661. Portugal: doctors that do not exist

Officially, there are no dentists in primary health care. The medical career dentist is not even provided for in the National Health Service (SNS in Portuguese). But there are thousands of Portuguese who go to the dentist at the health center and thank. They are hired as technicians, assistants, administrative or other professional qualifications. A situation that puts them outside the law.Despite the secrecy, they are precious to many people. Cater mainly patients at risk, fewer resources or people who just family doctors determine. Serve those who can, because some groups of health centers, comes to be a dentist to 500,000 people, or more. Sometimes there are parameters to define who should be attended to, sometimes not. Will be a few dozen, dentists in health centers. Sure no one has yet managed to count them. Most requests for information to the Regional Health Administrations went unanswered. The exceptions are the Alentejo, it says have no dental health centers, and the Algarve, states that there is only one, in the health center of Faro. 

The latest available data show that there are some dentists in some health centers, but also show that the number of consultations of this specialty has always decreasing. The region of Lisbon and Tagus Valley, the Regional Health Administration says in writing that the Oral Health Program in force in this area only includes dental checks. Official data show, however, that there is a dentistry unit that receives users of various health centers in the capital. They work here 7 dentists and 1 stomatologist. We were not allowed to report.

The unit is part of the Shared Services Centers Health Cluster Center Lisbon. It is open from 8 am to 8 pm. The waiting room is a quiet, comfortable place. It is noticed that many are repeat users. All come indicated by your family doctor and here are followed by your dentist. There are children, elderly, chronically ill but who simply can not afford a private dentist. Staff in this health unit were not allowed to testify.

Who they are and how they work - Jose Frias Bulhosa chose not to have private practice. Works in Health Center of Aveiro, and not only. In my health centers grouping'm the only dentist to 369,000 inhabitants. I was put in Vagos 3 years ago, the equipment was not working. Not to be stopped went for consultations Aveiro. They will when the equipment are free when hygienists are not using. Between here and there, there are many revealing cases of missing that dentists do. There are still months identified a woman with a tooth in good sky. The family doctor had never noticed. You would have a 35, 40, did not know what it was. I am also me to remember a 4 year old with 20 teeth and needed intervention 18.

The clients are referred by your doctor or family nurse. Otherwise it would be humanly impossible. The exception are the cases where there is suspicion of malignancy, I always see, anytime. Now with the dentist-check for these situations I can already send these people to another location. Jose Frias Bulhosa also serves children in the region who have exhausted the dental checks to which they were entitled and who attend private schools, which do not receive these checks.
The most difficult cases, said Jose Frias Bulhosa, are the adults with pathology, transplanted with immune problems. These people rarely appear with a cavity, usually they need to deal with 20 or 30 teeth. Most dentists working in health centers know their place can be removed at any time. We should not find excuses. We have therefore chosen, by dentists do not identify which follow.

Antonio is dentist, working in a health center of the central region, but does not exercise is superior technician overall career. I have worked as a dentist, but it was illegal, I can not, if something happens ... ..
A health center of the great Lisbon Joana talks about the risks of working as well. I am better technique, I've been told that I can not anesthetize without permission from the doctor, the truth is that taking our consultation, there is nothing in this area. We are 3, but since we were only two dentists to 400,000 inhabitants and our reference Hospital Amadora-Sintra, has the specialty of dentistry. This query is for risk patients: diabetes, cardiac surgery, transplant, cancer patients. Still, family physicians also in send abscesses. For many people, these dentists are the first and last resort.

Joana does not need to pull the memory to give a few examples: Appeared me a girl of 13 years with a fistula, under the chin, to drain pus for over 6 months. It was a giant external abscess. It is also common to see pregnant women who doctors hesitate to give dental checks for fear of treatment during pregnancy. Then there are those people who enter the vicious circle: do not get jobs because they had the bad teeth, enter the query to take 5 or 6 roots at once, but we can not give prosthetics and they also do not can afford. Also I get to have patients who drop out of consultation by no longer having exemption from prescription charges.

The dentist's career does not exist in the National Health Service, it is therefore not expected to exist in the health centers, but the official price list is posted there. A health center is charged as specialty hospital consultation, costs 7.75 euros, and extraction of a tooth, for example, costs an additional 3.5 euros.Cheques dental yes, dentists do not - Officially, all oral health care within the primary health care is provided by more than 3000 private dentists who have joined the National Oral Health Program. The model is the check-dentist, a voucher for consultation and treatment that is available to children of low-income elderly, patients with HIV-AIDS, pregnant and who has signs or suspicion of malignant lesions in the oral cavity. Rui Calado, director of the National Mental Health Programme explains which are likely to be included new beneficiaries of the dentist-check, but only when there is sustainable funding guarantee. As for the inclusion of dentists in the National Health Service, the costs are considered unaffordable.

Dora Pires

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