742. OMD: Proposals for oral health presented to the Minister of Health

The Portuguese Dental Association (OMD) presented to the Minister of Health a proposal for the creation of a strategy and planning committee for oral health, with the objective of defining, in the short, medium and long term, proposals with effective responses to medical needs. -dental care of the Portuguese population.

The OMD intends to reformulate the National Program for the Promotion of Oral Health (PNPSO) and focus it on a logic of prevention and promotion of oral health, with a specific financing model, which makes use of different models of access to oral health care, whether public, private or the social sector.

For Miguel Pavão, chairman of the OMD, “oral diseases continue to be the health area most neglected by health systems, resulting in an oral health deficit for the Portuguese. Reversing this reality is complex and lacks a multidimensional approach that allows for a transversal and integrated articulation of public health policies, with a view to reducing the burden of oral diseases. It is essential in this equation to relate social inequalities, poverty and addictive behaviors and addictions in oral diseases”.

During the meeting, the Minister of Health recognized that it is a complex and difficult task to reverse the delays of several years of investment in oral health.

Among the proposals presented by the chairman is the creation of oral health units in all health centers, with the entry of dentists in the Regional Health Administration to lead the implementation and development strategy, in conjunction with the General Directorate of Health. The OMD wants dentists to manage the local and regional teams and even the national team of the PNPSO, which classically has been given to professionals without specific training in oral health.

The chairman of the OMD reveals that “we asked the minister to move quickly with the creation of the commission in order to resolve this patchwork of oral health in the SNS. It is important for everyone to understand that there is no general health without oral health. A maxim that has been forgotten. The SNS is over 40 years old, but the dental check was only created in 2008, and as a solution limited to some audiences. In other words, there is a huge delay in relation to other areas of health”.

The OMD defends the extension of the dental check to new segments, namely an emergency check for trauma and a review of technical aids for, for example, dental prostheses. The OMD also calls for a review of the value of the dental check, reduced since 2014, within the scope of the troika's financial rescue program.

Knowing that Marta Temido takes over the health financing dossier, Miguel Pavão questioned the minister about the allocation of funds for oral health in the State Budget for this year, which the Government will deliver this Wednesday to Parliament.

The chairman of the OMD recalls that “the government program approved in the Assembly of the Republic is very vague in relation to oral health. He has intentions, but nothing comes true. What we want from the Minister of Health is that she takes action, that she commits herself to a fixed budget for oral health in the State Budget, which can also additionally be financed with revenue from the tax on soft drinks. We want a fixed budget for oral health, we want to know where and how it is invested. It is the only way to guarantee that all Portuguese people have access to medical and dental care. Both the SNS and the private sector are part of the solution, the Government understands the need to address oral health in a more strategic, integrated and inclusive way”.

Ordem dos Médicos Dentistas

 

741. MIGUEL PAVÃO: "Oral health is being permanently postponed"

 

In an interview, Miguel Pavão, chairman of the Portuguese Dental Association, points out some necessary reforms in terms of oral health. This is the case of the reformulation of the dental check and the need for an effective integration of professionals in the National Health Service (SNS).

What portrait do you make of oral health in Portugal?

Oral health is something that is being permanently postponed due to what were the historical vicissitudes of not having been integrated into the creation of the SNS. It was a mistake at birth, which was hardly corrected and reversed. And it was forever postponed, because it was only in 2008 that there was an attempt to implement a project, which is the dentist's check, in which some steps were taken. But there was an ambition for the project to evolve and that ended up not happening. Simultaneously, there were disorganized and strategyless attempts to integrate dentists into the SNS. The ridiculous thing happened that there were ARS [regional health administrations] that set up dental clinics and never had a dental appointment. Then, there was a small leap in 2017, with the creation of the Oral Health for All project, by Minister Adalberto Campos Fernandes and Secretary of State Fernando Araújo, who, I would say, was the one who really took this cause and founded it, but who ended up not being able to complete the process because there was a government reform. With the entry of Minister Marta Temido, the process stagnated, and then a pandemic entered, which always served as an excuse. If there has been an evolution in the oral health of the Portuguese, it is due to professionals in the private sector.

Does the lack of investment in oral health in the SNS create inequalities in access to care?

As of today, and according to our barometer data, a large part of the population still does not visit the dentist and does not access dental offices. About 41% of the Portuguese did not visit the dentist in 2021. It means that there is a level of the population, which is very much in line with socioeconomic indicators of poverty, which still does not have access to dental clinics. What happens is a bipolarity in the access to care. Whoever has the economic capacity invests. On the other hand, we have a segment of the population that, due to lack of economic capacity, cultural level and literacy, does not have this possibility.

Almost 2.4 million dental checks were wasted. Should the project be rethought?

Completely. There was an important leap [with the creation of the check], but the truth is that the project did not evolve. In fact, it just went backwards. We cannot forget that, after the introduction of the troika, there was a reduction in the value, which has never been updated. Dental checks have been lost across the board. There have been no audits, there has been no ambition in the project and the Portuguese Dental Association, at the moment, feels quite incapable because it does not have interlocutors, either in the Ministry of Health or in the Directorate-General for Health, who say "let's work on this dossier". This is one of the weaknesses that we have been pointing out. I presented a proposal to the Minister of Health, before the fall of the government, for the creation of a working group for a strategic reflection on various dimensions of oral health.

A new agenda for post-pandemic oral health

The next legislature will be marked by political stability and PRR funds. What should be the priorities in oral health?
One of the priorities is the integration of dentists in the SNS and the reform of primary health care for oral health, where the creation of oral health units must also be formatted. We also have the dental check and the oral health program. And we have a third dimension, which cannot be neglected, which has to do with the preparation and planning of professionals who are linked to oral health. We train too many dentists, we have too few hygienists.

In 10 years, there was a 70% increase in the number of dentists. Do you defend the reduction of vacancies in universities?

Of course yes. It is not because we are increasing the number of dentists that the population is having more access to oral health care. What is lacking are truly programmed policies to achieve equity in access to medical and dental care. The World Health Organization launched, in 2021, a resolution that will influence until 2030 an attempt that Member States can really adapt health professionals to a more preventive intervention. From our point of view, there must be planning and a strategic vision of measures, in which we have to reduce the number of vacancies for dentists in medical and dental schools and prepare, so that there is training and qualification of other aspects, such as more community and preventive intervention.

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