THE FUNDAMENTAL RIGHT TO ORAL HEALTH AND ITS JUDICIALIZATION IN THE BRAZILIAN STATE

Abstract

Objective: The objective of this study is to investigate the protection of the right to oral health as a fundamental human right, analyzing the legal demands on the subject, with the aim of understanding how the protection of oral health has occurred by the Brazilian Judiciary, as well as the parameters established by the courts. Theoretical Framework: The right to health, as a human right, was recognized for the first time in the 1948 Universal Declaration of Human Rights. It should be noted that human rights are indispensable for the debate regarding the guarantee of the right to qualified and safe oral health, with a direct relationship between general health, oral health and human dignity. Furthermore, the National Oral Health Policy of the Brazilian State, materialized in Law No. 14,572/2023, attributes to the Unified Health System (SUS) the competence to define the guidelines and standards for the physical and organizational structure of oral health services, serving as panel to reflect on its importance, which goes beyond the aesthetics of the smile, permeating essential aspects of the physical, mental and social health of human beings. Method: The methodology applied was the deductive method; As for the means of research, bibliographical methods were used, using doctrine, legislation and jurisprudence on the subject; Regarding the purposes, the research is understood as qualitative. Results and discussion: The results obtained revealed that, although oral health is a right constitutionally affirmed by the Brazilian State, given the implicit recognition as a social right in article 6 of the Magna Carta, the judicial route still stands out as an important instrument for its implementation. The need to implement greater protection, in practice, for oral health is evident, since, despite legislative developments to achieve this fundamental human right, there is a lack of concrete actions by the Executive Branch. Research Implications: The results of this work are of great relevance for the health of the Brazilian population, and the need to implement greater protection for oral health remains evident, since, despite legislative developments in Brazil and the world to expand the scope of this human right fundamental, there is a lack of concrete actions by the Executive Branch to implement social and economic policies guaranteed in art. 196 of the Federal Constitution. Originality/Value: This study contributes to the literature by demonstrating that the Judiciary, in the 21st century, continues to be constantly used as an alternative to implement the right to oral health, which demonstrates that this right still remains on the margins of general health and society. In this way, the jurisprudential survey carried out is of great relevance in the knowledge acquired that can contribute to the promotion of public policies aimed at oral health.

Alternate abstract:

Objetivo: O objetivo deste estudo é investigar a tutela do direito à saúde bucal como um direito humano fundamental, analisando as demandas judiciais acerca do tema, com o intuito de compreender como tem ocorrido a proteção à saúde bucal pelo Poder Judiciário brasileiro, bem como os parâmetros estabelecidos pelos tribunais. Referencial Teórico: O direito à saúde, como um direito humano, foi reconhecido pela primeira vez na Declaração Universal dos Direitos Humanos de 1948. Atente-se que os direitos humanos são indispensáveis para o debate a respeito da garantia do direito à saúde bucal qualificada e segura, havendo uma relação direta entre a saúde geral, a saúde bucal e a dignidade da pessoa humana. Ademais, A Política Nacional de Saúde Bucal do Estado brasileiro, materializada na Lei n° 14.572/2023, atribui ao Sistema Único de Saúde (SUS) a competência para definir as diretrizes e normas de estrutura física e organizacional dos serviços de saúde bucal, servindo como painel para reflexão sobre sua importância, a qual vai além da estética do sorriso, permeando aspectos essenciais da saúde física, mental e social do ser humano. Método: A metodologia aplicada foi o método dedutivo; quanto aos meios de pesquisa, utilizou-se o bibliográfico, com uso da doutrina, da legislação e da jurisprudência sobre o assunto; no tocante aos fins, a pesquisa compreendese como qualitativa. Resultados e Discussão: Os resultados obtidos revelaram que, embora a saúde bucal seja um direito constitucionalmente positivado pelo Estado Brasileiro, ante o implícito reconhecimento como direito social no artigo 6° da Carta Magna, a via judicial ainda se destaca como importante instrumento para sua concretização. Fica evidente a necessidade de se efetivar uma maior proteção, na prática, à saúde bucal, uma vez que, a despeito da evolução legislativa para o alcance desse direito humano fundamental, faltam ações concretas pelo Poder Executivo. Implicações da Pesquisa: Os resultados deste trabalho são de grande relevância para a saúde da população brasileira, restando evidente a necessidade de se efetivar uma maior proteção à saúde bucal, uma vez que, a despeito da evolução legislativa no Brasil e no mundo para ampliar o alcance desse direito humano fundamental, faltam ações concretas do Poder Executivo para a implementação de políticas sociais e econômicas garantidas no art. 196 da Constituição Federal. Originalidade/Valor: Este estudo contribui para a literatura ao demonstrar que o Poder Judiciário, em pleno século 21, continua sendo constantemente utilizado como alternativa para concretização do direito à saúde bucal, o que demonstra que esse direito ainda permanece à margem da saúde geral e da sociedade. Deste modo, o levantamento jurisprudencial realizado é de grande relevância no conhecimento adquirido que pode contribuir para fomento de políticas públicas direcionadas à saúde bucal.

Alternate abstract:

Objetivo: El objetivo de este estudio es investigar la protección del derecho a la salud bucal como derecho humano fundamental, analizando las demandas legales sobre el tema, con el objetivo de comprender cómo la protección de la salud bucal ha ocurrido por parte del Poder Judicial brasileño, así como como los parámetros establecidos por los tribunales. Marco teórico: El derecho a la salud, como derecho humano, fue reconocido por primera vez en la Declaración Universal de Derechos Humanos de 1948. Cabe señalar que los derechos humanos son indispensables para el debate sobre la garantía del derecho a una salud bucal calificada y segura. con una relación directa entre la salud general, la salud bucal y la dignidad humana. Además, la Política Nacional de Salud Bucal del Estado brasileño, materializada en la Ley n° 14.572/2023, atribuye al Sistema Único de Salud (SUS) la competencia de definir las directrices y normas para la estructura física y organizativa de los servicios de salud bucal, atendiendo como panel para reflexionar sobre su importancia, que va más allá de la estética de la sonrisa, permeando aspectos esenciales de la salud física, mental y social del ser humano. Método: La metodología aplicada fue el método deductivo; En cuanto a los medios de investigación, se utilizaron métodos bibliográficos, utilizando doctrina, legislación y jurisprudencia sobre el tema; En cuanto a los propósitos, la investigación se entiende como cualitativa. Resultados y Discusión: Los resultados obtenidos revelaron que, aunque la salud bucal sea un derecho constitucionalmente afirmado por el Estado brasileño, dado el reconocimiento implícito como derecho social en el artículo 6 de la Carta Magna, la vía judicial aún se destaca como un instrumento importante para su implementación. Es evidente la necesidad de implementar una mayor protección, en la práctica, de la salud bucal, ya que, a pesar de los avances legislativos para lograr este derecho humano fundamental, faltan acciones concretas por parte del Poder Ejecutivo. Implicaciones de la investigación: Los resultados de este trabajo son de gran relevancia para la salud de la población brasileña, y la necesidad de implementar una mayor protección de la salud bucal sigue siendo evidente, ya que, a pesar de los avances legislativos en Brasil y en el mundo para ampliar el alcance de este derecho humano fundamental, faltan acciones concretas por parte del Poder Ejecutivo para implementar las políticas sociales y económicas garantizadas en el art. 196 de la Constitución Federal. Originalidad/Valor: Este estudio contribuye a la literatura al demostrar que el Poder Judicial, en el siglo XXI, continúa siendo utilizado constantemente como una alternativa para implementar el derecho a la salud bucal, lo que demuestra que ese derecho aún permanece al margen de la salud general y de la sociedad. De esta manera, el relevamiento jurisprudencial realizado resulta de gran relevancia en los conocimientos adquiridos que pueden contribuir a la promoción de políticas públicas dirigidas a la salud bucal.

Headnote

ABSTRACT

Objective: The objective of this study is to investigate the protection of the right to oral health as a fundamental human right, analyzing the legal demands on the subject, with the aim of understanding how the protection of oral health has occurred by the Brazilian Judiciary, as well as the parameters established by the courts.

Theoretical Framework: The right to health, as a human right, was recognized for the first time in the 1948 Universal Declaration of Human Rights. It should be noted that human rights are indispensable for the debate regarding the guarantee of the right to qualified and safe oral health, with a direct relationship between general health, oral health and human dignity. Furthermore, the National Oral Health Policy of the Brazilian State, materialized in Law No. 14,572/2023, attributes to the Unified Health System (SUS) the competence to define the guidelines and standards for the physical and organizational structure of oral health services, serving as panel to reflect on its importance, which goes beyond the aesthetics of the smile, permeating essential aspects of the physical, mental and social health of human beings.

Method: The methodology applied was the deductive method; As for the means of research, bibliographical methods were used, using doctrine, legislation and jurisprudence on the subject; Regarding the purposes, the research is understood as qualitative.

Results and discussion: The results obtained revealed that, although oral health is a right constitutionally affirmed by the Brazilian State, given the implicit recognition as a social right in article 6 of the Magna Carta, the judicial route still stands out as an important instrument for its implementation. The need to implement greater protection, in practice, for oral health is evident, since, despite legislative developments to achieve this fundamental human right, there is a lack of concrete actions by the Executive Branch.

Research Implications: The results of this work are of great relevance for the health of the Brazilian population, and the need to implement greater protection for oral health remains evident, since, despite legislative developments in Brazil and the world to expand the scope of this human right fundamental, there is a lack of concrete actions by the Executive Branch to implement social and economic policies guaranteed in art. 196 of the Federal Constitution.

Originality/Value: This study contributes to the literature by demonstrating that the Judiciary, in the 21st century, continues to be constantly used as an alternative to implement the right to oral health, which demonstrates that this right still remains on the margins of general health and society. In this way, the jurisprudential survey carried out is of great relevance in the knowledge acquired that can contribute to the promotion of public policies aimed at oral health.

Keywords: Right to Oral Health, Human Rights, Judicialization of Oral Health, Law n° 14.572/2023, National Oral Health Policy.

RESUMO

Objetivo: O objetivo deste estudo é investigar a tutela do direito à saúde bucal como um direito humano fundamental, analisando as demandas judiciais acerca do tema, com o intuito de compreender como tem ocorrido a proteção à saúde bucal pelo Poder Judiciário brasileiro, bem como os parâmetros estabelecidos pelos tribunais.

Referencial Teórico: O direito à saúde, como um direito humano, foi reconhecido pela primeira vez na Declaração Universal dos Direitos Humanos de 1948. Atente-se que os direitos humanos são indispensáveis para o debate a respeito da garantia do direito à saúde bucal qualificada e segura, havendo uma relação direta entre a saúde geral, a saúde bucal e a dignidade da pessoa humana. Ademais, A Política Nacional de Saúde Bucal do Estado brasileiro, materializada na Lei n° 14.572/2023, atribui ao Sistema Único de Saúde (SUS) a competência para definir as diretrizes e normas de estrutura física e organizacional dos serviços de saúde bucal, servindo como painel para reflexão sobre sua importância, a qual vai além da estética do sorriso, permeando aspectos essenciais da saúde física, mental e social do ser humano.

Método: A metodologia aplicada foi o método dedutivo; quanto aos meios de pesquisa, utilizou-se o bibliográfico, com uso da doutrina, da legislação e da jurisprudência sobre o assunto; no tocante aos fins, a pesquisa compreendese como qualitativa.

Resultados e Discussão: Os resultados obtidos revelaram que, embora a saúde bucal seja um direito constitucionalmente positivado pelo Estado Brasileiro, ante o implícito reconhecimento como direito social no artigo 6° da Carta Magna, a via judicial ainda se destaca como importante instrumento para sua concretização. Fica evidente a necessidade de se efetivar uma maior proteção, na prática, à saúde bucal, uma vez que, a despeito da evolução legislativa para o alcance desse direito humano fundamental, faltam ações concretas pelo Poder Executivo.

Implicações da Pesquisa: Os resultados deste trabalho são de grande relevância para a saúde da população brasileira, restando evidente a necessidade de se efetivar uma maior proteção à saúde bucal, uma vez que, a despeito da evolução legislativa no Brasil e no mundo para ampliar o alcance desse direito humano fundamental, faltam ações concretas do Poder Executivo para a implementação de políticas sociais e econômicas garantidas no art. 196 da Constituição Federal.

Originalidade/Valor: Este estudo contribui para a literatura ao demonstrar que o Poder Judiciário, em pleno século 21, continua sendo constantemente utilizado como alternativa para concretização do direito à saúde bucal, o que demonstra que esse direito ainda permanece à margem da saúde geral e da sociedade. Deste modo, o levantamento jurisprudencial realizado é de grande relevância no conhecimento adquirido que pode contribuir para fomento de políticas públicas direcionadas à saúde bucal.

Palavras-chave: Direito à saúde bucal, Direitos humanos, Judicialização da saúde bucal, Lei n° 14.572/2023, Política Nacional de Saúde Bucal.

RESUMEN

Objetivo: El objetivo de este estudio es investigar la protección del derecho a la salud bucal como derecho humano fundamental, analizando las demandas legales sobre el tema, con el objetivo de comprender cómo la protección de la salud bucal ha ocurrido por parte del Poder Judicial brasileño, así como como los parámetros establecidos por los tribunales.

Marco teórico: El derecho a la salud, como derecho humano, fue reconocido por primera vez en la Declaración Universal de Derechos Humanos de 1948. Cabe señalar que los derechos humanos son indispensables para el debate sobre la garantía del derecho a una salud bucal calificada y segura. con una relación directa entre la salud general, la salud bucal y la dignidad humana. Además, la Política Nacional de Salud Bucal del Estado brasileño, materializada en la Ley n° 14.572/2023, atribuye al Sistema Único de Salud (SUS) la competencia de definir las directrices y normas para la estructura física y organizativa de los servicios de salud bucal, atendiendo como panel para reflexionar sobre su importancia, que va más allá de la estética de la sonrisa, permeando aspectos esenciales de la salud física, mental y social del ser humano.

Método: La metodología aplicada fue el método deductivo; En cuanto a los medios de investigación, se utilizaron métodos bibliográficos, utilizando doctrina, legislación y jurisprudencia sobre el tema; En cuanto a los propósitos, la investigación se entiende como cualitativa.

Resultados y Discusión: Los resultados obtenidos revelaron que, aunque la salud bucal sea un derecho constitucionalmente afirmado por el Estado brasileño, dado el reconocimiento implícito como derecho social en el artículo 6 de la Carta Magna, la vía judicial aún se destaca como un instrumento importante para su implementación. Es evidente la necesidad de implementar una mayor protección, en la práctica, de la salud bucal, ya que, a pesar de los avances legislativos para lograr este derecho humano fundamental, faltan acciones concretas por parte del Poder Ejecutivo.

Implicaciones de la investigación: Los resultados de este trabajo son de gran relevancia para la salud de la población brasileña, y la necesidad de implementar una mayor protección de la salud bucal sigue siendo evidente, ya que, a pesar de los avances legislativos en Brasil y en el mundo para ampliar el alcance de este derecho humano fundamental, faltan acciones concretas por parte del Poder Ejecutivo para implementar las políticas sociales y económicas garantizadas en el art. 196 de la Constitución Federal.

Originalidad/Valor: Este estudio contribuye a la literatura al demostrar que el Poder Judicial, en el siglo XXI, continúa siendo utilizado constantemente como una alternativa para implementar el derecho a la salud bucal, lo que demuestra que ese derecho aún permanece al margen de la salud general y de la sociedad. De esta manera, el relevamiento jurisprudencial realizado resulta de gran relevancia en los conocimientos adquiridos que pueden contribuir a la promoción de políticas públicas dirigidas a la salud bucal.

Palabras clave: Derecho a la salud bucal, Derechos humanos, Judicialización de la salud bucal, Ley n° 14.572/2023, Política Nacional de Salud Bucal.

1 INTRODUCTION

Oral diseases are among the most widespread non-communicable diseases in the world, estimated to affect, according to the latest World Health Organization (WHO) report on the topic, about 3.5 billion people, or almost half (45%) of the world population (WHO, 2022).

WHO defines oral health as the condition of the mouth, teeth and orofacial structures that allow people to perform basic functions, such as eating, breathing and speaking, highlighting that it also affects psychosocial dimensions, such as self-confidence, well-being and the ability to socialize and work without pain, discomfort or embarrassment (WHO, 2022). It is solar evidence that oral health varies throughout life, from the most tender to old age, being an inseparable part of general health, helping people to participate in society, with dignity, achieving a healthy quality of life (WHO, 2022).

There is no doubt that health is a fundamental and indispensable human right for the exercise of other human rights. In this way, every human being has the right to enjoy the highest level of health that enables him to live in dignity.

It so happens that health begins with the mouth. Besides being the largest cavity in the body to have contact with the external environment, it is the place where the first stage of digestion occurs. In this sense, oral health plays a crucial role in general well-being, transcending the mere aesthetics of smiling. In this talant, the right to oral health has a direct relationship with the enhancement of human dignity.

The present study seeks to demonstrate the protection of the right to oral health as a fundamental human right, analyzing both domestic law and international human rights treaties and conventions on the subject, as well as analyzing the role of the Judiciary in the demands that seek the implementation of this right in Brazil, understanding the possible parameters established by the courts of the homeland.

Therefore, the research problem can be summarized in the following question: to what extent have the difficulties of access to oral health promoted lawsuits for the realization and implementation of this fundamental human right?

The justification for the research stems from the current theme, especially in the light of the novel Política Nacional de Saude Bucal do Estado brasileiro [National Oral Health Policy of the Brazilian State], materialized in Law No. 14,572/2023, which attributes to the Unified Health System (SUS) the competence to define the guidelines and norms for the physical and organizational structure of oral health services, serving as a panel for reflection on its importance, which goes beyond the esthetics of smiling, permeating essential aspects of the physical, mental and social health of the human being.

2 THEORETICAL FRAME

The right to health, as a human right, was first recognized in the 1948 Universal Declaration of Human Rights. Health, as a right of all to enjoy full physical and mental enjoyment, is protected in Article 25 of the Declaration, in verbis (UN, 1948):

Every human being has the right to a standard of living capable of ensuring health, well-being for himself and his family, including food, clothing, housing, medical care and essential social services, and the right to safety in the event of unemployment, sickness, disability, widowhood, old age or other loss of livelihood in circumstances beyond his control, [griffon]

Today, the right to health presents a much broader concept. If, in the early days, health covered only the absence of a disease, nowadays it translates into the right to a better quality of life, focusing on disease prevention (Lamy; Roldan; Hahn, 2018).

In other words, the concept covers a better quality of life, the right to happiness7. It remains, therefore, the change of focus, which previously concentrated only on the absence of disease, that is, a negative concept, passing the protection of the physical, psychic, social and cultural well-being of men, seeing this expansion of the concept by the documents and international treaties themselves (Lamy;Roldan; Hahn, 2018).

Health, therefore, is a right that tends to expand, since "technological scientific evolution has raised the minimum levels of enforceability for what should be considered a dignified life for every citizen" (Lamy; Roldan; Hahn, 2018, p. 45). The right to health encompasses both individual and collective health and, for this reason, is an asset of all humanity, a founding and most personal constitutional right, as well as an internationally recognized human right, in that it allows for the existence of all other rights (Lamy; Roldan; Hahn, 2018).

Summarizes the lesson, Veda Parro and André Guerrero (2016, p.109):

The right to health is part of the orbit of constitutionally guaranteed social rights, which is a subjective public right. In the ethical and legal field, the right to health is considered a human right, positioned in the Brazilian legal system as a fundamental right

In 1945, the Brazilian physician Geraldo Horacio de Paula Souza proposed, with the Chinese diplomat SzemingSze, the creation of a UN entity aimed at international health. It should be noted that the doctor and the diplomat were, respectively, members of the delegations of Brazil and China at the Conference that gave rise to the UN (D'avila, 2020).

In April 1948, as a result of this initiative, the World Health Organization - WHO was created, an intergovernmental agency linked to the UN, specialized in health and decentralized regionally, since its regional offices have discretionary authority in relation to the headquarters in Geneva, working directly with the Ministries of Health of each country, in the regions in which they operate (Moreira, Santos e Souza, 2020). The agency "works with 194 member states through more than 150 representations around the world" (Moreira, Santos and Souza, 2020, p. 112).

It should be noted that the world's oldest international public health organization, founded in 1902, is the Pan American Health Organization (РАНО), which is part of the Latin American context of health management. Subsequently, it began to function as an agency specialized in health of the inter-American system, being a regional office of the WHO for the Americas, acting in promoting the health and quality of life of the populations of this continent (Moreira, Santos e Souza, 2020). Therefore, even though it was founded in 1902, before the World Health Organization, OPS is considered a daughter agency of WHO.

The aim of the WHO is to achieve the highest possible level of health for all people. For both the WHO and the UN, the right to health is an inclusive right because, "besides being related to access to health care and the construction of hospitals, it comprises a wide range of factors that can contribute to a healthy life" (Lamy; Roldan; Hahn, 2018, p.49)

It should be borne in mind that human rights are essential to the debate on guaranteeing the right to qualified and safe oral health. This is because there is a direct relationship between general health, oral health and human dignity (Martinez, 2017). Oral diseases are among the most widespread non-communicable diseases in the world, estimated to affect, according to the latest WHO report on the topic, about 3.5 billion people, almost half (45%) of the world population (WHO, 2022).

In this line, it is worth highlighting the initiatives adopted by the WHO in advising, planning, analyzing and summarizing data, which has proved extremely useful in epidemiological studies of oral health, stimulating the establishment of standards to be adopted by countries (Oliveira et al, 1998).

The WHO presented its first survey of data specifically on oral health in 1961, through a document prepared by the WHO Expert Committee on DentalHealth8 (Oliveira et al, 1998). In this document "the WHO's concern to establish standards for international uniformity was already made explicit, in order to facilitate the comparability of the data" (Oliveira et al, 1998, p. 178).

In 1978, the International Conference on Primary Health Care, meeting in Alma-Ata, capital of the Republic of Kazakhstan, drafted the Alma-Ata Declaration on Primary Care, expressing the need for urgent action by all governments in promoting the health of all peoples of the world, and incorporating oral health into the vision of international bodies in the Health for All agenda (Parro; Guerrero, 2016).

Highlights the Alma-Ata Declaration on Health as a Fundamental Human Right (WHO, 1978, p.l):

I - The Conference emphatically reaffirms that health - a state of complete physical, mental and social well-being, and not simply the absence of disease or infirmity - is a fundamental human right, and that achieving the highest possible level of health is the world's most important social goal, the achievement of which requires the action of many other social and economic sectors in addition to the health sector, [griffon]

The appeal launched in Alma-Ata was a key milestone and represented the starting point for other initiatives. However, "there was a great time before the topic of oral health was part of the health conferences" (Moreira, Santos and Souza, 2020). In Brazil, for example, only in 1986 did oral health have its own Conference, the 1st. National Conference of Oral Health (Moreira, Santos and Souza, 2020).

Promulgated in 2005, the Liverpool Declaration was drawn up by the WHO in partnership with the International Association for Dental Research (IADR.), the European Association for Dental Public Health (EADPH) and the British Association for the Study of Community Dentistry (BASCD). This Declaration incorporates the precepts of the theoretical-normative reference of the right to health, detailed by the Committee on Economic, Social and Cultural Rights, and expresses, in its preamble, oral health as a human right (Freitas; Queluz, 2020).

It is necessary to score, still, that in the 60th. The World Health Assembly, held in 2007, oral health was placed as an essential part of general health (Martinez, 2017).

Also in 2007, the International Dental Federation (IDF)9, a non-governmental and non-profit organization working with the UN and WHO on oral health lssues'establlshed March 20 as World Oraiio Health Day. The current FDI campaign, covering the three-year period 2024-2026, has as its theme "A happy mouth is... a happy bodyV'u, representing the multifaceted nature of oral health, i.e. raising awareness among the population about the relevance of oral care and the understanding of its relationship with health in an integral way (WDF, 2024).

In 2015, the United Nations established actions until 2030, which are divided into 17 Sustainable Development Goals (SDGs) and 169 goals, built on the legacy of the Millennium Development Goals. Among these, the number 3, which is to ensure healthy life and well-being for all, which obviously includes oral health (UN, 2015), stands out.

In 2021, the World Health Assembly adopted a landmark resolution on oral health. For the first time, WHO members agreed that oral health should be on the NCD agenda and that NCD policies should be included in universal health coverage programs (WHO, 2022).

The following year, 2022, the WHO published its latest study on oral health. Available only in English and Spanish, the Report on La situación Mundial de La salud bucodental12 presents in detail the development and adoption of a Comprehensive Global Strategy on Oral Health, with the bold aspiration to achieve universal coverage of oral health services by 2030 (WHO, 2022).

In this Report, it was noted that oral diseases are among the most widespread non-communicable diseases worldwide, especially in low- and middle-income countries, and that vulnerable populations are more likely to suffer from oral diseases and their consequences (WHO, 2022). In the preface to the report (WHO, 2022, p.v), signed by the Director General of the WHO, it was noted:

Oral health has been largely neglected in global health programs.Our oldest challenge right now is to ensure that all people, wherever they live and whatever their income, have the tools and knowledge to care for their teeth and mouth and access prevention and care when they need it.For this to happen, all countries must have sufficient resources, trained oral health personnel and oral services included in national health coverage plans, free of charge or at an affordable13 price, [free translation]

The clear conclusion of the report is that the overall oral health situation is alarming and requires urgent action. The report serves as the basis for the states to adopt public policies directed towards oral health, besides allowing the monitoring of the effectiveness or otherwise of the adopted policies, since it provides a unique vision of the key areas and oral health markers that are relevant for the decision makers (WHO, 2022).

Prioritization of oral health in the global, regional and national contexts is therefore necessary.

2.1 JUDICIALIZATION FOR DENTAL TREATMENT IN BRAZIL

The implementation of health as a fundamental right in the Brazilian legal system is affirmed in Law No. 8,080, of September 19, 1990 (Brazil, 1990), known as the "Organic Law of Health".

Even if the law gives the State the obligation to provide the conditions necessary for the full exercise of the right, this duty does not exempt persons, the family, companies and society from also providing their rights, thus covering the activity carried out by both natural and legal persons, whether under public or private law.

It was through Law No. 14,572, of May 8, 2023, that the National Oral Health Policy was instituted in the Unified Health System (SUS), besides the significant amendment of Law No. 8,080/2023, cited in the previous paragraph, being instituted four guidelines.

The first of them is the inclusion, within the scope of the SUS, of the implementation of oral health actions, in accordance with Article 6, paragraph I, letter "e", of Law No. 8,080/1990. The second guideline concerns the definition of the term "oral health", in Article 6, paragraph 4, of Law 8.080/1990, as follows (Brazil, 1990):

§ 4° Oral health is defined as the set of actions, at all levels of complexity, aimed at ensuring promotion, prevention, recovery and dental rehabilitation, both individual and collective, in the context of the whole of health care.

The third guideline corresponds to the attribution, to the national direction of the SUS, to define the guidelines and norms for the physical and organizational structure of oral health services. The fourth and last guideline deals with the complementary competence of the SUS State Board for the coordination and, in a complementary nature, "the implementation of actions and services" of oral health, in accordance with article 17, paragraph IV, point "e", as well as the municipal direction of the SUS regarding the "execution" of oral health services, provided in article 18, paragraph IV, point "f, of Law No. 8.080/1990 (Brazil, 1990).

It is important to highlight that in the Proposition of Senate Bill 8/2017 (BRAZIL, 2017), converted into Law 14.572, of May 8, 2023 (Brazil, 2023), the National Policy of Attention to Oral Health was instituted, which is nothing more than the set of guidelines to guide actions aimed at the social production of oral health at all levels of health care.

The Opinion of the Legislative Commission (Brazil, 2017), when analyzing the Bill, corroborates the understanding of the author of the project, in which the Policy needs to "evolve" into a policy of State, and not of government, since it would always be subject to conjunctural variations and the discretion of the public administrator, based on previous experiences that weakened actions over the years.

2.2 THE DIFFICULTY OF EXTRACTING DATA FROM THE BRAZILIAN JUDICIARY RELATED TO DENTAL TREATMENT AND ORAL HEALTH DEMANDS

As the country's courts adopt the System of Management of Unified Procedural Tables (CNJ, 2024), managed by the National Council of Justice (CNJ), the survey of jurisprudential understandings began with the consultation of the Panel of Procedural Statistics (CNJ, 2024) that, despite allowing the search of cases for several fundamental rights, such as the right to health, does not detail the judicial actions related to the subject "Oral Health".

Consequently, the bulletins were searched with the details of the changes in the unified procedural tables, with registration until 30 November 2023, finding only the subject "Medical-Hospital Assistance", linked to Law No. 6.880, of December 9, 1980, which provides for the Statute of the military, without any mention of a subject related to the Organic Law of Health and oral health.

As the research did not detect legal actions focusing on oral health as a fundamental right, even due to the entry into force, on August 7,2023, of Law 17.572/2023, judicial demands related to compensation for material and moral damages for the execution of civil services and security warrants were found due to the requirement of admission requirements for public tender. Having said that, we went on to analyze the lawsuits with the subject "dental assistance".

We also analyzed the Statements on Health Law of the National Forum of the Judiciary for Health (FONAJUS), available on the portal of the National Council of Justice (CNJ, 2024).

In the same understanding of the research presented in this article, the multidisciplinary character to support judicial decisions has the collaboration of the Technical Support Centers of the Judiciary (NATJUS), created by CNJ Resolution No. 238/2016 (CNJ, 2016), which allowed the creation of the National Bank of Opinions and Technical Notes, including with area of access to public information (e-NatJus, 2024).

Although oral health was included in the Organic Health Law in 2023, the following will highlight decisions of collegiates that consolidate the understanding that it is a fundamental right.

3 METHODOLOGY

Science as programmed, systematic and methodical knowledge has as its central objetive the search for the truth about things. Reasons and techniques used by science can be identified and the steps taken to the final result can be verified. The methodologies present a consistent logical character for basing a research.

Thus, the method would be the path we take to achieve a certain end. About the scientific method, Mezzaroba and Monteiro assert that it is: "the path followed by scientists in pursuit of their desired investigative results" (2017, p.50).

Thus, science is not done without a method, since the scientist needs a safe route for developing his studies. One can therefore classify such methods as: inductive, deductive, hypothetical-deductive, dialectical, and systemic. These methods are considered primordial and mutually exclusive in the research activity, but besides these there are auxiliary methods, which fulfill strategic function. Using auxiliary methods, the researcher is trying to guarantee the necessary objectivity for the treatment of the researched things in question.

The present research used as an approach the hypothetical-deductive method, since it starts from a true premise (the right to health as a human and fundamental right) to seek a rational logical conclusion and as a method of procedure the historical, which consists in investigating past events, processes and institutions to verify the influence on today's society (biodiversity), besides materializing, in a certain part, the comparative method, which aims to make comparisons, with the purpose of verifying similarities and explaining divergences.

As for the purpose, it is applied; as for the objective, it is descriptive; as for the approach, it is qualitative; as for the procedures, it is bibliographic and documentary, using doctrine, legislation and jurisprudence on the subject, besides journals and scientific articles.

4 RESULTS AND DISCUSSIONS

The Judiciary has been constantly sued as an alternative to the realization of the right to oral health, highlighting the content of these judicial decisions, especially as regards the criteria used for granting or not granting the claims. It should be stressed, first of all, that the reflections of this fact must be analyzed beyond the individual benefited, since they involve the whole of society.

4.1 LEGAL ACTIONS DEALING WITH REQUIREMENTS FOR APPROVAL IN A PUBLIC TENDER PROCEDURE

Indirectly, oral health is important in public calls for tenders that require candidates to prove their oral health, but this violates other fundamental rights, such as intimacy and the person's own image, according to the judgments considered to be of paramount importance in order to prove the need to analyze the fundamental right to oral health together with other fundamental rights:

CONSTITUTIONAL AND ADMINISTRATIVE. CIVIL PROCEEDINGS. REGULATORY STANDARDS FOR ENTRY AND HEALTH INSPECTIONS IN THE BRAZILIAN ARMY - ORDINANCE NO. 41-DEP/2005, AMENDED BY ORDINANCE NO. 119-DEP/2008. JOINING THE MILITARY CAREER. MINIMUM HEIGHT AND ORAL HEALTH REQUIREMENT. SUMMARY EXCLUSION OF CANDIDATES WITH AUTOIMMUNE, IMMUNODEPRESSIVE OR SEXUALLY TRANSMITTED DISEASE. INFRINGEMENT OF THE PRINCIPLE OF LEGAL RESERVE. DISCRIMINATION CONFIGURED. MEDICAL TESTS FOR SYPHILIS AND HIV. POSSIBILITY [...] II - The summary exclusion of candidates in selection processes for the staff of the Brazilian Army, due to height limitation, oral health hygiene and to being carriers of autoimmune, immunodepressant or sexually transmitted disease, constitutes discriminatory and unreasonable conduct, incompatible with the current legal order, since such ailments do not lead to an automatic incapacity for the work. Precedents. [,..].(TRF 1st Region: Public Civil Action 0025111-54.2010.4.01.3400; Rapporteur (a): FEDERAL JUDGE Souza Prudente; Trial Body: 5th Class; Judgment Date: 11/03/2015; Registration Date: 11/03/2015)

APPEAL. OPEN COMPETITION. DISMISS THE IMMEDIATE APPLICATION. OPEN COMPETITION. CLAIM TO THE OFFICE OF SOLDIER PM 2ND CLASS. FAILURE OF A MEDICAL EXAMINATION. Elimination criteria provided for in the public notice. Oral health. Requirement of absence of caries. Reason for deletion. Existence of caries. Unreasonable demand. Judicial control. Discriminatory criterion requiring legal prediction. Not in competition. It is essential to observe the limits of discretion in order to establish the basis of the competition and the criteria for judgment. Breach of the principle of legality. There is no law providing for the absence of caries as a criterion to be observed for entry into the State Military Police. Unlawfulness of the notice of formal notice and, consequently, unlawfulness of the act which led to the candidate's exclusion. Precedents of the TJSP and the STJ. Grant the immediate application. Reform of the judgment. APPEAL PROVIDED. (TJSP; Civil Appeal 1003073-76.2015.8.26.0053; Rapporteur (a): José Maria Cámara Junior; Judicial Body: 9th Chamber of Public Law; Foro Central - Fazenda Pública/Accidents - 5th Court of Public Treasury; Date of Trial: 12/08/2015; Date of Registration: 13/08/2015)

As can be seen from the case-law analysis, the possibilities of access to information are making a difference, since at present a large number of candidates are aware of their rights during competitions. Thus, any misconception or irregularity in the process can be the subject of judicial proceedings.

However, it is clear that there are still many doubts about how to operationalize the right to oral health, when it ends up being used as a tool of social exclusion, leading to undue conduct by the banks and damaging the candidate.

4.2 LEGAL PROCEEDINGS RELATING TO THE CONSUMER'S RIGHT TO ORAL HEALTH

The research sought jurisprudential understandings within the framework of the Amazonas State Court, with the subject "oral health". What has been found is related to lawsuits such as a safety warrant to ensure the appointment in public tender for specific position of health professional, or civil lawsuits with request for early protection of urgency, for poor provision of dental services that generated several problems in oral health.

It is worth highlighting the prevalence of lawsuits for dental error filed against private institutions providing services, where the right to health was based on actions involving oral health. Although the main ground contested by the defendants is the absence of any unlawful act committed, since the negative coverage of the treatment requested by the author occurred because of the absence of specific forecast in mandatory role of the NS A, the Amazon Court follows the same understanding of the Supreme Court (STJ), in the sense that the list of procedures discriminated in Resolution RN 465/21-ANS (ANS, 2024) is merely illustrative, as follows:

INTERNAL AGGRAVATION IN THE AGGRAVATION ON SPECIAL APPEAL. ACTION FOR COMPENSATION FOR MATERIAL AND NON-MATERIAL DAMAGE. 1. TREATMENT PRESCRIBED BY THE DOCTOR. ABUSIVE CONDUCT. UNDUE NEGATIVE COVERAGE. PRECEDENTS. SUMMARY 83/STJ. 2. LIMITATION OF THERAPY SESSIONS AND COLLECTION OF CO-PARTICIPATION. NO PREQUESTIONING. INCIDENCE OF SUMMARY 211/STJ. 3. INTERNAL AGGRAVATION IMPROVED. 1. Indeed, the case-law of this Superior Court has already established the understanding that "the negative treatment indicated by the health professional as necessary for the health and cure of disease actually covered by the health plan contract is not acceptable". And 'the fact that any medical treatment is not included in the list of procedures of the NS A does not mean, per se, that its provision cannot be required by the insured person, since, in the case of an illustrative list, the refusal to cover the medical procedure whose illness is provided for in the contract concluded would imply the adoption of an interpretation that is less favorable to the consumer' [...] (Aglnt no AREsp 1.471.762/DF, Rei. Minister MARCO AURELIO BELLIZZE, THIRD CLASS, judged on 23/03/2020, Die 30/03/2020).

INTERNAL AGGRAVATION IN THE SPECIAL APPEAL. CIVIL PROCEDURE. HEALTH PLAN. COVERAGE NEGATIVE. ANS ROLL. EXAMPLE. ... 2. The list of NS A procedures is merely illustrative, and the negative nature of the health plan's coverage of the treatment deemed appropriate to safeguard the patient's health and life is abusive. 3. Internal aggravation not provided. (STI - Aglnt no REsp: 1882735 SP 2020/0164233-5, Rapporteur: Minister RICARDO VILLAS BOAS CUEVA, Judgment Date: 08/02/2021, T3 - THIRD CLASS, Publication Date: DJe 12/02/2021)

It is a corollary to the understanding that the protection of oral health is guaranteed by the right to health, and that the contractually guaranteed interest for the health plan cannot suppress other constitutionally guaranteed fundamental rights in the arts. 5, 196 and 197 of the Federal Constitution.

It is also worth noting that although the right to oral health is currently positioned in a legal norm, one cannot commit abusiveness in the amount requested for the damages suffered, since even if they are relevant, they must meet the punitive and pedagogical purposes of the penalty, without representing unjust enrichment.

In the lawsuits brought, besides the request for early protection for oral health to be immediately restored, there are requests for values much higher than what the courts understand, being generally fixed between R $ 3 to R $ 5 thousand reais the quantum compensation of moral damages. As for aesthetic damage, the understanding is that only after the performance of repair services is it possible to measure what damage has been achieved.

The setting of the compensatory quantum should be based on the principles of reasonableness and proportionality, aiming at arbitration of an appropriate value to both compensate for the non-material damage suffered by the victim and to discourage the service provider from performing similar acts in the future. If we don't see:

Menenta: UNNAMED RESOURCE. CONSUMER LAW. SERVICE DELIVERY FAILED. FIRST DEGREE MATERIAL DAMAGE GRANTED. NON-MATERIAL DAMAGE DISMISSED AT THE FLOOR. THE AUTHOR'S INSURGENCY FOR MORAL DAMAGE. KNOWN AND PROVIDED RESOURCE. SENTENCE PARTIALLY REFORMED. [...]. - However, the non-material damage resulting from the failure to provide a service is admittedly in re ipsa, that is to say, it occurs simply because the event occurs, without there being any need to demonstrate its effects on the victim, so the obligation to compensate is present. However, it is easy to visualize the occurrence of said damage, when one observes the frustration in being at risk of losing an investment of time, money and also the sacrifice of 04 years of dedication to oral health improvement and aesthetic that directly influence self-esteem, factor this linked directly to personality. [...]. (Civil Appeal No. 0618868-20.2022.8.04.0001; Rapporteur (a): Francisco Soares de Souza; District: Manaus/AM; Court: 1st Class Recursal; Date of judgment: 15/05/2023; Date of registration: 15/05/2023)

It should be pointed out, after analyzing the decisions transcribed, that the authors of the lawsuits consider, in a mistaken manner, that the health plans or the SUS should cover any type of services that they intend to use, since there are a large number of judicial demands aiming at full coverage of the dental treatment.

Although the case-law has consistently held that the list of products and services is merely illustrative, important guidance and awareness of the treatments to be carried out, as well as of the materials and services available on the market, should be made available to consumers/customers during the first dental care, highlighting which ones are covered by the plan. In this way, it is possible to choose the material that best meets the consumer's expectations and budget. In this way, the unnecessary adjudication of judicial claims is avoided.

In addition, the transparency of information about the wide range of materials that can be used in the service should be considered in the dental relationship between the service provider and the consumer.

Finally, the use of the balancing of interests method should be punctuated, particularly as regards the setting of non-material damage values. The Amazonas State Court, for example, usually highlights the non-feasibility of setting exorbitant values, since it considers the risk to the continuity of the legal person providing the services.

5 CONCLUSION

Just as human rights have as an international legal landmark the Universal Declaration of Human Rights, in 1948, it is worth highlighting that in the same year the World Health Organization (WHO) was created, with the purpose of achieving the highest degree of inclusion of health for all human beings, that is, the universalization of health, a principle adopted by Brazil in its constitutional text.

Healthy life for all should prioritize preventive oral health actions, since WHO studies have pointed out oral diseases present mainly in vulnerable populations in low and middle income countries.

Law No. 14,572, of May 8, 2023, included, in the Organic Health Law - Law No. 8,080/1990, competence of the Brazilian Unified Health System - SUS to define the guidelines and norms of physical and organizational structure of oral health services. As it is a law that entered into force on August 7, 2023, that is, less than 1 year ago, there is no precise statistical data of the judicial demands registered with the subject "Oral Health", which should soon have the updated theme in the System of Unified Procedural Tables of the National Council of Justice.

Despite the lack of precise statistical information on the topic of "oral health", from the analysis of the jurisprudential framework presented, it is apparent the need to base the initial petitions with the novel legislation that defines the concept of oral health in the organic law of health and inserts it as a fundamental right, so that there is a greater probability of the demands achieving success, mainly as to the understanding of granting the emergency protection for immediate execution of the dental treatment necessary to the recovery of personality and return of the social living of the person, as well as the use of the NatJus system for obtaining technical opinions that can support the judicial decisions, because the cost of expertise makes it difficult all real access to justice.

The fight for the right to oral health, for the SUS and for social policies that guarantee well-being and quality of life for all, is part of a global arc of citizenship rights, directly linked to democracy. In this regard, in relation to oral health in the Brazilian state, it was observed that the most important achievement is the irreversibility of oral health as an essential human right and citizenship right, since it is included in the list of SUS policies.

In the end, it is concluded that, although oral health is a constitutionally positive right by the Brazilian State, in view of the implicit recognition as a social right in Article 6 of the Magna Carta, the judicial way still stands out as an important instrument for its realization. It is clear, therefore, the need to provide greater protection to oral health, since, despite legislative developments in Brazil and in the world to extend the reach of this fundamental human right, there is a lack of concrete actions by the Executive Branch to implement social and economic policies guaranteed in Article 196 of the Federal Constitution.

The Judiciary, in the 21st century, continues to be used as an alternative for the realization of the right to oral health, which shows that this right still remains on the margins of general health and society.

Footnote

7 The United Nations recognized happiness as a right in its 2011 General Assembly Resolution, when it called upon nations to strive to extend society's overall happiness

8 Translation: WHO Expert Committee on Oral Health

9 World Dental Federation

10 World Oral Health Day

11 A happy mouth represents... a happy body!

12 Translation: Report on the Global Situation of Oral Health

13 In the original, in Spanish: La salud bucodental has been largely unattended in the worldwide salud programs. Nuestro mayor recto enestos moments is to ensure that all the personas, dondequiera que vivan y cualesquiera que sean sus tickets, tengan wools herramientas y conocimientos necessary to take care of your dients y bocas, y acceder a prevención y cares cuando los necesiten. For ello sea así, all the countries debentener enough personal trained in salud bucodental y los servicios bucodentales deben be included in los planes nationales de coverage de salud, free of charge or to a precious asequible.

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