Work Ingles

8/3/2019 Work Ingles

1/13

ORAL HEALTHBRAZIL vs PORTUGAL

Work done by GislandaSouza

Enta. 2012

Oral health in Brazil and Portugal


2/13

ReportCurso Tcnico Especialista Higiene Qualidade Alimentar

islanda Santiago Souza

ABSTRACT: A research was made by a Brazilian student named Gislanda

Santiago Souza, age 30, attending Enta School (New Technologies school of

the Azores), enrolled in the Hygiene and Food Quality course. Her study based

upon the bad oral hygiene of the Portuguese people comparing to the Brazilian

people.

The pivotal aspect that motivated her interest in the referred study and

consequent work was that she could notice the Portuguese shy and sad smiles

hiding wracked and unhealthy teeth. Her school was the perfect scenario and,

at the same time, she wanted to boost a change in the peoples mind and in

their dental health.

These studies are about the oral health in Brazil and in Portugal taking into

account their different economic situation, epidemiology, prevention in dental

caries and periodontal diseases.

Brazil shows a scenario of dental development, a growing offer of dental

surgeons. On the contrary, studies show that Portugal needs further

implementation of school based oral health promotion and application of

population-directed preventive strategies.

Method: The method used for this paper was the research in articles online andthe enquiries that the school students kindly accepted to do.

Findings: The findings are based in the analysis of the enquiries, the focus of

the groups of students and their statements about their oral routines, their

feedback in the questioning and, of course, the reading of some precious

articles about the subject.

Terms /key words: Oral health, Brazil, Portugal, sanitary odontology, health

services, dental caries, prevention.

CONTEXT

2

Ponta Delgada, 04, February of 2012


3/13



The history of oral health in Brazil

The inauguration of the Public Health Special Service in 1952 prompted the

first dental health programs in Brazil. They were chiefly aimed at school children

who were considered epidemiologically liable to disease and, at the same time,highly sensitive to public health intervention. Although the care model was

aimed at developing educational activities, the clinical practice actually

reproduced what dentists did in their private clinics. The model conceived was

highly individualistic and did not aim at developing a technology program as the

result of a planning process. Nevertheless, an important landmark for health in

Brazil was achieved during the 1980s owing to the deep transformation which

occurred in health policies throughout the country after the Decentralized

Unified Health System (SUDS in Portuguese) was inaugurated. Later on, this

system evolved into the current Brazilian Health System (SUS in Portuguese).

The same environment indicating the dire need for changes in the health care

model was in place when the basic principles of the Brazilian Health System

were defined. In fact, the Brazilian Health Conference in 1986, coordinated by

Dr. Srgio Arouca, President of the Oswaldo Cruz Foundation (FIOCRUZ) at

the time, insisted on the guidelines of health care universality, decentralization,

social control and equity. Decentralization of the Brazilian health policy, one of

the foundational guidelines of the Health Reform movement, remained a basic

premise of the Brazilian Health System within the 1988 Constitution and of Law

n. 8080 of September 19, 1990 which regulated the Brazilian Health System.

The establishment of the Basic Operational Norm (NOB-SUS, 1993)

consolidated developments such as funding standardization and the

decentralization process in the administration of services and other activities

within the system.

3



4/13



The incorporation of coverage of oral health collective procedures (CP),

defined by Government Regulation n. 184 of October 9, 1991 published by the

Ministry of Health, was a landmark during the 1990s of this important change

from an individualistic-curative stance to a collective-preventive one. The Family

Health Program (FHP) was established in 1994. Since the focus was placed on

the family, on patient registration and on a clinical practice based on a social

epidemiology rationale, it became an efficient strategy for the reorganization of

basic care. The establishment of links, commitment and responsibility between

professionals and the community is one of its high points. Inclusion of Oral

Health Teams (OHT) within the Family Health Program was effectively defined

by Government Regulation n. 1444 of December 28, 2000. The Brazilian Oral

Health Policy launched by the Ministry of Health in March 2004 was the result of

a long historical process of institutionalization of dentistry within the Brazilian

Health System.

Epidemiological aspectsIn 1986 the Brazilian Ministry of Health undertook the first Epidemiological

Oral Health Survey with population samples from the greater areas of Brazilian

capital cities. Its aim was the planning of programs and strategic fronts. A second

National Oral Health Survey11 was undertaken in 1996, and then again in 2003. The

4



5/13



latter was called the "Oral Health Conditions in the Brazilian Population". Several

dental institutions and organizations, including the Brazilian Dentistry Organization

and its regional sections, several universities and state and municipal health

departments participated in the project. Some two thousand professionals (dentists

and assistants, health agents and others) from 250 Brazilian municipalities also took

part in the survey.

Furthermore, 108,921 individuals including children (18-36 months old; 5

years old and 12 years old); young people (15-19 years old), adults (35-44 years

old) and elderly people (65-74 years old) from urban and rural areas were

examined. In spite of a sharp decrease in the level of dental caries among the

children population during the last decades, high levels of oral diseases were still

extant in certain population groups. Whole sections of the population remained

without any sort of care. The results revealed that a mean of 14 teeth were still

affected by caries during adolescence and adulthood (graph 1)

DENTAL HEALTH IN PORTUGAL: A DIFFERENT REALITY

In Portugal, oral healthcare is provided almost entirely by the private sector.

Public dental services are available in only a few hospitals involving major

treatment requiring hospital admittance. A handful of Public Health Centres

provide simple restorations and extractions.

5



6/13



A Public Oral Healthcare system based on prevention is being developed.

Dentists who want to participate inform the local Health Centres. Children of 6-10

years from schools are then referred to the private practices of these dentists.

Each child is allowed 2 visits per year. Payment is made by the Ministry of Health

and is based on a fee per child per appointment. Treatment of first permanent

molar includes fissure sealants, simple filling, basic endodontic and extractions. By

2002, approximately 10% of this group age received care and 4.5 million Euros

were paid of the Ministry budget.

In the Autonomous regions of Madeira and Azores oral healthcare is

provided within the National Health Service and is financed by the regional

Government.

Health Expenditure

% of GDPSpent

on Health

AnnualExpenditure

on Oral HealthCare

% of GDPSpent

on OralHealth

Year Source

Total 10.2 n.a. 0.36 (2004) 2006 1)

1) Manual of Dental Practice. The Council of European Dentists, Nov 2008.N.A- not available.

Portugal and Brazil in dental healthConventional wisdom for many years was that caries were the main

reason for tooth loss before age 35, and periodontal disease was the main

reason after age 35. This belief was based on some old and rather dubious data.

6



7/13



Even as late as 1978 there was a report that 8-10% of teeth are lost to

periodontal disease by age 40, and that such loss increases rapidly after that

age.

According to some authors, since the mid-1980s, studies from a numberof countries and among different types of populations have consistently found

that caries is the principal cause of tooth loss at most ages, with the possible

exception of the oldest (i.e., those over 60 years).

In Brazil tooth loss is a serious public health problem, and the percentage

of adults with total loss is high. A number of research studies have been carried

out to determine the reasons for tooth loss, all of which have shown tooth decay

as the most important factor for tooth loss, followed by periodontal disease.

Educational level and age factors are associated to tooth loss. Tooth

retention throughout the life course should be the main concern for both dental

surgeons in general and all professionals working in public health services.

In Brazil, less than 22% of the adult population and less than 8% of the

elder people present healthy gum tissue. The data are from "SB Brasil 2003", the

most complete oral health survey in the country.

Furthermore, it is already possible to follow the impact of actions on oralhealth over the country, especially regarding the reduction in dental extraction

indexes. Since 2002, about 2 million teeth were not extracted owing to these

actions. This is an important health indication and it shows an improvement in the

quality of oral health care in Brazil.

Water fluoridation, supervised tooth brushing, controlled fluoride

mouthwash programs, use of sealant on pit and fissures, and early diagnosis and

treatment of dental caries and periodontal diseases are all effective measures.

Talking about a different reality as Portugal, the results emerged from the

studies and meetings assert that it is imperative that the Portuguese health

authorities clearly take tooth decay as the main infectious disease affecting the

Portuguese population and to establish immediate goals for their effective control

and eradication.

7



8/13



Portugal cannot continue to be the a poor third-world country related in

Europe, in what regard to oral health care provided by the national Health

Service. It is unacceptable that, compared to Portugal, there is currently poor and

underdeveloped countries of the Third- World to do more and better oral health

for their populations.

It is about time to acknowledge that Portugal has all the facilities and

human and financial resources that enable the control and eradication of dental

caries, missing only the political will to take the right step in that direction.

There are services in Portugal that can spend less and work better. The

increase should focus on enhancing the network of continuing care and palliative

care, which is now spread across the country, and the creation of another oral

medicine that is virtually nonexistent.

There are already checks dentists for pregnant women, children and

elderly, however it should be moving towards the creation of a valence of oral

health, which is very important, not just to have beautiful teeth and functional, but

to prevent other diseases.

On another hand, and as the former Minister of Social Affairs said, at the

time of crisis Portugal is living, the social sector must be strengthened tocompensate for the inequalities that now aggravated by unemployment and other

precarious situations.

The current bleak picture of oral health in Portugal, the responsibility of

Governments past and with full connivance of the Directorate must change

rapidly.

Portugal is closer to of poor and underdeveloped countries than their

European Union partners in terms of oral health.

According to Leske et al. (1993), traditionally the prevention of oral

diseases has been well-founded on three levels:

1- Primary prevention, related to the initiation of the disease;

8



9/13



2- Secondary prevention, where the aim is to stop the progression of the

disease and also disease recurrence;

3- Tertiary prevention, where the goal is to avoid tooth loss (loss of function).

Statistics show that the Brazilian Government's Oral Health Program (within

the SUS), with strong public oral health policies applied all over the country is

an effective effort to reach the first prevention level. Two prevention levels,

however, remain uncovered by the government's actions. The loss of teeth due

to periodontal disease and/or to endodontic infections, and the replacement of

the teeth by dental prostheses are still inaccessible to a great portion of Brazil's

population, and only Dental Schools and few municipalities have had the

resources to treat a small portion of those needs.

Thus, the Dental Specialty Centers (CEOs) are a valid alternative to

complement the population's needs all over the country. However, as Brazil has

a continental dimension, great challenges still have to be overcome. In spite of

the social policies undertaken and some favorable economic factors, more

centers and more specialists must still be better distributed over the country's

different regions in order to achieve a better balance in oral care health to the

population as a whole.

CONCLUSION

Based on the data and numbers studied this paper concludes that public

actions on oral health must involve both preventive and curative procedures in

order to minimize distortions in the oral health of the populations of developing

countries. To this end, the Dental Specialty Centers are a valid and welcome

social program in Brazil. Unfortunately Portugal is taking baby steps in order to

change children and adults dental habits, treatment and preventions, as well as

giving the awareness of a healthy oral life at an early age.

9



10/13



RECOMMENDATIONS

Taking into account the previous study, I recommend that the Portuguese

government and also some private institutions to take serious measures in

order to improve Portuguese oral health.

The Portuguese government should take a step to help young children at

school to implement a hygiene oral routine to present caries and teeth loss in

such a young age.

Taking a step to grant medical, dental appointment to poor families and

implement in the public school. Then take copy the good example of prevention

that Brazil implemented a long time ago.

THE DIFFERENCES ARE OBVIOSLY NOTICEDWHENEVER WE HAVE TIME TO LOOK AT THEM.

Picture A- A Portuguese presenter

10

http://www.google.com/imgres?q=sorriso+de+teresa+guilherme&hl=pt-PT&gbv=2&biw=1366&bih=587&tbm=isch&tbnid=zqWUZfS92p914M:&imgrefurl=http://ocavalheirodaimaculada.blogspot.com/2011_11_01_archive.html&docid=IpZjvnJBbXpfEM&imgurl=http://4.bp.blogspot.com/-uIYtcge4Ghs/TtVbCy1GYtI/AAAAAAAAAKI/XUvrZGLwQoI/s1600/teresa-guilherme-2009[1].jpg&w=412&h=377&ei=j8ceT82OIMmeOpfp0eMO&zoom=1


11/13



Picture B- Brazilian actress

CONTENTS

Abstract------------------------------------------------------------------------------2

11



12/13



The history of oral health in Brazil/Epidemiologicalaspects-------------3- 4

Dental health in

Portugal----------------------------------------------------------5

Portugal and Brazil:Comparison----------------------------------------------6-8

Conclusion/ Recommendations--------------------------------------------------9

References--------------------------------------------------------------------------11

12



13/13



REFERENCES

Programa Nacional de Servios Bsicos de sade, 1981.

Narvai PC. Odontologia e sade bucal coletiva. So Paulo: hucitec, 1994

Ministrio da Sade. Levantamento epidemiolgico em Sade Bucal,

Braslia, 1988

http://bdigital.cariedentaria.pt

www.ortodontiaereabilitaaooral.pt

13

http://bdigital.cariedentaria.pt/http://bdigital.cariedentaria.pt/http://opt/scribd/conversion/tmp/scratch17932/http://www.ortodontiaereabilita?aooral.pt/http://opt/scribd/conversion/tmp/scratch17932/http://www.ortodontiaereabilita?aooral.pt/http://opt/scribd/conversion/tmp/scratch17932/http://www.ortodontiaereabilita?aooral.pt/http://bdigital.cariedentaria.pt/

Work Ingles

Documents