Dr. Liana Bastos Freitas Fernandes
University of Lund
Health Promotion through PROESA - Odontological School Program of Health The PROESA Project as an Odontological School Program of Health began in 1985 by Dr. Rui Oppermann in the Municipal Office of Porto Alegre (Brazil) where, since 1980 a series of clinical and laboratory work have been realized to help science. Such studies were about the process of des-remineralization, the dynamics of the process as well as the factors that interfere in the process. A study on how the Surgeon-dentist and hygienist could intervene on the process of des-remineralization or in the caries activity of each individual leveling it with the consequent reduction of the individuals caries activity. The first aspect approached was of the diagnosis of the caries within the field situation in the public health in Brazil. This method was developed through active white spots in a process of des-remineralization and was used as indicator of the caries activity in the individuals. A test study was realized with nursery school children that had the number of white spots reduced in 6 months with the application of fluoride gel when brushing their teeth, with the help of a professional. Many of the white lesions disappeared after 6 months, reducing the cost. PROESA had as its goal, to study the decrease of the white lesions where it could have a reduction of the experience of the caries itself through DMFT of a bigger population in a long period of time. The PROESA intends to remove dental plate from the children's mouth as well as to apply fluor-gel with the toothbrush. Parallel to this, instructions on how to educate the children on the oral health subject were given in the school yard, as a social activity.
The implementation of a program like PROESA begins initially with a seminar in the community like syndicates, churches, leadership, schools, parents, teachers, governmental units, surgeon-dentists and helpers that eventually will be participating in the project. The objective of the seminar is to discuss what is the meaning of each odontological treatment so that the population can have the knowledge of the real concept of health. Consequently, the individuals feel motivated to change the odontological practice. Children receive, 6 to 8 times in a period of one year, help from professionals on how to use the toothbrush as well as on removal of plate and fluor application. As an example, children from the City of Manaus (Amazonas, Brazil) had a very significant reduction of cases of caries.
Initially, 600 children were attended by PROESA in a period of 3 years. Today, with the assistance of Dr. Oppermann, PROESA, at national range, assists 666.000 children. This number does not include the children assisted by several professionals applying the PROESA method without Dr. Oppermann's supervision. Unfortunately, there is a limitation to offer consultation but through the guidebook many professionals in various Brazilian communities apply the prevention program.
Oral Health in the City of Curitiba (Paraná, Brazil)
The City of Curitiba in 1981-1983, like the City of Brasilia did before, began to use a simplified method with specially trained people working in the schools.
In 1983, Dr. Sylvio was already a professor of Preventive Social Odontology with the University of Paraná and dentist of the City of Curitiba. As the head of the Odontological department he started a plan to reestimate the results in the schools, discussing its productivity capacity. Because of the schools calendar with many holidays, the dentists working in the schools had more time off. Besides the service was limited to students Dr. Gevaerd had the help of a group of professionals to organize the municipal health service in order to call odontological attention to the population of Curitiba. Odontology became a part of general health care and was taken to another segment of the population outside the schools. The purpose in 1983 was to attach the odontological clinic to the medical unit. Odontology and medicine evolved together in the attention to health care. Since 1983 to 1994, 70 odontological clinics were introduced. A module of 4 dentist-chairs with 2 dentists per term and 6 helpers was established as well as a place to teach the technics of oral health. The municipality offered a course in hygiene. The odontological clinics attended children up to 14 years of age during the day and stayed open to adults at night time. Groups of pregnant women and maternal/childhood also were reached. The neighborhood associations started to propagate the importance of the health promotion and to divulge the odontological services. The people of Curitiba accepted the proposal of immediate treatment. In this period the people longed only for a mutilated service. Basically, they did not have a great knowledge of the treatment of oral diseases demonstrated in a higher demand on the number of extractions. Groups of children and adults in risk of diseases were selected and received treatment. All children attending schools and day-care nurseries were selected and got fluoride-gel treatment and those in the group of risk had their caries treated. The need for healing treatment was replaced by the maintenance of the odontological treatment that reached 80% of the population. In 1992, the service started to assist all the people that needed treatment.
The first estimation on dental caries in various age groups of people in the City of Curitiba was realized between 1979-1982. The dental service was equipped with computer services since 1985, all oral data are programming making the productivity control easier. The second estimation was realized between 1988-1989. Recently, a more elaborated work was realized through a computer program to favor and epidemiological analysis of this population. Caries incidence has gone down in different groups of people in the City of Curitiba. In the future one hopes that this service will be well organized so as to evaluate and treat periodontal diseases.
University of Lund
Fax: (4640) 323113 - Sweden
(55) (21) 290-8148 - Brazil