Acessibilidade / Reportar erro

The legislative and the regulation of dental assistants professions in Brazil

O poder legislativo e a regulamentação das profissões auxiliares em saúde bucal

ABSTRACT

Objective:

To analyze the conditions of possibilities and contributions of the legislative power to the regulation of oral health assistants (in Portuguese “Auxiliar de Saúde Bucal” – ASB) and oral health technicians (in Portuguese “Técnico de Saúde Bucal” – TSB) in Brazil.

Methods:

This socio-historical study used Bourdieu´s theoretical framework. Twelve legislative processes were included. Information about their objects, similarities and differences, main stakeholders, their social and professional trajectories and their relationship with oral health were sought. An interview with two key informants was conducted. The multiple correspondence analysis investigated the association between the variables and their intensity of contribution.

Results:

This issue remained in dispute between 1977-2008 and was regulated by Law 11.889/2008, after the incorporation of Oral Health Teams in the Family Health Strategy. The restrictive practice was related to parliamentarians from the southeast region, linked to the pole of the private market, without training in the health area. The defense of clinical practice under dentist´ supervision was related to health and human sciences agents.

Conclusion:

The ASB profession has always been a consensus in regulation. The issue in dispute was the activities of Oral Health Technicians. It prevailed in the Law text a more progressive and broader view.

Indexing terms
Government regulation; Legislative; Oral health; Patient care team

RESUMO

Objetivo:

Analisar as condições de possibilidade e contribuições do poder legislativo para regulamentação das profissões de auxiliar em saúde bucal (ASB) e técnico em saúde bucal (TSB) no Brasil.

Métodos:

Estudo sócio-histórico que utilizou o referencial teórico bourdieusiano. Foram incluídos 12 processos legislativos sobre o tema. Buscou-se informações sobre seus objetos, similaridades e diferenças, principais envolvidos, suas trajetórias social e profissional e relação com a saúde bucal. Realizou-se entrevista com dois informantes-chave. A análise de correspondência múltipla investigou a associação entre variáveis e intensidade de contribuição.

Resultados:

Essa questão permaneceu em disputa entre 1977-2008, sendo regulamentada pela Lei 11.889/2008, após a incorporação da Saúde Bucal na Estratégia Saúde da Família. A prática restritiva esteve relacionada a parlamentares do Sudeste, vinculados ao pólo privado, sem formação na área de saúde. A defesa da atuação clínica sob supervisão do dentista relacionou-se a agentes das áreas de saúde e ciências humanas.

Conclusão:

A regulamentação da profissão de ASB sempre foi um consenso, sendo a questão em disputa as atividades pertinentes ao TSB, prevalecendo no texto da Lei a visão mais progressista e de atuação mais ampliada.

Termos de indexação
Equipe de saúde; Saúde bucal; Regulação governamental; Poder legislativo

INTRODUCTION

The actuation of auxiliary personnel is part of the functioning of the majority of dental services. The first regulation for the profession happened in 1907 in the United States of America (USA), formalizing the occupation of the dental hygienist as a dental assistant [11 Sanglard-Oliveira CA, Werneck MAF, Lucas SD, Abreu MHNG. Exploring professionalization among Brazilian oral health technicians. Human Resources for Health 2012;10(5):1-10. https://doi.org/10.1186/1478-4491-10-5
https://doi.org/10.1186/1478-4491-10-5...
], followed by New Zealand, which created the profession of dental nurse in 1920 [22 Baltutis LM, Gussy MG, Morgan MV. The role of the dental hygienist in the public health sector; an Australian perspective. Int Dental J. 2000;50(1):29-35. https://doi.org/10.1111/j.1875-595X.2000.tb00543.x
https://doi.org/10.1111/j.1875-595X.2000...
]. The performance’s difference consisted of the latter having clinical assistance as a focus, while the former focused on preventive care [33 Zanetti CHG, Oliveira JAA, Mendonça MHM. Divisão do trabalho odontológico em perspectiva: desafio de interpretar as competências dos técnicos. Trabalho, Educ Saúde 2012;10(2):195-222. http://dx.doi.org/10.1590/S1981-77462012000200002
https://doi.org/10.1590/S1981-7746201200...
].

In Brazil, this debate started half-way through the 20th century, yet, only in 2008, the professions of Orthe professions of Oral Health Assistant (in Portuguese “Auxiliar de Saúde Bucal” – ASB) and Oral Health Technician (in Portuguese “Técnico de Saúde Bucal” – TSB) were regulated in the country.

The establishment of a profession depends on its state regulation and its acceptance and incorporation by civil society. In Brazil, the insertion of auxiliary oral health professions happened first in the public sphere, through the Special Public Health Service (in Portuguese “Serviço Especial de Saúde Pública” – SESP), from 1950 [44 Frazão P, Narvai PC. Lei n.11.889/2008: avanço ou retrocesso nas competências do técnico em sáude bucal? Trabalho, Educ Saúde. 2011;9(1):109-123.]. Under the influence of technical education development in the USA, and aiming to amplify oral health promotion services [55 Pezzato LM, Cocco MIM. O técnico em higiene dental e o atendente de consultório dentário no mundo do trabalho. Rev Saúde Debate. 2004;68(1):212-219.], the Federal Council of Education (in Portuguese “Conselho federal de Educacão” – CFE) established guidelines for the education of Dental Hygienist Technicians (in Portuguese “Técnico de Higiene Dental” – THD) and Dental Office Assistants (in Portuguese “Auxiliar de Consultório Dentário” – ACD) [66 Brasil. Parecer MEC/CFE n.º 460 de 6 de fevereiro de 1975. Dispõe sobre a habilitação em nível de 2º grau de Técnico em Higiene Dental e Atendente de Consultório Dentário. Diário Oficial da República Federativa do Brasil, seção I, p. 3937.].

In the 80s, the social construction of auxiliary professions involved movements, national encounters, class entities, and associations, having been debated since the first National Encounter of Administrators and Technicians of Public Dental Services (In Portuguese “Encontro Nacional dos Administradores e Técnicos do Serviço Público Odontológico” – Enatespo), with the recommendation to institute courses for “Dental Assistants” and “Dental Hygienists” [77 Enatespo. I Encontro Nacional de Administradores e Técnicos de Serviços Públicos Odontológicos. Relatório. Porto Alegre: Enatespo; 1984.]. The Brazilian Movement of Dental Renovation (In Portuguese “Movimento Brasileiro de Renovação Odontológica” – MBRO) adopted a similar position to that of assistant personnel in Dentistry, appointing the THD as an instrument for dental practice transformation and demonopolization of dental knowledge. The THD would be fundamental to the rendering of dental services in the country, not being a threat in the dentist labor market, nor a “practitioner”, contributing to the greater quality of services [88 Narvai PC, Manfredini M, Botazzo C, Raineri N, Schneider DA, Frazão P. Contra o técnico em higiene dental. Rev Saúde Debate. 1989;28:59-65.].

The debate on auxiliary professions was also present in the three National Conferences of Oral Health (in Portuguese “Conferências Nacional de Saúde Bucal” – CNSB. The 1st CNSB (1986) pointed to the need for immediate education and incorporation of ACD and THD aiming at coverage extension and an enhancement in productivity, delegating to the public power the financing, encouragement, education and reformulation of the time’s legislation [99 Brasil. Ministério da Saúde. Relatório final da 1ª Conferência Nacional de Saúde Bucal. Brasília: Ministério da Saúde; 1986 [citado 2020 Mar 10]. Disponível em: <https://bvsms.saude.gov.br/bvs/publicacoes/1_conferencia_nacional_saude_bucal_relatorio_final.pdf>.
https://bvsms.saude.gov.br/bvs/publicaco...
]. The 2nd CNSB (1993) recommended the approval of the law project on the regulation of THD and ASB professions (PL 53/1993) and the resolution by the Federal Dentistry Council (in Portuguese “Conselho Federal de Odontologia” – CFO), with the aim of assuring the exercise of functions, representativity in class organs and insertion in the the Brazilian Health System (in Portuguese “Sistema Único de Saúde” – SUS) [1010 Brasil. Ministério da Saúde. Relatório final da 2ª Conferência Nacional de Saúde Bucal. Brasília: Ministério da Saúde; 1993 [citado 2020 Mar 10]. Disponível em: <http://189.28.128.100/dab/docs/portaldab/publicacoes/2_conferencia_nacional_saude_bucal_relatorio_final.pdf>.
http://189.28.128.100/dab/docs/portaldab...
]. In the 3rd, the education of assistants was a recurring theme. It was ruled the need of creation and recognition of courses for ACD and THD by the Ministry of Education (in Portuguese “Ministério da Educação” – MEC), its interiorization, warranty of spots for all workers of the oral health team in the public service, the association of these professionals in the class council and integration of dentistry courses with the education of assistant personnel, foreseeing comprehensive healthcare [1111 Brasil. Ministério da Saúde. Relatório final da 3ª Conferência Nacional de Saúde Bucal. Acesso e qualidade superando a exclusão social. Brasília: Ministério da Saúde; 2005 [citado 2020 Mar 10]. Disponível em: <https://bvsms.saude.gov.br/bvs/publicacoes/3_conferencia_nacional_saude_bucal_relatorio_final.pdf>.
https://bvsms.saude.gov.br/bvs/publicaco...
].

In the clinical area, the actuation of auxiliary personnel reduces clinical time, allowing greater productivity, continuity of operation movements, and less physical and emotional wear of the dentist. It optimizes dental service, influencing professionals’ quality of life, contributing to promotion and education in health and disease prevention [1212 Leite DO, Souza RC, Naressi SCM, Nicodemo D, Koga KS, Orenha ES. Impacto do trabalho auxiliado na qualidade de vida do cirurgião dentista. Braz Dental Sci. 2011;1(2):27-33. https://doi.org/10.14295/bds.2011.v14i1/2.706
https://doi.org/10.14295/bds.2011.v14i1/...
].

Resolution CFO 63/2005 defined private activities of the TSB, a result of the discussions on auxiliary professions within the organ [44 Frazão P, Narvai PC. Lei n.11.889/2008: avanço ou retrocesso nas competências do técnico em sáude bucal? Trabalho, Educ Saúde. 2011;9(1):109-123.], despite not being the organ’s first resolution on auxiliary personnel.

The process of social construction which culminated in the promulgation of Law 11.889/2008 was permeated by contradictory interests between associations and movements of the area’s assistants and technicians, unions, federations, entities and class councils and organs of the country’s education and health system. Through the propositions of different law projects (In Portuguese “Projetos de Lei”– PLs), their approvals, discontinuance and veto, the Legislative Power reflected the national political context [44 Frazão P, Narvai PC. Lei n.11.889/2008: avanço ou retrocesso nas competências do técnico em sáude bucal? Trabalho, Educ Saúde. 2011;9(1):109-123.]. Law 11.889/2008 represented an advancement in the definition of a regulatory mark in the administration of labor in health, a relevant achievement in these professions’ work and the amplification of access to dental services [44 Frazão P, Narvai PC. Lei n.11.889/2008: avanço ou retrocesso nas competências do técnico em sáude bucal? Trabalho, Educ Saúde. 2011;9(1):109-123.].

Revised literature identified studies that brought contributions to the theme, treating this professional category in different perspectives [44 Frazão P, Narvai PC. Lei n.11.889/2008: avanço ou retrocesso nas competências do técnico em sáude bucal? Trabalho, Educ Saúde. 2011;9(1):109-123.,1313 Garcia LP, Blank VLG. Prevalência de exposições ocupacionais de cirurgiões-dentistas e auxiliares de consultório dentário a material biológico. Cad Saúde Pública. 2006;22(1):97-108. https://doi.org/10.1590/S0102-311X2006000100011
https://doi.org/10.1590/S0102-311X200600...

14 Narvai PC. Recursos humanos para promoção da saúde bucal: um olhar no início do século XXI. In: Kriger L, coord. ABOPREV: promoção de saúde bucal. 3ª ed. São Paulo: Artes Médicas; 2003. p. 475-94.

15 Paranhos LR, Ricci ID, Tomasso S, Salazar M, Siqueira DF. Análise da relação entre o cirurgião-dentista e o pessoal auxiliar. Rev Odonto Ciênc. 2008;23(4):365-70.

16 Silva RF, Monini AC, Daruge Junior E, Francesquini Júnior L, Lanza MA. Utilização de auxiliares odontológicos em Ortodontia: implicações éticas e legais. Rev Dental Press Ortod Ortop Fac. 2006;11(5):121-128. http://dx.doi.org/10.1590/S1415-54192006000500013
https://doi.org/10.1590/S1415-5419200600...
-1717 Pezzato LM, Monteiro MI, Bagnato MHS. Processos de formação do técnico em higiene dental e do auxiliar de consultório dentário no Brasil: algumas memórias. Odontole Soc. 2007;9(1):39-49.]. These works approached the epidemiological perspective when connecting the role of those professionals in the promotion of oral health [1414 Narvai PC. Recursos humanos para promoção da saúde bucal: um olhar no início do século XXI. In: Kriger L, coord. ABOPREV: promoção de saúde bucal. 3ª ed. São Paulo: Artes Médicas; 2003. p. 475-94.], their participation in specialized fields, such as orthodontics [1616 Silva RF, Monini AC, Daruge Junior E, Francesquini Júnior L, Lanza MA. Utilização de auxiliares odontológicos em Ortodontia: implicações éticas e legais. Rev Dental Press Ortod Ortop Fac. 2006;11(5):121-128. http://dx.doi.org/10.1590/S1415-54192006000500013
https://doi.org/10.1590/S1415-5419200600...
], their degree of occupational exposure [1313 Garcia LP, Blank VLG. Prevalência de exposições ocupacionais de cirurgiões-dentistas e auxiliares de consultório dentário a material biológico. Cad Saúde Pública. 2006;22(1):97-108. https://doi.org/10.1590/S0102-311X2006000100011
https://doi.org/10.1590/S0102-311X200600...
], their education [1717 Pezzato LM, Monteiro MI, Bagnato MHS. Processos de formação do técnico em higiene dental e do auxiliar de consultório dentário no Brasil: algumas memórias. Odontole Soc. 2007;9(1):39-49.], the relation between CD and high school level and technical level professionals [1515 Paranhos LR, Ricci ID, Tomasso S, Salazar M, Siqueira DF. Análise da relação entre o cirurgião-dentista e o pessoal auxiliar. Rev Odonto Ciênc. 2008;23(4):365-70.]. However, the identified studies did not analyze the content of legislative processes referring to this regulation and the main agents involved. This Analysis contributes to the comprehension of the long process of legislation construction referring to auxiliary professions in Oral Health in Brazil, and the main points in dispute.

In that sense, the present study has the goal of analyzing historical conditions of possibilities and contributions of the Brazilian legislative power to the formalization of TSB e ASB professions and knowing the main agents involved in the process, their positions and stances.

METHODS

A qualitative study was carried out, from a socio-historical perspective, through document analysis of legislative processes regarding the formalization of auxiliary professions in oral health in Brazil, between 1970 and 2016. It is a subproject of the research “The genesis of oral health policy at the national and municipal levels”, financed by the Fundação de Amparo à Pesquisa do Estado da Bahia - Fapesb notice n. 017/2013.

Bourdieu’s [1818 Boudieu P. Razões práticas: sobre a teoria da ação. Campinas: Papirus; 1996.] theoretical-methodological framework was used, especially the concepts of agent, social space, field and illusio.

The document analysis was based on the legislative processes, and on the main agents’ social and professional trajectory, complemented by two key informants’ interview.

A search for documents was carried out at the Brazilian Senate’s electronic address (http://www25.senado.leg.br) considering the terms: “dentistry”, “oral health”, “dentist” and “oral health assistant”. All identified documents were organized in a matrix in the Microsoft Excel 2010 program, containing the following information: date, document, author, content summary, committees in which it was discussed and their respective rapporteurs, president, political regime, political party and source. Documents referring to operating authorization, recognition of institutions, and those that did not address auxiliary professions were excluded. From these procedures, nine parliamentary files submitted between 1977 and 2011 were added, also 4 more files were attached to previously identified projects during the documentary analysis. Among them, there was a PL on the profession of technician in dental prosthesis (in Portuguese, “Técnico de Prótese Dentária” – TPD). The 12 processes referring to the TSB and ASB professions between 1977 and 2015 were included (table 1).

Table 1
Parliamentary processes referring to the formalization of assistant professions (ACD/ ASB, THD/ TSB e TPD) in Dentistry and its proposition period.

About each PL, information was sought on: object, similarities and differences between them, main stakeholders (authors and collaborators), their social and professional trajectories, and relationship with oral health. We also sought to identify the positioning of class entities, such as the Brazilian Dentistry Association (in Portuguese “Associação Brasileira de Odontologia” – ABO), CFO, Interstate Dentistry Federation (In Portuguese “Federação Interestadual dos Odontologistas” – FIO) and MBRO, through the analysis of bulletins and/or newspapers of these entities, reports from 2005 published in the electronic mailing list Cedros, in addition to articles published in the Jornal do Site Odonto (www.jornaldosite.com.br) on the topic.

The trajectories were analyzed through information published on the legislative assembly and political parties’ websites, interviews, and articles published on free electronic access bases. This information was organized into matrices and transformed into text. The sources used, except the legislative processes already presented, are listed in table 2.

Table 2
Consulted sources.

An interview was conducted with two key informants, selected considering their involvement in the direction of union movements and/or in management, directly or indirectly related to oral health, over the period studied, as pointed out by Rossi [1919 Rossi TRA. Produção social das políticas de saúde bucal no Brasil. Salvador: EDUFBA; 2018.]. The interview was carried out simultaneously with both informants, considering the following questions: Who were the main agents and how did they contribute to the construction of bills related to the regulation of auxiliary professions in oral health? What are the reasons for the authorship of the legislative processes to be of the parliamentarians identified?

For the purposes of analysis, the implementation of the SUS was adopted as a landmark, subdividing the period studied into two stages: pre (1977-1987) and post-SUS (1988-2015). This division is related to the implications and challenges that the offer of public oral health actions and services, in particular their necessary expansion, brought to the debate on the formalization of auxiliary professions.

Multiple correspondence analysis (MCA) was performed to investigate the association between different variables and the intensity of their contribution [2020 Greenacre, M. La prática del análisis de correspondências. Bilbao, Espanha: Fundación BBVA; 2008.]. MCA makes it possible to analyze the relationship between a set of variables, in general, homogeneous to the same theme. Education, year and party variables were included as supplementary due to their influence on inertia [2121 Infantosi AFC, Costa JCGD, Almeida RMVR. Análise de correspondência: bases teóricas na interpretação de dados categóricos em Ciências da Saúde. Cad Saúde Pública. 2014;30(3):473-486. http://dx.doi.org/10.1590/0102-311X00128513
https://doi.org/10.1590/0102-311X0012851...
].

The project was approved by the Research Ethics Committee of the Collective Health Institut of Federal University of Bahia, under number 18153513.0.0000.5030. All respondents signed an informed consent form.

RESULTS AND DISCUSSION

The analysis of the 12 parliamentary processes related to the TSB and ASB professions shows that since the end of the 1970s their formalization has been on the agenda among entities and class associations, seeking to identify parliamentarians to defend their proposal. This issue remained in dispute for 31 years, resulting in the presentation of bills on which several filings and a veto were imputed.

[...] the majority of conservative dental entities, the most conservative leaders in the Dentistry academia, were very resistant [...] – These people are going to do what? Replace the dentist’s workforce ?! [...] you cannot do any kind of activity that could reduce this field of work. More with THD and less with ACD [...] (E1, 59 years old, male, dentist and manager)

The Oral Health Technician: the main dispute

Over the entire period studied, one interviewee explains:

[...] the strong divergence was in the technician’s duties. Everyone was in favor, but we defended that they had to have assignments that really expanded access, it was no use being an ACD [...], that would not solve the access problem, there would be two regulations with exactly the same assignment [...] ”

(E2, 53 years old, female, dentist, ex-manager, emphasis added)P

In the pre-SUS situation, during the military dictatorship, initiatives emerged both from the opposition party to the regime (Brazilian Democratic Movement/ In Portuguese “Movimento Democrático Brasileiro”– MDB) and from the one supporting it (Arena). Contrary to what might be expected, the proposal by the deputy of the current party, by allowing the technician to take clinical actions, contradicted the logic of the sectors characterized as reactionary concerning the issue [2222 Kovaleski DF, Boing AF, Freitas SFT. Recursos humanos auxiliares em saúde bucal: retomando a temática. Rev Odontol UNESP. 2005;34(4):161-65.].

PL 4,465/1977, by deputy Geraldo Freire (Arena), lawyer, suggested changes in the curriculum of technical training courses to allow the performance of extractions and technicians’ autonomous exercise in places without CD (tables 3 and 4). These proposals were justified by the low quantity of CD and generated significant controversy among the sectors of market dentistry, fearful of the performance of THDs as “practical”, in a clear positioning of the market reserve [2222 Kovaleski DF, Boing AF, Freitas SFT. Recursos humanos auxiliares em saúde bucal: retomando a temática. Rev Odontol UNESP. 2005;34(4):161-65.]. Thus, this first professional regulation initiative was stillborn (table 3).

Table 3
Parliamentary processes referring to the formalization of assistant professions in oral health, year and author, main proposals, similarities and differences in regards to previous processes, Brazil, 1977-2015.

The following year, deputy José Zavaglia (Brazilian Democratic Movement / In Portuguese “Movimento Democrático Brasileiro”– MDB), an economist (table 4), brought the question back to the debate, seeking a consensus between the interests of dental assistants and entities. It included the ACD, suppressed the exercise of clinical procedures, imposed direct supervision of the dentist, minimum professional workload, criteria for granting the exercise of the profession to those who were exercising the functions until the publication of the law and determined minimum remuneration for THD and ACD (table 3). This proposal was filed even before it was analyzed by the House of Representatives commissions.

From 1984 onwards, counter-hegemonic social movements such as MBRO and Enatespo, spaces of criticism of the State’s responses to the oral problems of the population and related to the development of oral health policies [1919 Rossi TRA. Produção social das políticas de saúde bucal no Brasil. Salvador: EDUFBA; 2018.,2323 Aguiar DML, Frazão P. A insuficiência da política pública para inclusão do técnico em saúde bucal na atenção primária no Brasil. In: Chaves SCL, org. Política de saúde bucal no Brasil: teoria e prática. Salvador: EDUFBA; 2016. p. 297-317.], guided the defense of auxiliary personnel [1919 Rossi TRA. Produção social das políticas de saúde bucal no Brasil. Salvador: EDUFBA; 2018.]. This was also a defense of professors and dentists from the Social and Sanitary Dentistry current, which started to be discussed in the 1950s and 1980s, respectively [2323 Aguiar DML, Frazão P. A insuficiência da política pública para inclusão do técnico em saúde bucal na atenção primária no Brasil. In: Chaves SCL, org. Política de saúde bucal no Brasil: teoria e prática. Salvador: EDUFBA; 2016. p. 297-317.].

The 1st CNSB defended the expansion, dynamization and lowering the cost of clinical care by incorporating auxiliary personnel with an expanded function, under the supervision of the dentist, approaching a conception of technology compatible with the socio-economic reality and knowledge transfer [1919 Rossi TRA. Produção social das políticas de saúde bucal no Brasil. Salvador: EDUFBA; 2018.,2424 Barbosa SN. Pessoal auxiliar em Odontologia: regulamentação das profissões de THD e ACD. Rev Divulg Saúde para Debate. 1991;6:37-39.]. A more comprehensive and progressive perception on the subject, linked in particular to public health, in contrast to that more linked to clinical and market dentistry, present in the bills proposed in the pre-SUS period. This caused the CFO to consider its recommendations and appoint a special commission to analyze the exercise of auxiliary professions without legal qualification: requirements necessary for their training and qualification, absence of regulations in the Ministry of Labor and the need to reformulate the attributions of these professions in view of the requirements of activities in the public and private spheres [55 Pezzato LM, Cocco MIM. O técnico em higiene dental e o atendente de consultório dentário no mundo do trabalho. Rev Saúde Debate. 2004;68(1):212-219.].

[...] it was the public health personnel versus the people who dominated the dental entities: national ABO, CFO was basically composed at that time by professionals from private practices, there was almost no one in the public health area. The FIO that came with a new staff, [...] more connected to the area of public health, and that was where this struggle of regulation took on more strongly.

(E2, 53 years old, female, dentist, ex-manager, emphasis added)

[...] FIO started to act within the scope of collective spaces, including the National Health Council, [...] everyone who offered to help us wanted, regardless of party affiliation, the parliamentarian knew, supported, and understood it important, we wanted it. ”

(E1, 59 years old, male, dentist and manager)

The main issue in dispute, since its beginnings, has therefore always been the definition of the THD’s duties. In contrast to a broader, progressive performance, related to dental practice in the public sphere and the expansion of the service offer; and a more restrictive performance, defended by the market dentistry pole, which saw in the broader practice of technicians, the expansion of competition in the job market. This issue permeates all the legislative processes analyzed, from 1977 to 2008 (table 3).

Regulatory paths

After the promulgation of the 1988 Constitution and the creation of SUS, the discussion was resumed with the presentation of Bill n. 2,244 / 1989 by Deputy Robson Riedel Marinho (Brazilian Social Democracy Party - PSDB). The PL provided for the regulation of the professions of THD and ACD, had the technical assistance of 10 CDs (5 university professors and heads of class entities, two leaders of dental entities, two federal deputies and a clinician) and a THD (table 4). Dentists Emil Adib Razuk, Raphael Baldacci Filho, who belonged to the political field, and Moacyr da Silva, with a predominant trajectory in the scientific field, were classified as collaborators, while Álvaro Siqueira Vantine, Volnei Garrafa, Vitor Gomes Pinto, João Hildo de Carvalho Furtado and Swedenberger do Nascimento Barbosa as a technical adviser (table 4).

Table 4
Participants in legislative processes on auxiliary professions in oral health from 1977 to 2015, according to place and date of birth, training and activity related to documents.

It was also observed the participation of dentists with political dispositions and founders of Collective Oral Health in Brazil and responsible for the insertion of oral health in the Brazilian Health Reform (in Portuguese “Reforma Sanitária Brasileira” – RSB) process [2525 Soares CLM, Paim JS, Chaves SCL, Rossi, TRA, Barros SG, Cruz DN. O movimento da Saúde Bucal Coletiva no Brasil. Ciênc Saúde Coletiva. 2017;22(6):1805-1816. https://doi.org/10.1590/1413-81232017226.22972016
https://doi.org/10.1590/1413-81232017226...
], such as Volnei Garrafa and Swedenberger do Nascimento Barbosa. It is worth mentioning that these two agents have a trajectory within the scientific field, with one pursuing a career in the university bureaucratic field and the other within the political field. Rozângela Fernandes Camapum, cited as a “surpassable” collaborator, also had political dispositions (table 4).

This proposal maintained the direct supervision of the dentist for the procedures of the auxiliary team and the minimum course load. It rescued the performance of clinical activities, but it banned advertisements from assistants, including in magazines in the area, and granted the profession’s exercise to those who were at least three years working. It established the control of the professional practice of the category by the CFO and parameters for the assistants’ annuity with this entity (table 3).

This parliamentary process was approved in all instances in which it was processed, but it was shelved at the end of the deputy’s mandate. Almost all the PLs presented later, as well as Law 11,889 / 2008, bring aspects very similar to the text and justification of PL 2,244 / 1989, with minimal changes, and made reference to the importance of Deputy Robson Marinho for the cause (table 3).

In 1991, deputy Augusto Carvalho (Brazilian Communist Party - PCB), presented PL 284/1991, approved in the Senate (PLC 53/1993) and taken to presidential sanction, but vetoed by President Itamar Franco. The veto was based on questions of an economic nature and which could also represent threats to market dentistry itself, presented contradictory arguments to the proposal, suggesting that it discouraged professional improvement when the training course was a prerogative. In addition, he cited the creation of another council for the category, when the body responsible for its regulation already existed.

The regulation of such professions restricts the labor market, delimits freedom of work, discourages professional development and prevents full contractual freedom [...] and will create, as in other regulated professions, the creation of another council category and in its midst the inconvenience of forming another reserve of the labor market [...] (Veto message No. 1,103, of December 30, 1993)

Oral Health Team

After this veto, social mobilization for the professional formalization of auxiliary staff in Dentistry in Brazil cooled. Only 7 years later, a new PL was presented by deputy Agnelo Queiroz (Communist Party of Brazil/ In Portuguese “Partido Comunista do Brasil” – PCdoB), with the same content as the previous proposal, removing only the definition of maximum annuity to be paid by assistants (Table 3). This PL was joined by another one from 2001 by Deputy Marcos Cintra (Liberal Front Party/ In Portuguese “Partido da Frente Liberal” – PFL), economist and professor at the School of Business Administration of São Paulo, Fundação Getúlio Vargas. For the first time in legislative acts, the terms TSB and ASB appeared, albeit in a restrictive perspective, limiting the TSB’s attributions to those of the ACD in the other proposals. A position opposed to the PL series presented up to that moment. PL n. 2,487 / 2000 was archived at the end of the legislature (tables 3 and 4).

The terms ASB and TSB appear as Professor Paulo Capel Narvai’s propositions in an article related to the VIII Enatespo, carried out in São Paulo, in 1991, prepared for discussion and propositions on the theme of auxiliary professions by invitation of the National Division of Oral Health / Ministry of Health [2626 Narvai PC. Em defesa do técnico em saúde bucal. Divulg Saúde para Debate. 1991;6:27-34.]. The author questioned the use of the term ACD, considering that its actions were not restricted to the dental office, just as the term attendant would also not be the most appropriate. With regard to THD, he pointed out that the term should be more debated, discussing the importance of the oral health team.

There is a paradox between the actions of the legislative and executive branches. From the 2000s onwards, as a result of the Enatespos and the participation of agents primarily from the scientific and bureaucratic fields, militants of the health movement, who were consultants at the Ministry of Health at the time of the formulation of the oral health policy [1919 Rossi TRA. Produção social das políticas de saúde bucal no Brasil. Salvador: EDUFBA; 2018.], the insertion of the oral health team in the Family Health Strategy (ESB / ESF) generated approximately 10,000 new public jobs and courses for technical training and training of the auxiliary team [55 Pezzato LM, Cocco MIM. O técnico em higiene dental e o atendente de consultório dentário no mundo do trabalho. Rev Saúde Debate. 2004;68(1):212-219.]. The executive branch opened vacancies for ASB and TSB, even without these professions being regulated.

In 2003, three more PLs were presented, two of equal content, reproducing the text of PL No. 4,487 / 2000, disagreeing only about the terminology for the auxiliary categories and the determination of maximum annuities for the TSB and ASB. The third was the re-presentation of PL n. 4,381 / 2001, by deputy Marcos Cintra (table 3).

Bill 1.140 / 2003 (PLC 3/2007, in the Senate), presented by Deputy Rubens Otoni (Workers Party/ In Portuguese “Partido dos Trabalhadores” – PT), obtained approval in all instances and gave rise to Law 11,889, of 12/24/2008, regulating the exercise of TSB and ASB in Brazil. The other two PLs proposed in 2003 were attached to it.

Strategies and disputes

The presence of a dentist in the president’s office was important for the approval of the PL. This CD was able to access technical standards by which the text should pass so that it was not vetoed, having made the necessary adjustments.

[...] how will it be vetoed?! It will be vetoed because there it said what was the contribution [related to the value in the class council], the registration of TSB and ASB in the Federal and Regional Councils of Dentistry. What we wanted was the question of assignments, the question of salary, we made another bill [...]

(E1, dentist and manager)

During the processing of PL 1.140 / 2003, there were moments when the dispute between the ideologies of professionalism [33 Zanetti CHG, Oliveira JAA, Mendonça MHM. Divisão do trabalho odontológico em perspectiva: desafio de interpretar as competências dos técnicos. Trabalho, Educ Saúde 2012;10(2):195-222. http://dx.doi.org/10.1590/S1981-77462012000200002
https://doi.org/10.1590/S1981-7746201200...
], on one hand, and the scientific administration articulated to the political administration, on the other, became even more explicit. In an account of the mobilization activities in the Chamber of Deputies on 11/22/2005, in the Cedros list, two union activists narrate: “We were FIO, ANATO, CRO-GO, SODF, SOEGO and THDs from Goiânia and Brasília. We arrived early, filled the auditorium, passed in all offices [...]”. There is reference to entities representing auxiliary personnel (National Association of Auxiliary and Dental Technicians), dentist union entities (FIO, Union of Dentists of the Federal District and Union of Dentists in the State of Goiás) and a professional entity (Regional Council of Dentistry) Goiás).

The main element of disagreement was evident: “[...] we reached an agreement, leaving a single impasse: the Brazilian Association of Dental Surgeons (ABCD) and the São Paulo Regional Dentistry Council (CRO-SP) did not accept for THDs to do restorations”, verbalizing the ideology of professionalism more forcefully.

FIO 2005 bulletins / newspapers portrayed articulation between national dental entities and the national oral health coordinator with the objective of approving the PL and the process inside the Chamber of Deputies. In April / 2005, he cited a manifesto signed by the Ministry of Health, FIO, ABO, CFO and ANATO in support of the substitute for PL 1.140 / 2003 with the deletion of the item “prophylaxis of oral diseases” and the CD / THD ratio in the proportion of 1 to 5, as proposed in Resolution 185/1993 of the CFO. However, the opinion of the rapporteur, Deputy Marcelo Barbieri, in the Labor Committee, in September, disregarding the agreement with FIO and national associations of THD and ACD, prevented the presence of THD in SUS and in Smiling Brazil program, which provided for the supervision of a dentist for each THD and assignments in preventing oral diseases. The opinion was pointed out as a historical setback, but it was supported by the APCD, which criticized the position of the other entities. In December of that year, the support of Deputy Jovair Arantes stood out in the defense of the proposal prepared by class entities and his work in substituting for a more comprehensive wording regarding the performance of THD and ACD.

The vehement defense of the interdiction of restorations by auxiliary personnel exemplifies what Freidson [2727 Freidson E. Para uma análise comparada das profissões: a institucionalização do discurso e do conhecimento formais. Rev Bras Ciências Sociais. 1996;11(31):141-154.] lists as a ubiquitous characteristic of the professions: the claim that there are such complex problems that it would be in the public interest that their execution is denied to those who do not have a specific type of training.

The CFO, with a favorable position for approval, highlighted on its official website the possibility of voting on the project of the Chamber of Deputies in July / 2007. A speech by professors from PUC-RS in favor of the ACD and THD in the Chamber of Deputies was booed. The position of dentistry students at that time was compared to that of doctors when they proposed the “Medical Act”:

[...] any day they will be against the prevention of diseases in the mouth for fear of taking the work from dentists [...]. We were fought a lot when we used [auxiliary personnel] in the pilot program in the city of Bagé, from SESP [...]. And now colleagues come to want to imitate the Medical Act. I believe that a reformulation in dental education is lacking, giving a greater emphasis on what our profession is and how it should be exercised with assistants.

(Flavio Luce apud Narvai, 2007)

Strategy to make oral health policy feasible?

The approval of the regulation of auxiliary professions, especially the TSB, was understood by the interviewees as a stimulus for hiring technicians and a strategy for universal and comprehensive oral health care.

[...] I believe that regulation was a great victory. It was from there that more [vacancies] were opened, either in private entities or in the public service [...] it was when the insertion of TSB was expanded [...]

(E1, dentist and manager)

Although the participation of THD in modality II of the ESB / ESF predicted an increase of 23.1% in the financial incentive in relation to modality I [2828 Brasil. Ministério da Saúde. Política Nacional de Saúde Bucal. Brasília: Ministério da Saúde; 2004.], the National Oral Health Policy (In Portuguese “Política Nacional de Saúde Bucal” – PNSB) proved to be insufficient as a strategy to expand access through auxiliary personnel, especially technicians [2323 Aguiar DML, Frazão P. A insuficiência da política pública para inclusão do técnico em saúde bucal na atenção primária no Brasil. In: Chaves SCL, org. Política de saúde bucal no Brasil: teoria e prática. Salvador: EDUFBA; 2016. p. 297-317.]. PNSB foresees similarity in the performance of technicians and assistants, with an emphasis on health education and supervised oral hygiene actions [2828 Brasil. Ministério da Saúde. Política Nacional de Saúde Bucal. Brasília: Ministério da Saúde; 2004.], to the detriment of assistance actions [33 Zanetti CHG, Oliveira JAA, Mendonça MHM. Divisão do trabalho odontológico em perspectiva: desafio de interpretar as competências dos técnicos. Trabalho, Educ Saúde 2012;10(2):195-222. http://dx.doi.org/10.1590/S1981-77462012000200002
https://doi.org/10.1590/S1981-7746201200...
]. To expand access, it proposes to overcome the biomedical model, through the transversal insertion of oral health in a more comprehensive perspective, through lines of care and by living condition [2828 Brasil. Ministério da Saúde. Política Nacional de Saúde Bucal. Brasília: Ministério da Saúde; 2004.].

The approval of the PL in the Senate was celebrated by the class entities. FIO highlighted the importance of Filomena Barros, president of ANATO in monitoring the process at the National Congress. The role of CD Swenderberger Barbosa, special advisor to the presidency, was also highlighted when the project arrived at the Planalto Palace to be sanctioned.

After Law 11,889 / 2008 was enacted, there are still demands. In that sense, in 2011 and 2015 PL were presented in this regard, respectively, by Gorete Pereira (Party of the Republic - PR) and by Cabo Sabino (PR) to establish a national professional salary floor. The proposals were for a minimum wage for an eight-hour daily and forty-weekly workday for both categories, being higher for the TSB, differing only in the amount proposed in each PL (table 3).

The analysis of the 12 parliamentary processes shows that in Brazil, even with the inclusion of auxiliary professionals in the public sphere since the 1950s and the expansion of the participation of these professionals from the inclusion of ESB / ESF, the Brazilian State was silent regarding formalization of the ASB and TSB professions, even though the CNE has approved the THD and ACD courses since 1975, highlighting their duties (Brazil, 1975), and the series of resolutions by the CFO since 1984 recognizing the auxiliary professions and adapting their assignments to their interests [2323 Aguiar DML, Frazão P. A insuficiência da política pública para inclusão do técnico em saúde bucal na atenção primária no Brasil. In: Chaves SCL, org. Política de saúde bucal no Brasil: teoria e prática. Salvador: EDUFBA; 2016. p. 297-317.]. The legislative path until the formalization of auxiliary professions lasted 31 years (1977 to 2008), permeated different political-administrative situations, starting in the period of the military dictatorship and extending until the end of the first decade of the 21st century. The deliberations of the Legislative and Executive branches reflected the national context, whether vetoing or not concluding the processing of these projects during the term of a legislature, leading them to be archived. Five parliamentary cases were closed, one was vetoed (PL 281/1991, PLC 53/1993), 4 rejected and 1 approved.

Only after seven years of the incorporation of ESB / ESF, PL 1.140 / 2003 was approved, which gave rise to Law 11.889 / 2008, regulating the exercise of auxiliary professions. The importance of the performance of dental surgeons within the political field is highlighted in different ways from 1989 until regulation was obtained in 2008. These dentists were important agents for the collective oral health space, with political and militant dispositions from the the RSB [2525 Soares CLM, Paim JS, Chaves SCL, Rossi, TRA, Barros SG, Cruz DN. O movimento da Saúde Bucal Coletiva no Brasil. Ciênc Saúde Coletiva. 2017;22(6):1805-1816. https://doi.org/10.1590/1413-81232017226.22972016
https://doi.org/10.1590/1413-81232017226...
].

Who was interested in the theme and why?

The diversity of social, professional and political affiliations (including both right and left parties) among proponents is highlighted. The initiatives were made both by deputies from the opposition party to the military dictatorship (MDB) and in support of it (Arena). In the democratic period, the bills were formulated by parties of the left (PT, PCB and PCdoB), right (PR) and center (PSDB), according to the classification proposed by Schimitt [2929 Schimitt RA. Partidos políticos no Brasil (1945-2000). Rio de Janeiro: Zahar; 2000.].

The multiple correspondence analysis related the restrictive practice of TSB to parliamentarians from the southeastern region (São Paulo and Espírito Santo), without training in the health field and with professions related to the private market, graduates in economics and engineering (figure 1). The defense for the clinical performance of the TSB, under the supervision of the dentist, was related to agents in the health area (Medicine) and human science (Law, Sociology and Pedagogy). The projects that dealt with the claims about a salary floor were presented by a health professional and with incomplete higher education, respectively, after the regulation of auxiliary professions (figure 1).

Figure 1
Multiple correspondence analysis.

The identification of these parliamentarians took place, according to empirical evidence, through the network of contacts (social capital) of the dentists that worked in associations and class entities, especially the FIO, in Collective Oral Health and in RSB. In other words, it did not matter which party or political current they were affiliated with, as long as they were sensitive to the cause [3030 Barros SG. Política Nacional de Aids: a construção da resposta governamental à epidemia de HIV/aids no Brasil. Salvador: Edufba; 2018.]. The final reports by Enatespos and the CNSB expressed support for auxiliary personnel, the PLs always obtained favorable opinions. The regulation incorporated into the official discourse the point of view of entities such as FIO, ANATO, dentists’ unions, which are more progressive and have a broader role in the TSB, with direct supervision by the dentist for clinical activities.

CONCLUSION

The analysis carried out showed the long historical process of social construction of the regulation of auxiliary professions in oral health in Brazil, especially the TSB profession. It points to the need to mobilize different types of capital, especially social, political, bureaucratic, and the articulation of agents from different social spaces, with emphasis on the political field and the militant space, but also the scientific field and founders of Collective Oral Health in this construction.

The development of this entire process is not separate from internal disputes in the dental field, its product being a result of the struggle between different projects. The interests of the private sector (Dentistry Market) and the public sector permeated the advances and setbacks for each PL presented, filed, vetoed or approved. The interests of the SUS, related to the implementation of oral health teams and the expansion of the offer of services, were not shown to be sufficient for a timely regulation and were even threatened. The articulation between representatives of the executive, legislative and judicial branches, absent throughout almost the entire process, was what made it possible to regulate the professions of TSB and ASB in the country.

How to cite this article

REFERENCES

  • 1
    Sanglard-Oliveira CA, Werneck MAF, Lucas SD, Abreu MHNG. Exploring professionalization among Brazilian oral health technicians. Human Resources for Health 2012;10(5):1-10. https://doi.org/10.1186/1478-4491-10-5
    » https://doi.org/10.1186/1478-4491-10-5
  • 2
    Baltutis LM, Gussy MG, Morgan MV. The role of the dental hygienist in the public health sector; an Australian perspective. Int Dental J. 2000;50(1):29-35. https://doi.org/10.1111/j.1875-595X.2000.tb00543.x
    » https://doi.org/10.1111/j.1875-595X.2000.tb00543.x
  • 3
    Zanetti CHG, Oliveira JAA, Mendonça MHM. Divisão do trabalho odontológico em perspectiva: desafio de interpretar as competências dos técnicos. Trabalho, Educ Saúde 2012;10(2):195-222. http://dx.doi.org/10.1590/S1981-77462012000200002
    » https://doi.org/10.1590/S1981-77462012000200002
  • 4
    Frazão P, Narvai PC. Lei n.11.889/2008: avanço ou retrocesso nas competências do técnico em sáude bucal? Trabalho, Educ Saúde. 2011;9(1):109-123.
  • 5
    Pezzato LM, Cocco MIM. O técnico em higiene dental e o atendente de consultório dentário no mundo do trabalho. Rev Saúde Debate. 2004;68(1):212-219.
  • 6
    Brasil. Parecer MEC/CFE n.º 460 de 6 de fevereiro de 1975. Dispõe sobre a habilitação em nível de 2º grau de Técnico em Higiene Dental e Atendente de Consultório Dentário. Diário Oficial da República Federativa do Brasil, seção I, p. 3937.
  • 7
    Enatespo. I Encontro Nacional de Administradores e Técnicos de Serviços Públicos Odontológicos. Relatório. Porto Alegre: Enatespo; 1984.
  • 8
    Narvai PC, Manfredini M, Botazzo C, Raineri N, Schneider DA, Frazão P. Contra o técnico em higiene dental. Rev Saúde Debate. 1989;28:59-65.
  • 9
    Brasil. Ministério da Saúde. Relatório final da 1ª Conferência Nacional de Saúde Bucal. Brasília: Ministério da Saúde; 1986 [citado 2020 Mar 10]. Disponível em: <https://bvsms.saude.gov.br/bvs/publicacoes/1_conferencia_nacional_saude_bucal_relatorio_final.pdf>.
    » https://bvsms.saude.gov.br/bvs/publicacoes/1_conferencia_nacional_saude_bucal_relatorio_final.pdf
  • 10
    Brasil. Ministério da Saúde. Relatório final da 2ª Conferência Nacional de Saúde Bucal. Brasília: Ministério da Saúde; 1993 [citado 2020 Mar 10]. Disponível em: <http://189.28.128.100/dab/docs/portaldab/publicacoes/2_conferencia_nacional_saude_bucal_relatorio_final.pdf>.
    » http://189.28.128.100/dab/docs/portaldab/publicacoes/2_conferencia_nacional_saude_bucal_relatorio_final.pdf
  • 11
    Brasil. Ministério da Saúde. Relatório final da 3ª Conferência Nacional de Saúde Bucal. Acesso e qualidade superando a exclusão social. Brasília: Ministério da Saúde; 2005 [citado 2020 Mar 10]. Disponível em: <https://bvsms.saude.gov.br/bvs/publicacoes/3_conferencia_nacional_saude_bucal_relatorio_final.pdf>.
    » https://bvsms.saude.gov.br/bvs/publicacoes/3_conferencia_nacional_saude_bucal_relatorio_final.pdf
  • 12
    Leite DO, Souza RC, Naressi SCM, Nicodemo D, Koga KS, Orenha ES. Impacto do trabalho auxiliado na qualidade de vida do cirurgião dentista. Braz Dental Sci. 2011;1(2):27-33. https://doi.org/10.14295/bds.2011.v14i1/2.706
    » https://doi.org/10.14295/bds.2011.v14i1/2.706
  • 13
    Garcia LP, Blank VLG. Prevalência de exposições ocupacionais de cirurgiões-dentistas e auxiliares de consultório dentário a material biológico. Cad Saúde Pública. 2006;22(1):97-108. https://doi.org/10.1590/S0102-311X2006000100011
    » https://doi.org/10.1590/S0102-311X2006000100011
  • 14
    Narvai PC. Recursos humanos para promoção da saúde bucal: um olhar no início do século XXI. In: Kriger L, coord. ABOPREV: promoção de saúde bucal. 3ª ed. São Paulo: Artes Médicas; 2003. p. 475-94.
  • 15
    Paranhos LR, Ricci ID, Tomasso S, Salazar M, Siqueira DF. Análise da relação entre o cirurgião-dentista e o pessoal auxiliar. Rev Odonto Ciênc. 2008;23(4):365-70.
  • 16
    Silva RF, Monini AC, Daruge Junior E, Francesquini Júnior L, Lanza MA. Utilização de auxiliares odontológicos em Ortodontia: implicações éticas e legais. Rev Dental Press Ortod Ortop Fac. 2006;11(5):121-128. http://dx.doi.org/10.1590/S1415-54192006000500013
    » https://doi.org/10.1590/S1415-54192006000500013
  • 17
    Pezzato LM, Monteiro MI, Bagnato MHS. Processos de formação do técnico em higiene dental e do auxiliar de consultório dentário no Brasil: algumas memórias. Odontole Soc. 2007;9(1):39-49.
  • 18
    Boudieu P. Razões práticas: sobre a teoria da ação. Campinas: Papirus; 1996.
  • 19
    Rossi TRA. Produção social das políticas de saúde bucal no Brasil. Salvador: EDUFBA; 2018.
  • 20
    Greenacre, M. La prática del análisis de correspondências. Bilbao, Espanha: Fundación BBVA; 2008.
  • 21
    Infantosi AFC, Costa JCGD, Almeida RMVR. Análise de correspondência: bases teóricas na interpretação de dados categóricos em Ciências da Saúde. Cad Saúde Pública. 2014;30(3):473-486. http://dx.doi.org/10.1590/0102-311X00128513
    » https://doi.org/10.1590/0102-311X00128513
  • 22
    Kovaleski DF, Boing AF, Freitas SFT. Recursos humanos auxiliares em saúde bucal: retomando a temática. Rev Odontol UNESP. 2005;34(4):161-65.
  • 23
    Aguiar DML, Frazão P. A insuficiência da política pública para inclusão do técnico em saúde bucal na atenção primária no Brasil. In: Chaves SCL, org. Política de saúde bucal no Brasil: teoria e prática. Salvador: EDUFBA; 2016. p. 297-317.
  • 24
    Barbosa SN. Pessoal auxiliar em Odontologia: regulamentação das profissões de THD e ACD. Rev Divulg Saúde para Debate. 1991;6:37-39.
  • 25
    Soares CLM, Paim JS, Chaves SCL, Rossi, TRA, Barros SG, Cruz DN. O movimento da Saúde Bucal Coletiva no Brasil. Ciênc Saúde Coletiva. 2017;22(6):1805-1816. https://doi.org/10.1590/1413-81232017226.22972016
    » https://doi.org/10.1590/1413-81232017226.22972016
  • 26
    Narvai PC. Em defesa do técnico em saúde bucal. Divulg Saúde para Debate. 1991;6:27-34.
  • 27
    Freidson E. Para uma análise comparada das profissões: a institucionalização do discurso e do conhecimento formais. Rev Bras Ciências Sociais. 1996;11(31):141-154.
  • 28
    Brasil. Ministério da Saúde. Política Nacional de Saúde Bucal. Brasília: Ministério da Saúde; 2004.
  • 29
    Schimitt RA. Partidos políticos no Brasil (1945-2000). Rio de Janeiro: Zahar; 2000.
  • 30
    Barros SG. Política Nacional de Aids: a construção da resposta governamental à epidemia de HIV/aids no Brasil. Salvador: Edufba; 2018.

Edited by

Assistant editor: Luciana Butini Oliveira

Publication Dates

  • Publication in this collection
    06 May 2022
  • Date of issue
    2022

History

  • Received
    23 July 2020
  • Reviewed
    24 Oct 2020
  • Accepted
    11 Dec 2020
Faculdade São Leopoldo Mandic Rua José Rocha Junqueira, 13, CEP: 13045-755 , Tel.: +55 (19) 3211-3689 - Campinas - SP - Brazil
E-mail: contato@revistargo.com.br