Saúde bucal no contexto do Programa Saúde da Família: práticas de prevenção orientadas ao indivíduo e ao coletivo Oral health in the context of the Family Health Program: preventive practices targeting individual and public health

As práticas profissionais refletem a estruturação dos serviços de saúde, relacionando-se aos princípios norteadores do modelo de atenção vigente. Nesse sentido, objetivou-se conhecer as práticas preventivas e educativas em saúde bucal realizadas pelos dentistas do Programa Saúde da Família de Natal, Rio Grande do Norte, Brasil. Realizou-se entrevista estruturada com 80 dentistas e análise documental no SIA-SUS (Sistema de Informações Ambulatoriais do SUS) e no Sistema de Informação de Atenção Básica. As atividades individuais de orientação de higiene bucal e de aplicação tópica de flúor, entre todos os entrevistados, corresponderam a 87,5% e 95%, respectivamente. Em âmbito coletivo, todos que atuavam nas escolas (91,2%) realizavam aplicação tópica de flúor, enquanto 86,2% desenvolviam ações educativas. Nos registros do SIA-SUS, as atividades preventivas representaram 41% do total de procedimentos. Dentre essas, aplicação tópica de flúor gel por sessão correspondeu a 24,4% e escovação supervisionada, a 31%. Quanto às atividades educativas, 57,4% realizaram-se no estabelecimento de saúde e 42,6%, na comunidade. Diante dos resultados, constatou-se que as práticas preventivas direcionam-se à cárie dentária, com maior atenção aos escolares, sendo necessária ampliação para diferentes problemas bucais, grupos e espaços sociais.<br>Professional practices reflect the structuring of health services and are related to the underlying principles of the prevailing health care model. This study focused on preventive and educational practices by dentists in the Family Health Program in Natal, Rio Grande do Norte State, Brazil. A structured interview was held with 80 dentists, in addition to analysis of documents from the Outpatient Database of the Unified National Health System (SIA-SUS) and the Primary Care Database. Individual activities involving orientation for oral hygiene and topical application of fluoride were reported by 87.5% and 95% of dentists, respectively. At the collective level, all the dentists that worked in schools (91.2%) performed topical fluoride application, while 86.2% conducted educational activities. According to SIA-SUS records, preventive activities accounted for 41% of all procedures. Among these, topical application of fluoride gel per sitting and supervised brushing accounted for 24.4% and 31%, respectively. As for educational activities, 57.4% were held in the health care unit and 42.6% in the community. The findings indicate that the preventive practices focus on dental caries, particularly in schoolchildren, and that they need to be expanded to include other oral health problems

Personalizing health care: feasibility and future implications

Considerable variety in how patients respond to treatments, driven by differences in their geno- and/ or phenotypes, calls for a more tailored approach. This is already happening, and will accelerate with developments in personalized medicine. However, its promise has not always translated into improvements in patient care due to the complexities involved. There are also concerns that advice for tests has been reversed, current tests can be costly, there is fragmentation of funding of care, and companies may seek high prices for new targeted drugs. There is a need to integrate current knowledge from a payer’s perspective to provide future guidance. Multiple findings including general considerations; influence of pharmacogenomics on response and toxicity of drug therapies; value of biomarker tests; limitations and costs of tests; and potentially high acquisition costs of new targeted therapies help to give guidance on potential ways forward for all stakeholder groups. Overall, personalized medicine has the potential to revolutionize care. However, current challenges and concerns need to be addressed to enhance its uptake and funding to benefit patients