747. REPORTAGEM VIVAbem UOL (BRAZIL): Stain, wound and nodule - mouth cancer gives signs and asks for a quick diagnosis

White or reddish spots, wounds that do not heal after 15 days, lumps on the neck. In more advanced cases, bleeding, difficulty swallowing and speaking. These are some of the symptoms of mouth cancer - also known as cancer of the oral or oral cavity. According to Inca (National Cancer Institute), it is more common in men over 40 years old, being the 4th most frequent tumor in males in the Southeast region. The challenge, as with other types of cancer, is a quick and accurate diagnosis.

"The sooner the diagnosis is made, the greater the patient's chance of cure", explains Letícia Lang, oncology dentist at Oncoclínicas Londrina and the Oncology and Radiotherapy Center of Londrina, Paraná. The tumor can affect any region that is inside the oral cavity, that is, in the mouth. It can also involve the oropharynx, which is the junction of the back of the tongue with the pharynx - in this case, there is a greater relationship with infection by HPV, the human papillomavirus. Even so, it is more common for lesions to appear in the following regions:

- Lateral edge of the tongue;

- Buccal floor (under the tongue);

- Lower lip (depending on the type of tumor, it may be considered skin cancer);

-Palate;

-Inner part of the cheek.

According to Luciana Ramalho, a dentist and stomatology consultant at Grupo Oncoclínicas in Bahia, cancer does not happen overnight, but it gives signs that may go unnoticed and that are confused with other wounds. The canker sore, for example, heals and heals. "Most of the time, it appears as a white or red spot or as a wound that doesn't heal and doesn't hurt either. If it doesn't heal in 15 days, it should trigger an alert", she says.

That's because the more time passes, the more the symptoms can get worse. "These spots or wounds are gradually transformed. In more advanced cases, bad breath appears, difficulty speaking and swallowing, in addition to lumps in the neck", he points out. See the symptoms:

-White or reddish spots;

- Wounds that do not heal after 15 days;

- Nodules or growth of the mucosa;

- Lumps in the neck (sometimes this is the only symptom present).

Signs in more severe cases:

- Difficulty chewing, swallowing and talking;

- Feeling that there is something stuck in the throat;

-Bad breath;

- Difficulty moving the tongue;

- Bleeding.

Don't forget your mouth, do a self-examination – The mouth has an "advantage" over other parts of the body: we can analyze it without much difficulty, every day, especially when we do hygiene. This is exactly why we should keep an eye out for possible changes, but how?

There is a self-examination that can be done quickly, according to experts. "Open your mouth wide in front of the mirror with your tongue out. Look to the right and left, see if there are any of the symptoms. Place two fingers on the inside of the cheek to assess the region. Also check the roof of the mouth and the bottom of the tongue.

If you have any injury, look for a specialist", explains Leonardo Arcoverde, oncological surgeon at SBCO (Brazilian Society of Oncological Surgery), head and neck coordinator at Hospital Esperança Recife and head of the Hospital do Câncer de Pernambuco. replaces the need for a consultation with a health professional. It is not the patient's obligation to make the diagnosis, but the doctor or dentist's. "The self-examination is an initial screening. If he identifies something different, he should, yes, look for a dentist", says surgeon-dentist from Londrina.

But if you are still in doubt, check out this image below, created by dentist Letícia Lang. It is these regions that you should look at most carefully.

 

Tobacco, alcohol and HPV: the risk group – Some people may be more at risk of developing oral cancer. Patients (more men) who smoke tobacco and/or are alcoholics, mainly, are more likely to have tumors in the oral cavity region. Considering the regions of the mouth, cancer of the lips is the third most frequent type, corresponding to 25% to 30% of all types of oral cancer. It occurs mainly in fair-skinned men over 50 years of age. Lip protection, in this case, is essential for anyone who spends the day exposed to the sun.

But that doesn't mean that individuals outside this group can't also develop cancer. Even younger people are often diagnosed with an association with HPV infection, as explained by Felipe D'Almeida Costa, pathologist, director of Education at the SBP (Brazilian Society of Pathology) and head of pathological anatomy at the ACCamargo Cancer Center (SP).

"They are younger patients with no history of smoking or alcoholism. Generally, the primary lesion in the tonsil is small and hidden. While the ganglion in the neck is already enlarged", says the medical coordinator of Pathology Education at Dasa. "With tumors not associated with HPV, they are alcohol and tobacco dependent patients. They are older and the primary lesions are larger than those in the neck", he concludes.

It is important to point out that, in addition to mandatory condoms in all sexual relations, there are still vaccines against HPV offered free of charge for boys aged between 11 and 14 years and for girls aged 9 to 14 years. For adults, it is also indicated, it is possible to find it in private clinics. Another important point raised by specialists is that oral cancer has a strong social component involved, affecting low-income people, without access to dentists and with little knowledge of the importance of oral hygiene.

"When we go to the poorest regions of the country, we notice that the risk of oral cancer grows a lot, if compared to regions where people with greater purchasing power live", says an oncological surgeon from SBCO.

There are ways to prevent mouth cancer, which involve the following precautions: No smoking; Limit alcohol consumption, drink socially; Maintain good oral hygiene; Have a healthy eating; Going to the dentist regularly; Use a condom during sexual intercourse; Get vaccinated against HPV; If you work in the sun, wear a wide-brimmed hat and lip balm; Seek medical attention quickly if any symptoms appear. Challenge: the diagnosis arrives in advanced stages It is a disease of important magnitude in Brazil, with significant regional variations, both in incidence and mortality. It is estimated 11,180 new cases of the disease in men and 4,010 in women for each year between 2020 and 2022. The Southeast and South regions have the highest incidence and mortality rates of the disease, according to Inca. Unfortunately, patients arrive with an advanced diagnosis, especially if they are from the public network, which greatly reduces the chances of cure. This is even one of the main challenges of oral cancer: early diagnosis.

"The treatment can be aggressive, so the sooner it is detected, the less problems the patient will have in relation to the treatment. They will be more conservative surgeries and the quality of life will be better", explains Lang.

It is the biopsy that will close (or not) the diagnosis. Among the most common types of cancer is squamous cell carcinoma, also called squamous cell carcinoma, with 95% of cases, and then tumors in the minor salivary glands, representing 5% of cases.

There are ways to treat and cure oral cancer – Treatment involves surgery, radiotherapy and chemotherapy – sometimes a combination of them. This depends on what stage the cancer is at and where it is located. Who takes care of this part is the surgeon, but dentists accompany the patient throughout the treatment.

According to Arcoverde, the "gold standard" of treatment is surgery to remove the tumor when there are safety margins. "Therefore, I recommend prevention and early diagnosis. Thus, we manage to treat the tumor even 'small', performing less radical and more conservative surgeries", he says. Rapid diagnosis not only helps in treatment, but also in survival. "Unfortunately, the majority arrive at professionals in more advanced stages, with a survival rate of less than 50% in 5 years. This is low in relation to other tumors", explains Ramalho.

Have a healthy mouth – This article is part of the VivaBem Have a Healthy Mouth campaign, which aims to explain how and why it is important to maintain good oral hygiene. We will also address common mistakes in brushing, oral cancer, how mental health affects teeth, the limits of aesthetic and corrective procedures, oral health of children and pregnant women, among other subjects.

Luiza Vidal

From VivaBem, in São Paulo

https://www.uol.com.br/vivabem/noticias/redacao/2021/06/01/cancer-de-boca-o-que-e-quais-sintomas-e-tratamento-ha-cura.htm

746. Scam in dental clinics passes through Tomar (Second part)

745. Scam in dental clinics passes through Tomar (First part)

Amélia Martins, from Tomar, is one of those injured by the sudden closure of Lusosmile dental clinics. Like other clients, she paid in full for dental treatments that she never had.

Journalist Sandra Felgueiras published an article in the magazine Sábado about this scandal that is also happening in Tomar, because one of the clinics had facilities in Corredoura.

 The magazine, citing the victims, says that the clinics required users to take out loans. “The contracts, made in record time, were drawn up at the clinic itself, which decided with which banks these same loans were made”, reads the report. “They told us that they only worked with credit, they prepared everything and we just had to sign. They received the money and I paid 120 euros to the bank for 60 months”, says Manuel Martins, Amélia's husband.

The injured person was approached on a street in the city of Tomar for a free evaluation consultation. This was followed by a budget of more than 6,000 euros to treat the teeth and the imposition of a credit as a condition for starting treatments, reports the reporter.

“We made him take credit to Cetelem right there at the clinic. I even asked if I could pay for the consultations, I could do it with difficulty, thus avoiding taking out a loan, but I was told right away that it was not possible. After all, neither money nor treatment”, laments Manuel Martins in the report that was also broadcast yesterday on CMTV.

This is just one of many cases of desperate and indebted families with the unexpected closure of LusoSmile dental clinics in Caldas da Rainha, Felgueiras, Tomar, Vila Real and Almada. The injured are joining and there is already a lawyer hired to represent them in court.

Tomar na Rede

744. Health is confusion. From the oral, you don't even talk.

In recent days, serious problems with the SNS began to lead the national news agenda; in particular, after the sad case in which a pregnant woman lost her baby.

These problems are old and no government has been able, to date, to solve them adequately; not for lack of good ideas from some ministers of health. But because little was put into practice.

Is the problem structural? Conjunctural? In my opinion, the problem is structural and the portrait has been around for a long time. There is no shortage of doctors, there are doctors, but they run away from the SNS. The finance minister even says that the problem is not financial; therefore, it will have its roots in the mismanagement and strategy adopted over the years by the various governments.

In 2017, “Integrated Responsibility Centers (CRI)” were created with the mission of ensuring the development of best clinical practices focused on the needs of users, adapting the internal organization of SNS entities to efficient management; to foster clinical governance processes that contribute to the continuous improvement of the quality of care provided in the SNS; increase the accessibility and response times of the SNS to citizens; to maximize the installed capacity on the public SNS network; promote the autonomy, involvement and accountability of professionals in the management of resources, encouraging them to exclusively develop their activity in the SNS; increase the levels of productivity and satisfaction of SNS professionals,

The question that arises is, why do the CRIs work well, for example at Hospital de São João, in Porto (by the way, a hospital that has had a strong dynamic and administration), and in other hospital centers it has an image “ ghost"? A case to say “It has to be investigated”, as our President says.

In the next few lines, I will give some focus to oral health, despite knowing that in other areas of health, chaos reigns and care for life is compromised. But I will speak, because oral health is itself at risk and if it is not restructured, it will be on the verge of extinction. And at this point I have to talk about sustainability, based on three essential pillars: social, economic and environmental (with an emphasis on waste).

In the social chapter, accessible oral treatments are essential to improve health conditions and reduce the disparities that exist between populations; as well as to limit the health burden on the population and reduce socio-economic inequalities. Social disparities in health and health care are particularly evident in the oral cavity. There is a clear association between poor oral health and chronic diseases such as diabetes, cardiovascular and respiratory diseases. Many people are chronic carriers of infections in the oral cavity, limiting themselves to overloading the emergency department in case of an exacerbation, where they are often prescribed palliative antibiotic medication. In addition to not solving the pathology, it entails significant costs.

It should be noted that in 51 hospital centres, there are 27 Stomatology Services where 145 stomatologists work.

On the other hand, most dentists are self-employed in the private sector, as there is no career that allows these professionals to be integrated into the NHS staff. However, the lack of proximity responses in oral health has led some health centers to enter into “service contracts” with dentists; there are, today, around 135 to 150 dentists in health centers, providing primary care.

Interestingly, the number of dentists in Portugal, per capita, is 1 dentist for 884 inhabitants, more than double the number recommended by the World Health Organization, which is 1 professional for 1500 to 2000 inhabitants. Of course, as the market does not absorb them, more than 20% either emigrated (12.72%) or gave up the profession (7.96%), according to data from the Portuguese Dental Association.

Arrived here, there is still a huge need on the part of the population to receive oral health treatments in the SNS, which does not respond to these needs. Stomatologists work in tertiary hospitals and are scarce; on the other hand, and while there are almost no dentists working in the SNS primary care, the unemployment or underemployment of dentists reaches numbers never imagined.

The real encounter between patients and dentists or stomatologists is reserved for those who “can”. This is the true expression of waste and the inverted pyramid.

There is a great need for the training of integrated teams of dentists and stomatologists in the SNS, as well as the creation of more oral medicine offices, in health centers and in public hospitals.

Addressing the environmental aspect , we found that private offices, with the implementation of Decree Law 108/2018, which sets safety standards regarding protection against the hazards resulting from exposure to ionizing radiation (relative to our rx devices) combined with a evident lack of knowledge by its national editors of the reality of the Health sector, namely Oral Health and Veterinary Medicine, is proving to be impossible to implement, leading to the ruin and extinction, in a few months, of two sectors of human health and animal. I am also referring here to Veterinary Medicine, which has provided valuable services to the country and which in recent decades has had a development, recognized by all.

However, the aforementioned legal diploma hands over to the Portuguese Environment Agency (APA), the inspection body, which is neither more nor less than IGAMAOT - general inspection of agriculture, the sea, the environment and spatial planning, which inspects and imposes fines. , which can range from 24,000 to 5,000,000 euros. I ask: what do our little rx's do to the environment? Radiation is minimal, incidentally described in scientific articles. Does not make sense. If, on the one hand, Rx are essential diagnostic tools, the professionals who deal with these devices meticulously comply with the entire safety protocol. Concern for the environment has always been important for health professionals.

In blatant panic, dentists in the private sector cannot help but wonder: are public health establishments and private hospital groups subject to the same rigorous scrutiny as the imaging activity, or is this yet another attempt to crush small health providers? health?

Will the practice of Oral Medicine be the new nuclear disaster of the 21st century? Given the surprising possibility of fines in the order of tens of thousands of euros, which could reach hundreds of thousands, would it not be financially more reasonable to close dental practices?

From an economic perspective, it is imperative to try to assess the future financial impact of full coverage of the entire national territory, taking as a goal the existence of 1 dentist for every 1500 inhabitants on the poverty line, thus assuming a more universal and equitable access to oral health care.

Considering the need to hire 1379 professionals and an annual cost of €41580 per dentist + assistant (estimating €1600 + €800 of gross salaries + social charges), the financial impact for the total coverage of the population on the poverty line is €57,338,820 per year.

According to the State Budget report for 2021, it was expected that the Budget (consolidated revenue) of the Ministry of Health would amount to 12,565.4 million euros. It would thus be an increase of only 0.46%, and we would have served the fringe of the most needy population. I'm only talking about the most needy, because let's forget about a universal SNS that can serve the population as a whole.

Private oral health clinics are closing due to the bureaucratic impositions required and difficult to comply with, the millions of Portuguese who seek the SNS find a “band-aid” in all areas of medicine, and the chaos seems to last.

And because we must think of solutions, together with dariacordar/zerodesdicio, chaired by Paula Policarpo and where I am the oral health coordinator, we have a 360 sustainable project thinking about the three aspects of sustainability for oral health.

Also at SEDES, together with dentists and stomatologists, we wrote a document containing possible solutions for oral health, which will be published together with all the recommendations of the different groups included in the SEDES observatory.

Ana Sofia Lopes

 OBSERVADOR

743. Ministry of Health hires 9 out of 10 dentists on green receipts

The absolute lack of interest shown by the Ministry of Health in the oral health of the Portuguese population is revealed, for example, by the scandalous way in which it treats dentists who work for the SNS (9 out of 10 with green receipts).

* * *

More than half of young dentists are dissatisfied with their profession, and if they could go back they would choose another career, and close to 25% intend to complete their studies in another area in order to practice another profession. The survey received more than 2,400 responses from a universe of 4,745 dentists registered with the Order under 35 years of age.
Most young dentists practice their profession in one (38%) or two clinics (26%). On average, 43% see between 6 and 10 patients per day and approximately 40% see more than 11 patients daily.
Only 17% of dentists under 35 years old claim to have a work contract. Close to 70% of respondents are self-employed without employees, that is, they work on green receipts. A situation that worsens for those who work for the State, almost 90% of young dentists placed in health centers or public hospitals are hired on green receipts, and almost half (48.9%) are hired through companies. 92.5% work in private clinics and offices, 4.1% in private hospitals and 2.4% in health centers.
In the private sector, the vast majority (78%) receive on a percentage basis, and of these, almost 55% earn between 31 and 40% of the value of the medical act. It should be noted that 92% of respondents reveal that they receive a percentage lower than 50%. Almost half (45%) of those who responded to the questionnaire took a year or more to earn an amount similar to the national minimum wage. Data show that more than 50% of young dentists have a gross monthly income of less than 1,500 euros (53%) and more than 70% have a net monthly income, that is, after discounts, below that same amount (74 %). More than half (51%) of young dentists receive less than 1,000 euros net per month.
The results of this survey are in line with the concerns that the chairman of the Portuguese Dental Association, Miguel Pavão, has publicly expressed about the excess of dentists and the underemployment conditions of younger professionals.
O Jornal Dentistry

742. OMD: Proposals for oral health presented to the Minister of Health

The Portuguese Dental Association (OMD) presented to the Minister of Health a proposal for the creation of a strategy and planning committee for oral health, with the objective of defining, in the short, medium and long term, proposals with effective responses to medical needs. -dental care of the Portuguese population.

The OMD intends to reformulate the National Program for the Promotion of Oral Health (PNPSO) and focus it on a logic of prevention and promotion of oral health, with a specific financing model, which makes use of different models of access to oral health care, whether public, private or the social sector.

For Miguel Pavão, chairman of the OMD, “oral diseases continue to be the health area most neglected by health systems, resulting in an oral health deficit for the Portuguese. Reversing this reality is complex and lacks a multidimensional approach that allows for a transversal and integrated articulation of public health policies, with a view to reducing the burden of oral diseases. It is essential in this equation to relate social inequalities, poverty and addictive behaviors and addictions in oral diseases”.

During the meeting, the Minister of Health recognized that it is a complex and difficult task to reverse the delays of several years of investment in oral health.

Among the proposals presented by the chairman is the creation of oral health units in all health centers, with the entry of dentists in the Regional Health Administration to lead the implementation and development strategy, in conjunction with the General Directorate of Health. The OMD wants dentists to manage the local and regional teams and even the national team of the PNPSO, which classically has been given to professionals without specific training in oral health.

The chairman of the OMD reveals that “we asked the minister to move quickly with the creation of the commission in order to resolve this patchwork of oral health in the SNS. It is important for everyone to understand that there is no general health without oral health. A maxim that has been forgotten. The SNS is over 40 years old, but the dental check was only created in 2008, and as a solution limited to some audiences. In other words, there is a huge delay in relation to other areas of health”.

The OMD defends the extension of the dental check to new segments, namely an emergency check for trauma and a review of technical aids for, for example, dental prostheses. The OMD also calls for a review of the value of the dental check, reduced since 2014, within the scope of the troika's financial rescue program.

Knowing that Marta Temido takes over the health financing dossier, Miguel Pavão questioned the minister about the allocation of funds for oral health in the State Budget for this year, which the Government will deliver this Wednesday to Parliament.

The chairman of the OMD recalls that “the government program approved in the Assembly of the Republic is very vague in relation to oral health. He has intentions, but nothing comes true. What we want from the Minister of Health is that she takes action, that she commits herself to a fixed budget for oral health in the State Budget, which can also additionally be financed with revenue from the tax on soft drinks. We want a fixed budget for oral health, we want to know where and how it is invested. It is the only way to guarantee that all Portuguese people have access to medical and dental care. Both the SNS and the private sector are part of the solution, the Government understands the need to address oral health in a more strategic, integrated and inclusive way”.

Ordem dos Médicos Dentistas

 

741. MIGUEL PAVÃO: "Oral health is being permanently postponed"

 

In an interview, Miguel Pavão, chairman of the Portuguese Dental Association, points out some necessary reforms in terms of oral health. This is the case of the reformulation of the dental check and the need for an effective integration of professionals in the National Health Service (SNS).

What portrait do you make of oral health in Portugal?

Oral health is something that is being permanently postponed due to what were the historical vicissitudes of not having been integrated into the creation of the SNS. It was a mistake at birth, which was hardly corrected and reversed. And it was forever postponed, because it was only in 2008 that there was an attempt to implement a project, which is the dentist's check, in which some steps were taken. But there was an ambition for the project to evolve and that ended up not happening. Simultaneously, there were disorganized and strategyless attempts to integrate dentists into the SNS. The ridiculous thing happened that there were ARS [regional health administrations] that set up dental clinics and never had a dental appointment. Then, there was a small leap in 2017, with the creation of the Oral Health for All project, by Minister Adalberto Campos Fernandes and Secretary of State Fernando Araújo, who, I would say, was the one who really took this cause and founded it, but who ended up not being able to complete the process because there was a government reform. With the entry of Minister Marta Temido, the process stagnated, and then a pandemic entered, which always served as an excuse. If there has been an evolution in the oral health of the Portuguese, it is due to professionals in the private sector.

Does the lack of investment in oral health in the SNS create inequalities in access to care?

As of today, and according to our barometer data, a large part of the population still does not visit the dentist and does not access dental offices. About 41% of the Portuguese did not visit the dentist in 2021. It means that there is a level of the population, which is very much in line with socioeconomic indicators of poverty, which still does not have access to dental clinics. What happens is a bipolarity in the access to care. Whoever has the economic capacity invests. On the other hand, we have a segment of the population that, due to lack of economic capacity, cultural level and literacy, does not have this possibility.

Almost 2.4 million dental checks were wasted. Should the project be rethought?

Completely. There was an important leap [with the creation of the check], but the truth is that the project did not evolve. In fact, it just went backwards. We cannot forget that, after the introduction of the troika, there was a reduction in the value, which has never been updated. Dental checks have been lost across the board. There have been no audits, there has been no ambition in the project and the Portuguese Dental Association, at the moment, feels quite incapable because it does not have interlocutors, either in the Ministry of Health or in the Directorate-General for Health, who say "let's work on this dossier". This is one of the weaknesses that we have been pointing out. I presented a proposal to the Minister of Health, before the fall of the government, for the creation of a working group for a strategic reflection on various dimensions of oral health.

A new agenda for post-pandemic oral health

The next legislature will be marked by political stability and PRR funds. What should be the priorities in oral health?
One of the priorities is the integration of dentists in the SNS and the reform of primary health care for oral health, where the creation of oral health units must also be formatted. We also have the dental check and the oral health program. And we have a third dimension, which cannot be neglected, which has to do with the preparation and planning of professionals who are linked to oral health. We train too many dentists, we have too few hygienists.

In 10 years, there was a 70% increase in the number of dentists. Do you defend the reduction of vacancies in universities?

Of course yes. It is not because we are increasing the number of dentists that the population is having more access to oral health care. What is lacking are truly programmed policies to achieve equity in access to medical and dental care. The World Health Organization launched, in 2021, a resolution that will influence until 2030 an attempt that Member States can really adapt health professionals to a more preventive intervention. From our point of view, there must be planning and a strategic vision of measures, in which we have to reduce the number of vacancies for dentists in medical and dental schools and prepare, so that there is training and qualification of other aspects, such as more community and preventive intervention.

Jornal de Notícias

 

740. SMD calls for unionization

In a short video published on its Facebook page, the Dentists Union (SMD) calls for the registration of professionals in the sector. 

With the slogan “Together we are stronger”, the SMD intends to capture the attention of dentists for an active participation in the sector. For those interested, the SMD provides a Registration Form with the union. 

The SMD has been very active in its actions with the holding of a webinar on “labor relations in dentistry” and a meeting with the ADSE on the “Agreed Regime of the ADSE provider network and within the scope of the Regime”. 

More recently, the union's actions included the holding of the Odonto Summit where “The State of the Class” was debated and the presentation of a complaint to the Ombudsman about the “contractual illegalities of Dentists in the National Health Service”. 

dentalpro 

739. PORTUGAL IS NOT JUST LISBON: Free oral health for children and young people

Since it opened two years ago on Avenida Almirante Reis, SOL – Saúde Oral in Lisbon, a service of Santa Casa da Misericórdia, has already attended to more than 9,000 people of 38 nationalities and carried out 40,000 free consultations.

Are you between 0 and 18 years old and need to go to the dentist? If you live in the capital, you have access to the free services of SOL – Saúde Oral em Lisboa, an equipment of Misericórdia de Lisboa whose main objective is to prevent the oral health of children and young people.

To register for the various types of consultations, simply present your identification document and confirm your place of residence and age.

According to André Brandão de Almeida, coordinator and clinical director of SOL, the work developed over these two years has been more in the context of treatment than prevention. The objective is to change this reality, that is, to make the response increasingly involve prevention, early treatment and changes in habits.

One of the most recent studies and projects developed by SOL, on eating habits during the period of confinement, reveals that children ate more sugary products and more fresh fruit than usual. Another conclusion: during the time they stayed at home, the children changed the frequency with which they brushed their teeth.

SIC Notícias

* * *

Santa Casa da Misericórdia has gambling recipes nationwide. Isn't it ALSO YOUR OBLIGATION to provide the same oral health support service to all children nationwide, without discriminating where they live?

 

738. President of dentists warns of calamitous oral health cases in the country: there are young people aged between 25 and 30 who no longer have any teeth in their mouths

 

Three out of ten people in Portugal do not have access to oral health, warned the president of dentists today, reporting "calamitous" cases such as 25-year-olds without any teeth and elderly people who have never entered an office. Over the course of four days, Miguel Pavão evaluated the conditions of dentists who work in various health units of the five Regional Health Administrations (ARS) in the country, in an itinerary that ended today with a visit to the Damaia Health Center, municipality of Amadora, district of Lisbon.

At the health centre, where the president of the Lisbon and Tagus Valley ARS, Luís Pisco, was present, the chairman of the Portuguese Dental Association (OMD) took stock of the "Dental Medicine in the SNS" roadmap, starting by alerting that the goal of the "Oral Health for All Project" for 2020 has not been met. The goal was for all health centers to have the possibility of having a dentist, but in 2021 the OMD "went to the field, traveled around the country, and realized that this design is to be fulfilled", Miguel Pavão told the Lusa agency. Only 40% of the territory is covered in terms of dental medical assistance, he pointed out, justifying that, of the 278 planned health centers, only 132 are operating with a dental office.

During the tour, Miguel Pavão observed situations of "very calamitous oral health": "There are young people between 25 and 30 years old who no longer have any teeth in their mouths. It is worrying these days to witness this reality". On the other hand, in the countryside, there are "very old people" who have never had the opportunity to go to the dentist, he said, arguing that this "is an opportunity" to finally have access to dentistry. However, he defended, this response needs to be complemented with the part of oral rehabilitation, which involves people being able to put on dental prostheses, a possibility that the OMD will present to the Government, through public-private partnerships.

Miguel Pavão explained that dentists, who have a network of private providers throughout the country, can provide this service in "a shared way, either by the user or by the budget of the Ministry of Health". He also said that during the script he found "a major discrepancy" between the ARS, and that "there is no truly grounded and oriented strategy for dentistry".

The chairman said that the Center was the region where he saw "a lot of deficit and a lot of difficulty regarding the issue of oral health", but he noted that "it is not good" to compare who "goes more advanced". But he said there are "good examples" that could be replicated: "In Lisbon and Castelo Branco I saw oral health units created that have to be a precursor example of what will be scaled, disseminated and disseminated so that dentistry is a vigorous reality and a capable response that the Portuguese can trust". "Dentists have a very important private service network, there are co-payments and models that are in place and there are others that can be created, but this answer in the SNS does not duplicate the answer, because 30% of the Portuguese population do not have care and still do not has access to the dentist", creased. This is "a socially disadvantaged population", which covers 2.3 million Portuguese who need oral health support, which "is fundamental for social inclusion and employability", he said, considering that this "is a cause national. Present at the visit, Inês Monteiro Filipe, a dentist in a public health unit, and who is part of the regional group of Oral Health of ARSLVT, defended that it is necessary to guarantee equity of access to the population. "We have municipalities with a high population density and with a dentist and we have municipalities with a smaller population density with a dentist as well and, therefore, it does not guarantee equity of access", he stressed. According to the dentist, the medium and long-term project is to increase the capacity of Dentistry in these municipalities to reach a time when there is no family dentist, but "a dentist for most of the population that has this need". Currently, he said, "we have 37 offices already set up in 26 municipalities, there are 52 in ARSLVT, and until the end of this month,we expect the opening of 12 more and by the end of the year the opening, if not all, of most".

HN // HB

SAPO

737. Pilot projects of dentists in health centers fail to set targets

The Order of Dentists (OMD) lamented the government's inaction, before the pilot projects to include dentists in health centers. In a statement, the order informs that the projects mark five years without the defined goals are being fulfilled.

The main objective of having at least one dentist in all clusters of health centers is far from reaching and the whole process is stopped from the beginning of the pandemic, it can read in the news published on the OMD website.

The government has released this project for five years to begin to fill a serious failure in the National Health Service that 40 years ago left out of dental medicine. The pilot project was created to give the most disadvantaged population, with a range of restricted treatments.

The president of OMD, Miguel Pavão, considers that the government pilot project fails in virtually the entire line and defrauds the expectations of patients and professionals. In five years, nothing has changed. Continues to be a pilot project, only for those who have great economic shortage and although to welcome the number of treatments and interventions already carried out, they have surely changed the lives of patients, the truth is that limitations continue to be huge.

With regard to the situation of dentists who are part of the pilot project, Bastonario denounces the precarious conditions in which they work. Most are contracted by companies, through agreements to provide 12-month services, without holiday subsidy or Christmas, without the right to support in unemployment and without any chance of being integrated into the staff.

Miguel Peacão further recalls that there is a specific career for dental medicine in the National Health Service, approved by the Ministry of Health, but it has been waiting for the Ministry of Finance for years. An unacceptable situation that leaves doctors dentists without possibility of making career in the National Health Service as other health professionals.

For the OMD Bash is urgent to look at this pilot project and make it definitive, in five years there was time to know how to do it. It is necessary to ensure dentists in all health centers, implementing the career of dental medicine in the National Health Service, hiring dentists without a term contract, to end the turnover of professionals, extend the concept of economic shortness to cover more population and increase the number of treatments available, possibly using a convention with the private sector.

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736. Private education students are part of the dental check program

According to an order by the Deputy Secretary of State and Health, António Lacerda Sales, published in Diário da República this Monday (May 24), the National Program for the Promotion of Oral Health (PNPSO) now covers all children and young people aged between 7 and 18 years, regardless of the school or institution they attend, as well as a new age group, referring to children who are four years old.
This measure is a positive sign, which demonstrates the Government's will to reverse the inequity that has existed since the creation of the dental check, said Miguel Pavão, president of the OMD. This decision has been demanded by the Order of Dentists over the past few months, which defends a deep restructuring of the program, not only in terms of universal access, but also investment in the preventive component, they say on its website.
For Miguel Pavão, this could be the starting point for reversing and reformulating a program that, since 2008, has wasted more than two million dental checks. The president believes that the dental check should be more preventive and focused on health literacy and behavioral change.
As the OMD advances, Miguel Pavão warns that it is equally urgent to restore the value of checks (which were cut during the troika period and, however, were not replaced) and update them, in order to respond to the increase in costs incurred by dentists and to correspond to the valorization of the medical act.
Order No. 5201/202 defines the update of the PNPSO for the period 2021-2025, which aims to continue the strategies that have been implemented in the context of health promotion, prevention and early treatment of oral diseases. In the case of four-year-old children, referral for oral hygiene consultations in primary health care units is assigned, or up to two dentist checks are assigned. As for the other age groups, access is maintained via the school context.
The updating of the program also foresees, according to the legislation, the reinforcement of actions to promote health and literacy in oral health, carried out by family health teams in pregnancy surveillance, child and youth health and general and family medicine consultations carried out by school health teams, in kindergartens, schools and institutions in the area covered by the health center cluster.

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735. Madeira will allow a career in dentistry in the public health service

The Legislative Assembly of the Autonomous Region of Madeira (RAM) approved, in plenary, the creation of a career in dentistry in the national health service of the Autonomous Region of Madeira (SESARAM).

Miguel Pavão, President of the Order of Dentists (OMD), traveled to Funchal to attend what he considers to be “a historic day for dentistry in our country, as it is the first time that dentists are part of a public service they start to have a career, like other state employees. It is a milestone in our profession and the Autonomous Region of Madeira is the first to take this step”.

In the meeting with the regional secretary of Health, the chairman of the OMD thanked the commitment of the Regional Government, stressing that “today the RAM did justice to a gap in the National Health Service and the RAM provides an example that the integration of dentists is viable and is required. We hope that this is a starting point for the Autonomous Region of the Azores and the Continent to follow this example very soon”.

The Secretary of Health and Civil Protection, Pedro Ramos, highlighted the “important and historic moment” of this approval, which “reveals the pioneering spirit of the Regional Health Service and the respect of the Region for our professionals”.

Fabião Castro Silva, OMD representative in RAM, said “it is with great pride that I see Madeira taking this step, which is so significant for our profession. It is a step that completes the full integration of dentistry in SESARAM”.

The new career in dentistry will cover all dentists working in the health centers of Madeira and Porto Santo, and at the Dr. Nélio Mendonça Hospital, in Funchal. 

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734. More than two million dental checks remained unused in the last twelve years

Since the launch of the National Program for the Promotion of Oral Health, more than seven million dental checks have been issued, but only five million have been used, reports Jornal de Notícias. The Order of Dentists wants to reformulate the program and the Government will carry out an audit. The dental check usage rate is around 70%, but it has been falling for the past five years.

3.8 million users have already been assisted, especially children and young people up to 18 years of age, but also pregnant women in a total of 20 million treatments. The Government has planned an audit of the program later this year, which has not made any progress due to the pandemic. The Ministry of Health informs that the audit aims to confirm that all treatments paid for by the dental check were actually carried out.

The Order of Dentists argues that the audit should go further to understand if the investment made had an impact and produced results in the oral health of the population and if there were changes in behavior. Heard by JN, the President of the Order asks for a reformulation of the program that he considers to be poorly built from scratch. In statements to the TSF, the president of the Order of Dentists wants to understand what happened to the two million dentist checks that have not been used in the last 12 years. Miguel Pavão argues that an audit is needed to understand what happened.

Miguel Pavão argues that the audit is necessary, to understand if the investment made in the last 12 years had an impact on the oral health of the Portuguese. For the president, the program should bet more on prevention than on treatment and review values, since prices are not updated since the troika, when it went from 40 to 35 euros.

TSF 

733. dental clinics on facebook

 

“We live in the digital age, so our life is increasingly made in cyberspace. As such, social networks occupy a central place in the daily lives of most people, companies and organizations, as they function as a means of communication with the world and as a vehicle for transmitting information and knowledge”.

Dentist António Faria, from Clínica Médica Jardim, referred to Facebook in this way, when he was asked to give testimony about the strategy used by his clinic regarding presence in the virtual world. There are many other opinions worth reading in this issue. From dentists to clinic owners to marketing directors, almost everyone believes in a premise: new behaviors and consumption habits associated with generations born in the digital age are imposed.

Generation Millennials (born in the 1980s and 1990s) and Generation Z (digital natives) value online commenting, compare prices, appreciate experience over ownership, grew up in an environment of instability, and saw the downfall of major financial institutions. Hence the importance of credible and valuable content. We know that, often, before visiting the clinic or physical store, people search the site and evaluate the content and comments on social networks.

As João Lemos Diogo, marketing director of the OralMED Saúde group confided in us, “in strategic terms, we believe that potential patients develop digital research pathways about oral health or about dentists and dental brands in particular, before making a decision . In our perspective, there is an eminently digital patient-journey, and increasingly omnichannel, which can have different causes and which extends beyond the post-treatment phase. Knowing this mapping of research and behavior on the part of patients, we actively develop specific content for each of these stages”.

That said, a good strategy for managing social media is extremely important for anyone who wants to succeed in the future (and in the present!). And, as Facebook (FB) is one of the most used social networks in the world, DentalPro decided to carry out an exhaustive study on the presence of dental clinics on this platform. We restricted our analysis to the year 2020, mainly because we realized that the Covid-19 pandemic gave a new importance to the digital, both for clinics and companies to maintain direct contact with patients and clients, and as a privileged place for professional and commercial interactions.

Medicinadentária

732. Net empregos: Job offers (dentists)

 Link: https://www.net-empregos.com/dentistas/

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731. Impact of pandemic on dental check is worrying

From January to July this year, according to data from the Transparency Portal, less than 99,160 dental checks were issued and 108,029 less were used. Likewise, within the scope of the Early Oral Cancer Intervention Project (PIPCO) there were 2,343 fewer checks issued and 6,907 less used in that period.

A scenario that reveals that the impact of the pandemic affected not only private practice, but also, “and in a worrying way”, the National Oral Health Promotion Program (PNPSO), better known as a dental check. For the president of the OMD, this area needs “a recovery plan”, which involves implementing “different models” so that the program reaches effectively vulnerable groups of the population.

Speaking to RTP, Miguel Pavão suggests the possibility for the Directorate-General for Health to issue dental checks in an online format, noting that we are about a month from the end of the use of this module.

The president argues that the effects of the pandemic in the sector "require a deep reflection on the program and are an opportunity to propose new solutions and changes in oral health programs". And he leaves the warning: "if nothing is done, there is a risk of losing the oral health gains achieved in recent years".

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730. AIMD sends letter to Cristina Ferreira, Medicare ambassador

 

The Independent Association of Dentists (AIMD) sent the following letter to Cristina Ferreira, with a view to her partnership with Medicare:

Exma. Ms. Cristina Ferreira, Ambassador for Medicare,

The Independent Association of Dentists (AIMD) was born under the pressing need to fight for professional dignity and valorization of Dentistry. One of its action plans is to expose the subterfuge of insurers and health plans, constituting representation and spokesperson in the dialogue and negotiation with these entities, and striving for the implementation of representatives in their medical councils with the title of dentists.

In our understanding and that of all colleagues, Medicare, the health plan that you represent through the position of ambassador, induces the practice of dumping in oral health. A health plan that offers its customers the possibility of carrying out free medical acts and others below cost is a dishonest and defrauding practice. Did you know that Medicare offers its customers 20 dental acts and / or treatments? We calculate that it is of your knowledge, seen so vehemently advertising to which it is directly associated.

Since healthcare professionals are not paid for these medical acts, namely through Medicare reimbursement, how do you expect clinics to carry out these medical acts without prejudice to operating and material costs? How do you expect health professionals to be paid for their work? So that this point is not too abstract, we exemplify one of Medicare's free medical acts and the cost of material involved: Monoradicular tooth extraction (“tooth extraction”); cost of running the clinic (eg electricity, water); user protection material (eg surgical cloth or bib); compresses, hemostatic sponges; chemical and thermal conditioning and sterilization of the material; dentist working time,dental assistant and other clinical staff.

Are you aware that the Code of Ethics of the Portuguese Dental Association prohibits the carrying out of free medical acts? We now cite Article 39 of the same: “1- Dental medicine is by nature an activity with inherent costs, for which pecuniary consideration is freely fixed, and free professional acts cannot be practiced in a generalized or regular manner, except when covered by the legal regime of volunteering and when the rules of this Code and the OMD Statute are respected ”.

What we intend to bring to your attention is that you are an ambassador and publicize a health plan that violates the deontology of Dental Medicine and promotes the economy of scale associated with the Health area. It is not possible for health professionals to practice free and have no detriment to their livelihood. Basically, you are representing and advertising a health plan that induces the exploitation of dentists and contributes to your precarious work.

Did you know that dentists turned to the Food Bank against Hunger? Are you aware of Medicare's numerous policyholder complaints? Do you know that in the Complaint Portal, in the last twelve months, there have been almost a thousand complaints submitted against Medicare, namely for contractual irregularities and fraud?

Through a news item published in the magazine “Vidas”, it came to our attention that Medicare presented the Lady with a 2018 Porsche Panamera E-Hybrid, for its partnership with this entity. To make it clear, this asset, which now belongs to its alleged fleet, is the symbol of exploration in Health. For dentists, Medicare and any health plan that promotes the practice of dumping are one of the cancers in the Health area Is this the public image that Ms. Cristina Ferreira wants to be associated with? We leave you with this appeal: ask yourself if you see yourself in what Medicare stands for; if you would like to work and not be paid for your work, and still have a loss. Not everything is worth in life.

6 July, 2020

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