Orlando Monteiro da Silva

Through the acronym of three words – Portugal, Oral, All – I intend to address the pertinence of oral health in my country, Portugal, and at a global level, being more inclusive of all the professions that make it up.

Specifically, I’m referring to dentists, leaders, oral hygienists, and dental technicians: for different reasons, and in different contexts, these are the jobs that work most closely in the oral health team.

My vast international experience at the helm of the FDI – World Dental Federation, CED – Council of European Dentists and FEDCAR- Federation of Dental Competent Authorities and Regulators makes me confident that this path should be taken further by the main global organizations representing dentistry.

Preface: the growing scientific evidence of the intrinsic relationship between oral and systemic health has caused global health organizations, academia, health professions, regulators, professional organizations, and society in general to reflect.

Patients and their organizations, as well as insurers and public and private funding systems, have taken this integrated approach to oral health into account. Nothing could be more right and proper.

Involving family doctors in the context of the desirable inclusion of oral health in primary health care, in a universal coverage approach, with their collaboration:

• nutritionists, given the widespread sharing and relationship between nutrition and oral health,
• psychologists, now that everyone is aware of the impact and relationship of oral health on mental health and vice versa. In the latter case, it would be enough to take into account the impact of addictions to various substances on oral health;
• also in terms of temporomandibular joint pathology, TMJ, bruxism and occlusal problems and their relationship with physiotherapy, sleep medicine and neurology.

And other collaborations could be identified with nurses, pediatricians, speech therapists, etc. examples of this relationship between oral and systemic health in various areas of health.

But with so much looking around, we’re perhaps forgetting to look inwards, at the oral health team with whom we work every day.

Note that the “Global Report on the State of Oral Health: Towards Universal Health Coverage for Oral Health by 2030” presents a comprehensive overview of the challenges and opportunities in the field of oral health globally.

The World Health Organization (WHO) highlights that oral diseases are among the most common non-communicable diseases, affecting approximately 3.5 billion people worldwide.

These diseases are, as an obvious result, dental caries, and periodontal disease, which are largely preventable through educational, preventive, and clinical interventions, along with approaches to combat risks common to all chronic diseases.

The report points to the need to include oral health services in publicly funded national health coverage services, accessible free of charge or at a cost that people can afford.

In addition, it describes the main determinants and risk factors of oral diseases, including sugar consumption, tobacco use and excessive alcohol consumption.

This approach highlights the fact that chronic diseases and some pathologies of the oral cavity share a set of risk factors that can be conditioned or altered.

Oral hygienists, who are true experts in prevention, play an essential role in the prophylactic and educational approach and in oral health literacy.

On the other hand, in the rehabilitation of edentulism and tooth loss, the device developed by Dental Prosthesis Technicians (DPT) is crucial.

As such, while not being exhaustive, because these senior health technicians, OH and DPT, are broader in their professional scope than described collaboration and dialog between dentistry and these oral health jobs is fundamental.

It would be highly advisable to establish permanent contact platforms between these different professional profiles, for the sake of patients and users.

True alliances for oral health.

In conclusion:

Yes, it is essential to look at interprofessional collaboration with other areas of health. It certainly is. But we can’t leave behind dialog and interaction with those who work with us every day to prevent, treat and rehabilitate diseases of the oral cavity.

The major international and national organizations that represent and regulate oral health must include the medicine of oral hygienists and dental technicians with dental medicine.

In the name of excellent interdisciplinary oral health: PortugOralL.

You can read the full article, in Portuguese or English, in the Portuguese monthly edition of Dentistry magazine:

Open the English version of the article (pdf).

Open the Portuguese version of the article (pdf).

The key to a rewarding career lies in the harmony between who We Are and what We Do.

Managing a career is a huge challenge, especially for those who are starting a highly qualified professional activity such as dentistry.

There are many factors that influence a career path. Today I’m going to talk a little about the importance of self-knowledge in personal and professional development with some examples applicable to the various aspects of dentistry today.

Most religions and spiritualities describe in their principles, formulations, and practices, although in very different ways, the centrality of self-knowledge in decision-making and in the choices that we are permanently making throughout life.

Philosophy has also been doing so since ancient times.

Socrates said, “Know thyself”.

Lao Tzu wrote more comprehensively: “He who knows others is wise. He who knows himself is enlightened”.

In other words, self-knowledge and the knowledge of others are intimately linked in a desirable balance and harmony.

Subsequently, Psychology through various currents has emphasized over centuries until today the importance of our family, genetic, environmental context, our thoughts and our emotions in the Choices and Decisions that we make throughout life.

In recent decades, a panoply of diversified proposals for all tastes, inside and outside the traditional branches of religions, spiritualities and science, has become common under the general concept of self-help.

In fact, the paths of self-knowledge and the knowledge of others have no end, they are processes, permanent constructions and always unfinished.

Our decisions and attitudes must arise, as far as possible, from the balance of these two aspects, that of the external approval that we all seek, from patients, from our colleagues, from family, from friendships, with the integration of a more interior, more personal aspect that, when harmonious, exalts us in the various existential planes.

It is important, regarding the management of a career in dentistry, to emphasize that the awareness of some aspects of our personality must be, as far as possible, considered in the choices we make, proving to be fundamental for the type of path, of career we build.

It is therefore important when we embrace a profession to know our strengths, our values, our goals, so that what we identify as essential in the professional path we aim for is not only determined by the interests and expectations of others, but also by those that each of us values.

Understanding our strengths means that we should focus on paths that enhance them. It is much easier to evolve professionally from good to excellence than from mediocre to enough.

The developments of the last 25 years have progressively transformed dentistry from a narrow-band profession to a broad-band one.

Contributing to this is the recognition of the various skills and specializations that dentistry currently has, the technological possibilities in data science and digital and, above all, the growing and increasingly robust relational evidence of oral health with systemic health.

These developments are in themselves generating enormous opportunities in the oral health profession, in addition to those in which the trinomial | dentist | turbine | chair | they were dominant.

There is now room for the provision of generalist dental procedures, the most sought-after, as well as in the areas of clinical specialization, orthodontics, oral surgery, implantology, rehabilitation, endodontics, pediatric dentistry and non-clinical, such as management and public health.

In addition, there are the differentiated skills that the dentist can acquire with growing demand from the public, such as harmonization and orofacial filling, temporomandibular dysfunction, acupuncture, sleep dentistry, ozone therapy, supportive dentistry in home continued care and dentistry in conflict contexts, among others.

To make career decisions, the dentist can and should study himself and ask:

Which profile is dominant in me?
Will I be a Reformer or a Perfectionist?
A more Altruistic , Caregiver?
A Doer, Motivator, driven by results?
An Individualist, more of an Artist?
A more Theoretical Researcher?
Someone who prioritizes the group, the organization, the security? An Enthusiastic, Optimistic
who favors change and novelty?
A Challenger, Protector, Punisher?
Or a Pacifist, Conciliator?

If we are good in a surgical area, if we are interested, for example, in implantology, why would we waste time and resources on a professional career in public services where such expertise is not applicable?

Or, on the contrary, I would say if a young dentist has within him characteristics of an entrepreneur, of a doer, if he shows interest in concretizing, in achieving results, he should not value this aspect and, in addition to the clinical practice of the profession, improve his
management skills, making an organization grow, making it more profitable, creating more value for himself, for teams and for society?

Someone who recognizes himself as a perfectionist, who favors a more artistic, integrated, harmonized aspect, attentive to detail, often seeks the more aesthetic aspect of dentistry, dentistry, rehabilitation. Does it make sense for a perfectionist to be integrated into an
environment where detail, detail, is devalued in terms of functionality at the lowest cost?

Should the individualist, who chooses solo exercise, who has difficulty working in a group, who feels comfortable working directly with his patients, not valuing the organizational aspects that make the viability of a structure possible, privilege the path of team management in an organization?

It is not intended to answer this type of question other than through the importance of each one of us analyzing ourselves from the point of view of their personality, their professional profile, the skills they have acquired, those they want to improve, the specialization they want to achieve in order to make compatible choices that can bring satisfaction to each professional path, Fulfillment and compatibility appropriate to the individual personality type and abilities.

We cannot ask someone with a vocation for orthodontics to dedicate himself to endodontics…. They are very different choices.

Regarding the longevity of careers in dentistry, there are few studies on the subject; But, in general, the high degree of demand in the oral health professions, in physical terms, in posture, in the degree of visual demand, auditory, mental demand, communicational and among others, makes them relatively short, compared to other careers in the medical fields.

In addition, there are generally few opportunities for differentiation and progression outside the clinical field. As such, the construction and projection of a career should provide for parallel or complementary alternatives, whether around management, business, volunteering, civic intervention or others so that the dependence on exclusively clinical practice does not prove to generate frustration due to its relatively short life span and the lack of a previously planned alternative parallel career.

In a world where differentiation and specialization become increasingly important, understanding oneself deeply makes it possible to identify specific niches within dentistry where one can not only survive, but actually thrive. Be it through surgery, management, dental aesthetics or any other of the numerous facets of this profession.

Dentistry is diverse enough to respond to very different career visions adapted to very different personality profiles.

You can read the full article, in Portuguese or English, in the Portuguese monthly edition of Dentistry magazine:

Open the English version of the article (pdf).

Open the Portuguese version of the article (pdf).

Throughout 2023, I had the opportunity to follow and complete a series of postgraduate courses in management, regulation, bioethics and defence/cybersecurity.

At the same time, as part of my consultancy activities, I regularly take part in a series of webinars on wide-ranging topics with leading figures from all areas of knowledge, from companies, universities, the environment, digital, public health, regulation, security and defense, the independent practice of professions, among others.

Having not practiced clinically for some years now, I nevertheless feel even more like a dentist, more capable of writing this chronicle in which I will try to symbolically identify 24 trends that I believe will be decisive for global dentistry in 2024.

In the collaboration that I have renewed with O’JornalDentistry over the course of this year, I will develop some of these trends in a monthly chronicle, with an approach in which I will try to bring a different angle to all those who are interested in following the health sector and dentistry.

As usual, these chronicles will be written in Portuguese and translated into English. A greeting and thanks to the publisher Hermínia Guimarães and to the readers who receive them or look for them all over the world and who have encouraged us to renew this project where I collaborate pro bono.

These trends have been grouped in alphabetical order, due to my personal inability to organise them in any other way.

You can read the full article, in Portuguese or English, in the Portuguese monthly edition of Dentistry magazine:

Open the English version of the article (pdf).

Open the Portuguese version of the article (pdf).

Dentistry, like other medical fields, lives in a limbo, in a conflict between its curative and aesthetic aspects.

Between the need to prevent, treat and rehabilitate functions and the desire to look better, to correct, to alter, to whiten, to align the teeth, jaws and attached structures for aesthetic reasons.

This conflict is resolved naturally with a holistic approach to these two inseparable aspects.

Aesthetics and function must fundamentally and for the dentist be integrable.

Clients, that is, all those who in their essence will be able to choose to whom they entrust the improvement or resolution of their perceived needs, more connected to function and felt desires, more connected with aesthetics, tend to separate both aspects.

You can read the full article, in Portuguese or English, in the Portuguese monthly edition of Dentistry magazine:

Open the English version of the article (pdf).

Open the Portuguese version of the article (pdf).

Paulo Romão, recognized as one of the best Portuguese designers, boasts a resume and portfolio that speak for themselves.

He is the creative mind behind the logo and image of the Portuguese Association of Liberal Professionals.

He’s taken on a new project that I find extremely interesting and wanted to share with my friends and contacts around the world: The Bird Houses.

All Bird Houses are handmade and unique pieces built to order, taking the best out of the natural beauty of the materials. These are made from different types of wood, Burel (traditional portuguese wool textile), steel and high temperature glazed ceramic.

The unique combination of carefully chosen materials is what makes it an exclusive piece of design. There aren’t two pieces of wood the same. Therefore, there will never be two identical Bird Houses.

I invite you to check out this unique artistic concept on The Bird Houses.

We need collective networks of providers and organizations that collaborate in coopetition to help design the salary and working conditions of dentists in Portugal.

I will start some reflection on the three concepts that give the title to this chronicle, identifying the concrete example of tourism in dentistry. It is a topic of the greatest relevance, multifaceted and with variants that I will address here in a sectoral way, although it may be deepened in a future publication.

First of all, let’s remember the basics, in the current organizational context of Portuguese dentistry, consisting of about 98% of operators working exclusively in the private sector: the fact that it is made available essentially through private sector financing, in direct out-of-pocket payments, including ADSE, including public and private insurances, health plans and conventions, stimulating competition to the detriment of a more virtuous combination with other approaches that would present numerous advantages in a reality of fragmentation of thousands of clinics and dental offices.

You can read the full article, in Portuguese or English, in the Portuguese monthly edition of Dentistry magazine:

Open the English version of the article (pdf).

Open the Portuguese version of the article (pdf).

Nesta segunda parte da conversa, muito ficou por dizer. Complemento no texto em baixo…

A minha personalidade é a de um nº 3 do Eneagrama. 

Foco-me muito em resultados. E sempre transmiti isso a todas as equipas com que trabalhei e que integrei. Liderando ou sendo liderado.

Assim, nos quase 20 anos em que liderei a Ordem dos Médicos Dentistas, fomos decisivos para:

• Aumentar a acessibilidade da população à saúde oral de cerca de 15%, em 2001, para mais de 60% em 2020. Todos juntos, conseguimos:
  • Na prática privada da profissão, integrados numa rede de cerca de 6000 clínicas e consultórios de medicina dentária que cobrem 97% do território nacional;
  • Com a ajuda do programa Cheque-Dentista, 3,5 milhões de portugueses acederam a consultas de medicina dentária;
  • E, mais tarde, com a integração de cerca de 120 médicos dentistas no SNS.

• Atingir o reconhecimento pleno da medicina dentária como uma profissão médica, e dos médicos dentistas como “médicos de saúde oral”, alargando o seu papel e a sua intervenção na sociedade, mediante a introdução de especialidades e de competências em medicina dentária.
• Combater com êxito a, então, elevadíssima taxa de sucesso o exercício ilegal da profissão.
• Licenciar e certificar o universo de consultórios e clínicas dentárias a operar.
• Criar um Observatório de Saúde Oral, que permitiu estudar e promover a profissão e a saúde oral através de barómetros, campanhas e estudos, que proporcionaram visibilidade pública e se revelaram eficazes e promotores de políticas de saúde pública mais efetivas.
• Integrar na sociedade portuguesa o conceito de Saúde Oral/ Saúde Geral, um contributo essencial para a qualidade de vida dos portugueses.
• Implementar Formação Contínua tendencialmente gratuita para todos os médicos dentistas.
• Afirmar o Congresso da nossa Ordem como um dos maiores e mais prestigiados da Europa.
• Implementar Especialidades e regulamentar Competências na medicina dentária.
• Neste período, inquestionavelmente, projetamos a nossa profissão de forma efetiva e torná-la relevante, quer ao nível social quer nas plataformas de decisão pública.

A nível nacional, enquanto bastonário da nossa Ordem, foi possível ocupar lugares de destaque e de prestígio para todos nós:

• Na Presidência do CNOP – Conselho Nacional das Ordens Profissionais;
• No Conselho Económico e Social;
• Em inúmeros grupos de trabalho e fóruns de diálogo com agentes políticos e da sociedade civil de uma forma geral.

A nível internacional através da participação ativa nos organismos mais representativos da profissão, designadamente: 

• Na Presidência e Comités da FDI – Federação Dentária Internacional;
• Na Presidência e Comités do CED – Conselho Europeu dos Médicos Dentistas; 
• Na Presidência da FEDCAR – Federação dos Reguladores Europeus da Profissão;
• Em diversas parcerias estabelecidas com os países de língua e expressão portuguesa, em especial o Brasil, e ainda no âmbito da Associação Dentária Lusófona.

Os médicos dentistas e a medicina dentária portuguesa são hoje reconhecidos automaticamente na União Europeia e considerados como profissionais valorizados a nível global.

Afirmo, com orgulho na profissão, que a medicina dentária praticada no nosso país ultrapassa em muito os limites das nossas fronteiras. Somos uma área de vanguarda, reconhecida como produtora de conhecimento e de mais-valias para Portugal.

Com cerca de 96% dos seus membros a exercer essencialmente no setor privado, num País em que o sistema público de saúde foi esquecendo, durante muitos anos, a saúde oral como área fundamental para a saúde pública, que o é. Nesse sentido, a OMD teve intervenção constante junto dos decisores públicos, criando uma lógica de permanente negociação visando defender a profissão, os médicos dentistas e as populações ou, tantas vezes, evitando que medidas danosas ou políticas erradas fossem implementadas.

Tal como outras profissões liberais, nestes últimos 20 anos, enfrentamos desafios muito difíceis:

• A desregulação económica da profissão, decorrente da globalização;
• A crise económica da crise do SubPrime e a subsequente intervenção da Troika;
• A emigração daí decorrente, ainda em curso nos dias de hoje de médicos dentistas, grande parte das vezes forçada, nomeadamente no espaço europeu;
• E, mais recentemente, a crise resultante da pandemia Covid-19, que obrigou à suspensão da atividade durante cerca de 45 dias. 

Mas, esta profissão é resiliente, os seus profissionais são bem preparados e muito capazes, e as pessoas precisam muito dela.

Neste podcast, deixo um agradecimento especial a todos os que comigo caminharam nestas quase duas décadas, quer integrando os órgãos sociais quer através da sua participação nas muitas iniciativas e atividades da nossa Ordem.

Em conjunto, deixamos o legado que mais nos deve orgulhar – uma Ordem respeitada, sempre ouvida, exemplarmente gerida, com um corpo de funcionários e colaboradores leais, dedicados, competentes, incondicionais na sua entrega, que constituem uma enorme mais-valia no dia-a-dia da Instituição. Constituem-se, autenticamente, no motor desta Ordem.

E, numa altura de crise generalizada do país, das instituições e das empresas, quero realçar o facto de deixarmos uma Ordem económica e financeiramente muito robusta, com 6 milhões de ativos financeiros  disponibilidades e excedentes financeiros mais do que suficientes para enfrentar o futuro. Num país em que a falta de recursos financeiros sempre pauta o funcionamento das suas instituições, peço-lhes que me permitam a veleidade de exibir um especial orgulho neste facto importante para todos nós, porque sem uma Ordem financeiramente saudável, a nossa profissão não teria quem a pudesse defender eficazmente.

Acabei as minhas funções de Bastonário por vontade própria, com a noção plena de ter servido a Ordem dos Médicos Dentistas e a profissão com o melhor do meu esforço, com as minhas qualidades e limitações,  mas sobretudo, com a consciência do dever cumprido.

Poderá ouvir a entrevista no Spotify, no Apple Podcasts ou Google Podcast.

Também poderá ouvir aqui diretamente o ficheiro áudio mp3.

A primeira parte da entrevista, publicada na semana passada, está disponível em Entrevista ao podcast Sorrir Melhor.