A estomatologia e a odontologia para pacientes com necessidades especiais nos Centros de Especialidades Odontológicas do Sistema Único de Saúde

Abstract

The National Oral Health Policy brought integrality in dentistry with advances in both primary and specialized care, with the implantation of the Dental Specialties Centers (CEO). The CEO is a key element in the configuration of the network, offering more complex procedures, acting as a specialized reference for primary care and articulating tertiary care. In Brazil, the current governmental initiative for evaluating secondary care is the National Program for Improving Access and Quality of Dental Specialization Centers (PMAQ / CEO). The present study aimed to describe the networking process of the specialties of stomatology and dentistry for patients with special needs (PNE), in Brazil, from the perspective of the PMAQ-CEO. This is a cross-sectional study, of a quantitative and descriptive nature, whose variables were collected from the database of the external evaluation stage of the first cycle of the program. Stomatology was present in 65.6% of CEOs and dentistry for PNE in 90%. Less than half of the professionals had specialized training (stomatology - 47.9% and PNE - 36.8%). These specialized services were mainly concentrated in the Southeast and the North, with the lowest national average. There were regional differences in the organization of reference services, however, it was observed, in most CEOs: clinical protocols that guided referrals to stomatology (57.8%) and PNE (66.7%); access to the CEO by referral (57.3%) and patients referred with a term in writing or electronically both for stomatology (61.7%) and for PNE (75.6%). The counter-reference occurred through a specific form (86.2%). As for permanent education, 49.5% of the teams evaluated participated in the action. The theme of oral cancer was addressed by 54.5% of the teams, in the matrix. The biopsy procedure was performed by most of the teams assessed (82.4%). About 60% of all services had a hospital reference for dental treatment under general anesthesia / sedation, with the average hospital referral being one to four users / month. The Northeast region was the one with the lowest number of teams with reference agreed for hospital treatment (43.4%). Inequality was observed in the geographical distribution of CEOs and professionals working in both areas and the absence of a hospital reference for cases that require dental treatment under general anesthesia / sedation in some locations, factors that can represent a barrier to access to services. There is a need to encourage permanent education as well as the approach to oral cancer in matrix support actions. The weaknesses inherent to the organization of the network service, point to the need to strengthen the management mechanisms considering that the principles of regionalization and hierarchy in health planning can reduce inequalities in the provision of care.