Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 13 nº 4 - Oct/Dec - 2016

Brief Communication Imprimir 

Páginas 124 a 126


Legal aspects of the dental examination in municipal schools of Joinville (SC)

Aspectos legales del examen bucal en escuelas municipales de Joinville (SC)

Aspectos legais do exame bucal em escolas municipais de Joinville (SC)

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
2. Christine Bohm da Costa: Master`s Degree in Dentistry; area of concentration: Collective Health (UFSC). Basic Healthcare Unit Management (GUAB), Municipal Health Bureau, Joinville, Santa Catarina State, Brazil

Allan Abuabara
Rua Araranguá, 397, América
Joinville, SC, Brasil. CEP: 89204-310
allan.abuabara@gmail.com

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How to cite this article

Keywords: Public health, laws, dental diagnosis, adolescent, oral health.
Palabra Clave: Salud pública, leyes, diagnóstico bucal, adolescente, salud bucal.
Descritores: Saúde pública, leis, diagnóstico bucal, adolescente, saúde bucal.

Abstract:
Since 1998 Joinville/SC has a specific public oral health program for children and adolescents from public schools. This work shows the experience on the legal aspects of the dental examination in the municipal schools. With the end of parental authorization requirement for the oral examination of children and adolescents, supported by the Regional Council of Dentistry, Municipal Secretary for Health, Municipal Secretary for Education and Public Prosecutor's office for Children and Youth, the work process for the oral health team has become more agile and less bureaucratic. This positive experience may be of interest to other cities.

Resumen:
Desde 1998, el municipio de Joinville/SC cuenta con un programa de salud bucal específico para niños y adolescentes de la red pública de enseñanza. Este trabajo presenta la experiencia municipal sobre el carácter legal del trío y examen bucal de los niños y adolescentes matriculados en la red pública de enseñanza. Con el fin de la necesidad de autorización de los padres o responsables para el examen bucal, respaldados por el Consejo Regional de Odontología, Secretaría Municipal de Educación, Secretaría Municipal de Salud y Ministerio Público, Promotoría de Justicia de la Infancia y Juventud, el proceso de trabajo de los equipos de salud se tornó más ágil y menos burocrático. Esta experiencia positiva puede ser de interés para otras ciudades.

Resumo:
Desde 1998 o município de Joinville/SC conta com um programa de saúde bucal específico para as crianças e adolescentes da rede pública de ensino. Este trabalho apresenta a experiência municipal sobre o caráter legal da triagem e do exame bucal das crianças e adolescentes matriculadas na rede pública de ensino. Com o fim da necessidade de autorização dos pais ou responsáveis para o exame bucal, respaldados pelo Conselho Regional de Odontologia, Secretaria Municipal da Educação, Secretaria Municipal da Saúde e Ministério Público, Promotoria de Justiça da Infância e Juventude, o processo de trabalho das equipes de saúde se tornou mais ágil e menos burocrático. Esta experiência positiva pode ser de interesse para outras cidades.

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.

In view of the facts narrated and in the best interests of the oral health of the citizens of Joinville, we feel that certain limits on non-invasive screening conducted in order to classify and recommend care for pupils/patients do not constitute a breach of the Dental Code of Ethics.

We stress that any procedures other than mere non-invasive evaluation and classification undertaken by the municipal civil service are not encompassed by this authorization and require correct ethical conduct under the aegis of the CRO, with the oral health team responsible for preventing any type of personal benefit for the practitioners involved or private referrals for pupils under examination, as well as referring pupils to the Municipal Child Protection Council, that do not receive the authorized treatments once they have been examined.

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.


REFERENCES

1. Soares LKDC, Arantes DC, Nascimento LS, Azevedo PSB. Índice de placa dental e condição socioeconômica de crianças e adolescentes vítimas de violência sexual. Adolesc Saude. 2014;11(4):61-7.

2. Tôrres TRF, Nascimento EGC, Alchieri JC. O cuidado de enfermagem na saúde sexual e reprodutiva dos adolescentes. Adolesc Saude. 2013;10 (Suppl 1):16-26.

3. Brasil. Conselho Federal de Odontologia. Código de ética odontológica. Aprovado pela Resolução CFO-118/2012. São Paulo: Conselho Federal de Odontologia; 2012.

4. Brasil. Constituição da República Federativa do Brasil. Diário Oficial da União, 5 de outubro de 1988. Brasília: Diário Oficial da União; 1998.

5. Brasil. Presidência da República. Lei n. 4.324, de 14 de abril de 1964. Institui o Conselho Federal e os Conselhos Regionais de Odontologia, e dá outras providências. Brasília: Casa Civil; 1964.

6. Brasil. Presidência da República. Lei n. 5.081, de 24 de agosto de 1966. Regula o exercício da odontologia. Brasília: Casa Civil; 1964.
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