Bringing Oral Healthcare To The Community

Bringing Oral Healthcare To The Community

It was also in the latter half of the 1920s that the British administrators began to seriously plan for organised dentistry. In 1929, a building in the Pudu area of Kuala Lumpur, formerly housing the poor, was converted into the first government dental clinic. It was demolished 43 years later in 1972, and replaced by the Cahaya Suria building owned by the Urban Development Authority (UDA). Two floors of this 16-floor building have been allocated to house the headquarters of the Dental Department of the Federal Territory of Kuala Lumpur.

In 1946, a Dental Division was established in the Medical Department and a professional man was appointed to head the dental services in Malaya. Mr. Charles F. Mummery was appointed Chief Dental Officer of the Federation of Malaya and the Straits Settlement and was instrumental in charting the course of the public dental services.

The public dental health services began with British dentists (officially Government Dental Officers) employed in the main hospitals and assisted by locally qualified dentists. These dentists visited districts or towns to undertake emergency dental care for one or two days a week. These part-time dental care centres later became full-time government dental clinics manned by qualified dentists.

In 1947, there were 20 dental officers in the public sector. The bulk of the service continued to be provided by the private sector then consisting of 50 private practitioners and approximately 400 registered dentists.

Development planning and the introduction of Five-Year Plans began in the post-war reconstruction of colonial Malaya. Planning for healthcare then was little more than a list of government departmental projects designed to make use of whatever monies were available. Following World War II, the Emergency consumed the major part of government resources and energies and little was done in healthcare planning until the establishment of the First Malaya Plan (1956-1960) and the Second Malaya Plan (1961-1965). These Five-Year Malaya Plans justified the expansion of healthcare and was the catalysts for expansion of public dental services.

Subsequently, the Malaya Plans became Five-Year Malaysia Plans. These Plans have seen public sector oral health services gaining strength and transforming into the comprehensive, decentralised services of today. In 1970, there were only 398 dental clinics of various types. Today, we are in the Eleventh Malaysia Plan, and there were 1,670 dental facilities, including mobile dental clinics and boats, at the end of 2017.

3.1 National Concern for Dental Health

Between the years 1952 to 1963, the organised dental profession began to consolidate its concern for the dental health of the nation. Although this period saw more practitioners venturing into private practice, the states, which had previously relied solely on central control, were now given the mandate to develop their own dental health programmes under the direction of the Principal Dental Officer. It was at this stage that mobile clinics were established. Oral health services were extended to rural populations with an emphasis on school children and ante-natal mothers, and dental health education was integrated into dental care programmes. Dental clinics were established for the general public and for specific groups such as police personnel, the armed forces, prisoners, lepers and TB patients.

Focus is now shifted to the lower-age range target groups,that is the toddlers and pre-schoolers, as well as the young adults after they leave school. Apart from that, taking into consideration that Malaysia is going to be an aged nation by 2030, the oral health of the elderly should not be ignored.

3.2 Oral Healthcare for School Children

In the early 1940’s, with the under-18s forming 50% of the population, and exhibiting oral health which was described as 'appalling', there was a serious need to provide dental services specific for school children. In 1948, the school dental service was launched. In was also in this year that the dental nurses' scheme was introduced, whereby this category of personnel was allowed to provide limited dental services to schoolchildren, under supervision. At first, the dental nurses' scheme was strongly opposed by the profession, but was later accepted when it was proven innovative and advantageous to the country.

By 1952, there were 19 school dental clinics. In the following year, dental components were incorporated in health centres. When the Rural Health Service Scheme was introduced in 1955, dental services extended its coverage to the rural population. By Independence in 1957, there were 55 school dental centres and 40 school dental clinics operated by dental nurses. By 2017, the numbers had increased more to than 923 school dental clinics, including school dental centres.

The School Dental Service is now the core business of dental public sector services. Expansion to cover almost 92% of primary and 60% of secondary school children has been achieved largely through the outreach strategy implemented in the early 1970s. Informally and affectionately known as 'flying squads', these mobile teams, utilising portable equipment, ensure provision of services to all areas. Mobile dental teams increased about from 13 in 1970, to 606 with 36 mobile dental clinics in 2017.

3.3 Oral Healthcare for the Public

Oral healthcare for the public was delivered through main dental clinics. A main dental clinic was officially opened in Kuala Terengganu in 1954 to serve the public, soon to be followed by the development of main dental clinics in other states.

An important milestone at this time was expansion into specialties with dental officers being sent overseas to specialize in oral surgery, orthodontics and dental public health. Specialist services commenced in 1950 with the establishment of oral surgery centres in Johore Bahru and Penang .

Chronological Development of Dental Specialist Services in the Ministry of Health

Year	Specialty Discipline	Total Number of Dental Specialists (as of 30 September 2018)
1950	Oral Surgery	78
1954	Orthodontics	70
1961	Dental Public Health	87
1967	Oral Medicine and Oral Pathology	14
1984	Periodontology	42
1985	Paediatric Dentistry	45
2005	Restorative Dentistry	31
2007	Forensic Dentistry	1
2010	Special Needs Dentistry	5
Grand Total Number of Dental Specialists		373

3.4 Oral Healthcare for Specific Segments of the Population

Specific segments of the population also have dedicated access to oral healthcare. In 1953, the Department of Orang Asli Affairs was established to provide services to the indigenous groups residing in interior areas of Malaysia. The Health and Medical Division of the Ministry of Rural Development provided dental services to the 'orang asli' population till 2012, when the service was taken over by the Ministry of Health.

In 1955, a dental clinic was opened at the Sungai Buloh Leprosy Centre in Selangor to cater to the inmates. Two additional clinics for police personnel were set up in Kuala Lumpur and Ipoh. In the 1960s, service expanded to the Pudu Penitentiary in Kuala Lumpur.

In 1958, the Armed Forces Dental Services (AFDS) was established to provide oral healthcare to military personnel and their families. Initially, dental officers were seconded from the Ministry of Health, before . A major focus is to attain and maintain combat readiness and fighting fitness of our troops. Today, the AFDS also undertake outreach programmes as a civic duty, and have also been actively deployed to other countries, where Malaysian troops have been stationed.

The outreach concept of service provision was not confined to merely mobile clinics overland. In 1958, the marine dental clinic became operational, providing oral healthcare along the Perak River.