Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ
NESA Publicação oficial
ISSN: 2177-5281 (Online)
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Páginas 124 a 126
Autores: Allan Abuabara1; Christine Bohm da Costa2
1. Allan Abuabara: Health Management Specialization, Santa Catarina Federal University (UFSC), Family Health (UFSC), Orthodontics (Santa Catarina State Dentist Association (SOESC), Dental Radiology and Imaginology, Campinas State University (UNICAMP). Auditing area, Municipal Health Bureau, Joinville, Santa Catarina State, Brazil
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Keywords: Public health, laws, dental diagnosis, adolescent, oral health.
The Joinville Oral Health Program is implementing a set of actions at the individual and collective levels encompassing promotion and protection, disease prevention, diagnosis, treatment, rehabilitation and maintenance of oral health among people of all ages. The oral health teams consist of a Dentist and an Oral Health Aide (ASB). At some units, there are also Oral Health Technicians (TSB) and support provided by Community Health Agents (ACSs) for educational activities and supervised tooth-brushing sessions.
Since 1998, the oral health teams have conducted annual examinations of the mouths of children and adolescents enrolled in the government school network and Early Childhood Education Centers (CEIs). Conducted on the school premises, this examination is a screening process that steers strategies and assigns top priority to children and adolescents in greater need of dental treatment. The importance of the oral examination is not limited to assessing tooth status, but may also indicate other problems, ranging from poor social and economic conditions up to sexual violence 1. In general, adolescents are rarely seen at healthcare clinics2. Thus, making good use of this time with the oral health team may be a strategy for building up stronger links between these youngsters and government clinics.
Article 11-X of the Dental Ethics Code3 underscores the need for parental or guardian authorization for conducting these examinations at schools:
Any dental procedure or treatment constitutes a breach of ethics, when undertaken without a prior consent of the patient or the legal representative thereof, except in cases of urgency or emergency.
In 2012, 80% of the children enrolled in the 1st to 9th grades of the government school network and CEIs were examined by the oral health teams. Over 10,000 children (some 20%) were not examined due to the absence of parental or guardian authorization, due either to refusal or omission (authorization left blank). This figure was even higher in 2013: 25% of parents did not authorize oral examinations when enrolling their children in school. Empirically, it is believed that this is due to a lack of information or forgetfulness. It is stressed that dental treatment is provided only when necessary, at the Basic Health Clinic after planning and authorization signed by parents or guardians.
As oral examinations in schools are intended to screen and identify children with greater dental treatment needs, with equity being one of the principles of Brazil's Unified National Health System (SUS), using non-invasive procedures with disposable materials, the Joinville Municipal Health and Education Bureaus and the Public Prosecutor's Office (IV Prosecutor's Office - Childhood and Youth) believe that there is no need for authorizations prior to oral examinations for children enrolled in government schools, nor for participating in preventive education activities and supervised brushing sessions conducted by the oral health teams. Grounded on the Brazilian Constitution4, Law Nº 4,324/645, Lei Nº 5,081/666 and Resolution Nº 118/20123 issued by the Federal Dentistry Council (CFO) the Regional Dentistry Council (CRO/SC), adopted a position in favor of this decision, in order to endow dentists employed by the municipal government with ethical security. Transcribed below is part of the Opinion Nº 003/2013 issued by the CRO/SC:
(...) as this is a municipal program, it must be implemented in the municipal school network by the municipal oral health team (always overseen and headed by the chief dentist), run in partnership with the Public Prosecutor´s Office and warranting our support.
By 2014, there was already no need for parental or guardian authorization in order to conduct oral examinations of children and adolescents. Consequently, almost all youngsters addressed by the oral health team planning were examined. Children not examined were those parents did not allow this or were absent on the day the oral health team performed the activities, being examined during a second round. Through these actions, many children and adolescents in the government school network benefitted through timely diagnoses and treatments. Furthermore, the work processes of the oral health teams were more streamlined, with less paperwork. Finally, through this screening process, the principle of equity is respected, as children with greater needs are assigned higher priority.
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