Half of young people have caries, and adults demand prostheses – 07/10/2023 – Health

The oral health of Brazilians has improved in the last decade, but most children and adolescents have decayed teeth, and most adults and the elderly need dental prostheses and dental care.

The scenario appears in preliminary data from the National Oral Health Survey, which has been carried out by the Ministry of Health in partnership with UFMG (Federal University of Minas Gerais). The collection of information would end on the last 30th, but it was extended until August 14th.

The study involves interviews and oral exams in the population of 422 Brazilian cities, including the 27 capitals and 395 cities in the interior. People of the following age groups are being examined and interviewed in their homes, at random: 5 years old, 12 years old, 15 to 19 years old, 35 to 44 years old and 65 to 74 years old.

Among children and adolescents, the main problem identified is tooth decay. At 5 years old, half (50.2%) of them have decayed teeth. At 12, the proportion is similar (50.8%). From 15 to 19 years old, 67% have cavities. The scenario is bad, but it has been worse. In 2010, the proportion was 76% in the latter group.

In the age group between 35 and 44 years, more than half (57.8%) need elective (non-urgent) or immediate dental treatment. In this group, 21.3% needed an upper prosthesis (fixed or removable), and 29% needed a lower prosthesis.

In the group aged 65 to 74 years, 37.5% need an upper prosthesis, and 28%, a lower one. In this age group, 50% require elective or urgent care.

Retired Albertinho Sebastião da Silva, 75, is one of those who need a prosthesis, but he still hasn’t managed to extract the condemned teeth because his diabetes is out of control. Last Wednesday (5), when arriving at UBS Cambuci (central region of São Paulo), the glycemic index was 274 (normal is below 100), and the appointment was postponed.

“He has scheduled three extractions to then place the prosthesis. But this is the second time he has come and the diabetes is out of control”, says dental surgeon Fabio Benistock, who referred Silva to the family health team, with the recommendation that he is also evaluated by a nutritionist.

The retiree says that he takes medication to control blood glucose, but that he cannot do physical activities and also does not give up eating what he likes. “My breakfast is sacred: it’s two loaves of bread and two bananas every day.”

The country has had an oral health program, Brasil Sorridente, since 2004. At the time, 15 million Brazilians had already lost all their teeth, 75% of the elderly were completely toothless and only 42% of the Brazilian population had regular access to brushing and toothpaste.

Progress has been made since then, but the provision of services across the country is uneven, with large inequalities in vulnerable and difficult-to-access regions. With the Covid-19 pandemic, bottlenecks have increased.

In May, President Luiz Inacio Lula da Silva (PT) signed a law establishing dental treatment as a SUS policy. Now, it is determined by law to offer universal access to oral health services, which cannot be discontinued or interrupted by managers.

“Many times the manager perceives the provision of dental services in the municipality as something optional, an extra benefit that he is providing. But it is a right, the population needs to know that. Nobody can have a healthy body if the mouth is not healthy” , says Luiz Evaristo Volpato, treasurer of the CFO (Conselho Federal de Odontologia).

The federal government announced the accreditation of new oral health teams, the creation of new services and the qualification of mobile units and dental laboratories, and an investment of R$ 136.8 million. Today, municipalities pay, on average, 60% of the costs of oral health teams. The rest comes from the federal government through financial incentives.

For Mauro Junqueira, executive secretary of Conasems (National Council of Municipal Health Secretariats), it is not by launching new policies that the Ministry of Health will solve the care problems at the top of the SUS. “It is important to have the incentive to help and support, mainly, the municipalities that only do the basics in oral health. But incentives do not guarantee stable financing. New money has to come.”

Maria José Evangelista, technical advisor at Conass (National Council of Health Secretaries), which represents state managers, says that ideally there should be an oral health team for each family health team. “This has not yet been possible due to lack of funding. But we have already grown. Before we had nothing, we were a country of toothless people”, she says.

For her, it is also important to have investments in the prevention of dental problems, with intersectoral policies. “You can’t solve everything just with attendance. If schools continue to put sugary drinks in lunch, we won’t advance.”

Data from Previne Brasil, a federal program that links part of primary care resources to the fulfillment of care goals, show that one third of the municipalities (33%) failed to meet the goal of keeping the oral health of pregnant women under control in the first trimester of 2023 .

“Access is lacking because the number of teams is insufficient. The policy is one oral health team for two family health teams, but many municipalities do not even have that”, says Kleverson Miranda, specialist in family medicine and Impulso consultant. Gov.

Junqueira, from Conasems, says that almost 70% of the UBSs in the country provide oral care, in general the most basic ones. The main bottleneck is the more complex cases, such as those that require root canal treatment, prostheses and dental surgeries, which depend on specialized services. “The number of services is small, the demand is great, and the queues are gigantic.”

According to Doralice Severo Cruz, coordinator of Oral Health at the Ministry of Health, access to oral health has been expanding, but, in addition to expanding the offer, it is now necessary to qualify this service. “The survey will help governments plan public policies based on the real needs of Brazilians.”

For Luiz Volpato, from the CFO, another challenge is the presence of dentists in hospitals. As there is no regulation on this, the decision is up to the managers. “They are only present in reference institutions. It is still seen as a ‘plus’, not as a priority.”

SP offers fixed prostheses and studies dental implants

In the city of São Paulo, of the 470 UBSs, 427 offer dental care in primary health care, according to the municipal management. There are also 31 CEOs (Dental Specialty Centers), which serve areas such as surgery and orthodontics.

In December, a new dental care center was inaugurated, with ten offices open from Monday to Friday, from 7:00 am to 10:00 pm, and on Saturdays, from 7:00 am to 7:00 pm.

This year, the municipality started to offer fixed prostheses in DSCs and started a pilot project, in Capão Redondo (south zone), to offer dental implants.

In two centers, it has also dealt with orofacial complaints (relating to the mouth and face) and temporomandibular disorders (which affect the masticatory muscles), a demand that has increased during the pandemic.

“Many people started to lock their teeth, causing pain that appears on the face”, says Marta Cypriano, responsible for the technical area of ​​oral health at the Municipal Health Department.