667. Monteiro da Silva re-elected president of dentists

Orlando Monteiro da Silva was re-elected to a new four-year term as president of the Order of Dentists (OMD). The elections were held this weekend under the new statutes of the OMD.
In addition to the election for the office of president, the various governing bodies were elected, including the new General Council, one of the main novelties of the new OMD statutes. The General Council is a body that will include 50 members of the MDG from around the country and will function in a similar way to a parliament.
An independent, single list was also elected for the Deontological and Disciplinary Council and led by the dentist Luis Filipe Correia.

The priority of the new team will be the development of a pilot project for the inclusion of dentists in health centers and family health units. This project will be prepared at the request of the Ministry of Health and reflects one of the requirements of the program with which List A presented itself to the elections: the need to guarantee the access of the whole population to oral health care.

The list led by Orlando Monteiro da Silva also intends to focus on the training and qualification of dentists, improve the organization of the OMD and the regulation of the profession in accordance with the new OMD Statute, according to a press release.
Orlando Monteiro da Silva believes that this re-election marks a new phase in the life of the OMD. The new statutes bring new challenges and the creation of the General Council will allow for greater plurality. In total, it is a team of 104 people of excellence, available to take on the new commitments, arising from the new challenges that the profession is to be placed.

Oje 

666. Health Regulatory Entity

https://www.ers.pt/

665. Ten Sick Teeth for Portuguese: Portrait of a Country in which Almost Everyone Has Had a Caries

The big problem is that we have a very high value of teeth lost due to caries, surely because people look for the dentist very late, says the coordinator of the Oral Health Program of the Directorate-General for Health. Only 3% of adults in Portugal Dental caries problems, with the situation worsening in the elderly, who still have on average 11 teeth totally lost, according to an official study.
The third National Study of Prevalence of Oral Diseases was conducted in five age groups representative of the Portuguese regional and national population, according to criteria recommended by the World Health Organization (WHO). For the first time, age groups of the adult population were included in the National Prevalence Study of Oral Diseases, with the children, previously studied, showing "significant improvements" in their dental health.

The group of 35-44 years is the great surprise of the national study. Virtually all people have had contacts with caries. Only 3% of adults in Portugal never had caries problems. From a certain age, we can expect that all Portuguese have or have had problems related to dental health, said Rui Calado, coordinator of the Oral Health Program of the Directorate General of Health. The study identified an average of 10.3 teeth with problems per person, but concluded that almost five of those teeth are already treated, and four are missing teeth.

The big problem is to have a very high value of teeth lost due to caries, surely because people look for the dentist very late. But access to dental medicine exists and was verified, because of the 10.3 with problems, only 1.5 are to be treated, explained Rui Calado. In fact, the levels of membership, access, are news for us. We were expecting worse access levels. What happens is that people have access but they look for the dentists very late, he added.In the group of the elderly, between 65 and 74 years, there are an average of 15 diseased teeth per person, 11.5 of which are already totally lost teeth, in which the only alternative is rehabilitation through prostheses. The only solution is rehabilitation. The form has to be thought and studied because any account, however slight, indicates that we are talking about astronomical values, if we want to make a public intervention, said the coordinator of the Oral Health Promotion Program.

With regard to children, the DGS says that health gains have been made clear by the development of the Program (which provides dental checks, among other interventions), with more than half of children aged six and 12 being totally free Of cavities and with all healthy teeth. The average number of teeth with problems is 1.6 in six - year - old children and 1.2 in children of 12, which are halved compared to what was found in the 2000 study.We have an excellent dental health situation in children up to 12 years of age, said Rui Calado, considering that the application of sealants promoted by the Oral Health Program has been working, as well as treatments performed through dental checks. The National Oral Health Program, which has been developed in partnership with the Ordem dos Médicos Dentistas, promotes the application of fissure sealants in healthy permanent molars in children and allows other treatments through dental checks provided at 7, 10, 13 and 15 years.

Expresso

664. Dispatch number 12889/2015

Ordinance number 301/2009, dated March 24, regulates the operation of the National Program for the Promotion of Oral Health, regarding the provision of personalized oral health care, preventive and curative, provided by specialized professionals, providing, throughout Access to oral health care to various target groups. At this moment, children and young people under the age of 16, pregnant women in the National Health Service, beneficiaries of the solidarity supplement for the elderly and users infected with the HIV / AIDS virus benefit from this program. Through Order number 686/2014, dated January 6th, the said Program was extended, to include, also, the early intervention in oral cancer.

In this context, the third National Study of Prevalence of Oral Diseases revealed that in recent years there has been a marked reduction in the levels of disease among children and young people who have benefited from a long work of promoting and preventing oral and , On the other hand, an increase in the number and effectiveness of the treatments performed, which has resulted in an enormous improvement in the dental health situation of this target group.

It was noted, however, that children and young people with special needs do not always benefit from the National Oral Health Promotion Program, so the requirements that establish access to it are now defined.
It has also been found that users infected with the HIV / AIDS virus, for whom it is determined that they may use up to six checks - dentists may present new treatment needs and, in view of the increased risk of health problems In these users, additional cycles are now provided.

Therefore, pursuant to the provisions of articles 2, paragraph 2 and 3 of article 7 of Administrative Rule number 301/2009, of March 24, I determine:
1 - The National Program for the Promotion of Oral Health (PNPSO) is extended, to include:

a) 18 year olds who have been beneficiaries of the PNPSO and concluded the treatment plan at the age of 16;
b) users infected with the HIV / AIDS virus who have already been covered by PNPSO and have not been receiving treatment for more than 24 months;
c) Children and young people of 7, 10 and 13 years of age with special health needs, including those with mental illness, cerebral palsy, trisomy 21, among others, who have not yet been covered by PNPSO.

2 - The enlargement foreseen in the previous number is:a) 18-year-olds who have been beneficiaries of the PNPSO and completed the treatment plan at the age of 16, a dentist's check is awarded;b) Patients infected with the HIV / AIDS virus who have already been covered by the PNPSO and who have not been treated for more than 24 months, are allowed access to a cycle of treatments composed of up to two dentist's checks, which can be repeated Not less than 24 months;c) Children and young people of 7, 10 and 13 years of age with special health needs, such as those with mental illness, cerebral palsy, trisomy 21, among others, who have not yet been covered by PNPSO, and following screening promoted by the Health unit of the National Health Service:i) A check-dentist or referral for Oral Hygienist is awarded;ii) If the child or young person is not expected to collaborate in an oral health consultation, in particular because sedation may be necessary, referral by the family physician, through the Time and Hour Consultation, to the hospital stomatology services Of your area of ​​residence.

3 - This order shall take effect on March 1, 2016.
November 9, 2015. - The Minister of Health, Fernando Serra Leal da Costa

Diário da República

663. Prevalence of oral diseases decreased significantly in children and young people

Data on the prevalence of oral diseases are included in the report presented by the Directorate-General for Health and Health of the Portuguese - Perspetiva 2015 (pdf). The results of the new studies on the prevalence of oral diseases among children and youngsters up to the age of 24 show a trend towards general improvement that covers all ages.
The severity of dental caries in the permanent dentition at 15 and 18 years has been declining consistently since the year 2000.

At 18 years of age, disease levels, measured through the CPO index - number of decayed and extracted teeth per patient, show a decrease from 4.7 to 2.5. The percentage of young people with at least one permanent dentition sealant increased from only 19.8% to 29.3%.
The number of 15 and 18 year olds with healthy gums practically doubled from 21.1% to 41.8%, confirming the importance that is increasingly given to oral hygiene, since 96% of 18-year-olds reported brushing their teeth every day.

As early as March, data on children aged six and 12 years showed a reduction in the prevalence of oral diseases. At age six, 79% of children claim to brush their teeth every day, at age 12 they are almost 90%.

According to Paulo Melo, the secretary general of the Dentistry Doctors (OMD), this improvement in the oral health of the younger Portuguese is due to three factors. Firstly, the existence of a public oral health program that includes the dental check and allows the youngest to be regularly followed by dentists. Secondly, because this program teaches to prevent oral diseases and introduces the habit of brushing teeth at least twice a day and also allows these young people to be treated when the disease is still in its infancy. This study then demonstrates the importance of the role of Portuguese dentists in the oral health of Portuguese young people, who are on the right track in the teaching of preventive care and in the treatment of cases of illness.

Faced with these good results, Paulo Melo believes that an extension of the National Program for the Promotion of Oral Health should be studied in order to cover more poor sections of the population. Dental consultations are practically non-existent in the National Health Service (SNS), and it is therefore imperative to create conditions for all Portuguese to have access to oral health care. Whether with the integration of dentists in public hospitals and health centers, or through conventions between the state and private clinics and clinics.

The data on the prevalence of oral diseases are part of the report presented by the Directorate-General for Health 'The Health of the Portuguese - Perspectiva 2015', which highlights the need for an integrated approach to the various medical specialties in the prevention and treatment of Diseases that most affect the Portuguese.
The DGS report concluded that poor nutrition is the factor that robs the Portuguese of more years of healthy life, and as the Secretary General of the OMD points out, is also the main risk factor for oral health as well as tobacco.

The dentist can play a decisive role since our mouths accurately reflect the foods we eat with serious dangers for diseases such as diabetes and cardiovascular diseases, which especially condition oral health and are also conditioned by oral diseases.
There is here a work of general health promotion that oral health can and should play, making a very important contribution to prolong life, and especially the quality of life, of the Portuguese.

Ordem dos Médicos Dentistas     

662. Teenagers do not brush teeth daily

Teen is rebellious, not only when you want to leave and return later, as time to brush your teeth. A survey by the Medical School of the University of Porto in Portugal, revealed that 20% of adolescents do not brush their teeth daily and only one in four brush your teeth two or more times a day.According to pediatric dentistry professor at the USP School of Dentistry, Mariana Minatel Braga, the most common oral health problems in adolescence are caries and gingivitis, results of this neglect of hygiene. Often, it was a child who did not have these diseases and start to present them because of typical changes of adolescence and passing from father responsibility for the child, he says.On the other hand, it is known that a child who had caries in children is most likely to have also decay in adolescence. This is understandable, because the bad habits related to oral health tend to perpetuate from one stage to the other and may even worsen in adolescence, says Mariana.According to expert in relation to the gingival diseases, adolescence may be a stage at which such problems are facilitated due to hormonal changes. However, without biofilm (plaque), they do not occur. In addition to the hormones (which are facilitators) should be careless with hygiene, otherwise not occur such kinds of events.

TERRA – Saúde Bucal

661. Portugal: doctors that do not exist

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

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

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

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

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

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

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

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

Dora Pires

substânciaactiva

   

660. Oral Cancer: utilization of diagnostic checks is reduced

According to data revealed by the Dental Association (OMD) in the European Day eve of Oral Health, the 4,341 checks issued between March 2014 and June 30 this year were used less than one-third, or 1,315 checks for cancer diagnosis oral. In its initial phase there were some problems with the computer system that makes the issue of checks, said the agency Lusa Pedro Trancoso, the direction of the Dental Association, assuming that the number of checks actually used by users go starting to increase.

The goal of Early Intervention Project Oral Cancer would reach about five thousand annual biopsies and, therefore, it is necessary to increase the checks issued by family doctors, and especially that patients use the network adhering dental checks that they are passed. Despite a reduced rate of effective use of checks for diagnosis of mouth cancer, Pedro Trancoso stresses that the checks execution rate for biopsy is very high, around 90%, which means that suspected cases are being properly directed and monitored.

Of the total diagnostic checks used almost half advanced to biopsy. The 585 carried out under this program allowed to detect 24 cancers and 17 lesions with malignant transformation potential. Pedro Trancoso recalls that 24 cases of detected cancer refer only to early intervention project, with in Portugal many more cases several diagnosed belatedly, which contributes to the mortality rate is less than 50% five years. If the diagnosis is made of early, survival rates can exceed 80%, says the head of the Dental Association.
Arguing that it is essential to increase the use of checks issued by family doctors, the Order believes it is necessary to know the warning signs of oral cancer: wounds that do not heal within two weeks, unexplained volume increases, loss of sensitivity or mobility language.

Observador

  

659. PORTUGAL: One in three people has never been to a dentist

658. Dental social clinic opens in Setúbal

657. The association "Mundo a Sorrir" already took care of the oral health of 33 thousand Portuguese

Between awareness projects, screening measures or treatments, the non-governmental organization Mundo a Sorrir (World Smile) - Doctors Association Dentists Portuguese Solidarity reached more than 163,000 people over its nine years of activity - with operations in Portugal and several Portuguese-speaking African countries such as Cape Verde, Guinea-Bissau and Sao Tome. in Portugal, the president of the NGO said that were made almost 12,000 screenings and more than 21,000 treatments, especially vulnerable populations. Michael Peacock believes that in future, the work will increasingly focus on the health prevention in a very deprived area in the country.

In the month that the World Smile complete nine years of activity, Miguel Pavão account that the project, which was born out of a personal volunteer experience that the dentist had in Cape Verde with colleague Mariana Dolores, ended up walking to many countries and which continues to struggle for ensuring the universal right to access to oral health care, working with the high-risk groups such as the elderly, children, pregnant women or people with few financial resources. 12 initial volunteers, went to more than 600, including physicians, dentists, hygienists and nutritionists. There are still little care in terms of oral health in the country and little focus on prevention, even in nutritional terms. We have a very system focused not on the right to health but for the right to treat the disease. I think this is the great turning point that we do not treat the disease itself but look at them in an interconnected way, describes the dentist, which highlights the work done in this regard by the Programme for Inclusion and Healthy Life of the World Smile . The project, which has European funding has come through training and screenings to 54,000 children and young people and should end the year with 70,000.

Since they started working in 2005, only Portugal already have 2332 health promotion lectures and hygiene and it is precisely in non-formal education and the introduction of concepts in a playful way that the specialist believes more. Miguel Pavão, covering the country in terms of oral health has improved, especially with vouchers dentist called, attributed to some groups defined as priority by the National Oral Health Promotion Plan. The problem, he says, is that the bet has just been on the side of prevention. Only 3% of healthcare budgets in the European Union that are dedicated to the promotion and health prevention, said, exemplifying that treat oral cancer, including surgery, chemotherapy and radiation therapy, can cost 100 000 euros, a value that says that would give do training in this area throughout the country. The NGO has no direct links to the check-dentist, but the dentist says they have had a concertation logic and adapted programs to help that policies like this are best executed and without the work of volunteers overlap to what exists in State. Not everyone knows that you are entitled to checks or how to use and screenings and activities help in this direction, illustrates.

The inequities in access to oral health care continues to be a problem in Portugal, with most of the treatments to be held outside the National Health Service. In fact, in June the Regulatory Authority of Health (ERS) published a study where ruling on dental checks available to some risk groups under the National Oral Health Promotion Plan. In the document, the ERS believes that the program should be extended to children and youth in private schools and also to non-elderly beneficiaries of the solidarity supplement and even to pregnant women who are not followed in the National Health Service.

For now, only children aged 7, 10 and youth 13 and 16 years who attend public schools are entitled to receive these checks in the amount of 35 euros each. Until the age of six checks should only be given to serious cases. The study also highlights other limits of this plan, such as those relating to the setting of a maximum number of dental checks to be allocated to each group. The ERS adds, moreover, that most dentists think that the number of checks and the value of these are not compatible with the needs of the beneficiaries.

Romana Borja-Santos

PÚBLICO

   

656. New research project wants to make dental care in Europe

A new research project, funded by about 6 million euros by the European Union wants to revolutionize the practice of dentistry and oral health, shifting the focus of dental treatments for preventive practices.
According to EU data, dental treatments have an estimated cost of around 79 billion euros annually in the European Union.

The project will last four years and will be led by the University of Leeds, the Academic Centre of Dentistry Amsterdam and the University of Heidelberg. The goal is, by European health data, work together with dental professionals and insurance companies in order to identify strategies for the prevention of oral health problems in each of the European countries.

The World Health Organization has said that oral diseases are the most common chronic diseases to humans. We want to change that, says Helen Whelton, Rector of the University of Leeds and responsible for the project. The hope is that, by evaluating the performance of dental professionals, we can implement change and encourage a shift to preventive practices in dental care.

The initiative will evaluate health data from a total of eight countries such as the UK, Denmark, Germany, Hungary, Ireland and the Netherlands.

Ana Rita Costa

Saúde Oral – Revista Profissionalde Estomatologia e Medicina Dentária

  

655. Health space serves population Mire de Tibães

In order to provide citizens with access to basic and primary health care, with the provision of various services, the project Health Area grew implemented by Mire Parish Council Tibães.The intention of the project does not involve the replacement of the health center, but to offer an additional option of proximity to the population, focusing on high competence of professionals who provide services there.We assess the needs in the middle where people are located. Sometimes the simple fact that people enter the health center hinders the expression, because not always verbalize the needs they feel and sometimes the values ​​are changed one bit. We know that some people often change, for example, the value of blood pressure. According to the health profile of the Northern region had to examine factors associated with excess weight, smoking, alcohol consumption, diet and medication regimen, explained Adriana Barbosa, licensed nursing and mentor of the project.In parallel with the work developed with the adult population, the Health Zone also works with children. In the Kindergarten has gone very well. Children take well the program at this time is devoted to oral health. We are teaching how to be cleaning the teeth, what the benefits of proper washing, which foods are good for teeth, which are bad, etc. It is a very playful and interactive component so we can convey the message, said Adriana Barbosa.José Magalhães, president of Mire Parish Council Tibães, explains that the project aims to continuous improvement and the identification of valences that can be integrated into the initiative to contact the population.Initially, the professionals involved in the health space carry out an evaluation of the patients who will dictate its continuity or not this service, depending on the loyalty of the population.

BRAGA TV

654. Braga will offer 6,000 dental consultations per year

The Braga council approved Monday, Braga project Smiling, which aims to ensure the free access of the poorest people to oral health care. The program will provide 6000 consultations, in partnership with the NGO World Smile, an investment of 200,000 euros. To benefit from this service, users will have to be marked by the Social Action services of the local authority, the Parish Councils and IPSS of the county, as explained by the Braga Municipal Council (CMB) in a statement. Additionally, this action will also cover all children and the elderly in the county, with several actions in the 1st cycle schools, nursing homes and day centers in the county, promoting oral hygiene and the training of technicians and professionals work in these spaces Braga to Smiling will be developed in partnership with the NGO world smile that in nine years of existence, has conducted about 20 projects related to oral health, they were beneficidas more than 170,000 people worldwide . With this partnership, it is expected that more than 5000 children and 500 elderly county benefiting from this action will perform to a total of more than 6,000 consultations per year. This is a pioneer project in which the city of Braga takes health support policies among older; education of the younger population and also a social inclusion policy, with the possibility of greater integration into social and professional level who have no access to oral health care, says the president of CMB, Ricardo Rio, quoted by the same statement.

Boas Notícias

653. Looking for volunteers to treat children's mouths

The Good Dentist project needs volunteer doctors in the municipality of Cascais. Thank needy children. The mission is simple: to improve the oral health of underprivileged children and young people aged between 11 and 17 years, providing them with free treatment until they are 18 years. Work that the Panel of the Well has played in Portugal since 2010. And it wants to continue to pursue. But it needs volunteers, dentists that offer their time, something goes missing. Cascais is even a county where there is a risk of the mission not be brought to fruition.

Half an hour a week or 15 to 15 days is the time that dentists have to offer in offices, explains the Destak Alaize Maria da Silva, dentist, volunteer and coordinator of the Good Dentist Project in Cascais, where there are already 30 volunteers. But more are needed to join the 550 that exist all over the country. The benefits for children are many. It is not only safeguarded the oral health as improves their self-esteem. The children come to us at the office with his head down, shoulders hunched because they are ashamed. To be dealt with, take the hair out of her eyes. Will now be integrated and have other income, he adds.

And again calls: what we need is volunteer dentists. More information at:

turmadobem.org.br/pt/ 

652. Study released twice ...

The World Day of oral health in Portugal was celebrated this year in our country with a study in which they had already been presented the findings at the celebration of the World Day of oral health in 2013. Only someone distracted was thinking it had been presented a study again, for this III National Prevalence Study of oral Diseases it has been done for several years and does not portray the oral health of children and young people currently in Portugal.
It was good that the Ministry of Health and the Dental Association had specified the specific date on which the study was conducted, since the same study served to celebrate the World Day of oral health in Portugal in several years.With nothing new in oral health in Portugal, forwards the reader to the conclusions of the study published in this blog in April 2015.

651. More than half of children aged six and twelve years had caries

In the oral health of young people, Portugal is on track, although there is still much work to do. The numbers are impressive: at the beginning of this century only 33% of children under six years were free of cavities, in 2013 more than half (54%) were already in this situation. A similar trend to that seen in children of 12 years this year, 53% had never had tooth decay. As age advances, the situation is not so positive - at 18, only a third (32.4%) of young people have never had caries lesions - but this increase is expected as we age.

Prevalence data are the third National Study of Oral Diseases 6, 12 and 18 years of age that the PUBLIC had access and that this Friday will be announced at a ceremony to mark the World Day of Oral Health. Prepared by Health General Directorate in partnership with the Dental Association (OMD), the study allows to realize that, besides being to reduce the number of children and young people with caries, the basic oral hygiene habits in children and young people are improvement: while the six years 79% of children said brushing your teeth every day, to 12 are almost 90% the guarantee that do it and, at 18, the percentage rises to 96%.

All indicators improved. We move to a situation where the level of dental caries is already very reasonable compared to the European average, says Paulo Melo, one of the authors of the study and general secretary of the OMD. Evolution was indeed significant, to believe the data from this study: in children six years between 2000 and 2013 the number of dental cavities decreased by 21%. But the reduction of tooth decay is not the only good news that emerges from this work. It is also favorable developments of the treated teeth and the number of missing teeth and this improvement cuts across all regions of the country.

Over that period, to 12 years average of decayed teeth per person fell 50%, while the average number of teeth treated increased by 15%, which means that two out of three decayed teeth are treated, further underlines the OMD. Disease levels are measured using an average rate per person which counts the number of decayed, filled and extracted (lost), the indicator that is used by the World Health Organization (WHO). Featured deserves the fact that the results of this index to 12 years have already exceeded the targets recommended by the WHO in 2020. In addition there are fewer people with caries, there are fewer individuals with severe carious lesions, synthesizes Paulo Melo.

The improvement observed in the permanent dentition in children and young people under the age of 18 is justified largely due to the National Program of Oral Health Promotion (checks-dentist called) that was launched in 2009 for these age groups. This program allows children, even the poorest, to access dental consultations which, in addition to treating any injuries, put fissure sealants on the teeth to prevent the onset of disease and also learn oral hygiene (brushing teeth at least twice a day) and healthy eating.

Paulo Melo is optimistic, because it believes that the focus on prevention and early treatment if it will translate into huge gains in the future. Surely we will not have, in 30 or 40 years, a number of edentulous elderly as high as we now anticipate. According to the results presented barometer in 2014, about 7% of the Portuguese have a single tooth.

The general secretary of the OMD also recalls that there is still a way to go to achieve the goals set by the WHO for 2020, especially in early childhood, the temporary teeth (called milk teeth). It is necessary to reduce the percentage of children who reach the age of six without cavities. Here, there is still some work to do, but it has to be done by parents and families, accentuates.

Children and young people are the main users of the dentist-check program, which also covers the elderly with the solidarity supplement, pregnant women and people with HIV. Last year, the rate of use of dental checks rose to 74%, having been used in total 406,689. Sixty percent were used in preventive procedures, the application of fissure sealants. In total, 4,334,877 caries were treated for only 207,239 tooth extractions, refers to OMD. Since the beginning of this program have been used 2,378,363 checks.

Alexandra Campos

PÚBLICO

       

650. Oral Health Program: Evolution, instruments and results

The program of oral health in the national health service Portuguese (SNS.) started with the promotion of oral health in schools, and later extended to preventive and curative measures. Preventive measures were introduced at an early stage with the entry of oral hygienists for the SNS. As these professionals were insufficient to meet the population's needs, the policy adopted to address this problem was contracting with private service dentistry. Including well beyond the application of fissure sealants also dental treatments. In 2008 this contractual model was revised and implemented the dentist check.

After more than 25 years of the program, children and young Portuguese still have significant oral health problems. In the sample studied was found that at 7 years of age, only about 45.5% of children have free teeth cavities. WHO advocated that for 2010, 65% of children were free of caries at 6 years old. According to WHO guidelines the DMFT index at 12 years should not exceed 1.5, as of 2010. The data collected in the study this value is exceeded only in children 10 years but approaches (1, 2), and at 13 it reaches a considerably higher value (2.1).

The study data show a half accession of children to a totally free and as demonstrated program, applied to children who actually had oral health needs and did not use dental check (24.7%). However virtually all children using the check complete the treatment plan. The exception that occurs at age 10 related to the premolar eruption suggests a review of the age cohorts assignment dentist check.

The pre-screening of children as a procedure to adopt in all situations, which may be performed by dental hygienists employed by the SNS, would mean a reduction of program costs and would ensure oral health services accessible to children and young people, integrating strategies universal, that is directed at the entire population, selective, when we plan to intervene on risk groups and indicated, because those who have the disease need regular oral care. The definition of children at risk or risk groups as the basis for the definition of health policies is widely held in the literature.

Considering the evidence that current methods and to provide oral care systems are relatively inefficient, expensive. The Health Management's mission is to improve the functioning and increase the efficiency and effectiveness of health institutions, promoting management models that allow greater administrative and financial autonomy and the corresponding responsibility of the respective management bodies for achieving results in terms of health gains. This mission can only be realized through the development of instruments of influence and monitoring and evaluation criteria to enable support their development (Ministry of Health, 1998).

Health services are an integral part of political, economic and administrative structure of any society. Simply import a healthcare model for a society without taking into account its characteristics may have negative effects. The country that imports these models may not be able to bear the costs. Example of this is the application of models of developed countries to least developed countries, based on curative measures, based on clinical care by highly specialized professionals (Traebert, 1996).

Policies should be geared towards promotion and prevention strategies in public health. The question of oral diseases is simple and inexpensive public health measures are available to prevent and control because the causes are known: diet, poor plaque control, tobacco, stress and accidents. The main factor that makes the dental treatment so expensive is the resulting limitation of the dominant restorative approach to treating and preventing disease. Although oral health is the goal to achieve was diverted for dental treatment, which is a strategy and not a goal. Treatment strategies can ensure better care for some and a dependence on professionals, but little is done in terms of health promotion and intersectoral work. Approaches with clinical and intensive capital base to treat diseases are unrealistic given the high costs and inadequate coverage (Sheiham, 2005).

The World Health Organization points to 2020 targets for oral health that require strengthening of health promotion and prevention of oral diseases, and greater involvement of health professionals and education, public and private services.

Future actions to improve oral health and reduce inequalities require a public health approach. Clinical prevention and education for oral health alone has a minimal effect and may increase inequalities in society. A health program to look for the root causes of poor oral health through an implementation with a wide range of complementary actions is the best way to success.

Estimate the need for oral health care is essential for public health. So far no progress is being made in this area. There are major deficiencies in the regulatory approaches of oral needs. An alternative approach to conventional, the sociooral approach that takes into account the impact that oral state has on quality of life, desire of people and behaviors, their propensity to change behaviors and importance, showing that the recommended treatment is effective.

European governments are making reforms in their oral health systems to do a thorough analysis. The big challenge is the ability to control what happens within the system. Problems such as the induction of demand and over-treatment. The development of appropriate measures and appropriate incentive mechanisms are more important in the acquisition of equity and success than increase the number of dentists (Batchelor, 2005).

The economic analysis of the health sector can make an important contribution in making decisions in this health sector. Although some specificity of oral health services, the same concepts and methods applied to the understanding of health services can be applied to the analysis of oral health services.
It would have been important to understand the reasons for non-use of the check, by applying a survey of parents. This study is intended as a contribution and the awakening of interest for future research in the area of public service partnerships with the private dental service to the detriment of other policies.

Estela Maria Malheiro de Castro

Programa de saúde oral :evolução, instrumentos e resultados