The Hong Kong Special Care Dentistry Association Limited (HKSCDA) began in 2013 when we saw the need to develop special care dentistry in Hong Kong.
SCD concerns about the provision of oral care services for the improvement of oral health of adolescents and adults who are unable to receive routine dental care because of certain physical, intellectual, medical, emotional, sensory, mental or social impairment factors or a combination of more than one of these factors.
While there was no formal SCD training available in Hong Kong, upon the advice of Dr. Sarah Manton, Chair of the Specialty Board of SCD, Royal College of Dental Surgeons of Edinburgh, UK, the HKSCDA founders had a vision to develop SCD locally through a self-learning initiative with the support of professional experts overseas. We believe that gaining hands-on experience from the provision of oral care services to the special needs patients is the sure way to the development of SCD in Hong Kong. And the development of SCD, based on our vision and missions, takes two main directions of actions: 1) the establishment of care services for the special care communities and 2) the training of dental professionals and ancillary dental professionals to meet the care needs.
In view of the long-neglected need for dental service for the persons with intellectual disability (PID), the Food and Health Bureau (FHB) initiated the idea of a dental service for the persons with intellectual disability (PID) to be delivered in the private sector. In early 2013, the HKSCDA seized the opportunity and submitted a proposal, to FHB, for a four-year “Pilot Project on Dental Service for PID” in collaboration with the Hong Kong Dental Association and the Evangel Hospital (EH). Upon the acceptance of the proposal, the Pilot Project was launched in August 2013. It was named the Loving Smiles Service. And EH was the service provider of the Project with HKSCDA as her professional advisor in SCD.
After mid-2014, circumstances of the EH operation of the Pilot Project changed and in late October 2014, HKSCDA had to take over the clinical service of the Pilot Project with the financial support from the Loving Smiles Foundation Limited (LSF). This has set the beginning of a close partnership with the LSF in the development and provision of a dental service for persons requiring special care.
In May 2015 LSF had fully taken over the dental clinic to operate a special care dental service and HKSCDA became the manager of this dental service under a professional service agreement with the LSF.
The scope of special care dental service has gradually expanded from the PID in 2013 to the persons with mental health problems in 2016 and the persons with physical disabilities in 2017.
LSS was a pilot project for dental service for the persons with intellectual disability (PID). It was organized by the HKSCDA and the Hong Kong Dental Association. The Loving Smiles Foundation Limited was the main service provider through their Loving Smiles Special Care Dental Centre, while Evangel Hospital provided the operating theatre facility for treatment under general anesthesia. LSS was launched in August 2013. It was planned for four years but owing to popular demand, the pilot was extended for one year till 13 July 2018 in order to complete the treatment of all the enrolled cases. The FHB provided subsidy for the dental treatment costs for the eligible persons.
The eligible target for the pilot was adults aged 18 or above with intellectual disability, who are also receiving one of the following benefits:
The eligible PID needed to be referred by their rehabilitation service units to the designated dental clinic, Loving Smiles Special Care Dental Centre, for initial check-up. Then according to their individual conditions, they would then be arranged to receive their necessary dental treatment, through behavioral management or under conscious sedation in the Dental Centre or under general anesthesia (GA) at the Evangel Hospital. Basic dental treatment was provided to all the eligible PID. When treatment was completed, oral health education and oral hygiene instruction would be given to the caregivers to help them maintain the oral health of the patients.
By the end of 2016, HKSCDA submitted an evaluation report based on the 1,600 completed cases. Owing to unanticipated circumstance, FHB called for a suspension of recruitment of new cases with effect from 20 February 2017. However, in commitment to complete all the enrolled cases, FHB injected an addition of $5million in July 2017 with an extension of the service period until 30 June 2018.
In order to maximize the number of beneficiaries from the remaining fund, the recruitment of new cases was re-opened with effect from 12 February 2018 and the project period was further extended to 13 July 2018.
About 3,400 PID enrolled in the pilot. Nearly 3,000 (88%) had treatment completed and 400 (12%) dropped out of the scheme. Of those who benefited from LSS, over 1,850 were treated by behavioral management, about 280 under conscious sedation and about 840 under GA. The service was demonstrated to be well received by the parents and the rehabilitative care workers of the PID.
The success of the pilot had prompted the Government to launch a similar programme named “Healthy Teeth Collaboration” by the Department of Health immediately following the pilot, commencing on 16 July 2018, to continue providing dental service to the PID for another 3 years. But the patients in this new scheme can receive their service from a number of selected NGO dental clinics.