Small Victory in Toothless Brazil

The World Health Organization says that up to the age of 12 children
should only have three cavities. In Brazil, the average has now
reached 2.8. But there are other less honorable numbers: 30
million Brazilians have never been to a dentist, 60 million do not
brush their teeth and 8 million have lost all their teeth.

Caio d'Arcanchy

The World Health Organization has established five targets in the area of buccal hygiene for the world's nations. Brazil has managed to reach one of them: number of cavities in children between the ages of 6 and 12.

Speaking at the opening of the 3rd National Conference on Buccal Hygiene, on July 30, minister of Health, Humberto Costa, declared that there is little for Brazil to celebrate and much to do. "We only reached one target out of five," said the minister.

WHO says that up to the age of 12 children should only have three cavities. In Brazil, the average is 2.8. The other targets were: percentage of children at the age of 5 who do not have cavities; percentage of youths age 18 with all their teeth, percentage of adults (35 to 44) with 20 or more teeth; percentage of senior citizens with 20 or more teeth.

Brazil plans to spend US$ 428 million (1.3 billion reais) on buccal hygiene by the year 2006, which will be a historical record.

Brazil is estimated to have 8 million people who do not have teeth. Another 30 million have never been to the dentist. Around 60 million Brazilians (40 percent of the population) do not regularly brush their teeth.

A Ministry of Health survey has found that only 55 percent of Brazilian adolescents have all their teeth. Among adults, the figure rises to 54 percent. All together, there are some 30 million Brazilians who do not have all their teeth.

The survey was made at the beginning of the year and found that besides missing teeth there is an epidemic of cavities and an enormous need for dental care. The survey found that it is hard to find free government-provided dental care.

In March the Brazilian government launched the Brazil Smile program which intends to distribute dentalcare kits (toothbrushes and toothpaste) to 500,000 public school students.

By 2006, the program will spend 1.2 billion reais (US$ 400 million), build 354 dentalcare centers in municipalities and set up 559 dental offices as part of the government's Family Health Plan. It is estimated that 13 percent of the country's adolescents have never been to the dentist.

With the Brazil Smile program the number of government buccal health teams should more than double to 16,000 by the year 2006. Another objective of the program is to provide fluoridation nationwide.

Adding fluor to water is cheap; it costs around R$1 per year per inhabitant. At the moment, slightly less than half the population of Brazil (70 million) has water with fluor.

The president of the Federal Odontological Council, Miguel Nobre, says that Brazil has a good dentist-to-population ratio (1 to 1,000; the World Health Organization recommends 1 to 1,500) and that the best cure is prevention.

He says the tooth villain has always been sugar, but people insist on eating sugar. "That is all right. What you cannot do is eat sugar without brushing your teeth," he says.

The Brazil Smile program will provide complete dental treatment, including periodontal care, surgery, orthodontic procedures, and assistance with buccal lesions and cancer.

Family Program

In a related health field, there are now 20,561 Family Health Program (PSF) teams operating in over 83 percent of Brazil's almost 5,600 municipalities.

Ten years after its creation, the program reaches around 67 million families. The objective of the program is to bring healthcare closer to Brazilian families.

With a 2004 budget of US$ 658 million (2 billion reais), the PSF deals with prevention of disease, delivery of care and recovery from illness. This takes place in basic healthcare centers or in homes where PSF teams visit.

The teams consist of a doctor, a nurse, a nurse's aide and four to six community health agents. Each team visits an average of 3,500 people monthly.

Their priorities are children, pregnant women, the elderly and people with diabetes or hypertension problems, as well as those who cannot make it to the healthcare center. They are always on the lookout for diseases requiring mandatory notification, such as leprosy, tuberculosis and AIDS.

The simplicity of the program and proximity of the healthcare teams makes for a strong, close relationship with the community being served, characterized by mutual respect.

Caio d'Arcanchy works for Agência Brasil (AB), the official press agency of the Brazilian government. Comments are welcome at lia@radiobras.gov.br.

Translated from the Portuguese by Allen Bennett.