Ancient Dental Act needs new teeth
Like all professions, dentistry is constantly changing. We face new ideas, new materials, and new challenges continuously. To stay relevant and to serve our patients, the profession must continually revise its practice standards, its ethical codes, its professional conduct, and its laws. For this very reason, the concept of self-governance is at the heart of the dental profession, as it is for all true professions.
Today, professions such as dentistry work with governments to give structure and legal authority to the concept of self-governance. Together, we establish laws that govern professions and make sure that regulatory bodies, such as the Dental Council, which sits in judgement over professionals, are filled mostly with peer professionals. The structure of the General Legal Council of Jamaica is a good example. Of its 17 members, all are lawyers of various ranks. Similarly, in dentistry, seven of the nine elected members are in the dental profession.
But while dentistry here and worldwide now has new technologies, new practising standards, and new ethical codes of conduct, the profession in Jamaica is still governed by the Dental Act of 1972 - a 43-year-old document with just one revision made very early in the new millennium. That was an update to introduce the practising certificate to the registration process for dentists and auxiliaries.
Since then, efforts have been made to be proactive so that new developments would be covered by updated laws. In 1999, the Dental Council and the Jamaica Dental Association (JDA) organised the first retreat to look at revising the Dental Act. In 2005, the Jamaica Dental Association, the Dental Council of Jamaica (DCJ) and the Ministry of Health (MOH) organised another retreat to create a new Dental Act.
The 2005 retreat appeared to be a success and a Draft Dental Act was written and agreed to by all. The council forwarded the draft Dental Act to the MOH for further processing, and all who contributed to this Dental Act expected the MOH would move it speedily through the necessary
corridors of power so that Parliament would establish a new Dental Act
This has not yet happened. Alarmingly, there has been no written correspondence from the MOH on the present status of the Dental Act revision. Each budget year, pronouncements are made by the minister of health raise the expectations of the profession. Now we are just about one year removed from the last House of Parliament budget-time pronouncement by the present minister of health, and we are seemingly no closer to a revised Dental Act.
In the absence of a revised Dental Act in 2015, the profession is heading along an uncertain path, and our future is very cloudy. The MOH's Dental Council of Jamaica has been trying to address the deficiencies in the 1972 Dental Act by putting together new regulations that require only ministerial decree. Unfortunately, none of these have the consent of, nor do they involve consultation with, the wider profession.
As an illustration of this, the website of the Dental Council of Jamaica now has as one of the recognised professions allied to dentistry the field of dental therapy! This field is not listed in the Dental Act, and no formal correspondence has been circulated by the Dental Council of Jamaica to sensitise the profession to this development. Most dentists don't even know what a dental therapist does.
A good Dental Act would allow the smooth and efficient functioning of the Dental Council of Jamaica to monitor and supervise the teaching and practice of dentistry and its allied professions. The 1972 Act, which is currently the law of the land, does not even recognise that the teaching of dental surgeons can occur in Jamaica. It gives no power to the DCJ in this area at all.
Persons teaching dentistry in Jamaica ignore the council because there was/is no rule. During its development, one local training institution consistently declined to provide information about its curriculum that the DCJ requested, and to date, the same institution has steadfastly refused to begin the process to become accredited by CAAM-HP, the regional accrediting authority. Antiquated laws irrelevant to the times allow this sort of anarchy.
The Dental Council of Jamaica is a creature of the Dental Act, and an out-of-date act cannot help but create an out-of-date council. Another illustration of this is that the council has decided to introduce a new licensing examination for dentists wishing to practise in Jamaica and to establish licensing procedures for graduates of the local dental schools. But the council has not informed all the institutions that train dental students, so these institutions cannot properly inform their students.
No established requirements
Another local institution that trains dental auxiliaries has not been able to have its graduates sit a licensing examination for the past four years as the council has ruled that their graduates have not met the requirements to sit the examination. But the council has not provided the institution with the requirements that their graduates must meet to sit their licensing examination.
Meanwhile, another institution with at least four of its teaching staff sitting on the Dental Council has had all of their graduates matriculate. Such poor governance encourages charges of corruption even when there is none.
Dentistry is a quiet profession because we are few in number and without significant financial clout. We are not given to loud public displays or blocking of roads. So despite repeated entreaties to all relevant authorities, and specifically to the minister of health, the JDA has been unable to get anyone to address our concerns.
As long as the status quo remains, the very foundation of the profession will be cracked. The trust we enjoy from the public has been hard-won over many years and will be severely eroded if we are unable to supervise and monitor our own teaching, training and practice in an efficient and transparent way, guided by well-meaning laws and regulations.
The students embarking on their chosen careers and dentists planning to practise in Jamaica deserve to know that the profession ensures they are properly schooled and that the necessary licensing procedures are in place to allow them to be admitted into our ranks as equals.
The Jamaican public deserves to know that when a dentist is allowed to be registered in Jamaica, he/she is well trained and competent. Only a sound Dental Act, finalised through a consultative process with all dental stakeholders, with a structured regulatory machinery where professionals are empowered to govern their own profession, will ensure that dentistry, as a profession, maintains the esteem it has come to enjoy.
On February 4, Prime Minister Portia Simpson Miller spoke at the launch of the new Medical Sciences facility and the dental programme at the University of the West Indies. In her speech, the prime minister said: "Work on a new dental act is now well advanced ... ."
At first glance, this appears to be good news for the profession. But since the Jamaica Dental Association has had no formal communication on this issue with any government agency over the last 10 years, we have no idea what the prime minister is speaking about. Is this the resurrection of our 2005 work? Or is this some new document manufactured in the Ministry of Health? Or, is this just another pronouncement as has been made before by others?
Unfortunately, we just do not know because the relevant parties within the MOH have not reached out to the interested stakeholders to further this process in a transparent and responsible way.
- Dr Jeffrey Meeks is president of the Jamaica Dental Association.
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