website states that an applicant only has two attempts at the qualifying examination which must be taken within 12 months of each other. The feedback from the ground is that the qualifying examination is very stringent and the failure rates are fairly high. I agree that we should set the bar high for the profession. The fact that we have several graduates who are failing the qualifying examination is not a reason to lower the bar. However, we should consider giving more time. With more time to practise and study, with more opportunities to attempt the examination, many dentistry graduates may, eventually, qualify and help alleviate the supply crunch facing the industry.

Can the Minister share if the Ministry is considering increasing the number of attempts allowed at the qualifying examination? Can the Minister also share if the Ministry is considering increasing the duration of 12 months between attempts, even as a temporary measure, considering the present circumstances of the pandemic? In addition, can the Minister share whether there are plans to provide increased support or training programmes for those who are struggling to pass this examination?

Dentistry is an extremely specialised degree and these graduates have spent many years applying themselves to it. It would be a shame to end their aspirations after just two attempts at the qualifying examination, especially when it is always possible to improve.

My second point is on the alternative careers for Singaporean graduates with foreign dentistry degrees. While there is likely to always be a proportion of graduates who are not able to pass the qualifying examination, this group of graduates may, nonetheless, possess some meaningful skills from their years of higher education.

Can MOH share if there are alternative pathways within the dentistry industry where we can channel this group of graduates into, so that these graduates can, nonetheless, pursue a career in this industry and help, again, to reduce our supply crunch?

My final point is on the present status of the dentistry industry. It is apparent from the 2019 Dental Association survey that we are some distance from easing the supply crunch. Can the Minister share more details about its progress in meeting the goal of the ratio of one dentist to 2,200 people? How effective has the measures adopted since 2017 been in easing the supply crunch? Are there plans to further increase the local intake of dentistry students to meet the population’s dentistry care needs?

Sir, notwithstanding the above clarifications, I stand in support of the Bill.

Mr Deputy Speaker: Dr Shahira Abdullah.

5.41 pm

Dr Shahira Abdullah (Nominated Member): Mr Deputy Speaker, I start by declaring my interest as a locally trained dentist in a public hospital.

For my speech, I will focus on the proposal to register all graduates who hold a foreign degree in dentistry, to pass a qualifying examination before they are granted conditional registration to practise as dentists in Singapore.

Firstly, I would like to say that I believe this is long overdue. Having the qualifying examinations ensures that the competencies of foreign graduates are aligned with the competencies of graduates holding a Singapore degree in dentistry. This protects the public by ensuring that only dentists who are adequately trained and qualified are eligible to start practising under conditional registration. This is already present in most other overseas jurisdictions and, with this, Singapore is actually aligning itself with the rest of the world.

Secondly, though I welcome this proposal, I do have some concerns regarding the implementation timing. At this juncture, there are many young students who are already enrolled in overseas universities who are part of the Schedule. They did so, particularly aiming for these universities, so they would not need to take the qualifying examinations. Therefore, I believe it is only fair to carry out these policies prospectively, giving them a few years, taking into account students who have already been accepted into these universities or who are unable to start the degree programme yet due to circumstances, such as National Service.

Thirdly, I do have some queries regarding section 14A which states that “any person who does not hold a Singapore degree or a degree from a specified university may also sit for the qualifying exam if the degree the person holds is, in the opinion of the Council, not lower in standing than the specified degrees.” May I know if the Council will be having a set of objective criteria to determining the quality of these foreign degrees?

I am, however, glad that the Ministry said that it is going to review the Schedule and adding universities or deleting universities from the Schedule, because I believe it will have more clarity for the students who are involved. For example, in my work with youths, I have encountered families who have decided to send their children to study in non-accredited universities just to help them realise their children's dreams. This kind of clarity will allow such families to make more informed decisions when preparing for entrance examinations before university.

Similarly, in subsection (b), clarity will also be beneficial in how the Council determines if a person has “a standing that is not lower than that of a local practitioner”. This is because the assessment has to be made before they are permitted to even take the qualifying examinations, which aim to peg their skills to the skills of a local practitioner.

Fourthly, I would also like to clarify what sort of circumstances MOH is envisaging would be of public interest to allow a graduate to sit or not sit for the qualifying examination.

Lastly, on the basis of the qualifying examination, it is based on the final examinations and competencies criteria of the dental graduates in Singapore. I think this is a fair benchmark to aim for.

However, there will be instances in which these young Singaporean graduates with foreign degrees may fail this examination and this may be due to a variety of reasons. For example, as an orthodontist and dentist myself, I have learnt that certain dental principles have to be applied to the local context. Dental graduates from foreign universities may not be so well-versed in, for example, the Singapore public health aspects, or that a Caucasian face would need a different treatment plan, as compared to the Asian face, or the fact that the range of common diseases changes from country to country, which means their experience and skills may differ accordingly.

The current guidelines dictate that the qualifying examination may be taken a maximum of two times. May I suggest increasing this but within reasonable limits, especially for the Singaporean graduates who have invested significantly in their dental education.

The serious implication that we must take into account is that after failing these qualifying examinations, the young graduate is, practically, unable to practise dentistry in Singapore. They are forced to look for alternative career pathways and maybe not even practise dentistry at all.

Another situation I feel we should think about is the fate of the young graduates with foreign degrees who come from families which are not so well-off. They are not able to work while doing the qualifying examination, which takes about a year to complete. If they fail, this may extend to another year, which may have a big impact on the family’s finances.

A suggestion I have is to provide some sort of scaffolding for these young dental graduates who may need help in retuning their skills to the local context. This can be in the form of short optional courses they can apply for, which the Dental Council can conduct. These young graduates are, essentially, our next generation of dentists and we should give them the support they need so that we do not lose our talents, especially as we aim to raise the standard of dentistry in Singapore.

Before I end, I would also like to wish a Happy Nurses’ Day to all the nurses who are such an integral part of the healthcare system, for their hard work, dedication, contributions and sacrifice, especially during this COVID-19 pandemic. Thank you!

Mr Deputy Speaker, Sir, notwithstanding those questions, I support the Bill.

Mr Deputy Speaker: Mr Ang Wei Neng.

5.46 pm

Mr Ang Wei Neng (West Coast): Mr Deputy Speaker, Sir, the Dental Registration (Amendment) Bill will require the increasing proportion of foreign-trained dentists in Singapore to be subjected to the mandatory Qualifying Examinations. This is to ensure that their competency and standards are aligned with those of local dental graduates.

I support the amendment Bill. Quality dental care is something which all Singaporeans will benefit from.

However, I want to take a step back to question the current system of training dentists and the target dentist-to-population ratio. It appears to me that we are introducing these amendments because we do not have enough Singapore-trained dentists and we want to make sure that those who studied dentistry overseas are of a good standard.

Why do we not train more dentists in Singapore? Back in 2017, a Straits Times article had already pointed out that Singapore was not training enough dentists to meet the needs of a growing and ageing population. The proportion of foreign-trained dentists in Singapore had risen significantly from 20% in 2008 to 36% in 2019. In 2019, 900 out of a total of 2,475 dentists were foreign-trained. I also understand that many of those who have obtained their dentistry degree overseas are Singaporeans and PRs.

This is not surprising as the Faculty of Dentistry at the National University of Singapore only has a small intake of 44 students in 2008, although it has increased to 80 this year. Even then, many Singaporeans who have very good grades, many with perfect university admission score of 90 points, cannot get into dentistry. As a result, many of the rejected aspiring dentistry students have to ask their families to fork out a fortune for them to pursue a dentistry degree overseas.

Thus, I would like to ask the Senior Minister of State if MOH can consider increasing the capacity of the dentistry course at NUS. If NUS has no capacity, can we consider opening up another dental school in say, NTU, to meet the aspiration of Singaporeans and solve the insufficient supply of dentists in Singapore? Or is there an intention to restrict the numbers of locally-trained dentists?

Ultimately, how many local and overseas trained dentists we need is contingent on the target dentist-to-population ratio. I understand MOH’s target ratio is one dentist to 2,200 people. Is that enough?

Currently, our dentist to population ratio is one is to 2,304, an improvement from one is to 3,215 in 2010. The question is: how do we derive the target of one dentist to 2,200 people?

Comparing to other countries’ dentist-to-population ratios, South Korea’s was one is to 2,000 in 2018; United States was one to 1,638 in 2020; Israel's was one is to 1,400 in 2017; Japan's was one is to 1,250 in 2014. So, is Singapore’s target of one is to 2,200 too conservative a figure?

Today, MOH recommends we consult a dentist twice a year. How many Singaporeans really consult a dentist every six months? Many Singaporeans that I know of do not. Why? The cost of scaling and checking your teeth by a dentist in an HDB estate will easily set you back by more than $100 and it is not mandatory for companies to provide dental benefits.

If you want to save some money and consult a dentist at a polyclinic, it will cost you about $30 to $50 but you have to wait for months before you can make an appointment to see the dentist in the polyclinic. Why is this so? Is it because MOH does not consider oral health as basic healthcare? Or is it a way to suppress the need to increase the dentist-to-population ratio?

Meanwhile, we understand that blue Community Health Assist Scheme (CHAS), Merdeka and Pioneer Generation cardholders receive subsidies when they visit private dentists for routine check-ups. To make oral care more affordable, I would like to appeal to MOH to extend the subsidies to orange and green CHAS cardholders. At the same time, I would like to appeal to MOM to make it compulsory for all companies to provide workers with dental benefits in Singapore. Mr Deputy Speaker, Sir, in Mandarin, please.

(In Mandarin): [Please refer to Vernacular Speech.] MOH has advised Singaporeans to see a dentist twice a year. However, it is expensive to see a dentist. It would cost over $100 even if you have your teeth cleaned at a neighbourhood dental clinic. If you want to save money by going to a polyclinic, you will have to wait a few months before you can see a dentist.

Fortunately, blue CHAS cardholders, Merdeka and Pioneer Generation Singaporeans can enjoy subsidies when they go to private dental clinics. However, green and orange CHAS cardholders do not get subsidies. Moreover, most employers do not give dental benefits to their employees. In other words, most Singaporeans only wait until they have a toothache before they see a dentist. This is not good. Hence, I suggest that MOH consider giving dental subsidies to green and orange CHAS cardholders. I also hope that MOM will also make it compulsory for employers to give dental benefits to their employees so that most Singaporeans can visit a dentist regularly and have affordable dental care.

If Singaporeans can afford seeing a dentist, there would be a corresponding increase in the demand for dentists. Are the current 2,475 dentists sufficient to meet the demand of Singaporeans? At the same time, we have to take into account the fact that an ageing population would have increased demand for dentists.

If there is a shortage of dentists in the short term, we will need to recruit a large number of foreign graduates to make up for the shortage of local dentists. The Dental Registration (Amendment) Bill will make it compulsory for foreign graduates to pass the local dental examinations to ensure that their skills are comparable to those of local graduates. I, therefore, support the Dental Registration (Amendment) Bill.

In the long run, NUS should consider increasing the number of dental students. The current number of 80 per year does not meet the demand of Singaporeans for dentists, much less the large number of students who apply for dentistry every year. As a result, many outstanding students have to pay high tuition fees to study dentistry abroad.

(In English): Mr Deputy Speaker, Sir, we hope that MOH could revamp the dentistry industry in Singapore and provide more subsidies for dental care. Otherwise, Singaporeans who opt to see a dentist at the polyclinic have to "dan gu gu" or "wait long long". If you cannot wait and have to see a private dentist, then you have to pay "high high", and this is not ideal.

Mr Deputy Speaker: Mr Yip Hon Weng.

5.54 pm

Mr Yip Hon Weng (Yio Chu Kang): Mr Deputy Speaker, dental health is important, as oral diseases affect people throughout their lifetime. Although these diseases are less likely to cause death, they can pose significant morbidity.

We need more dentists to meet Singapore’s oral health needs, especially in the public sector. Indeed, with an ageing population, the demand for dental services are not only increasing, but also changing due to more complex dental needs of elderly patients. I see many seniors in my constituency who require dental care. For example, a resident, Mr Tan, told me that he had never visited a dentist in his life. It was only after participating in Project Silver Screen and seeking dental care at a mobile dental clinic deployed at Yio Chu Kang CC that he discovered that he needed dental implants.

Indeed, the importance of dental care rises in old age. Cultivating good oral hygiene habits reduces the chances of dental and other health issues in the future.

Among advanced economies, the top three countries with the largest ratio of dentists per 10,000 population are Sweden, Norway and Spain, based on the latest data available in 2018. Sweden's ratio of dentists per 10,000 population stands at 17.9, Norway’s is 8.7 and Spain's is 8.1. In Singapore, there were about 4.1 dentists per 10,000 residents. The discrepancy is significant. So, we need to up our number of dentists in Singapore.

Mr Deputy Speaker, there are many Singaporeans who want to do dentistry. However, enrolment is very competitive, because the spaces in NUS are limited. Every year, there are between 50 and 60 dentistry graduates from NUS. From there, some stay in general dentistry or specialise. These range from orthodontics, prosthodontics, paediatric dentistry and so on. Hence, the training of aspiring dentists is not just a four-year programme. Many who cannot get enrolled into NUS have gone overseas to pursue their studies.

I have two suggestions.

First, Mr Deputy Speaker, we need to better align the professional qualifications for our dentists. It is important to have more competent and well-trained dentists in Singapore. However, we should ensure that there is alignment in accrediting and consistency in our dentists’ professional skills. This is because they may come from a variety of foreign universities.

Nevertheless, why is it that while their universities are listed in the approved Schedule, yet there is now a move requiring graduates from these universities to take a qualifying exam (QE) when there was none previously from the many years before? Has there been a change in the quality of graduates from some of the universities? The amendments to the Dental Registration Bill make the QE mandatory for all foreign-trained dental graduates with qualifications in the Schedule as well. Can the Minister clarify why the Ministry does not just refine the list of approved universities in the Schedule, to remove the universities that do not produce graduates on par with local graduates, instead of imposing a QE?

Similarly, what is the timeline for the implementation of this QE? Will the current students who have already been enrolled in these foreign universities be made to undergo a QE when they choose to return to Singapore to practise? There may be some anxieties that existing Singaporean dentistry students in overseas universities will be affected.

Second, Mr Deputy Speaker, the Government should consider opening up the intake for dentistry in Singapore without compromising the enrolment standards. We only have one dental school in Singapore, in NUS. On the other hand, we have three medical schools in Singapore: the Yong Loo Lin School of Medicine, the Duke-NUS Medical School and the Lee Kong Chian School of Medicine at NTU. Can we attract more foreign specialised universities to set up dental schools together with our universities? Is it possible for NUS to increase its intake? In this way, many of the students need not go overseas for their training. This would, in a way, reduce the number of returning overseas dental graduates.

In conclusion, Mr Deputy Speaker, I appreciate that the overall aim is to get more dentists to practise in Singapore and, at the same time, uphold the quality of practitioners. We all know dentistry is more than just extracting a tooth or doing an implant. Dentists are essential in maintaining oral health in our population, especially for our seniors. Moreover, good oral health can make a difference. It allows one to eat well, speak well and age well. Last but not least, it keeps that smile going. Sir, I support the Bill.

Mr Deputy Speaker: Senior Minister of State Koh Poh Koon.

5.59 pm

Dr Koh Poh Koon: Mr Deputy Speaker, Sir, I thank the Members who have spoken for their support of this Bill. I will address the queries that they have raised in their speeches.

In my opening speech, I outlined the need for a steady supply of dentists each year to meet the expected demand for dental services by Singaporeans.

Mr Yip Hon Weng expressed concern that we need to increase our number of dentists in Singapore. Singapore, indeed, has a lower ratio of dental professionals per capita, as compared to the Organisation for Economic Co-operation and Development (OECD) countries.

Hence, the DRA Schedule was revised comprehensively in 2008 to allow for the registration of a wider range of foreign dental qualifications. The dental workforce has experienced a 3% to 5% year-on-year growth since then.

Let me now come to the issue of the present status of the dental workforce raised by Mr Ang Wei Neng, Mr Louis Ng and Mr Yip Hon Weng.

To ensure adequate supply and continuity of dental care for Singaporeans, we have also increased our dental training pipeline to meet the growing dental care needs of our ageing population and to ensure a target ratio of one dentist to 2,200 people or 0.45 dentist per1,000 population by 2030.

The student intake into the NUS Faculty of Dentistry has, historically, been derived based on targeted dentist-to-population ratios.

Predicting how many dentists we will need in the future is actually not a very easy task. There are factors to consider, including population demographics that evolves over time, the different dental awareness amongst the population and also the health-seeking behaviour of our people.

Singapore currently, has 0.84 visits to the dentist per capita per year. This is low, compared to the average of 1.3 in the OECD nations.

We project an increase to one visit to the dentist per capita per year by 2030 and, with that, we will require a ratio of one dentist to 2,200 population by 2030. The annual intake into the NUS Faculty of Dentistry has increased by 36% from 44 in 2008, to 60 in 2018. Based on our service planning parameters, with the increased dental student intake of 80 this year, we expect to be on track to reach a target dentist-to-population ratio of one to 2,200 by 2030. And we will, of course, continue to look at the evolving needs and to adjust the NUS Faculty intake where necessary.

As pointed out by Mr Yip Hon Weng, it is important to have competent and well-trained dentists in Singapore. I could not agree more. All of us who ever see a dentist will want the dentist to be competent.

Currently, foreign-trained dentists who have graduated from the universities on the DRA Schedule can apply to register to practise in Singapore, if they fulfil the requirement to secure employment with a dental clinic or a healthcare institution, which is largely driven by market forces. This employment requirement will still be applicable when the new measures come into force.

Given the high degree of variability in overseas clinical practices and the dental curriculum of overseas universities, based either on the DRA Schedule or otherwise, the qualifying examination is, therefore, an important assessment to determine the clinical skills and competencies of a dentist, which are fundamental to the practice of dentistry and thus would ensure that the quality and competencies of foreign-trained dental graduates who are eligible to register and practise in Singapore remain high.

The qualifying examination, which is administered by the NUS Faculty of Dentistry, is benchmarked to the final-year professional dental examination that locally-trained dentists are required to pass before they can obtain their Bachelor of Dental Surgery degree from NUS. As such, the qualifying examination should be required for foreign-trained dentists applying for conditional registration, irrespective of their nationality.

I turn now to address Dr Shahira Abdullah's and Mr Louis Ng's queries on the number of attempts allowed for the qualifying examination.

To recap, the qualifying examination comprises three parts and the candidates will be provided with the qualifying examination syllabus and related preparatory materials.

For foreign-trained Singapore Citizens and Permanent Residents who pursue dental qualifications found in the DRA Schedule and wish to practise in Singapore, there will be no cap on the number of attempts to pass each part of the qualifying examination.

For other foreign-trained dentists who pursue dental qualifications found in the DRA Schedule and who wish to practise in Singapore, there will be a cap of two attempts to pass each part of the QE, with each second attempt having to be within 12 months of the first attempt. This has been the practice currently and there will be no change to this. Historically, in the final Bachelor of Dental Surgery degree examination here in NUS, over 90% of local students passed on their first attempt and close to 100% passed by the second attempt.

Hence, a two-attempt cap for non-residents, which is the current practice, is a reasonable benchmark for ensuring the standards of those taking the qualifying examination is on par with our local graduates.

For foreign-trained dentists, irrespective of nationality, who pursue dental qualifications not found in the DRA Schedule and wish to practise in Singapore, SDC will review their applications on a case-by-case basis and allow dentists of good repute who meet the requirements to take the qualifying examination to assess their competency to practise in the local context.

Dr Shahira Abdullah asked how SDC assesses the eligibility of foreign-trained dentists who do not hold a Singapore degree or a degree from a university specified in the DRA Schedule, to sit for the qualifying examination.

As stated in the DRA, this is left to SDC's discretion. SDC has, generally, allowed foreign-trained dentists to take the qualifying examination so long as the university from which they attained their basic dental degree is recognised by the respective dental regulatory body of the country. The teaching medium is in English, failing which, the dentist must take and pass an English Language proficiency test. And thirdly, if they meet other requirements, like having an offer of employment and whether the foreign-trained dentist has a connection to Singapore, such as being a Singaporean/Permanent Resident (PR) or married to a Singaporean/PR or children of PRs, for example, as published on SDC's website.

Mr Yip Hon Weng was concerned about the timeline for the implementation of the qualifying examination requirement as this may affect existing overseas Singaporean dentistry students.

I think it is a fair concern. But I want to reassure Members that there will be a transition period of seven years whereby foreign-trained dentists will still be able to apply for conditional registration under the existing regime under the current DRA, as the implementation of the qualifying examination is intended to only be effective from 1 January 2029. This means that students who are currently enrolled in or have secured places in dentistry courses overseas and will graduate before 1 January 2029, as well as foreign-trained dental graduates who already hold basic dental qualifications from universities on the DRA Schedule will not be affected by this change and will be considered for conditional registration to practise dentistry in Singapore if they fulfil the requirements under the current DRA.

Mr Yip Hong Weng has asked for clarification on why the Ministry does not just refine the current DRA Schedule by removing universities that do not produce graduates on par with local graduates, instead of imposing this qualifying examination.

In relation to the DRA Schedule, the SDC has reviewed local and overseas practices to assess the clinical competence and eligibility of a dentist for registration.

Jurisdictions, such as Canada, Hong Kong SAR and Thailand have adopted a national examination regime for foreign-trained dentists. Countries, such as Norway and Germany, use a Schedule of schools with exemptions on a case-by-case basis for non-citizens. Countries, such as Denmark, Ireland, Sweden, United Kingdom, United States of America, Australia and New Zealand have adopted a hybrid of Schedule and national examination, based on citizenship, location of dental training or licence. And as Dr Shahira Abdullah has pointed out, the QE is, in fact, present in many overseas jurisdictions and, with these amendments, Singapore would be in alignment with the rest of the world.

Additionally, SDC has reviewed the international rankings of the 89 universities in the DRA Schedule.

Most of the top-ranked schools in the latest international rankings, which are primarily based on academic/employer reputation and research citations, are not in the DRA Schedule. Together with the variation in dental practices and training across overseas universities, international rankings would, therefore, be less relevant for the purpose of removing universities that may not produce foreign dental graduates on par with local graduates.

Given that the majority of our foreign-trained dentists have graduated from a selected number of foreign dental schools, SDC will curate a more concise list of recognised basic dental qualifications to ensure the relevance of the Schedule. We will remove 27 schools that SDC has not received any registration over the past 12 years. The list of overseas dental schools and universities in the Schedule will be reduced from the current 89 to 62. SDC will make available the revised Schedule by end 2021.

Sir, I would like to conclude by addressing Mr Ang Wei Neng's query on making dental services affordable, especially for our ageing population.

I must clarify that, in contrast to what Mr Ang Wei Neng has said earlier, MOH actually has no guidance for a twice-a-year visit to a dentist. In fact, we are already moving to a risk-based approach, which is what is practised in the UK as well. For example, those who are deemed to have low dental risks actually may only need to see the dentist once every two years. So, this is more of a risk-based approach. And in the context of our local practice, we also have upstream basic care given to students in the schools. So, it is to be seen in the context of a holistic dental care ecosystem and not just at the primary care level, when the person has become an adult.

MOH monitors and reviews primary care dental capacity provided by private CHAS dental clinics and public polyclinics, both of which provide subsidised dental services. There are, currently, over 800 CHAS dental clinics islandwide.

Pioneer Generation, Merdeka Generation, as well as Community Health Assist Scheme (CHAS) Blue and Orange card holders, enjoy subsidies for selected basic dental services at private CHAS dental clinics. Singaporeans can also look forward to dental services in the upcoming polyclinics, such as Bukit Panjang and Eunos Polyclinic, which are scheduled to open this year.

Sir, I would like to assure Singaporeans that MOH will ensure that dental care will remain accessible, affordable and of good quality by competent dentists.

Mr Deputy Speaker, I would like to express my gratitude to the Members who have spoken on this Bill. Their questions and comments have provided valuable insight on the areas that we should focus on when implementing these measures. I am heartened at their support.

I should reiterate that, as I have mentioned in my speech earlier, for these proposed measures to ensure the continued quality of foreign-trained dentists seeking to practise in Singapore, we will need the support of the dental community to help implement and operationalise these amendments.

I am confident that these amendments will go a long way to ensure the continued high quality of foreign-trained dentists to complement our dental workforce in Singapore.

Mr Deputy Speaker: Dr Shahira Abdullah, you have a clarification?

6.12 pm

Dr Shahira Abdullah: I thank the Senior Minister of State for his comprehensive reply. I just have two points of clarification.

Moving forward, may I ask if the Ministry will consider reviewing the DRA Schedule more regularly because the last one was actually quite a while back and a lot of things have changed since then.

Secondly, is it moving forward in a manner in which to only allow those from schools on the DRA Schedule to take the qualifying examination, for better clarity of all those involved, instead of depending on SDC?

Dr Koh Poh Koon: Sir, I thank the Member for her questions.

On the review for the DRA Schedule, yes, I think we can review it periodically. But I think that the key is in the fact that dentistry is more of a practice where you actually do things with your hands, whereas the ranking of dental schools is not necessarily in conjunction with the quality of the practice of the person but more so depending on citations, research outputs, which does not necessarily translate into actual dental practice. So, the reputation of the school itself could well be more biased towards academia and research. What we want to do then is to put in place a qualifying examination where we can ascertain the actual quality, in terms of competency, skills and ability to perform a procedure, for example, of a foreign-trained graduate.

So, that leads me to the Member's second question, which is, when will SDC be the one that takes a case-by-case approach. In fact, actually, if the graduates are from the Schedule list after this amendment and they can secure employment, they will all, automatically, be eligible for the qualifying examination, the difference being, if you are a Singaporean/PR, you can take it many times. But if you are a non-Singapore/PR, you may only take it with a cap of two times within a 12-month period.

For those that SDC needs to make a decision, those are graduates who are not within the list itself, that means, if you take a degree that is outside the Schedule list, then you will need to have SDC look upon your application on a case-by-case basis, before the person can be allowed to take the qualifying examination. I hope that clarifies the Member's questions.

Question put, and agreed to.

Bill accordingly read a Second time and committed to a Committee of the whole House.

The House immediately resolved itself into a Committee on the Bill. – [Dr Koh Poh Koon].

Bill considered in Committee; reported without amendment; read a Third time and passed.