ORAL HEALTH BRAZIL vs PORTUGAL

Work done by Gislanda Souza Enta. 2012

Oral health in Brazil and Portugal

Gislanda Santiago Souza

Report Curso Tcnico Especialista Higiene Qualidade Alimentar

ABSTRACT: A research was made by a Brazilian student named Gislanda Santiago Souza, age 30, attending Enta School (New Technologies school of the Azores), enrolled in the Hygiene and Food Quality course. Her study based upon the bad oral hygiene of the Portuguese people comparing to the Brazilian people. The pivotal aspect that motivated her interest in the referred study and consequent work was that she could notice the Portuguese shy and sad smiles hiding wracked and unhealthy teeth. Her school was the perfect scenario and, at the same time, she wanted to boost a change in the peoples mind and in their dental health. These studies are about the oral health in Brazil and in Portugal taking into account their different economic situation, epidemiology, prevention in dental caries and periodontal diseases. Brazil shows a scenario of dental development, a growing offer of dental surgeons. On the contrary, studies show that Portugal needs further implementation of school based oral health promotion and application of population-directed preventive strategies. Method: The method used for this paper was the research in articles online and the enquiries that the school students kindly accepted to do. Findings: The findings are based in the analysis of the enquiries, the focus of the groups of students and their statements about their oral routines, their feedback in the questioning and, of course, the reading of some precious articles about the subject. Terms /key words: Oral health, Brazil, Portugal, sanitary odontology, health services, dental caries, prevention.

CONTEXT
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Ponta Delgada, 04, February of 2012

Gislanda Santiago Souza

Report Curso Tcnico Especialista Higiene Qualidade Alimentar

The history of oral health in Brazil

The inauguration of the Public Health Special Service in 1952 prompted the first dental health programs in Brazil. They were chiefly aimed at school children who were considered epidemiologically liable to disease and, at the same time, highly sensitive to public health intervention. Although the care model was aimed at developing educational activities, the clinical practice actually reproduced what dentists did in their private clinics. The model conceived was highly individualistic and did not aim at developing a technology program as the result of a planning process. Nevertheless, an important landmark for health in Brazil was achieved during the 1980s owing to the deep transformation which occurred in health policies throughout the country after the Decentralized Unified Health System (SUDS in Portuguese) was inaugurated. Later on, this system evolved into the current Brazilian Health System (SUS in Portuguese). The same environment indicating the dire need for changes in the health care model was in place when the basic principles of the Brazilian Health System were defined. In fact, the Brazilian Health Conference in 1986, coordinated by Dr. Srgio Arouca, President of the Oswaldo Cruz Foundation (FIOCRUZ) at the time, insisted on the guidelines of health care universality, decentralization, social control and equity. Decentralization of the Brazilian health policy, one of the foundational guidelines of the Health Reform movement, remained a basic premise of the Brazilian Health System within the 1988 Constitution and of Law n. 8080 of September 19, 1990 which regulated the Brazilian Health System. The establishment of the Basic Operational Norm (NOB-SUS, 1993) consolidated developments such as funding standardization and the decentralization process in the administration of services and other activities within the system.

Ponta Delgada, 04, February of 2012

Gislanda Santiago Souza

Report Curso Tcnico Especialista Higiene Qualidade Alimentar

The incorporation of coverage of oral health collective procedures (CP), defined by Government Regulation n. 184 of October 9, 1991 published by the Ministry of Health, was a landmark during the 1990s of this important change from an individualistic-curative stance to a collective-preventive one. The Family Health Program (FHP) was established in 1994. Since the focus was placed on the family, on patient registration and on a clinical practice based on a social epidemiology rationale, it became an efficient strategy for the reorganization of basic care. The establishment of links, commitment and responsibility between professionals and the community is one of its high points. Inclusion of Oral Health Teams (OHT) within the Family Health Program was effectively defined by Government Regulation n. 1444 of December 28, 2000. The Brazilian Oral Health Policy launched by the Ministry of Health in March 2004 was the result of a long historical process of institutionalization of dentistry within the Brazilian Health System.

Epidemiological aspects
In 1986 the Brazilian Ministry of Health undertook the first Epidemiological Oral Health Survey with population samples from the greater areas of Brazilian capital cities. Its aim was the planning of programs and strategic fronts. A second National Oral Health Survey11 was undertaken in 1996, and then again in 2003. The 4

Ponta Delgada, 04, February of 2012

Gislanda Santiago Souza

Report Curso Tcnico Especialista Higiene Qualidade Alimentar

latter was called the "Oral Health Conditions in the Brazilian Population". Several dental institutions and organizations, including the Brazilian Dentistry Organization and its regional sections, several universities and state and municipal health departments participated in the project. Some two thousand professionals (dentists and assistants, health agents and others) from 250 Brazilian municipalities also took part in the survey. Furthermore, 108,921 individuals including children (18-36 months old; 5 years old and 12 years old); young people (15-19 years old), adults (35-44 years old) and elderly people (65-74 years old) from urban and rural areas were examined. In spite of a sharp decrease in the level of dental caries among the children population during the last decades, high levels of oral diseases were still extant in certain population groups. Whole sections of the population remained without any sort of care. The results revealed that a mean of 14 teeth were still affected by caries during adolescence and adulthood (graph 1)

DENTAL HEALTH IN PORTUGAL: A DIFFERENT REALITY

In Portugal, oral healthcare is provided almost entirely by the private sector. Public dental services are available in only a few hospitals involving major treatment requiring hospital admittance. A handful of Public Health Centres provide simple restorations and extractions. 5

Ponta Delgada, 04, February of 2012

Gislanda Santiago Souza

Report Curso Tcnico Especialista Higiene Qualidade Alimentar

A Public Oral Healthcare system based on prevention is being developed. Dentists who want to participate inform the local Health Centres. Children of 6-10 years from schools are then referred to the private practices of these dentists. Each child is allowed 2 visits per year. Payment is made by the Ministry of Health and is based on a fee per child per appointment. Treatment of first permanent molar includes fissure sealants, simple filling, basic endodontic and extractions. By 2002, approximately 10% of this group age received care and 4.5 million Euros were paid of the Ministry budget. In the Autonomous regions of Madeira and Azores oral healthcare is provided within the National Health Service and is financed by the regional Government.

Health Expenditure % of GDP Spent on Health Total 10.2 Annual Expenditure on Oral Health Care n.a. % of GDP Spent on Oral Health Year Source

0.36 (2004) 2006 1)

1) Manual of Dental Practice. The Council of European Dentists, Nov 2008. N.A- not available.

Portugal and Brazil in dental health

Conventional wisdom for many years was that caries were the main reason for tooth loss before age 35, and periodontal disease was the main reason after age 35. This belief was based on some old and rather dubious data.

Ponta Delgada, 04, February of 2012

Gislanda Santiago Souza

Report Curso Tcnico Especialista Higiene Qualidade Alimentar

Even as late as 1978 there was a report that 8-10% of teeth are lost to periodontal disease by age 40, and that such loss increases rapidly after that age. According to some authors, since the mid-1980s, studies from a number of countries and among different types of populations have consistently found that caries is the principal cause of tooth loss at most ages, with the possible exception of the oldest (i.e., those over 60 years). In Brazil tooth loss is a serious public health problem, and the percentage of adults with total loss is high. A number of research studies have been carried out to determine the reasons for tooth loss, all of which have shown tooth decay as the most important factor for tooth loss, followed by periodontal disease. Educational level and age factors are associated to tooth loss. Tooth retention throughout the life course should be the main concern for both dental surgeons in general and all professionals working in public health services. In Brazil, less than 22% of the adult population and less than 8% of the elder people present healthy gum tissue. The data are from "SB Brasil 2003", the most complete oral health survey in the country. Furthermore, it is already possible to follow the impact of actions on oral health over the country, especially regarding the reduction in dental extraction indexes. Since 2002, about 2 million teeth were not extracted owing to these actions. This is an important health indication and it shows an improvement in the quality of oral health care in Brazil. Water fluoridation, supervised tooth brushing, controlled fluoride mouthwash programs, use of sealant on pit and fissures, and early diagnosis and treatment of dental caries and periodontal diseases are all effective measures. Talking about a different reality as Portugal, the results emerged from the studies and meetings assert that it is imperative that the Portuguese health authorities clearly take tooth decay as the main infectious disease affecting the Portuguese population and to establish immediate goals for their effective control and eradication. 7

Ponta Delgada, 04, February of 2012

Gislanda Santiago Souza

Report Curso Tcnico Especialista Higiene Qualidade Alimentar

Portugal cannot continue to be the a poor third-world country related in Europe, in what regard to oral health care provided by the national Health Service. It is unacceptable that, compared to Portugal, there is currently poor and underdeveloped countries of the Third- World to do more and better oral health for their populations. It is about time to acknowledge that Portugal has all the facilities and human and financial resources that enable the control and eradication of dental caries, missing only the political will to take the right step in that direction. There are services in Portugal that can spend less and work better. The increase should focus on enhancing the network of continuing care and palliative care, which is now spread across the country, and the creation of another oral medicine that is virtually nonexistent. There are already checks dentists for pregnant women, children and elderly, however it should be moving towards the creation of a valence of oral health, which is very important, not just to have beautiful teeth and functional, but to prevent other diseases. On another hand, and as the former Minister of Social Affairs said, at the time of crisis Portugal is living, the social sector must be strengthened to compensate for the inequalities that now aggravated by unemployment and other precarious situations. The current bleak picture of oral health in Portugal, the responsibility of Governments past and with full connivance of the Directorate must change rapidly. Portugal is closer to of poor and underdeveloped countries than their European Union partners in terms of oral health. According to Leske et al. (1993), traditionally the prevention of oral diseases has been well-founded on three levels:
1- Primary prevention, related to the initiation of the disease;

Ponta Delgada, 04, February of 2012

Gislanda Santiago Souza

Report Curso Tcnico Especialista Higiene Qualidade Alimentar

2- Secondary prevention, where the aim is to stop the progression of the

disease and also disease recurrence;

3- Tertiary prevention, where the goal is to avoid tooth loss (loss of function).

Statistics show that the Brazilian Government's Oral Health Program (within the SUS), with strong public oral health policies applied all over the country is an effective effort to reach the first prevention level. Two prevention levels, however, remain uncovered by the government's actions. The loss of teeth due to periodontal disease and/or to endodontic infections, and the replacement of the teeth by dental prostheses are still inaccessible to a great portion of Brazil's population, and only Dental Schools and few municipalities have had the resources to treat a small portion of those needs. Thus, the Dental Specialty Centers (CEOs) are a valid alternative to complement the population's needs all over the country. However, as Brazil has a continental dimension, great challenges still have to be overcome. In spite of the social policies undertaken and some favorable economic factors, more centers and more specialists must still be better distributed over the country's different regions in order to achieve a better balance in oral care health to the population as a whole.

CONCLUSION
Based on the data and numbers studied this paper concludes that public actions on oral health must involve both preventive and curative procedures in order to minimize distortions in the oral health of the populations of developing countries. To this end, the Dental Specialty Centers are a valid and welcome social program in Brazil. Unfortunately Portugal is taking baby steps in order to change children and adults dental habits, treatment and preventions, as well as giving the awareness of a healthy oral life at an early age.

Ponta Delgada, 04, February of 2012

Gislanda Santiago Souza

Report Curso Tcnico Especialista Higiene Qualidade Alimentar

RECOMMENDATIONS
Taking into account the previous study, I recommend that the Portuguese government and also some private institutions to take serious measures in order to improve Portuguese oral health. The Portuguese government should take a step to help young children at school to implement a hygiene oral routine to present caries and teeth loss in such a young age. Taking a step to grant medical, dental appointment to poor families and implement in the public school. Then take copy the good example of prevention that Brazil implemented a long time ago.

THE DIFFERENCES ARE OBVIOSLY NOTICED WHENEVER WE HAVE TIME TO LOOK AT THEM.

Picture A- A Portuguese presenter

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Ponta Delgada, 04, February of 2012

Gislanda Santiago Souza

Report Curso Tcnico Especialista Higiene Qualidade Alimentar

Picture B- Brazilian actress

CONTENTS
Abstract-----------------------------------------------------------------------------2

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Ponta Delgada, 04, February of 2012

Gislanda Santiago Souza

Report Curso Tcnico Especialista Higiene Qualidade Alimentar

The history of oral health in Brazil/Epidemiological aspects-------------3- 4 Dental health in Portugal----------------------------------------------------------5 Portugal and Brazil: Comparison----------------------------------------------6-8 Conclusion/ Recommendations --------------------------------------------------9 References-------------------------------------------------------------------------11

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Ponta Delgada, 04, February of 2012

Gislanda Santiago Souza

Report Curso Tcnico Especialista Higiene Qualidade Alimentar

REFERENCES
Programa Nacional de Servios Bsicos de sade, 1981. Narvai PC. Odontologia e sade bucal coletiva. So Paulo: hucitec, 1994 Ministrio da Sade. Levantamento epidemiolgico em Sade Bucal, Braslia, 1988 http://bdigital.cariedentaria.pt www.ortodontiaereabilitaaooral.pt

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