699. The importance of dental medicine in the National Health Service (SNS)

Since the 1980s, when I finished my degree in Dentistry, I hear about the importance of having dentists to provide oral health care at the National Health Service (SNS in portuguese). By that time, all those who had just finished their dental school were immediately working. All! Those who were very good students, the average and even the less skilled. We could all get to work. And all, or almost all, in the private exercise of the profession.But this abundance of work and the ease with which we settled in the professional world did not prevent the first leaders of the Professional Association of Dental Practitioners (APMD) from striking to see the political power of the time how important it was to entry of dentists into the public health service so that they could, broadly speaking, have access to oral health care. From the first moment that the maximum leaders of the APMD, in that time led by Professor Doctor João Carvalho, did everything to obtain this objective. It should be noted from the above that it was not because we had difficulty working, but because we could not be indifferent to the fact that a large percentage of the population, much more than today, does not have the economic capacity to access the offices and to private clinics.

A question of justice, enshrined in the Constitution of the Portuguese Republic: The right to health protection is carried out through a universal and general national health service and, taking into account the economic and social conditions of the citizens, is free. Guarantee the access of all citizens, regardless of their economic condition, to the care of preventive medicine, curative and rehabilitation.Unfortunately, since its inception, dental medicine has been excluded from the National Health Service. It was therefore quite natural that since 1991, when the APMD was created, this issue was part of the concerns, struggles and negotiations with the guardianship It's been over 25 years. It was not because of lack of commitment or lack of will of dental practitioners and their leaders that, with the exception of a few cases scattered throughout the Continent and the reality of Madeira and the Azores, oral health remained outside the public service.

It was because the politicians, the decision makers at this level, never wanted to take the step forward and always preferred to postpone the decision, making use of a wide variety of excuses to do so. I want to emphasize, as it is true and for justice, that all the staff members, secretaries-general and leaders of the APMD and the OMD have always defended and always beat each other to change this state of affairs. Only the political class, first, did not listen to us and then, when it began to hear us, was postponing the resolution of the problem.
And so it was in January 2016 when the Secretary of State Assistant and Health, Professor Fernando Araújo, announced the intention of his Government to create the conditions for dental medicine to enter the SNS. To this end, he proposed to dialogue with the OMD, in order to reach the much desired presence of dentists in the SNS.

The solution proposed by the Government in April last year did not meet our demands, as is well known. For this reason, it unanimously decided that the Governing Board of the OMD did not sign with the Government the protocol that defined the conditions of the 2016 pilot project and that led to the entry of 13 colleagues in other health centers to provide primary oral health. However, by not having signed the protocol, the Board of Directors of the OMD also wanted to keep the doors open for dialogue so as to be heard and to contribute to improving the conditions of care provided, should the Government decide, as it happened, to extend the pilot project, after the first year.Would another position be responsible? Could we seriously sulk and closed this door that had just opened? Even if it did not open as we all wanted? Indeed, some improvements have been achieved from the first to this second model of oral health care delivery in health centers: the contracts to be established are preferably from one to two years, from 13 health centers to more than 50, the geographical area it is no longer just Lisbon, Tagus Valley and Alentejo to cover the North, Center and South of the country, the salaries of the dentist and dental assistant are improved, etc. ...

We are all aware that the present conditions are not yet desirable and that there is much more to do. Nobody could expect that, after more than 25 years without anything very relevant having happened, immediately, in a year or two, if all the conditions we desired for the professional practice of dental medicine within the NHS were reached.
The recent decision of the Government to form a working group, which aims to create the conditions to reach the dental medicine career in the SNS, should concentrate our efforts in a serious and responsible way, continue to beat us for such important desiderato . I would remind you that the electoral program with which the current OMD board has presented itself to elections, this point, referring to the public service in the SNS, is one of the priorities.

It is really important to ensure that, even for the most disadvantaged and the poorest, there may be, within the NHS, dental clinics where primary oral health care is provided. We know that this process will take time to bear fruit. Let us not create false expectations. We want to hear all the social bodies of the OMD. We count on the collaboration of all the dentists; we will want to hear the whole class in a public consultation on this matter.

Portuguese dentists are needed, with a dignified career, in the National Health Service. The Portuguese population deserves, and needs, that this happens.
Dr. Pedro Pires, Vice-Chairman of the Board of Directors of OMD
O JornalDentistry