707. Dentistry in the SNS (National Health Service): an issue that is urgently solved

Urgent preventive medicine, informative, to address the small problems of today that will be enormous tomorrow. But can we continue to be a country that invests and does not reap the rewards?
This is a complex issue that must be tackled in a broad way. The ultimate goal is to ensure the access of the entire population to primary oral health care, without undermining the sustainability of state resources. Is it possible to do so? I think so. This will require a well structured plan that starts from scratch, evaluating all the hypotheses and not a project that starts already guided by a pre-established direction. By this I mean that the plan must begin by looking at the network that already exists, realizing if it is enough, and then yes, setting the course.

In a pragmatic way, we have to recognize that the means of the SNS are clearly insufficient and a large part of the population needs to be addressed which is not covered by subsystems or health insurance and does not have the financial resources to use the private sector . The problem is serious enough and requires urgent responses. It will not be possible to wait for the state to have the resources to create a network, nor does it seem to me the best solution.
It will be important to have the clairvoyance of realizing that the oral health problem in Portugal will only be quickly combated if the existing dental units are integrated into a future network, calling the dentists all to the discussion. I say well: everyone!

There is a need to optimize existing resources by listening to and integrating all dentists, not just large centers, since the reality in the less populated areas of the country is quite different from large urban areas. Taking advantage of the existing network will be a step that I consider vital to solve the serious public health problem that affects a significant part of the Portuguese population.
As we well know the public network of dental care in Portugal is so insufficient that would oblige investments of such order that would walk not for a global solution, but for such a slow and phased solution. Taking advantage of the existing network appears to be an act of intelligence in management. All on the basis of protocol services.

And what services would be provided? I believe that the best solution would be to invest in preventive medicine, with an annual check-up, co-responsible for the patient's oral health. The State should not assume costs arising from the patients' lack of care, but only ensure that users have access to consultations and information on oral hygiene care that avoid more serious problems - and therefore more costly for both parties.A preventive, informative medicine, to deal with the small problems of today that will be enormous tomorrow. Consultations where the patient can diagnose and treat, be directed to correct oral hygiene. This would prevent serious problems by also ensuring the correct use of public services in clinic cases where dental prostheses were implanted (which should obviously be reimbursed in the necessary cases, as in other areas of medicine).

Good management of scarce resources will be the way to find a global solution and not a phased solution. Good management not only of financial resources, but also of human resources. Portugal, with recognized merits in training, has also been an exporter of dentists. The question is: can we continue to be a country that invests and does not reap the rewards? Why not find a way to integrate students who finish their courses in vocational internships?These internships, duly paid, would last for one year. This dental medicine would allow that, at the end of this complementary training, these professionals were better prepared to carry out their activity. These stages and this provision of oral health services to the population would take place in the existing private units, as long as they fulfill the previously established requirements. In this integrated plan, Hospital Dental Medicine should be, above all, aimed at treating urgent situations and not cases of negligence on the part of the patient.

In short, and so that the Oral Health of the Portuguese does not remain hostage to subsystems and health plans, it is necessary to look at what we have in a transversal way and find a solution that allows integrating what already exists, also responding to surplus physicians dentists.

João Espírito Santo, Diretor Clínico, Clínica Medical ArtCenter    

706. ARS / Algarve puts dentists at the service of the population

The Regional Health Administration (ARS) of Algarve announced that, from today, Monday, 13, dentists were placed at the service of the population in the three Groupings of Health Centers in the region. The placement of dental professionals is part of the investment of the National Health Service in the area of oral health that, by the end of 2017, will integrate the specialty in 59 Health Centers nationwide, stressed the institution in a statement.
In an initial phase, the ARS / Algarve has three dentists and their dental assistants at the Barlavento Health Centers Group (ACES) in Portimão; in ACES Central, in Faro; and ACES Sotavento in Tavira. But the number of professionals in the area and the number of locations may grow during the year 2018, admits ARS.

In a meeting with the board of directors of ARS / Algarve, the regional coordinator of the Algarve Oral Health Program, executive directors and clinical directors of ACES, dentists and dental assistants, the guidelines were drawn up on how these new services work, which have the capacity to cover, at an early stage, users with risk factors and other situations that the family doctor considers to be clinically justified.
The referral of the users to the consultations of dental medicine is done through the family doctor. It thus increases the responsiveness of the National Health Service (NHS) in the Algarve to universal and equitable needs, taking into account the most vulnerable groups, says ARS / Algarve.

The institution stresses that there will be progressive access to oral health care in primary health care to guarantee access for people with chronic conditions to oral health care and to evaluate the oral health situation of people with the various pathologies defined and followed in the SNS.
To date, if there is a need to perform apical x-rays, dentists can do so because the cabinets are equipped with intraoral x-ray equipment. The reinforcement of primary health care in the region brings another novelty: from the beginning of December, the Algarve SNS provides for the first time in the ACES, a direct digital orthopantomograph for the execution of panoramic radiological images (digital orthopantomography) - previously possible only in the private health universe - which are available in the ARS / Algarve image filesystem. 

Consultations in the primary health care of the three ACES of the ARS / Algarve will be able to carry out the following interventions: dental medicine consultation, urgent consultation, definitive direct restoration in composite resin and cement, permanent and deciduous tooth extraction and supra - periodontal maintenance treatment, gingivoplasty and gingivectomy, drainage and sealing of fissures.

Região Sul