Following is a question by the Hon Lam Chun-sing and a written reply by the Secretary for Health, Professor Lo Chung-mau, in the Legislative Council today (October 30):

Question:

     Regarding dental care professionals (DenCPs), will the Government inform this Council:

(1) of the following information on the Department of Health (DH)'s recruitment exercise for dental hygienists, dental therapists, dental technicians and dental surgery assistants in each of the past five years: the (i) target number of recruits, (ii) number of applicants, (iii) number of persons invited to attend interviews/trade tests, (iv) number of persons who passed the interviews/trade tests, (v) number of appointment letters issued and (vi) number of persons who reported for duty;

(2) as the Working Group on Oral Health and Dental Care under the Health Bureau has pointed out in the Interim Report submitted to the Panel on Health Services of this Council in March this year that merely relying on the dentist workforce to meet the needs for enhancing dental care services is insufficient, and suggested that DenCPs play a more significant role in dental care services, whether the authorities have plans to expand the staff establishments of dental hygienists and dental therapists so as to enhance public services; if so, of the details and timetable; if not, the reasons for that;

(3) as DH currently provides annual tuition fee sponsorship of $70,000 to students pursuing studies as dental hygienists and dental therapists on the condition that they work in dental clinics under DH or specified non-governmental organisations for one year after graduation, how the authorities plan to attract those graduates to stay and serve in the public healthcare system upon the expiry of the one-year period;

(4) as there are views pointing out that the introduction of a statutory registration system for DenCPs (including dental hygienists and dental therapists) with their scope of practice defined under the Dentists Registration (Amendment) Bill 2024 (the Bill) has fundamentally altered the work nature, duties and work complexity of the dental hygienist and dental therapist grades in the Government, whether the authorities will commence a grade structure review for the aforesaid grades to comprehensively examine their entry requirements, qualification requirements for various ranks and remuneration packages; if so, of the timetable and roadmap; if not, the reasons for that;

(5) as the authorities indicated during the Second Reading debate on the Bill that they expected the Dental Council of Hong Kong (DCHK) to set up a registration system for DenCPs within three years upon the passage of the Bill, of the timetable and roadmap for the relevant work (including compiling a DenCPs register and drawing up a code of practice); whether they have plans to include dental technicians and dental surgery assistants in the registration system in phases, so as to enhance the protection for users of dental services; if so, of the details; if not, the reasons for that;

(6) whether the authorities will consider discussing with DCHK to further relax the scope of practice of dental hygienists to allow them to administer anaesthetic injections for periodontal disease and root canal treatments, as well as other non-invasive treatments, and to include relevant contents such as the procedure for administering anaesthetic injections in the training curriculum of dental hygienists; if so, of the details; if not, the reasons for that;

(7) whether the authorities have plans to further expand the participation of DenCPs in the primary healthcare system, including allowing them in the provision of oral healthcare at District Health Centre Expresses and District Health Centres, as well as dental health education and disease prevention services; if so, of the details; if not, whether the authorities will formulate the relevant plans expeditiously; and

(8) whether it has considered including DenCPs as healthcare service providers under the Elderly Healthcare Voucher Scheme to encourage the elderly to receive dental care services on a regular basis; if so, of the details; if not, the reasons for that?

Reply:

President,

     The Hong Kong Special Administrative Region (HKSAR) Government established the Working Group on Oral Health and Dental Care (Working Group) in December 2022 to review the policy objectives, implementation strategies, service scopes and delivery models, etc, of oral health and dental care, with a view to safeguarding the oral health of members of the public. The Working Group mentioned in its interim report released in December 2023 that the Government should work in line with the strategies set out in the Primary Healthcare Blueprint and aim at preventing oral diseases and enhancing the oral health of the community on the premise of improving oral health of all citizens. The report also mentioned that it is insufficient to merely rely on the dentist workforce to meet the needs for enhancing dental care services, and that ancillary dental workers, including dental hygienists and dental therapists, could play a more significant role in dental care services.

     The HKSAR Government has completed the amendment of the Dentists Registration Ordinance (Chapter 156) (DRO) to modernise the regulatory framework for dentists and ancillary dental workers (including dental hygienists and dental therapists), and increase the manpower resources for dental care profession by gradually increasing training places for dental hygienists and dental therapists. The measures above will contribute to the implementation of the recommendations of the Working Group, allowing ancillary dental workers to play a more significant role in providing more preventive primary dental care services to complement the direction of the Primary Healthcare Blueprint which attaches importance to prevention, early identification and timely intervention.

     The consolidated reply in response to the questions raised by the Hon Lam Chun-sing is as follows:

Registration system and scope of work of dental care professionals

     The amended DRO introduced a statutory registration system for two classes of ancillary dental workers (including dental hygienists and dental therapists) and retitled ancillary dental workers as dental care professionals (DenCPs), so as to ensure their service quality through a more formalised regulatory regime and establish their professional status.

     At present, dental hygienists can work in public or private sectors, and may perform preventive dental care (e.g. education, consultation, risk assessment, oral examination, fluoride application and scaling) in accordance with the directions of a dentist who is available in the premises at all times when such work is being carried out. Dental therapists work exclusively under the Department of Health (DH) to provide the School Dental Care Service. Dental therapists may perform preventive dental care and basic curative dental care (e.g. filling, extraction) in accordance with the directions of a dentist who is available in the premises at all times when such work is being carried out.

     The amended DRO suitably adjusted the scope of practice of dental hygienists and dental therapists based on a risk-based approach, taking into account the consultation outcome with the sectors and relevant stakeholders. It would enable them, upon training, to perform some lower-risk preventive dental care (e.g. oral examination, education, teeth cleaning and polishing, fluoride application) without the presence of a dentist, and perform scaling in accordance with the directions of a dentist who is present in the same premises. Dental therapists may also perform basic curative dental care (e.g. filling, extraction) in accordance with the directions of a dentist who is present in the same premises.

     The statutory registration system for DenCPs would be put in place within three years, and by then the revised scope of work of DenCPs will come into effect. All DenCPs (including dental therapists) will be allowed to provide services outside the DH (including institutions in the public or private sector). During the transitional period, the Dental Council of Hong Kong (DCHK) will develop clear guidelines on the collaborative relationship between dentists and DenCPs and establish the Continuing Professional Development arrangements for DenCPs. At the current stage, the DCHK is focusing on the preparatory work for establishing the registration system as soon as possible and will liaise with the sectors to explore the feasibility of implementing DenCP registration earlier in 2026. When the new registration system is in place, the DCHK will monitor both its implementation and the adaptation of DenCPs to the expanded scope of work to ensure the safety of patients. As things currently stand, the Government has no plan to further expand the scope of work of dental hygienists to perform higher-risk procedures such as injection of local anaesthetics. The Government will maintain dialogue with the dental professions and revisit the scope of practice of DenCPs from time to time, with a view to meeting local dental care service needs.

     In view of the actual needs in the community, the Government will examine the necessity for including other classes of DenCPs under the registration system on a risk-based approach. The Government will maintain communication with the dental professions to canvass their views.

The role of DenCPs in primary healthcare system

     Taking reference to the suggestion of the Working Group, the Government would promote primary dental services appropriate for different age groups and make use of the existing primary healthcare service system. For example, when the manpower supply for dental hygienists has increased, they can provide preventive primary dental services suitable for different age groups at District Health Centres or District Health Centre Expresses, including risk assessment, offering advice on oral care and personal lifestyle, and assisting the citizens in managing their own oral health, so as to put prevention, early identification and timely intervention of dental diseases into action.

     Furthermore, the Elderly Health Care Voucher Scheme (EHVS) currently allows eligible elderly persons to choose from private primary healthcare services provided by 14 categories of healthcare professions, including dentists. Following the upcoming establishment of registration system for DenCPs, the preventive primary dental service would be strengthened. Eligible elderly persons can use Elderly Health Care Vouchers to pay for the relevant service charges through dental clinics in future. The Government will review the relevant operational details of the EHVS in a timely manner.

Manpower of DenCPs 

     As at September 2024, there are a total of 614 registered dental hygienists, whereas 226 dental therapists are employed by the DH. To increase the manpower resources for dental care profession, the Government has gradually increased training places for dental hygienists and dental therapists to nearly double from 95 in the 2023/24 academic year to 185 in the 2024/25 academic year.

     When the statutory registration system is in place, dental therapists will be allowed to work in private institutions which will broaden their employment opportunities. Establishing a career ladder for DenCPs will, in the long run, attract more individuals to join the industry. To attract more young people to join the industry, the DH has been offering full tuition fee sponsorship since 2023/24 academic year to students studying the programmes for dental hygienists and dental therapists. Dental hygienists and dental therapists who have received the sponsorship are required to work in dental clinics of the DH or other specified non-governmental organisations (NGOs) for at least one year after graduation. The above measures could help provide sufficient manpower in support of dental care services provided by the Government, private institutions and NGOs in future.

     Regarding the establishment issue of DenCP grades in the DH, according to the prevailing policy guidelines, the Government may consider conducting a Grade Structure Review (GSR) as necessary in case of fundamental changes in the job nature, level of responsibilities and job complexity of a particular grade, or if there are proven and persistent recruitment and retention difficulties in the grade. For Dental Hygienist grade in the DH, when the relevant provisions of the amended DRO come into effect, given the minimum academic qualification requirement for registration as dental hygienist with the DCHK, the job entry requirements of the Dental Hygienist grade including the Qualification Group of the academic qualification will be changed. The DH is gathering relevant data and information of the Dental Hygienist grade (including their job nature, duties and responsibilities, and recruitment situation) for consideration of conducting a GSR for the grade. The Government will also assess the need for GSR for Dental Therapist grade in accordance with the relevant policy guidelines in due course. 

     In the past five years, the information of recruitment of dental ancillary grades of the DH is at Annex.

Ends/Wednesday, October 30, 2024
Issued at HKT 14:30

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