Dental appointments in health centers
-all clarifications in the following link:
-Location of health centers with dental appointments at the following link:
https://www.sns.gov.pt/cidadao/saude-oral/
APOMED-SP
(AssociaçãoPortuguesa dos Médicos Dentistas dos Serviços Públicos)
The Doctor. Manuel Pizarro, current Minister of Health, was only the 19th minister responsible for the Health portfolio who did not prove competent in resolving the adequate integration of dentists into the SNS. It was not due to a lack of time or opportunity, as the ministry renegotiated careers, created others and even, in just a few days, promoted dizzying changes to not one, but all of the statutes of the health professional orders.
In fact, since the creation of the SNS, dentistry has always been neglected in and by services, there has never been talent to create a career in dentistry in the SNS, which contributes to the pitiful state of oral health, especially among the poorest and most excluded. , who can only use the SNS.
This humiliating attitude towards public service dentists has been manifested throughout the legislatures, in repeated and fraudulent speeches regarding the legitimate aspirations of professionals as they repeatedly see themselves used as trained beings in the media circus of inaugurations or unveiling of tombstones, next to new offices.
Even the valuable reform that took place in 2016 with the pilot oral health projects, initially in 13 locations in the moribund ARS-Alentejo and LVT and which, in 2017, were extended to all the remaining ARS, quickly transformed into what are the conditions enslaving conditions typical of the 21st century, in which the worker is simply a number as a producer of wealth at the service of the employer, without any right to support for training, assistance in illness or parenting and at the same time easily disposable to the detriment of another who is compelled to accept the same, or more degrading, working conditions.
An example of these situations is the SNS taking advantage, from 2016, of the excellent training and quality of Portuguese dentists (so sought after and well paid in Europe at zero cost for this investment) by providing consultations in around 130 SNS health centers. oral health services that allowed access to hundreds of thousands of Portuguese people who, otherwise, would never have been able to access the most basic therapeutic oral health care, with all the repercussions on general health and quality of life that this represented over the decades.
At the same time, these dentists have been hired since then through service recruitment companies or through service provision contracts, which abuse this type of service among younger people, forcing them to end these “so fabulous” contracts in situations of illness or simple pregnancies or even making it difficult for them to update their training by discounting the days on which they participate in training, which will then allow for better provision of services.
This situation is the current reality for the overwhelming majority of dentists employed by public health services who work within working hours determined by the employer and in many situations with biometric attendance control, carried out on equipment and using materials made available by the employer and with replicated annual contracts, which despite the publicized and valid intentions of the current minister of labor to combat the so-called “false green receipts” has not yet discovered them within the scope of the SNS.
Having described the current situation of dentistry in the SNS, dentists feel, faced with this unexpected interruption of the legislature, that they have once again been enchanted by empty words about improving conditions alongside the immeasurable improvement and dedication that these young dentists brought to primary health care. Witnesses to this will be, more than governments or ministers, the Portuguese who every day encounter an excellent, highly differentiated professional, very often paid below the national minimum wage, due to holidays, participation in training, maternity or illness (as if it were possible to maintain health of this professional, forcing him to work from Monday to Friday, seven to eight hours a day, in an exercise of high performance and concentration, without the right to vacation and paid at 10, 9, 8 or even less euros per hour).
Therefore, it is important now in this upcoming period, and since, unlike other health professionals in the SNS, it is not envisaged that the current ministers will sit down at any negotiating table to palliatively try to resolve what cannot be resolved. have shown themselves competent in solving for dentists since September 1979 with the creation of the SNS, to be attentive to the electoral program proposals of the different parties competing in the elections of March 10, 2024, to understand which ones will have the courage to clearly expose their intention to create a career in dentistry in the NHS suited to medical and surgical skills in the field of oral health, and no longer a set of delaying words and acts.
The dentists' demands are also exposed on the banners placed over the stalls displayed in front of the steps of the Assembly of the Republic, where one can read: "SNS dentists have no legal framework. Tired of promises, we want careers" or "The dental check does not solve oral health problems. Social benefit at the expense of dentists". Protesters also shouted slogans such as “Health plans are a fraud” and “Oral health for all”. Portugal, they warn, has more than twice the professionals recommended by the World Health Organization (WHO) and, simultaneously, has "one of the worst oral health rates in the European Union". "The ratio of 800 inhabitants for each dentist will increase, in 2025, to 650 inhabitants for each dentist, which is clearly exaggerated and harmful both for the profession and for the class that is going through the biggest labor crisis since it existed in Portugal" , highlights the union.
Dentists also demand the regulation of health plans, the reformulation of dental vouchers, "the immediate reduction of the numerus clausus" and "prevent the opening of another dental medicine course". The union's president, João Neto, states that the proposals that led to the demonstration aim to "try to somewhat alleviate the precariousness, unemployment and underemployment that exists in the class and that will affect younger people." "Colleagues who have recently graduated will emigrate. There are more than 600 who emigrate every year and there are even more serious situations", said João Neto.
He also argued that it is necessary to "alert students, or anyone who is thinking about taking a dental medicine course, that they will not have the future perspective that they think, because there are too many dentists". It is necessary to "have the courage to reduce the numerus clausus (...) because otherwise there will be chaos", he warned. Having graduated less than a year ago, Mariana Batista, from Lisbon, pointed out the barriers she has encountered due to health plans that, "often, are a fraud", because patients think they are free but "the advertising is misleading".
The young dentist reported that, when patients arrive at the office, they have to be explained "everything about the health plans, that there are no free treatments". "It's not possible to have free treatments, because we have green receipts and if the patient doesn't pay, we won't receive it either," she said. "We have an assistant, we have a doctor, we have electricity to pay and it becomes complicated", lamented the young woman, who participated in the first national demonstration of dentists.
Resistant to rain and wind, the dentists made a point of being present at the protest "for the appreciation of dentists, dentists in the SNS and the oral health of the Portuguese", summarized João Neto. The union president lamented that oral health has been forgotten by successive governments, which is reflected in the State Budget proposal for 2024, in which "there are only two paragraphs about the oral health of the Portuguese".
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Anyone who needs consultations at more affordable prices, at the clinic of the Faculty of Dental Medicine of the University of Porto, there are 32 offices available, where students, supervised by teachers, serve the community.
Paulo Melo, director of the Faculty, guarantees that it is possible to schedule an appointment within a week or two.
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.
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.
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
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”.
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.
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”.
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.
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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?
HN // HB
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.
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.
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.
