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