If you hear a dental patient screaming as if he were watching a gruesome horror movie, he could just be seeing Dr Ang Kok Yang for a routine dental check.

Dr Ang has also had his fingers bitten by patients with behavioural issues that can be caused by medical conditions, such as dementia, autism and stroke.

Yet, he is undeterred. Dr Ang, a dental registrar at Tan Tock Seng Hospital, completed three years of postgraduate training in special needs dentistry last January. That makes him the only special needs dentist working in the hospital.

He joins a small, but growing, pool of such dentists in Singapore. It is a speciality that deals with the oral health of people who have intellectual disability, or medical, physical or psychiatric issues. Around half of Dr Ang's patients are above 75 years old and they usually have medical conditions, such as dementia and Parkinson's disease.

"I enjoy treating the Ah Kongs (grandfathers) and Ah Mas (grandmothers). Just yesterday, I had an elderly patient who kept pinching my hand to get me to stop checking her teeth," Dr Ang said matter-of-factly.

"Now, I understand them better and why they do that. They see this person in a gown, with goggles on and the lights are on, and they think that you're going to hurt them."

Dr Ang had treated elderly and special needs patients before his training. Now he is trained to plan a patient's long-term dental care. "We try to optimise their oral condition before their health conditions deteriorate," he said.

"We also try to educate the family on what they can do to help their oral hygiene as the condition progresses."

He spends at least 45 minutes to an hour for the more complex cases that he sees now, compared with half an hour for a general patient he saw previously.

"It involves looking at the medical records, talking to the family and the patient," he said. "I also look at the speech therapy reports and their diet. Many don't realise that a lot of oral problems are dependent on their diet."

If his elderly patients are taking milk supplements, he would advise them to rinse their mouth as it is usually sweet, he said.

"A lot of them are on medications, which mostly lead to dry mouth, and that puts them at a higher risk of tooth decay."

He may also refer his patients to other specialists, like a psychologist, if he sees the need, he said.

Retiree Alice Liew, 70, who has lupus, a chronic autoimmune disease, and poor eyesight, first saw Dr Ang eight years ago.

"Before his further training, he would just look at my teeth and treat the problem itself," she said.

Now, he has a better understanding of her conditions and the related side effects from the medications, she said.

"He advised me to get my teeth extracted before I start the medications for osteoporosis, as the medications will affect the healing of my wounds."

Her teeth need to be extracted due to poor gum health that is partly caused by her lupus flares and partly by medications.

Joyce Teo