Dentistry in Hong Kong during this century has advanced from an informal streetside practice to a discipline that now serves the community by way of registered oral health care personnel. Throughout the years, public attitudes towards dental care have also changed: from a palliative approach involving the extraction of teeth when pain arose, to the prevention of dental disease even at the formative stage of dentition through water fluoridation, regular therapeutic care, and oral health maintenance. The education and professionalisation of practitioners has evolved from apprenticeship to the establishment of a structured university curriculum and postgraduate specialist training of international standards.published_or_final_versio

Chiu, GKC

Davies, WIR

Hong Kong Medical Journal

HKU Scholars Hub

Title The historical development of dentistry in Hong KongAuthor(s) Chiu, GKC; Davies, WIRCitation Hong Kong Medical Journal, 1998, v. 4 n. 1, p. 73-76Issued Date 1998URL http://hdl.handle.net/10722/146327Rights Hong Kong Medical Journal. Copyright © Hong Kong MedicalAssociation.HKMJ Vol 4 No 1 March 1998      73History of dentistry in Hong KongMEDICAL HISTORYThe early yearsIn traditional Chinese medicine, the mouth is regardedas a mirror of the general systemic health of the body.Diseases of the soft tissues of the oral cavity weretreated by medical practitioners, whereas teeth caus-ing pain were extracted in the market place by toothremovers—the predecessors of dentists.After Hong Kong became a British Crown colonyin 1842 and with the subsequent establishment ofthe City of Victoria, traders soon flocked to HongKong. The population grew rapidly to about 33 000 inthe 1850s.1 More and more foreigners moved toHong Kong such that by the 1870s, there were over1 000 resident foreigners. Attracted by the local popu-lation’s dental demands, Dr Herbert Poate, who hadgraduated with a professional dental degree fromthe University of Pennsylvania, set up the first formaldental practice in the early 1880s.2 In 1887, DrJoseph Noble, another Pennsylvania alumnus, joinedthe Poate practice.3 Doctors Poate and Noble becameprominent among the very few formally trained den-tal surgeons, and both were actively involved with thelocal medical profession. Their names appeared in theminutes of the Hong Kong Medical Society during1886 to 1891,4 and they became well acquainted withDr Patrick Manson, who from 1887 was the first deanof the Hong Kong College of Medicine.The Poate-Noble dental practice gave free dentalservice at the Alice Memorial Hospital, where theCollege of Medicine was established.5 Because of hiscontributions, Dr Noble became a member of the Courtof the College of Medicine. In this capacity he wasinvolved in the early plans to incorporate the Collegeinto the University of Hong Kong; these plans wererealised in 1911. Prior to that, in 1901, the dentalprofession in Hong Kong had admitted Dr Moon-hungChaun as its first Chinese dentist who had beeneducated in a university (also the University of Penn-sylvania).6The status of a dental surgeon as a member of aprofession was formally recognised by Governor HenryMay who assented to the first Dentistry Ordinance on5 June 1914.7 Dental practitioners were categorisedinto two groups: the formally trained dental surgeonsand the ‘exempted’ practitioners. The latter group ofdental service providers were granted certificates ofexemption by the Governor-in-Council by dint oftheir long practice of dentistry in the Colony prior tothe enactment of the Dentistry Ordinance. The firstDental Register published in 1914 included onedental surgeon and one ‘exempted’ person.7 To con-trol more tightly the practice of dentistry because ofthe increasing number of dentists (23 dental surgeonsand 9 exempted persons in May 1940),6 the DentistryOrdinance was finally repealed, and the Registrationof Dentists Ordinance was passed in 1940 by theThe historical development of dentistry in Hong KongGKC Chiu, WIR DaviesDentistry in Hong Kong during this century has advanced from an informal streetside practice to adiscipline that now serves the community by way of registered oral health care personnel. Throughoutthe years, public attitudes towards dental care have also changed: from a palliative approach involvingthe extraction of teeth when pain arose, to the prevention of dental disease even at the formative stage ofdentition through water fluoridation, regular therapeutic care, and oral health maintenance. The educa-tion and professionalisation of practitioners has evolved from apprenticeship to the establishment of astructured university curriculum and postgraduate specialist training of international standards.HKMJ 1998;4:73-6Key words: Dentistry, History of medicine, 19th cent.; History of medicine, 20th cent., Hong Kong.Faculty of Dentistry, The University of Hong Kong, Prince PhilipDental Hospital, Hospital Road, Hong KongGKC Chiu, BDS, MDS, FHKAM (Dental Surgery)WIR Davies, FDSRCS (Eng), FHKAM (Dental Surgery)Correspondence to: Dr GKC Chiu74      HKMJ Vol 4 No 1 March 1998Chiu et alLegislative Council. This ordinance provided a 2-yearinterim period for any unqualified person to furnishan affidavit from a Justice of Peace, which certifiedthat he depended on the practice of dentistry as hisprincipal means of livelihood, as registration forexemption.8 As a result, there was an immediate in-crease in the number of exempted persons; however,this number decreased steadily through attrition, andthere were only 30 of them on the 1995 Dentist List.9The Registration of Dentists Ordinance formally putan end to the apprenticeship era of dentistry. Since itsimplementation, the practice of dentistry by anyoneother than a registered person has been illegal.Before the Second World War, the demand fordental care in the Colony remained very low. Teethwere considered a dispensable commodity by manypeople. Only the well-to-do could seek treatment fromprivate dental practitioners. The Government employedonly a few private dentists to carry out essential hospi-tal and emergency dental treatment for the public.Immediately before the Pacific War, dental officerswere brought to the Colony to serve the BritishEmpire military personnel. Following the Japanesesurrender in September 1945, three dental clinics anda dental laboratory were set up in Hong Kong; a vari-ety of equipment and stores were supplied by the Brit-ish Armed Forces. The dental officers from the ArmedServices and a few private dental practitioners provideddental care to the civilians who had previously beendetained by the Japanese10; this service was effectivelythe forerunner of the Hong Kong Government DentalService. Since then, the Government Dental Service,originally under the Medical and Health Department,has rendered comprehensive treatment to civil servants,their dependents, and Government pensioners. A limitedservice is also provided for prisoners and long-staypatients in public hospitals; it also offers specialistdental services in Government hospitals. In addition,the service gives a degree of emergency dental care tothe general public.Post-war developmentsAfter 1945, Hong Kong gradually recovered from theravages of the Pacific War, and the population increasedsteadily. The large influx of emigrants from MainlandChina after 1949 significantly aggravated the demo-graphic changes, which in turn created the need formore dental services. In order to better serve the com-munity and to improve communications within thegrowing profession, the Hong Kong Dental Society,which in 1973 became the Hong Kong Dental Asso-ciation, was founded under the leadership of Dr WCAllwright, the then officer-in-charge of the Govern-ment Dental Service, in February 1950.11 Less thanhalf a year after its inauguration, the Society startedholding free evening clinics—one in Kowloon and onein Wanchai—to relieve dental pain and to give oralhygiene education to the needy.12 Furthermore, theDental Society together with the Dental Board per-suaded the Government to acknowledge the need forimproved human resources within the dental service.The Hong Kong Government Dental ScholarshipScheme was instituted in 1955 to enable Hong Kongresidents to receive professional education in variousdental schools of Commonwealth universities, with theproviso that the graduates agree to serve the Govern-ment Dental Service for a period upon their return toHong Kong. This resulted in an annual recruitmentof about five dentists to the profession. Increasingdemands for dental care by the public also resultedin a number of local residents going abroad to studydentistry on a self-financed basis. The average annualrate of return of privately funded graduates was alsoabout five during the 1950s and 1960s.The Government soon realised that the ratherlimited number of registered dentists and the largeand continually growing population would make itimpossible to significantly improve the dental healthof local residents by a solely curative approach. TheHong Kong Dental Society compiled a review on theefficacy of water fluoridation in June 1953 and on itsrecommendation, the Government launched a domes-tic water fluoridation project in 1961. Within 25 years,this single project accounted for an eleven-fold increasein the percentage of children without dental decay intheir primary teeth (3% in 1960 and 33% in 1987).13Curative dental care for the general public, however,still largely rested with the private sector. Non–profit-making dental clinics were set up by charitable organi-sations such as Caritas Hong Kong and Project Con-cern Hong Kong to attempt to meet some of the dentaldemands of the underprivileged.Recent achievementsFollowing urban riots in 1967, the Hong Kong Gov-ernment became much more aware of the legitimategrievances and basic needs of the grass roots of thecommunity who felt they were entitled to a larger shareof the territory’s prosperity, to which they felt theyhad also contributed. From the 1970s onward, it wasapparent that Hong Kong’s public policy focused onnew initiatives that emphasised the creation of a morebenevolent and caring environment for the populace,the majority of whom was born locally and had anHKMJ Vol 4 No 1 March 1998      75History of dentistry in Hong Kongincreasingly strong sense of belonging. Factors suchas the general economic affluence and the rising levelof education contributed to subsequent substantialincreases in public expenditure on health care, and inshared concerns for personal hygiene, including oraland dental well-being. The administration underGovernor Sir Murray MacLehose thus embarked on asignificant reorientation in the public health servicesystem through the introduction, inter alia, of newcommitments to develop dental care institutions andtraining programmes.In 1973, the Medical Development Advisory Com-mittee pro-actively considered the overall developmentof dental care services in Hong Kong. At that time,there were only about 440 practising dentists, at aper capita ratio of 1:9000. Based on the data then avail-able, there would have been about eight new dentistsper year. Nevertheless, there would be an annual de-cline in excess of that number due to retirement, death,and emigration. The Legislative Council approvedthe 1974 White Paper on “The further development ofmedical and health services in Hong Kong” to bringdental education to the Territory.14Two proposals had enormous impact. The firstcalled for the creation of a School Dental Care Serv-ice (SDCS) with an associated Dental TherapistsSchool. The other envisioned the establishment of adental school at the University of Hong Kong (HKU).The dental school at the HKU would train approxi-mately 60 students per year and would meet therequirements of the United Kingdom (UK) GeneralDental Council.2 There were also to be developmentsin dental ancillary training, and a dental technologycourse was to be inaugurated at the then Hong KongPolytechnic in 1978. Furthermore, dental hygiene anddental surgery-assisting courses were to become partof the curriculum at the dental school. The recommen-dations for the SDCS included the provision of schooldental clinics, staffed by dental therapists; the aim wasto offer basic curative treatment and preventive dentalcare to primary school children under the supervisionof Government Dental Officers. A Dental TherapistsTraining School was set up in 1978 at the then newMacLehose Dental Centre; it was to enroll students ina 3-year training programme. The SDCS itself com-menced in 1980.2 The benefit of the SDCS becameapparent as the dental decay status of school childrentaking part in the scheme decreased by 3.5-fold over 7years.15A Dental Academic Advisory Committee wasappointed in June 1976 to advise the Government onthe implementation of the second proposal.16 Thecommittee chairman, Professor GL Howe, was subse-quently appointed Dean of Dental Studies at theHKU. Despite the undoubted complexity of the project,and with the strong support of Governor MacLehose,a brand new dental teaching hospital was planned andbuilt in less than 5 years. In March 1981, during anofficial visit to Hong Kong, Prince Philip, the Duke ofEdinburgh, officially opened the new hospital bearinghis name.17 The quality of education and the commit-ment of the dental teachers and students were evidentwhen the UK General Dental Council, after a scrupu-lous evaluation, announced in November 1984 thatthe Bachelor of Dental Surgery (BDS) of HKU metthe standards for automatic registration in the UK.18 In1985, the initial class of HKU dental students receivedtheir BDS degrees.Since then, the Dental School has been the princi-pal training ground for local dentists. By 1995, morethan one third of the practising dentists in the Terri-tory were educated in Hong Kong and the per capitadentist ratio has increased to 1:4050—more than dou-ble the estimate when the dental school was originallyplanned.19 The advancements in medical technologyand the maturation of health professions had resultedin the entire health care field demonstrating ever-increasing specialisation by the 1990s. The Hong KongAcademy of Medicine was inaugurated in December1993 with the College of Dental Surgeons of HongKong as one of its initial 12 specialty colleges.20 TheCollege of Dental Surgeons of Hong Kong therebybecame entrusted with the coordination of postgradu-ate training in dental surgery.The remarkable developments within the dentalprofession in Hong Kong during the 1980s alsoenabled it to play an increasingly important role in thearena of world dentistry. This was marked by thehosting of the 83rd Fédération Dentaire InternationaleAnnual World Dental Congress by the Hong KongDental Association in October 1995, which wasattended by more than 6000 dentists from all over theworld. This conference was the first one held outsideMainland China to have attracted the largest Chinesedelegation of health care professionals.21Looking aheadThere remain considerable needs and opportunitiesfor the expansion of postgraduate training and con-tinuing professional education at the HKU Faculty ofDentistry in collaboration with the College of DentalSurgeons from the Hong Kong Academy of Medicine.76      HKMJ Vol 4 No 1 March 1998Chiu et alThe further enhancement of research undertaken bythe HKU Faculty of Dentistry as supported by publicand non-public funding, locally and internationally,will further the Faculty’s aim of being a regionalcentre of dental education and oral health care. Bythe early 21st century, the joint effort of the HKUFaculty of Dentistry, the Government Dental Service,and the Hong Kong Dental Association should seeHong Kong’s dental care, in terms of human resources,provision and accessibility of service, scope of cover-age, and cost-effectiveness, ranked in the top tiers oforal health care systems in the world.The Ordinances of Hong Kong No. 1 of 1940. Hong Kong:Hong Kong Government, 1940.9. Hong Kong Government. Dentist List 1995. Hong Kong: HongKong Government, 1995.10. Small DH. Dentistry in Hong Kong. Dent Mag Oral Top1969;86:249-56.11. Chan DM, Lo EC. The history and growth of Hong Kong Den-tal Association. In: Hong Kong Dental Association Year Book.Hong Kong: Hong Kong Dental Association, 1988:32-5.12. Free dental treatment. South China Morning Post 1950 July14; Editorial.13. Evans RW, Lo EC, Lind OP. Changes in dental health in HongKong after 25 years of water fluoridation. Community DentHealth 1987;4:383-94.14. Hong Kong Government. The further development of medicaland health services in Hong Kong. White Paper, 1974. HongKong: Hong Kong Government, 1974.15. Department of Health, Hong Kong Government. Public HealthReport No. 2. Oral Health. Hong Kong: Department of Health,Hong Kong Government, 1995.16. Howe GL, Renson CE. Dental education comes to Hong Kong.Br Dent J 1979;147:121-5.17. Prince Philip Opens Dental Hospital. South China MorningPost 1981 Mar 25; Main News: pp1,10.18. Davies WI. Dental education in Hong Kong—the early years.Hong Kong Dental Association Newsletter (CommemorativeIssue). Hong Kong: Hong Kong Dental Association, Oct1995:5-6.19. Leong CH. My pledge. Hong Kong Dental AssociationNewsletter (Commemorative Issue). Hong Kong: Hong KongDental Association, Oct 1995:10.20. Hong Kong Academy of Medicine. First Annual GeneralMeeting Report, 1994. Hong Kong: Hong Kong Academy ofMedicine, 1984.21. Zhang ZK. China’s bright future. Hong Kong Dental Associa-tion Newsletter (83rd Fédération Dentaire InternationaleAnnual World Dental Congress). Hong Kong: Hong KongDental Association, 1995:4.References1. Chau KK. Dentistry in Hong Kong: a look into the past and aglimpse of the future. Int Dent J 1984;34:249-52.2. Davies WI. The development of dentistry in Hong Kong. In:The Medical Directory of Hong Kong. 3rd ed. Hong Kong:The Federation of Hong Kong Medical Societies, 1985;79-84.3. Walker RT. Joseph Whittlesey Noble, 1862-1949: an orientalentrepreneur. Bull Hist Dent 1985;33:7-12.4. The Hong Kong Collection, University of Hong Kong. HongKong Medical Society Minutes, 1886-1891. In: The concep-tion and foundation of the University of Hong Kong 1908-1913. Hong Kong, 1974.5. Walker RT. Joseph Whittlesey Noble: an American in HongKong. J Am Dent Assoc 1984;109:757.6. Chaun KK. The history of dentistry in Hong Kong. In: Themedical directory of Hong Kong. 2nd ed. Hong Kong: TheFederation of Hong Kong Medical Societies, 1981:68-9.7. Hong Kong Government. Dentistry Ordinance. The Ordinancesof Hong Kong No. 16 of 1914. Hong Kong: Hong Kong Gov-ernment, 1914.8. Hong Kong Government. Registration of Dentists Ordinance.

The historical development of dentistry in Hong Kong

http://hub.hku.hk/bitstream/10722/146327/2/content.pdf

The historical development of dentistry in Hong Kong

Abstract

Similar works

Full text

Available Versions

HKU Scholars Hub