1. A review was conducted of mobile dental clinics (MDCs) operated by the Ministry of Health Malaysia, including an evaluation of utilization records from 2009-2014 and a satisfaction survey of dental providers and patients. 2. The review found that while satisfaction with MDC services was generally high, utilization of MDCs has been declining and some clinics need replacement. Infrastructure constraints and limited service ranges were identified as areas for improvement. 3. Recommendations included developing standard operating procedures, increasing services to underserved communities, improving MDC designs for access, and conducting a more comprehensive national evaluation.

1. AN EVALUATION OF MOBILE DENTAL CLINICS IN
MINISTRY OF HEALTH MALAYSIA
A review of the literature and a descriptive study
by: Dr. Ghada Elmasuri
Supervised by:
Dr. JEGARAJAN N. S. PILLAY
Dr. Savithri A. P. Vengadasalam
Fri 5-12-2014

2. Introduction
 This ppt consisted of two parts;
I. A literature-based evaluation of mobile dental services in
Malaysia using Oral Heath division, MOH records (2009-
2014).
II. Assessment of patients & dental providers' satisfaction
(internal and external satisfaction) with dental services
provided by MDCs in rural Malaysian states of
Terengganu, Johor & Sarawak using a satisfaction survey.

3. Introduction
 Provision of health care facilities and the extent of their access is
one of the indices of human development.
Santoso et al., 2012
 It is a critical and an important determinant of health and it is at the
heart of the discourse on how to achieve the health-related
Millennium Development Goals.
United Nations General Assembly, 2000

4. Introduction
 Mobile & portable dental services provide an innovative solution
in bringing dental care to the doorsteps of the underprivileged &
rural population who lack of access for even the basic dental
services.
 A MDF is any self-contained facility where dentistry will be
practiced, which may be driven, moved, towed or transported
from one location or another.
US Executive Office of Health and Human Services

5. Historical Background
 Mobile dentistry started in Canada by formation of the Canadian
Army Dental Corps on 13 May 1915.
 While the first use in US was in 1917 during the World War I, when
the Preparedness League of American Dentists provided a “dental
ambulance” to the army in the name of Red Cross. Four dentists &
one or two assistants operated the ambulance.
Hyson 1989

6. MDCs continue since that to grow & expand
worldwide….
Carr et al., 2008; Morreale et al., 2005; Lundberg et al., 2011;
Bratthall 1996
UsageDatesCountry
Screening of the population for various oral diseases.
School & community dental health promoting program
Hard-to-reach populations such as low income families,
new immigrants, the homeless, persons with mental
illnesses or substance abuse problems, vulnerable
population as well as pregnant women & the elderly
1915
1917
1939
Canada
US
Australia
Underserved, hard to reach&remote areas1970India
Community dental health promoting program1996Thailand
School dental health promoting program2008Saudi Arabia

7. MDCs in Malaysia
 It was defined as “a dental clinic on wheels”.
MOH
 The first utilization of a MDC dates back to 1952 & was in Johor
&Penang.
 The services target preschool, primary, secondary school children
& the rural community.
 Services include dental examinations, curative treatment as dental
extractions, scaling and restorations, preventive including fissure
sealants, fluoride varnishes, dental health education.

8. MDCs in Malaysia
Oral Heath division MOH records
No of chairsNumbersType
26132- Surgery trailer
842- unit Caravan
22Lorry truck
11KPB 1 Malaysia- Bas 1
66Bas 1 surgery
22Lorry rigid
3328Total

9. MDC Models
Single chair MDC bus
Dual chairs MDC bus

10. MDC Models
Caravan
Trailer unit

11. MDC Models
1 Malaysia MDC
Bas MDCs
Lorry truck

12. MDC Manpower
 Personnel were categorized into 2 groups:
Group 1—Operating personnel & auxiliaries directly involved in the
dental procedures; dental officers (DOs), dental nurses (DNs), dental
surgery assistants (DSAs) & health attendants.
Group 2—personnel indirectly involved in procedures including dental
technologists, clerical staff & vehicle drivers.
Abdul Muttalib et al 2009

13. Evaluation of utilization and Patient
Satisfaction with MDCs services
provided by Ministry Of Health
Malaysia (MOH)
Fri 5-12-2014

14. Objectives
 A review was conducted in November 2014 aiming;
1. To assess the utilization of MDC in the provision of oral healthcare.
2. To determine the internal and external client (dentists & patients)
satisfaction with MDCs.
3. To identify strengths and weaknesses of the MDCs .
4. to set out recommendations for improvement of the provision of oral
healthcare through MDCs.

15. Methodology
1. Data on utilization was obtained from OH Data
(2013, 2014) and other reports (earlier years).
2. Client satisfaction survey conducted in 3 rural
Malaysian states (Terengganu, Johor & Sarawak).

16. Results
Fri 5-12-2014

17. Part I- MDCs Utilization; Treatment provided
The Table below shows the number of various procedures performed in
2014
CommunitySchool settingsActivity
1095589Extraction
3702393Scaling
-274Fissure sealant
3793021Fillings
19-Crown/ bridge
Oral Heath division MOH records

18. Part I- MDCs Utilization; Development Costs
 Table shows estimated cost of equipment needed to set up a mobile
dental unit
2 chairs1 chairActivity
5500033000Sterilization equipment
15600042000Hand instruments
40004000Capsulated amalgamator
100005000Computer &licenses operating
system
1000010000Chiller
515000234000Total
Oral Heath division MOH records

19. Part I- MDCs Utilization; Patients load
Oral Heath division MOH records
State No 2009 2010 2011 2012 2013
Perlis 1 2786 2453 2436 1518 4562
Kedah 3 3834 4853 3839 4417 4986
Pulau Pinang 2 - - - 1089 447
Perak 2 3834 4853 3839 3785 4707
Selangor 2 28 10806 79 6128 7382
WP Kuala Lumpur 2 187 386 361 579 551
Negari Sembilan 1 1412 1159 2156 1111 928
Melaka 1 903 1392 897 700 1780

20. Part I- MDCs Utilization; Patients load
Oral Heath division MOH records
State No 2009 2010 2011 2012 2013
Johor 3 15858 2077 22257 1518 4562
Pahang 3 545 354 1229 4417 4986
Terengganu 2 118041 117411 1281 3232 851
Kelantan 1 873 1068 997 3785 4707
Labuan 0 - - - 6128 7382
Sabah 0 - - - - -
Sarawak 0 0 - - - -
Total 28 148301 147766 40805 30722 32767

21. Part I- MDCs Utilization; Patients load
0.66%
99%
Total Pts seen through out reach Dental Services
in 2013
MDCs Dental Services Others
4.967.321 Pts
32.767 Pts
Oral Heath division MOH records
Facts that Figure, 2013:
MDT: ~500 teams
MDC:28

22. Part II- Customers satisfaction with MDCs by MOH
 Patient satisfaction is very important part of the treatment, as it
determine the level of quality of health care services as well as the
future utilization of services.
Hashim 2005; Levin 2004
 An satisfaction survey was conducted in November 2014 aiming to
evaluate the experiences of MDCs implemented by MOH in the states of
Johor, Sarawak & Terengganu.

23. Part II- Customers satisfaction with MDCs by MOH
Data collection
 A self-administered questionnaire was sent to the 3
states by email.
 The questionnaire consists of 2 surveys;
I. External Customer Satisfaction Survey.
II. Internal Customer Satisfaction Survey.

24. Part II- Customers satisfaction with MDCs by MOH
Data collection
I. External Customer Satisfaction Survey:
 Consists of 6 items that aims to measure patient satisfaction about the dental
services provided through a MDC.
 It was completed by the following number of respondents:
JohorSarawakTERENGGANU
191128296

25. Part II- Customers satisfaction with MDCs by MOH
Data collection
II. Internal Customer Satisfaction Survey:
 Aims to evaluate the satisfaction of the dental services providers .
 It consists of 7 questions related to the operating experience and delivery of
treatment by the MDCs . The questionnaire included the following number of
respondents:
JohorSarawakTERENGGANU
304633

26. Customers satisfaction with MDC
Results
98.7%
95.3%
99.3%
94.3%
95.3% 95.9%
96.9%
95.3%
96.9%
87.5%
85.2%
99.2%
97%
Cleanliness
of MDC
Level of
comfortness
in MDC
Services
provided
Confedence
in cross
infection
control
Scope of
services
given
Overall
satisfaction
The External customer satisfaction Survey
TERENGGANU SARAWAK JOHOR

27. Customer satisfaction with MDC
Results
94% 93.9%
72.7%
90.9% 94%
75.7%
81.9%82.6%
76.1%
80.4%
84.8%
87%
91.3%
80.4%
80%
0
10
20
30
40
50
60
70
80
90
100
Working
enviroment
Level of
comfortness
in MDC
Equipments
adequacy &
condition
Layout of
equipment
Cross
infection
control
Vehicle
performance
Overall
satisfaction
The Internal customer satisfaction Survey
TERENGGANU SARAWAK JOHOR

28. Limitation of the study
 Comprehensive national and state data on the use of the outreach
services including MDCs is currently not captured under the health
information management system (HIMS).
 A language barrier barriers existed, most records were in Malaysian
language for the foreigner researcher to completely analyze during
the 6 weeks time frame.
 However this barrier was overcome thanks to:
1. Dr 'Ainun Mardhiah Meor
2. Hayati Mohd Yasin

29. Discussion
 The rationale behind this preliminary evaluation was to identify
dentists’ & patients satisfaction of the use of MDCs in a community
outreach program & to identify areas for improvement.
 The results of this study indicated higher consumer satisfaction with
MDCs services, however the findings also illustrate a number of
potentially important areas, considering which may enhance the
overall function of the MDCs;
1. So far MDCs in Malaysia are conducted mainly in the school setting
as part of school-based programs & tend to focus less on other
population groups.

30. Discussion
2. Proportion of patients seen by MDCs is very low compared to
MDT for out reach services.
3. Some MDC are too big and not suitable to access very interiors
areas & with lack of infra structure.
4. Limited space for provision of care & waiting area.
5. Visits by the out reach services to rural and isolated villages in
the state of Sarawak depends on the availability of the vehicles,
designated staff, the conditions of the roads & weather and at
the moment its irregular.
SUHAKAM 2011

31. Key findings
 This study’s findings suggest 8 major conclusions:
1. Overall utilization of MDC is declining.
2. Operating, implementing & maintenance costs of MDCs may be
high ( based on internal customer survey in Johor).
3. Some of these clinics are old & need replacement .
4. Generally, there is no fixed Standard Operating Procedure
(SOP) on the use of the MDCs in the provision of oral health care
in Malaysia.

32. Key findings
5. Infrastructure (roads) & space constraint in schools may limit
access.
6. Waste disposal & discharge particularly hazardous materials
may increase the risk of cross-infection to the community.
7. Utility supplies to MDCs might be a problem in many rural
settings.
8. Limited range of services that may reduce patients satisfaction.

33. Recommendations
 to overcome the current limitations of the MDCs implemented
MOH Malaysia, the following recommendations are suggested :
1. Docking ports to be incorporated in specified public areas to
facilitate the MDCs.
2. SOP to be developed to address waste disposal & infection
control concerns & ensure proper maintained including PPM.
3. To ride on the mobile community transformation centre
program to get funding for additional/ replacement MDCs.
4. Increase MDC services to other groups in need in the
community and not solely focusing on school children.

34. Recommendations
5. Provide wider range of dental service, if constraints, patients
should be referred to the nearest dental facility.
6. More compact MDC designs for access to areas in anterior
without proper infrastructure especially in Sabah & Sarawak.
7. To include data on outreach services under HIMS which duo for
review in year 2016.
8. A more comprehensive evaluation of MDC services covering all
states is needed in the future.

35. Acknowledgements
 Special thanks to everyone who helped and contributed
to this review:
 Dr Khairiyah bt Abd Muttalib, Dr Noor Aliyah bt Ismail,
Dr Mohd Rashid bin Baharon, Dr Suhana bt Ismail, Dr
Ainun Mardhiah bt Meor Amir Hamzah and Cik Hayati
binti Mohd Yasin along with all the study participants.

37. References
 Santoso W L, Setiawan A, Gunawan S. Developing a Prototype of Mobile
Dental Information System in Indonesia. J Bua Infor. 2012;3(2):1–10.
 Hyson JM. The United States Military Academy Dental Service: A History
1825 – 1920. West Point, New York: United States Military Academy;
1989.
 Carr BR, Isong U, Weintraub JA. Identification and description of mobile
dental programs – A brief communication. J Public Health Dent
2008;68:234-7.
 Morreale JP, Dimitry S, Morreale M, Fattore I. Setting up a mobile dental
practice within your present office structure. J Can Dent Assoc
2005;71:91.
 Lundberg K, Ignacio CR, Ramos CM. The mobile care health project:
providing dental care in rural Hawaii communities. Glob J Community
Psychol Pract 2011;1:32-6.

38. References
 Human Rights Commission of Malaysia (SUHAKAM), Report on Human
Rights and Access to Equitable Healthcare(2011).p. 5.
 Levin R. The correlation between dental practice management and
clinical excellence. J Am Dent Assoc. 2004 Mar;135(3):345-6.
 R. hashim, patient satisfaction with dental services at Ajman
university,united arab emirates, eastern Mediterranean health
jornal,vol.11 No 5/6, 2005, 914-92.