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：旨在分析巴西《国家口腔卫生政策指南》发布后，初级卫生保健（primary health care）领域内口腔卫生服务工作的变革情况。
研究方法：本研究于2000年至2013年间，针对医学文献数据库（Medline）、拉丁美洲健康科学文献数据库（LILACS）、荷兰医学文摘数据库（Embase）、科学电子在线图书馆（SciELO）、巴西虚拟健康图书馆（Biblioteca Virtual em Saúde）以及考克兰协作网图书馆（The Cochrane Library）等数据库开展文献综述，以梳理用于分析工作变革的相关要素。所采用的主题词包括：初级卫生保健（primary health care）、家庭卫生保健、工作、卫生政策、口腔卫生服务、牙科学、口腔卫生以及巴西。最终纳入32项研究展开分析，其中以巴西东北部地区针对医护人员（尤其是牙医）开展的质性研究占比最高，研究核心聚焦于服务的完整性与质量。
研究结果：研究观察到的进展主要集中于教育培训与持续性教育举措、患者接待、医患联结及问责机制建设等领域。主要挑战则涵盖服务完整性强化、服务范围拓展与质量提升、整合式团队协作、工作条件改善、行动规划与监测评估、民众参与及社会监督的激励，以及跨部门协作等方面。
结论：尽管已构建新的监管环境，但口腔卫生服务工作的变革仍极为有限。从业者仍倾向于沿袭占主导地位的生物医学模式。未来仍需在工作管理、培训及持续性教育领域持续推进相关工作。可行的改进路径包括：推动管理者与从业者更深入地参与工作动态研究，并针对当地实际现状开展旨在实现实质性变革的培训。