Advances and challenges in oral health after a decade of the “Smiling Brazil” Program

ABSTRACT OBJECTIVE To analyze oral health work changes in primary health care after Brazil’s National Oral Health Policy Guidelines were released. METHODS A literature review was conducted on Medline, LILACS, Embase, SciELO, Biblioteca Virtual em Saúde, and The Cochrane Library databases, from 2000 to 2013, on elements to analyze work changes. The descriptors used included: primary health care, family health care, work, health care policy, oral health care services, dentistry, oral health, and Brazil. Thirty-two studies were selected and analyzed, with a predominance of qualitative studies from the Northeast region with workers, especially dentists, focusing on completeness and quality of care. RESULTS Observed advances focused on educational and permanent education actions; on welcoming, bonding, and accountability. The main challenges were related to completeness; extension and improvement of care; integrated teamwork; working conditions; planning, monitoring, and evaluation of actions; stimulating people’s participation and social control; and intersectorial actions. CONCLUSIONS Despite the new regulatory environment, there are very few changes in oral health work. Professionals tend to reproduce the dominant biomedical model. Continuing efforts will be required in work management, training, and permanent education fields. Among the possibilities are the increased engagement of managers and professionals in a process to understand work dynamics and training in the perspective of building significant changes for local realities.

摘要：
研究目的：分析巴西《国家口腔卫生政策指南》发布后，初级卫生保健（primary health care）领域内口腔卫生工作的变革情况。
研究方法：本研究针对2000年至2013年期间Medline、LILACS、Embase、SciELO、巴西虚拟卫生图书馆（Biblioteca Virtual em Saúde）以及考克兰图书馆（The Cochrane Library）数据库中，与工作变革分析要素相关的文献进行文献综述。所使用的检索词包括：初级卫生保健（primary health care）、家庭卫生保健（family health care）、工作、卫生保健政策、口腔卫生保健服务、牙科学、口腔卫生以及巴西。最终筛选并纳入32项研究进行分析，其中以巴西东北部地区针对医务工作者（尤以牙医为主）的定性研究占比最高，相关研究聚焦于照护服务的完整性与质量。
研究结果：本次研究观察到的进步主要集中在教育与终身教育举措、接诊接待、医患联结以及责任落实方面。主要挑战则涉及照护服务的完整性、服务的拓展与优化、整合式团队协作、工作条件、举措的规划、监测与评估、民众参与及社会监督的激励，以及跨部门协作等领域。
研究结论：尽管已构建新的监管框架，但口腔卫生工作的变革仍极为有限。专业人员仍倾向于沿用占主导地位的生物医学模式。未来仍需在工作管理、培训及终身教育领域持续发力。其中可行的优化路径包括：推动管理者与专业人员更多参与到理解工作动态的过程中，并开展面向本地实际需求、旨在实现实质性变革的培训工作。