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