The Parliamentary Group of the Left Bloc took the initiative to present to Parliament a draft law No. 154/IX on the 'Integration of the dental Service National Health (SNS)'. This presentation was made under Article 167 of the Portuguese Constitution and Article 131 of the Rules, bringing even the formal requirements of Article 138 of the Rules. The initiative fell to eighth Commission for issuance of their report and opinion that follows. The present bill is scheduled for discussion in general to the plenary on 6 February 2003.
The bill No 154/IX providing for the 'Integration of Dentistry in National Health Service' focusing its scope in the definition of dental technicians and senior health. In considering urgent:
-Extend qualitatively and quantitatively the Oral Health Program for Children and Adolescents;
-Ensure oral health care to poor people, especially elderly people, drug addicts, the disabled, prisoners, migrants and nomads;
-Give special attention to oral health of patients with diseases such as infectious patients, heart disease, hemophiliacs, hemodialysis, rugged area maxillofacial or others with increased risk;
-Establish a strategic program of oral health promotion activities that integrate prevention, early diagnosis, treatment including emergencies and rehabilitation of all the teeth;
-Provide for the continuity of the program through collaborative partnerships in particular with local authorities and the contracting of dentists.
Concludes that it is the duty of the State:
-Ensure, free of charge and under the National Health Service, basic care for oral health;
-Give priority to the monitoring groups particularly vulnerable and at increased risk derived from untreated dental disease;
-Ensure the human and technical resources in the health centers, hospitals and prisons.
For the classification of dental and higher health technicians, establishing criteria for placement and professional services and establishments under the Ministry of Health, Santa Casa da Misericordia of Lisbon and the Ministry of Justice, in proposing the amendment of Decree Law 414/91 of 22 October, in Articles 2 and 9. Proposed in its transitional provisions in its phased implementation, and from the third year of validity applies to all health facilities.
Oral health in general and dental caries in particular has always been understood in Portugal as an important factor for the development of global intervention to the health of the population.
Knowledge of high levels of oral disease but also its high vulnerability to simple preventative measures, affordable and proven effectiveness have led to intervention programs developed under the Community School Health, Child and Adolescent and monitoring of pregnant women . Teachers, coaches for municipalities and charitable organizations have long collaborated with health professionals including primary health care to achieve targets for control of the health problem most common in all age groups of the portuguese population .
The causal risk factors for this health problem are multiple and it is therefore necessary that your fight has always been a multi-profile and multi hopefully. Despite all the preventive strategy, there is still remaining condition for which need to be addressed in particular through dental care.
Although there are human resources in sufficient numbers (doctor or dentist to dentist about 2000 inhabitants, whereas the WHO recommends 1 / 1800 or 1 / 2000), accessibility to medical treatment and rehabilitation has been limited. It is estimated that only 40% of its population have easy access to curative care in private oral health.
In particular we say that 'the socially excluded groups and children with disabilities, not only the decay has a higher prevalence, such as accessibility to preventive services and treatment is low' (Health Gains in Portugal, DGS, March 2002). The problem of accessibility joins as well, another equity when you consider that probably the greatest need are those with greatest impediment economic, cultural or geographic area to use those services that are developed almost entirely in the private sector providing care. The treatments are virtually restricted to those who can pay directly or have health insurance in the oral health.
Additionally, we know that the seven schools of dentistry in the country, formed around 350 young professionals whose job is to target the private sector of care. During 1999, following a national study of prevalence of dental caries, drew up a comprehensive prevention strategy based on three sub-programs:
-The Basic Program of Oral Health, within the activities of School Health;
-Program-Specific Application of sealants, integrating the boards of health centers more Oral Hygienists (62 professionals in March 2002);
-The Intervention Program Medical, Dental, called Program for Promotion of Oral Health in Children and Adolescents, with the contracting of curative care with oral health professionals and for which payment is made according to a capitation system.
This program involved 40 000 children from 6-7 years, 177 health centers and 400 private practitioners on a contract system. Under review published in 2002, the health gains from implementation of the Oral Health Program allow us to be among the countries with moderate prevalence of disease indicators, to 12 years of age (CPO index equal to 2.95) consistent with the recommended by the WHO European Region (DMFT index equal to 3.00).
Observed that the number of professionals is woefully inadequate and that there will be a lot of equipment is certainly not profitable. Not know its state of repair.
In the hospitals of the Service National Health (SNS), it seems that only 30% of them have service dentistry, according to a survey conducted by the informative Dental Association in June 2001. Care is provided in outpatient or emergency department physicians with the specialty of dentistry and enrolled in the Order of Physicians.
We conclude that, despite the good performance of indicators and the gains in oral health, it seems that you will need:
-Strengthening the basic program and collaboration with schools and local authorities;
-Increase the number of oral hygienists in health centers;
-Progressively extend the contract system of oral health care, covering populations other than just the school;
-To promote the systematic epidemiological assessment;
-Making decisions before the existing equipment while minimizing the wastage of use.
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