712. The future of oral health in the National Health Service?

The World Health Organization considers that oral health is an essential component of health in general and a high oral health index is a fundamental human right, but the Portuguese National Health Service, when it was created in 1979, left out health oral.
Access to dental care has been provided by dental practitioners in private practices, but obviously for those with economic resources for such, which are less than half the population. Not surprisingly, Portugal has one of the worst situations in terms of oral health compared to other European countries. Last year, the Portuguese Observatory of Health Systems (OPSS) warned that the poorest countries continue to have less use of specialist consultations, particularly in access to oral and mental health and medicines, whose costs are classified as catastrophic expenses for these Portuguese.

Only in 2008 a first step was taken so that users of the National Health Service (SNS in portuguese) could access oral health consultations. The National Program for the Promotion of Oral Health, known as the Dentist's Check, in which the SNS hires adherent professionals, today more than 4000, some treatments for special groups of the population, children and adolescents, pregnant women, people with HIV / AIDS and combat to oral cancer. That is, only a small part of the population benefits from the Dentist's Check.

To extend oral health care to the entire population, several ways are possible: equip health centers and hire dentists to serve the population; extend the Check-Dentist program; to participate in the convention regime (type ADSE) the consultations of the users of the SNS by the State or to combine the previous hypotheses. The current government decided two years ago on the first hypothesis. It was a political option that deserved the applause of the Order of Dentists (OMD). How it would have deserved the same applause if the option had been another. From the perspective of the Order of Dentists and people, what is needed is to promote access for all to quality oral health care. If this is done in the public sector or in partnership with the private sector, it is indifferent. There are good international examples for both options.

In 2016, work was done in some health centers in the south of the country and dentists were hired for a pilot project aimed at providing care to the most vulnerable population. Since 2017, the pilot project has been extended and currently more than 50 health centers in the continent have dentists to serve the population, in appropriate facilities and equipment at the level of what happens in the private sector. The Government wants that by the end of the next year all the Groupings of Health Centers (ACE) have consultations of dental medicine.
In the pilot project, dentists are hired as providers of services, without employment or exclusivity, and for a period of 12 months without entitlement, for example, holiday allowances, Christmas or medical leave. Extending the supply of oral health consultations to all ACEs requires, however, that dentists to practice in the SNS have an appropriate framework, a career in dentistry. To this end, a working group was appointed by the Government which produced a proposal which was approved by the Ministry of Health. A career of its own because dental medicine is a unique profession. It combines the intellectual conception of a work, with the medical, surgical and surgical execution of the same with adequate procedures performed in the patient.

Dental medicine is an autonomous profession throughout the world, with a minimum of five years' training and 5,000 hours of university work directed at the specificity of dental medicine. It is not a specialty of medicine and has its own organization, through the Order of Dentists. In direct contact with the patient, the dentist, within the functional content of the profession, integrates medical and scientific knowledge acquired in the elaboration of the diagnosis and treatment plan with an operative and surgical approach in the patient in order to obtain the final result, prevention, maintenance and obtaining of function and aesthetics.
To this end, the dentist is assisted by a set of diagnostic, radiographic and imaging aids, among others, and a set of essential equipment and devices, dental materials and medicines, as well as the support of the health team oral, in particular dental assistant. The dentist also prescribes medicines and drugs through prescriptions and attests health and illness through medical certificates.

The current model of service delivery of the pilot project is precarious for dentists and dentists, who, without exclusivity, work in other offices and are constantly looking for a job, in search of a situation less precarious than in the SNS. Continuity of patient follow-up will always be at stake. The fact that dentists are not fully integrated makes it very difficult to articulate interdisciplinary teams as they recommend the best health practices, especially for example in the care of patients with cardiovascular diseases and diabetes, the most common in Portugal. There is no professional stability in the model, which undermines the recruitment and motivation of professionals who are subject to constant calls for tender.
To create a career in dentistry is for all these reasons to ensure that oral health consultations will be an integral and indivisible part of the SNS once and for all. The only certainty that there will be no retreat. As far as oral health is concerned, Portugal has wasted almost 40 years to guarantee a constitutional right. The fundamental rights and duties of the Constitution of the Republic of Portugal include that everyone has the right to health protection and the duty to defend and promote it and that, in order to guarantee the right to health protection, it is primarily the responsibility of the State to guarantee access for all citizens , regardless of their economic condition, to the care of preventive, curative and rehabilitative medicine. In oral health this right has been forgotten. 

Today, the investment is done and properly budgeted, dentists are contracted, missing only one last step, the essential co-approval of the career of dental medicine by the Ministry of Finance. We all hope that it will come quickly so that everything is not lost. The Portuguese deserve it.
Bastonary of the Order of Dentists

Orlando Monteiro da Silva

PÚBLICO

 

711. Oral Health Consultations at the National Health Service

Look on the map for the Health Center with the symbol closest to your area of residence. If you are your Health Center, or if you are a Health Center of your Health Centers Group (ACES) or Local Health Unit (ULS), you have access to oral health consultations.
You can make an appointment with your family doctor or, if you do not have a family doctor or the same is not available, another doctor at your health facility and he will give you the orientation for the first oral health consultation.

710. Interview with Miguel Stanley: Oral health is inseparable from general health

Renowned medical dentist is the scientific consultant in the field of dental medicine at Dr. Well's clinics. A conversation about the current moment of dental health in Portugal and the importance of its democratization.
These days, how would you explain the importance of oral health in anyone's life?

I've always had some difficulty understanding why it is that for so many people, the mouth is not part of the body ... I say this in jest because it obviously is. Oral health is indissociable from general health and, moreover, it is inseparable from our happiness and the smile is the maximum expression of it. I believe that the awareness of the Portuguese population about this problem is getting better and, of course, anything that puts people to brush their teeth is good for the population. Obviously in terms of health it is deeply important, but we can not forget the aesthetics, a pleasant smile can change the perception of others about us and can increase self-esteem exponentially, so I am a passionate in this matter.

One of the pillars of his partnership with Dr. Well's, as a scientific consultant in the field of dentistry, is the democratization of access to oral health care. Explain to me a little better what lies behind this concept?

Dr. Well's was born with the goal of democratizing access to quality health services. And knowing that only 5 in 100 Portuguese have the opportunity to put a dental implant, it shows that there are more than we, dentists, could do in the dental medicine industry.

How is the health of the mouth and teeth of the Portuguese?

The health of the mouth of the Portuguese should be seen by segments. I would say the children's is great, because fortunately parents have already learned and are more concerned about washing children's teeth, which is great because future generations will have more oral health. Obviously, the same can not be said of people between the ages of 60 and 100 because they unfortunately lived in an age where there were not many skilled dentists in the country and consequently there are a large percentage of them toothless and unable to afford to even think about rehabilitate your smile. Between these two segments of the population, there is a bit of everything, depending on economic ability and level of education. Obviously you can not generalize because I have experience of well-trained and economically capable people who have had the misfortune of not being well followed by your dentist and have to end up doing very costly and time consuming treatments to regain your smile.

If you were Minister of Health, what are the first steps you would take in the area of oral health in the country?

If I were health minister I would first go around the country to listen to health professionals and technicians, from north to south, to try to understand the difficulties they have. Nonetheless, I think that in terms of dentistry it would put a compulsory school program, a little like what is done in the Nordic countries, and make sure that the population, especially the most deprived, does regular oral hygiene and screening caries and early treatment. I have always found it strange that our taxes are not applied in this aspect of simpler dental medicine and I understand that it is something that should be a right of citizens.

And aesthetic medicine: is it a branch that has definitely entered the day to day of people or is it something reserved only to those who have the means to do so?

Dental medicine is one of the few medical areas that has an absolute 'crossover' between aesthetics and health. I usually say that a beautiful smile is the reflection or mirror of a healthy smile. So the first step to having a beautiful and aesthetic smile is to have it healthy. As such, people can not expect incredible aesthetic results if they do not have the functional and biologically sound part.

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