Desvelando os mistérios da saúde bucal: estudo epidemiológico e contribuições da salutogênese para a promoção da saúde bucal

The present thesis was presented in the format of scientific articles. The purpose of the first article was to analyze the salutogenic theory seeking to establish their interfaces with oral health promotion. There was a discussion on theoretical and conceptual aspects of the salutogenic theory to examine their potential to guide the development of actions in five fields of action proposed by the Ottawa Charter. The second article aimed to analyze the contributions of salutogenic theory for the development of education in oral health towards the empowerment of individuals and groups, considering the problematizing pedagogy as the backdrop. The methodology of this study was based on the reflection on the theoretical and conceptual frameworks of the salutogenesis and of their interfaces with problematizing education, considering empowerment the category axis that can structure these relations. The third article aimed to generate evidence of the salutogenic theory in the field of oral health. The study investigated the association between sense of coherence (the central construct of salutogenesis) and favorable outcomes of adolescents’ oral health. The favorable oral health outcomes in adolescents were: (1) the fact of adolescents 11-12 years of age had used oral health services and (2) the main reason for using these services have been for preventive purposes (rather than "curative"). A sample of adolescents from low socioeconomic level was gathered within the Sao Joao de Meriti city, RJ. The results of studies showed that the salutogenesis theoretical and conceptual framework proved to be consistent, showing potential to support actions to promote oral health. Adopting the perspective of salutogenesis and problematizing education in oral health education may be capable to make the rescue of the position of health promotion in relation to its commitment to subjects’ health production and of reflective and autonomous individuals, which in turn, favors the transformation of the social-health situation. The salutogenesis perspective suggests that oral health education practices should be moved for the co-research of “salutogenic” resources of individuals and groups. The respect for moral values is an essential condition for the effectiveness of this strategy. The results of the epidemiological study contributed to the consolidation of salutogenesis in the field of oral health promotion as it was concluded that maternal sense of coherence was associated with the adoption of favorable adolesccents’ oral health behaviours, namely: the fact that adolescents had used the dental services and most of the time for preventive reasons. The results showed that when the structural factors are unfavorable to health, oral health promotion actions using the salutogenic approach with the mothers may be capable to generate favorable oral health outcomes for their adolescents. The thesis highlights the potential of the salutogenic theory to renew the research and practice in oral health. The salutogenesis supports the importance to the more egalitarian distribution of power and resources within the society, seeking to redeem the commitment of the State, society and workers in oral health with the individuals’ life and community. It indicates that processes of empowerment committed to increasing the understanding, coherence and domain of subjects on the individual, social, economic and political aspects can enable better life conditions (and oral health) can be reached. It is also suggested the challenges that such approaches pose to the consolidation of collective oral health and to generate shifts in the work processes and in the subject of those proceedings.