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Impacto no contexto nacional das diretrizes internacionais na gestão e políticas de saúde pública oral: scoping review
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| Projeto de pós-graduação_41118 | 5.45 MB | Adobe PDF |
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Introdução: A saúde oral é reconhecida pela Organização Mundial da Saúde (OMS) como parte integrante da saúde geral e do bem-estar, mas continua marcada por desigualdades no acesso a cuidados. Nos últimos anos, várias diretrizes internacionais, incluindo a Estratégia Global da OMS em Saúde Oral 2023–2030, a Vision 2030 da Federação Dentária Internacional (FDI) e relatórios da União Europeia/OCDE, enfatizaram a necessidade de integrar a saúde oral nos sistemas universais de saúde. Em Portugal, apesar da existência de programas como o Programa Nacional de Promoção da Saúde Oral (PNPSO) e o Cheque-Dentista, subsistem lacunas de cobertura e proteção financeira. Neste contexto, torna-se relevante mapear de que forma as orientações internacionais têm influenciado a formulação de políticas nacionais de saúde oral.
Objetivos: O objetivo desta scoping review foi mapear, sintetizar e analisar criticamente a evidência disponível sobre o impacto das diretrizes internacionais de saúde oral (OMS, FDI e União Europeia/OCDE) na gestão e formulação de políticas públicas em Portugal, no âmbito do Serviço Nacional de Saúde (SNS), identificando avanços, desafios e lacunas na sua integração.
Métodos: A revisão foi conduzida de acordo com a metodologia do Joanna Briggs Institute (JBI) e com as recomendações do PRISMA-ScR, utilizando o modelo PCC: População - políticas e programas de saúde oral no SNS português; Conceito - diretrizes internacionais em saúde oral; Contexto - políticas públicas nacionais. Foram pesquisadas as bases PubMed/MEDLINE, SciELO, CINAHL e Web of Science, complementadas por literatura cinzenta e pesquisa manual (2000–2025). Após triagem e leitura integral, foram incluídos 30 documentos, entre artigos científicos, estudos observacionais, relatórios institucionais, declarações e estratégias internacionais.
Resultados: A análise identificou cinco eixos centrais: (i) impacto de programas nacionais (PNPSO, Cheque-Dentista), que demonstraram melhorias nos indicadores infantis mas cobertura limitada em adultos e idosos; (ii) desigualdades de acesso, com elevado peso de pagamentos diretos e necessidades não satisfeitas acima da média da UE; (iii) fragilidades na monitorização estatística e ausência de indicadores harmonizados; (iv) posição intermédia de Portugal em comparação internacional, mais próximo dos padrões do sul europeu do que dos modelos universalistas nórdicos; e (v) alinhamento formal com metas internacionais, embora a implementação prática se mantenha parcial e fragmentada.
Conclusão: Esta scoping review mostra que Portugal tem traduzido parcialmente as recomendações internacionais em políticas públicas de saúde oral, alcançando progressos em saúde infantil, mas mantendo desafios significativos de equidade, financiamento e integração nos cuidados primários. As principais lacunas identificadas incluem a escassez de evidência científica independente, a cobertura insuficiente de adultos e idosos, a fraca diversificação da força de trabalho e a ausência de mecanismos robustos de avaliação de impacto. Perspetivas futuras apontam para a necessidade de expandir a cobertura estatutária a grupos atualmente excluídos, reforçar estratégias preventivas universais, harmonizar indicadores com a OMS/UE, diversificar a força de trabalho e institucionalizar avaliações baseadas em evidência. Estes avanços são essenciais para que Portugal alinhe plenamente a sua política de saúde oral com os princípios da Cobertura Universal em Saúde e reduza desigualdades persistentes no acesso a cuidados.
Background: Oral health is recognized by the World Health Organization (WHO) as an integral part of overall health and well-being, but it remains marked by inequalities in access to care. In recent years, several international guidelines - including the WHO Global Oral Health Strategy 2023–2030, the Federation Dentaire Internationale (FDI) Vision 2030, and reports from the European Union/OECD - have emphasized the need to integrate oral health into universal health systems. In Portugal, despite the existence of programs such as the National Oral Health Promotion Program (PNPSO) and the Dental Voucher scheme, significant gaps in coverage and financial protection persist. In this context, it is relevant to map how international guidelines have influenced the development of national oral health policies. Objectives: The aim of this scoping review was to map, synthesize, and critically analyze the available evidence on the impact of international oral health guidelines (WHO, FDI, and European Union/OECD) on the management and formulation of public policies in Portugal, within the framework of the National Health Service (SNS), identifying advances, challenges, and gaps in their integration. Methods: The review was conducted according to the Joanna Briggs Institute (JBI) methodology and the PRISMA-ScR reporting guidelines, using the PCC model: Population – oral health policies and programs in the Portuguese NHS; Concept – international oral health guidelines; Context – national public health policies. Searches were conducted in PubMed/MEDLINE, SciELO, CINAHL, and Web of Science, complemented by grey literature and manual searches (2000–2025). After screening and full-text reading, 30 documents were included, comprising scientific articles, observational studies, institutional reports, declarations, and international strategies. Results: The analysis identified five central axes: (i) impact of national programs (PNPSO, Dental Voucher), which demonstrated improvements in child oral health indicators but limited coverage for adults and older adults; (ii) access inequalities, with a high burden of out-of-pocket payments and unmet dental care needs above the EU average; (iii) weaknesses in statistical monitoring and the absence of harmonized indicators; (iv) Portugal’s intermediate position in international comparison, closer to Southern European patterns than to universalist Northern models; and (v) formal alignment with international goals, although practical implementation remains partial and fragmented. Conclusion: This scoping review shows that Portugal has partially translated international recommendations into public oral health policies, achieving progress in child oral health but facing significant challenges in equity, financing, and integration into primary care. The main gaps identified include the lack of independent scientific evidence, insufficient coverage for adults and older adults, limited workforce diversification, and the absence of robust impact assessment mechanisms. Future perspectives highlight the need to expand statutory coverage to currently excluded groups, strengthen universal preventive strategies, harmonize indicators with WHO/EU, diversify the workforce, and institutionalize evidence-based evaluations. These advances are essential for Portugal to fully align its oral health policy with the principles of Universal Health Coverage and reduce persistent inequalities in access to care.
Background: Oral health is recognized by the World Health Organization (WHO) as an integral part of overall health and well-being, but it remains marked by inequalities in access to care. In recent years, several international guidelines - including the WHO Global Oral Health Strategy 2023–2030, the Federation Dentaire Internationale (FDI) Vision 2030, and reports from the European Union/OECD - have emphasized the need to integrate oral health into universal health systems. In Portugal, despite the existence of programs such as the National Oral Health Promotion Program (PNPSO) and the Dental Voucher scheme, significant gaps in coverage and financial protection persist. In this context, it is relevant to map how international guidelines have influenced the development of national oral health policies. Objectives: The aim of this scoping review was to map, synthesize, and critically analyze the available evidence on the impact of international oral health guidelines (WHO, FDI, and European Union/OECD) on the management and formulation of public policies in Portugal, within the framework of the National Health Service (SNS), identifying advances, challenges, and gaps in their integration. Methods: The review was conducted according to the Joanna Briggs Institute (JBI) methodology and the PRISMA-ScR reporting guidelines, using the PCC model: Population – oral health policies and programs in the Portuguese NHS; Concept – international oral health guidelines; Context – national public health policies. Searches were conducted in PubMed/MEDLINE, SciELO, CINAHL, and Web of Science, complemented by grey literature and manual searches (2000–2025). After screening and full-text reading, 30 documents were included, comprising scientific articles, observational studies, institutional reports, declarations, and international strategies. Results: The analysis identified five central axes: (i) impact of national programs (PNPSO, Dental Voucher), which demonstrated improvements in child oral health indicators but limited coverage for adults and older adults; (ii) access inequalities, with a high burden of out-of-pocket payments and unmet dental care needs above the EU average; (iii) weaknesses in statistical monitoring and the absence of harmonized indicators; (iv) Portugal’s intermediate position in international comparison, closer to Southern European patterns than to universalist Northern models; and (v) formal alignment with international goals, although practical implementation remains partial and fragmented. Conclusion: This scoping review shows that Portugal has partially translated international recommendations into public oral health policies, achieving progress in child oral health but facing significant challenges in equity, financing, and integration into primary care. The main gaps identified include the lack of independent scientific evidence, insufficient coverage for adults and older adults, limited workforce diversification, and the absence of robust impact assessment mechanisms. Future perspectives highlight the need to expand statutory coverage to currently excluded groups, strengthen universal preventive strategies, harmonize indicators with WHO/EU, diversify the workforce, and institutionalize evidence-based evaluations. These advances are essential for Portugal to fully align its oral health policy with the principles of Universal Health Coverage and reduce persistent inequalities in access to care.
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Palavras-chave
Saúde oral Políticas de saúde oral Políticas de saúde Diretrizes internacionais OMS Portugal Oral health Oral public policy Health policy International guidelines WHO