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

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