Brazilian oral medicine and oral histopathology services: The worrying reality in the COVID‐19 Era

Two recently published papers show the damage and concerns experienced by an oral diagnostic service and the reality of oral cancer during the coronavirus diseases 2019 (COVID-19) pandemic (Alves et al., 2020; Gomes, Schuch, Tarquinio, Etges, & Vasconcelos, 2020). The first paper describes an oral diagnostic service with more than 60 years of existence located in the Southern region of the Brazil, in a public university. It shows a total of 216 diagnoses that were retrieved during the analyzed months of 2019 in comparison with 65 in 2020 (Gomes et al., 2020). The second paper describes the implications of oral oncology in Brazil, Canada, and the United States in the same period. Observing this paper, in particular, the Brazilian reality is evident the deficit of clinical consultations and the absence of virtual consultation (Alves et al., 2020). What reflections and lessons these two papers applies to the current reality of Brazil? On February 26, approximately 56 days after the first case reported in China, the Brazil officially registered its first patient with COVID-19 in a 61-year-old man living in São Paulo who had recently returned from a trip to Italy (Simões, Oliveira, & Martelli, 2020). On May 9, 2020, the Brazilian National Congress has decreed three days of national mourning, due to the number of official deaths of COVID-19 having passed the mark of 10,000 (Martelli-Júnior et al., 2020). Unfortunately, from this symbolic date from the beginning of May 2020, to the present day, the Brazilian situation has placed the country in the epicenter of the world pandemic of COVID-19, in addition to knowing that these numbers underestimate the real depth of the pandemic in Brazil. This is because, to date, capacity for a massive surge in laboratory testing has not been enabled in our country (Diaz-Quijano et al., 2020). Only synthetically, following a brief timeline, on May 21, 2020, Brazil had already more than 20,000 deaths by COVID-19. A few days later, on May 31, the country already had approximately 30,000 deaths and 500,000 infected by SARS-CoV-2. On June 20, Brazil surpassed 50,000 deaths and more than 1 million infected. And drastically, the country already has approximately 100,000 deaths and 3 million confirmed cases of contamination (August 8, 2020) (https://www.sanarmed.com/linha-do-tempo-do-coronavirus-no-brasil). The country has 339,780 Dental Surgeons, 557 undergraduate courses in dentistry authorized (http://cfo.org.br/website/estatisticas/quantidade-geral-de-entidades-e-profissionais-ativos/) (access in August 2020), and 22 Dental specialties are recognized by the Federal Council of Dentistry (http://cfo.org.br). Oral Pathology (OP) was recognized as a specialty in 1971 and Oral Medicine (OM) in 1992. Brazil has approximately 295 specialists in OP and 443 in OM in activity, registered by the Federal Council of Dentistry (http://cfo.org.br). The services of OM and OP in Brazil are concentrated in public and private universities and the unified health system, particularly in a program created called the Access and Quality Improvement Program of the Centers of Dental Specialties (PMAQ-CEO). Currently, Brazil has 1,174 PMAQ-CEO and among the specialties developed in these Centers, is OM (https://aps.saude.gov.br/ape/pmaq). However, we do not have an objective overall prevalence of benign lesions considering these Services. Despite all the financial limitations involved in supporting Brazilian research (Martelli-Júnior, Martelli, Silva, Oliveira, & Oliveira, 2019; Oliveira, Martelli júnior, Silva, Martelli, & Oliveira, 2020), the areas of OM and OP have presented an important international highlight and performance (de Andrade, Martelli, de Almeida, et al., 2018; de Andrade, Martelli, Swerts, Oliveira, & Martelli, 2018; de Andrade, Martelli, Swerts, et al., 2018). The country has 104 postgraduate programs in dentistry, 22 of which have areas of concentration in OM and OP and two postgraduate programs are specific in the area of OM and OP (https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/programa/quantitativos/quantitativoIes.jsf?areaAvaliacao=18&areaConhecimento=40200000). During this period, we have outbreaks in our services. For instance, an integrate OM service at Paraiba state, with 30–40 new and reviewed patients per week, was interrupted since March 2020. This fact impacted negatively, and 222 different cases of oral diagnoses (including 23 malignant lesions) made last year resulted in less of 10 diagnosis made by virtual consultation during the pandemic (Personal communication, PRFP). Another example, our service at the State University of Montes Claros, since March 2020, has been without face-to-face activities. It performed an average of 50 weekly OM consultations and since April 2020, has held a maximum of 8 weekly virtual inter-consultations (Personal communication, HMJ). Although studies have highlighted the importance and participation of tele(oral)medicine in this quarantine period (Gueiros, Melo, & Carrard, 2020; Machado, de Souza, Oliveira, Martelli Júnior, & Bonan, 2020; Villa, Sankar, & Shiboski, 2020), Brazilian legislation on dental teleservice still needs to be improved. Just as an example, when analyzing the situation of oral cancer in the country, the numbers are worrying. The number of new cases of oral cavity cancer expected for Brazil for each year of the triennium 2020–2022 will be 11,180 cases in men and 4,010 in women. These values correspond to an estimated risk of 10.69 new cases per 100,000 men, occupying the fifth position. For women, it corresponds to 3.71 for every 100,000 women, being the thirteenth most frequent among all cancers (https://www.inca.gov.br/estimativa). Brazilian universities have paralyzed face-to-face activities and most oral health services, only attending emergencies (Martelli-Júnior et al., 2020). Thus, thinking about the numbers beyond those related to oral cancer, but in general, involving oral diseases, it is very evident the concern and urgent need of the country to think alternative ways to minimize present and future damage in a population strongly punished by the COVID-19 pandemic. Renato A Machado: Conceptualization; Data curation; Formal analysis; Funding acquisition; Investigation; Methodology; Project administration; Resources; Software; Supervision; Validation; Visualization; Writing-original draft; Writing-review & editing. Paulo Bonan: Conceptualization; Data curation; Formal analysis; Funding acquisition; Investigation; Methodology; Project administration; Resources; Software; Supervision; Validation; Visualization; Writing-review & editing. Petrônio Lima Martelli: Conceptualization; Data curation; Formal analysis; Funding acquisition; Investigation; Methodology; Project administration; Resources; Software; Supervision; Validation; Visualization; Writing-review & editing. Fabio Alves: Conceptualization; Data curation; Formal analysis; Funding acquisition; Investigation; Methodology; Project administration; Resources; Software; Supervision; Validation; Visualization; Writing-review & editing. Hercilio Martelli-Junior: Conceptualization; Data curation; Formal analysis; Funding acquisition; Investigation; Methodology; Project administration; Resources; Software; Supervision; Validation; Visualization; Writing-review & editing. The peer review history for this article is available at https://publons.com/publon/10.1111/odi.13624.

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