Saúde bucal da pessoa idosa no contexto do SUS: da caracterização dos usuários às práticas dos cirurgiões-dentistas.

Abstract

This thesis investigated dental care for the elderly within Brazil's Unified HealthSystem (SUS) by integrating a quantitative study with elderly individuals and a qualitative study with dentists in Pelotas/RS. The theoretical framework combined Merleau-Ponty's phenomenology and the expanded concept of access, analyzing it as a relational process between subjects, institutions, and territory. The quantitative study, with 152 elderly individuals from an "Elderly-Friendly" Primary Health Care Unit, revealed a profile with a strong connection to the Family Health Strategy and favorable oral health indicators. However, it identified an inequity gradient: elderly individuals with functional dependence showed worse conditions (lower use of dentures, greater need for rehabilitation) and less access to preventive consultations, highlighting autonomy as a critical determinant. The qualitative study, with professionals, demonstrated that the current care model is insufficient to ensure equity. The most vulnerable elderly (bedridden, with reduced mobility) are the least likely to reach health units. Barriers such as work overload, lack of materials, transportation, and institutionalized protocols marginalize home-based dental care, which depends on individual initiative. Community Health Workers emerged as essential actors for linking and identifying needs within the territory. The synthesis of the findings shows that access is limited by both objective (organizational and structural) and subjective barriers (beliefs that devalue care in old age). It is concluded that the institutionalization of home-based dental care as a policy is imperative. This requires: 1) its formal inclusion in the Elderly Care Line protocols; 2) specific funding; 3) permanent education for the team; and 4) strengthening the role of the Community Health Worker. The thesis provides theoretical and scientific contributions by articulating epidemiological and phenomenological perspectives, showing that failures in access are systemic. Ensuring equitable dental care for the elderly is a matter of social justice and dignity, demanding the construction of territorial and interdisciplinary practices centered on the individual.