The new board members for the Health Professions Council of South Africa have an opportunity to tackle the growing oral disease crisis by dealing with regulatory gaps and inequity, as well as making decisive reforms to the industry, argues Dr Bulela Vava.
The Health Professions Council of South Africa (HPCSA) has formally inaugurated its 12 professional boards for the 2025-2030 term, an administrative milestone that ordinarily passes quietly. Yet these appointments demand deeper attention, particularly for oral health. Two structures - the Professional Board for Dental Assisting, Dental Therapy and Oral Hygiene and the Medical and Dental Board - which includes seven dedicated seats for dentists and dental specialists, now assume responsibility for navigating the complex oral health professions regulatory space.
Their inauguration should mark more than the start of a new term. It must mark the beginning of a cycle in which long-standing tensions, gaps, and inequities in oral health regulation must finally be confronted with seriousness and clarity.
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The HPCSA's legislative mandate is expansive. It protects the public by regulating professional conduct, approving scopes of practice, overseeing education and training, and maintaining ethical standards across health professions. Within this framework, the oral health boards carry a unique burden. They regulate professions that sit across multiple points of care, from dental assistants to specialists, whose work directly touches millions of people in South Africa. In a country where oral healthcare is already strained by staff shortages, uneven workforce distribution, outdated scopes of practice, and rising complexity in service needs, the next five years will demand leadership that is as decisive as it is inclusive.
Oral disease crisis
South Africa's oral disease burden reflects a crisis that rarely receives national attention. World Health Organization data show high rates of dental decay among children, widespread gum disease among adults, and a concerning prevalence of oral cancers.
These are not isolated conditions; they emerge in a context shaped by trauma, inequality, and chronic underinvestment. South Africa's high rates of interpersonal violence and vehicular accidents routinely result in severe facial bone injuries, placing immense pressure on a specialist workforce that is limited in number and geographically maldistributed.
Fewer than 650 dental specialists (across five categories) serve the entire country, most of them clustered in major metropolitan areas. For the majority of the population, specialist oral healthcare remains out of reach.
Regulatory gaps and stagnation
Within this strained landscape, dental assistants offer a stark illustration of regulatory stagnation. Their revised scope of practice was gazetted for public comment back in 2024, yet final approval remains elusive.
The existing scope is outdated and fails to reflect the tasks dental assistants perform daily. This leaves them vulnerable to exploitation and professional insecurity.
Unregistered practices persist because regulatory ambiguity creates opportunity for unscrupulous employers and offers no clear upward trajectory for assistants committed to advancing within the profession. Without coherent policy direction, the dental assisting profession will remain a structurally weakened pillar of the oral health workforce, despite its central role in day-to-day dental practice.
A parallel tension plays out between general dentists and specialists, where disputes over scope encroachment have intensified in recent years. Generalists offering specialised orthodontics, implantology, or prosthodontic services face criticism from specialists who argue that such procedures require years of intensive training. Yet generalists counter with a compelling point: restrictive scopes further entrench inequity when specialist care remains inaccessible to the majority of the population.
The heart of the dispute, however, is a vague and enabling scope of practice for general dentists and the absence of formal scopes of practice for the various dental specialists. This regulatory oversight, with no hard boundaries, leaves much room for interpretation, for variable training pathways, and for escalating professional conflict. Dentists now pursue short postgraduate certificates that allow them to deliver services typically mastered over years of specialist training. Whether this trend represents innovation or risk depends on whom you ask, but what is undeniable is that regulation, not professional rivalry, should determine the boundaries of practice.
Lack of representation and transparency in oral health boards
Amid these pressing regulatory debates, questions about the composition of the oral health boards themselves have emerged. The Medical and Dental Board's seven dental seats, dominated by specialists, six of whom are university-affiliated, reflect a concentration of academic leadership that does not mirror the diversity of South African oral health practice. General dentists, who form the bulk of the profession, are not represented. Nor are community organisations, NGOs, civil society, or private sector practitioners, despite their central role in delivering care.
This imbalance does not diminish the expertise of the appointed specialists, who bring depth and experience. Instead, it raises a question of perspective. Can a body so academically weighted remain sensitive to the lived realities of practitioners in rural clinics, township practices, community health centres, and underserved provinces? And can it govern impartially when training institutions, specialist pipelines, and access barriers all converge in contested policy debates?
YAY OR NAY? The DA intends to propose legislation to allow healthcare professionals to do community service and internships in private hospitals. Such a legislative change risks exacerbating some of South Africa's healthcare inequalities, argues Bulela Vava.
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Concerns about transparency in the appointment process compound these frustrations. Across the oral health professions, practitioners have noted discrepancies between gazetted nomination lists and final appointments, with little clarity on how candidates were selected or why certain nominees were excluded. While allegations range from procedural opacity to possible irregularity, the underlying issue is straightforward: legitimacy depends on clarity. Without transparent processes, even well-intentioned appointments risk appearing compromised.
Oral health regulation is at a crossroads
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Taken together, these issues situate oral health regulation at a crossroads. South Africa cannot afford another five-year cycle marked by indecision, regulatory silence, and unresolved tensions. The sector requires clear, courageous reform.
Transparent appointment processes must become the norm rather than an exception. Consideration should be given to unifying oral health professions under a single regulatory board within the HPCSA to address fragmentation and strengthen coherence. Most urgently, scopes of practice, particularly for dental assistants and general dentists, require immediate finalisation to eliminate ambiguity and protect the public. Workforce planning must be grounded in equity and primary healthcare principles rather than historical precedent or institutional interests. Above all, regulatory decisions must be guided by a commitment to safe, accessible, and competent care for all communities.
The work that matters, the work that shapes access, quality, safety, and fairness in oral healthcare, begins now. South Africa's oral health boards enter this term with an opportunity to govern boldly, transparently, and inclusively. Whether they seize it will determine not only the future of professional regulation, but the lived health realities of millions who rely on a system still struggling to find its voice.
*Vava is an Atlantic Fellow for Health Equity at Tekano and Founder of the Public Oral Health Forum, a volunteer organisation committed to advancing oral health equity in South Africa.
Note: Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.
