Constructing public oral health policies in Brazil: issues for reflection

Abstract

This paper addresses the construction of public oral health policies in Brazil by reviewing the available literature. It includes a discussion of the social responses given by the Brazilian State to oral health policies and the relationship of these responses with the ideological oral health movements that have developed globally, and that have specifically influenced oral health policies in Brazil. The influence of these movements has affected a series of hegemonic practices originating from both Market Dentistry and Preventive and Social Dentistry in Brazil. Among the state activities that have been set into motion, the following stand out: the drafting of a law to regulate the fluoridation of the public water supply, and the fluoridation of commercial toothpaste in Brazil; epidemiological surveys to analyze the status of the Brazilian population's oral health; the inclusion of oral health in the Family Health Strategy (Estratégia de Saúde da Família - ESF); the drawing up of the National Oral Health Policy, Smiling Brazil (Brasil Sorridente). From the literature consulted, the progressive expansion of state intervention in oral health policies is observed. However, there remains a preponderance of hegemonic "dental" practices reproduced in the Unified Public Health Service (Sistema Único de Saúde - SUS) and the Family Health Strategy.

Oral Health in the Family Health Strategy: analysis of articles published in the period 2004-2014

“…Despite of these limitation, with a critical analysis of the publications included in this study, it is shown that there are still thematic categories poorly explored by the published scientific literature, such as aspects related to financing/investment in oral health and its relationship with social inequities or in-depth analysis of the real impact of OHT/FHS actions on oral health indicators. Considering the thematic categories poorly explored, the lack of validated indicators to assess the efficacy of health care practice accurately could be a limitation faced by researcher, as well as the implementation process of public oral health policies in Brazil is not well-established, due to the later incorporation of Oral Health Teams into the Family Health Strategy and the issues of resource allocation, costs, and financing that still need to be overcomed 58 . Future research should also look more deeply into the issue of the quality of the articles published with the aim of clarifying which research designs can provide the most valid and useful answer to the institutional and evaluative needs of oral health care in FHS.…”

Socioeconomic inequalities in dental health services in Sao Paulo, Brazil, 2003–2008

“…It aims to improve access to dental care at all levels of complexity, including preventive oral health services, basic oral health services and complex rehabilitation oral health services [3, 5]. Additionally, it aims to increase the quality of care for all dental health problems and decrease inequalities in dental services use [3, 5, 6]. Smiling Brazil promoted an increase in dental health care teams, which usually consists of a dentist, an oral health technician and an oral health assistant [4].…”

Comparative Study of the Oral Health Profile of Institutionalized Elderly Persons in Brazil and Barcelona, Spain

“…In the majority of municipalities, programs were conducted for school age children aged between 6-12 years, and pregnant women. Adults and the elderly only had access to emergency care units and mutilative treatment (23)(24)(25)(26). This exclusive oral health care model existed in Brazil until 2004, when the country implemented the National Oral Health Policy entitled "Brazil Smiling" whereby individual and collective actions were implemented, aimed at the promotion, prevention, diagnosis, treatment and rehabilitation in primary and secondary levels of oral health care.…”

“…27 Although there has been a gradual expansion of interventions in oral health policy, hegemonic models or private dentistry models focused on disease still prevail in Brazil. 24 In a case study on the implementation process of the National Oral Health Policy -"Smiling Brazil" -in the municipalities of the Regional Health Department of Araraquara, São Paulo, Brazil, it was observed that the municipalities still find it difficult to deploy assumptions of "Smiling Brazil" because it was observed the tendency of maintaining the model centered on disease due to large pent-up demand, the charges with the production of procedures and training technicalities and clinical. 25 It can therefore be stated that this new health policy has not had an effect on the older people in the present study, indicating the need for future studies to evaluate the impact of "Brazil Smiling" on this group.…”