Co-authors: Sandra Lunardelli, Marco Aurélio Peres and Mauro Antunes
This encounter, which historically has constitued itself into a forum of privileged discussions concerning collective health, gathered around 350 participants of 14 Brazilian States as well as the Countrie's Capital and has as president Prof. Telmo Mezardi, headmaster of UNIVALI School of Odontology.
The main topic of the event "Oral Health in the Municipalization Process" was approached by representatives of various segments of society, like the Health Ministry, National
Council of Municipal Health Secretaries (CONASEMS), Brazilian Association of Dental Education (ABENO), Interstate Dental Federation (FIO) and University and Services professionals, and was discussed by the people present.
The Commission which organized the event registered the inscription of 60 pieces of work developed in various States of the Country, of which, 36 were selected for presentation in the Coordinated Communications. In spite of the serious crisis in which our Country, in general, and the health sector in private, are going through, the work presented on Human Resources in Oral Health, Vigilance on Oral Health and Local Health Programs, demonstrated the creativity, talent and competence with which the private sector of odontology professionals have been working in order to contribute to the improvement of Oral Health among the Brazilian population.
Coherent and well succeeded experiences on the principles of the Unique Health System (SUS), as the ones developed in the municipalities of Santos (São Paulo State), Curitiba (Paraná State), Rio do Sul (Santa Catarina State) and Ipatinga (Minas Gerais State), were object of special attention, with the effective participation of the people present.
The present electoral politic moment in the country was also distinctively approached, with the discussion and presentation of proposals for the health sector by candidates Fernando Henrique Cardoso, Luis Inácio "Lula" da Silva and Orestes Quercia.
Parallel activities to the meeting were realized, as the meeting of professionals who work with the sanitary vigilance, concerning the grades of fluorine in waters of public supply, in municipal sphere and the criation of the Brazilian Odontology Teachers Group in Collective Health. Initially this Group wishes to discuss the scientific specificity due to health politics, odontological ethic, social problems among others, and the exchange of teaching experiences. A commission supervised by Professor Salete Pretto was elected to organize a meeting in Curitiba (Paraná) from April 30th to May 1st, 1995.
Under Dr. Sylvio Gevaerd's Coordination was also held a meeting of the Oral Health Work Group in SILOS's CEDROS Network, in which a proposal to study, in a multicentric way, attention models to be developed in some municipalities of the country was discussed.
The Final Document was discussed and voted in the Final Assembly where the following points are emphasized: The opponent position to the social-economic model present in Brazil, major responsible for the disastrous life and health situation of the population; in the specific oral health area, the strengthering of the need to increase the fluoridation of the water for public supply, a procedure known as the best method for the reduction of dental caries in the country, and the consequent sanitary vigilance of the same; and the protection to guarantee the entrance of money to states and municipalities as a way to make possible the municipalization of health.
The municipality of Natal (Rio Grande do Norte State) represented by Prof. José Ferreira Campos Sobrinho / UFRN - CEDROS Network, was determined as location for the XI ENATESPO, to be realized in 1995 and the City of Curitiba indicated as holder of the XIII ENATESPO.
Mailing address:
Universidade de São Paulo/USP
Al. Otavio Brisolla, 9-75
Baurú * SP * Brasil * 17043-101
Fax: (55) (142) 23-5525
Celebrations of the Oral Health Day in the Dental School of the
Lund University, Malmo - Sweden
The World Health Day of 1994 has been devoted to oral health. Campaigns for oral health promotion have been launched throughout the world to mobilize the health professions and the general public so that greater attention can be focused to this aspect of public health. As a collaborating center for research and education of the World Health Organization, the Centre for Oral Health Sciences of Lund University, was also engaged in the promotion of public health aspects of odontology.
Jump-starting the official WHO calendar, the Malmo Oral Health Centre has organized on April 5th a program for in depth discussion of contemporary aspects of oral health research and education. The activities started with the presentation of a doctoral dissertation. The Thesis, titled "Community Oral Health Care - Projects in Thailand" is written by Dr Yupin Songpaisan, Mahidol University, Bangkok, in collaboration with Lund university and under supervision by Professor Douglas Bratthall, Department of Cariology. In Sweden, a Thesis has to be publicly defended and an opponent ask for several hours in-detail questions about the work, and a Committee then follow with further questions and suggestions. Thus, for half a day the audience received a fine presentation of oral health problems in Thailand, a country undergoing rapid development.
In the afternoon, Prof. Madeleine Rohlin welcomed the participants of the Oral Health Day program emphasizing the role of WHO collaborating centers in focusing local community health needs and planning appropriate health programs in close cooperation with local health authorities.
Prof. Douglas Bratthall explained the role of WHO for oral health and presented the many activities of both the central WHO bodies as well as the Collaborating centres. Examples of international projects where Lund university centre is involved were given and included projects aiming at preventing fissure caries, projects testing an anti-microbial varnish and a large project in which a new "affordable" fluoride toothpaste is tested in a field trial.
The alternative restorative technique called "a-traumatic restorative treatment - ART" was discussed by Prof. Taco Pilot from the University of Groningen, The Netherlands, and by Prof. Prathip Phantumvanit from Khon Kaen University, Thailand.
Prof. Pilot presented the rational for this alternative method of low cost dental restorations. ART is based on the removal of carious dental substance with hand instruments and subsequent cavity filling with glass ionomer cement. Due to the chemical characteristics of modern glass ionomer formulations the restoration can effectively bind to dental cavity and does not need a specific retentive shape. The fluoride content of such materials are of great benefit in preventing new caries lesions. ART has been initiated in Tanzania in the mid 80s but it was only recently that tests under real field conditions were performed. Prof. Prathip Phantumvanit from Khon Kaen University, Thailand presented a paper on the two years field experiences with ART. The aim of the study was to assess the longevity of ART fillings placed under actual field conditions. 529 ART fillings were made in a village of rural Thailand. Evaluation of the quality of ART fillings was carried out one and two years after insertion. The one year results of one surface ART fillings show that 93% of permanent and 79% of deciduous teeth were judged successful. After two years the corresponding figures have dropped to 78% and 65%. The resources needed for restoration are considerably reduced in comparison to conventional amalgam or composite resin fillings. Since there is no need for electrically powered engines this technique is particularly suited for field applications.
The oral health system of different countries i.e. Australia, Brazil, Lithuania and Thailand, was discussed during a poster session. The availability of manpower, structure of public health services and the extension of preventive measures were considered as central aspects in the development of public health.
The educational aspects of oral health professions were discussed by Professor George N. Davies from the University of Queensland, Australia, and by professor Madeleine Rohlin from Lund University, Sweden.
Professor Davies presented the principles of the new integrated modular curriculum for all dental personnel in Fiji. The modular system is composed of clusters that allow efficient resources allocation and focus on good communication among dentists, hygienists, dental attendants and technicians. The program uses several educational strategies including problem based learning techniques to enhance critical thinking.Professor Rohlin focused the characteristics of the community as the base for a curricula in dental education. Health, social, economic, cultural and even geographic aspects are factors accepted to influence the prevalence and incidence of oral diseases. The interaction between health professionals and the target populations is also affected by such aspects. Therefore, the ability to identify local community characteristics can be considered a valuable skill for oral health professionals. Furthermore, by acknowledging the community as a responsible part for oral health levels a greater effort is placed on the patients own responsibilities during treatment and maintenance. The Malmo model for oral health education is primarily composed of problem based learning methods that encourages participants to actively engage on the learning process.
In a closing statement, Prof. Rohlin stated that comprehensive knowledge has been accumulated and preventive programs show that oral health diseases can be fairly well controlled. What remains to be done is to effectively bring higher levels of oral health to a larger portion of the global community. q
Mailing address:
Dr. Claudio Pinheiro Pernandes
Dentistry Departament, University of Lund
Phone: +46 40 322129 * Fax: +46 40 322113
E-mail: claudio.fernandes@oduciv.lu.se
Dr. Douglas Bratthall Dentistry Departament, University of Lund
Carl Gustavs v,,g 34, S-214 21 Malmo, Suecia.
Phone: +46-4- 322142 * Fax: +46-40 322145
E-mail: douglas.Bratthall@odcariol.lu.se
at the Universidad de Kaen, Tailandia