Abstract

This article proposes a reflection on the imperative of antiracism in collective oral health, which, as a science, field, core, and praxis, contributes significantly to the reconstruction of an ethos that considers equity and enables citizenship and democracy. As a paradigm, we assumed the concept of “Buccality” and the guidelines of the National Comprehensive Health Policy for the Black Population, emphasizing the defense of the right to health as a prerogative of the right to life and the combat against racism and all forms of discrimination systematically. As a critical exercise, we discussed the status quo of collective oral health. We pointed to adopting a racial pro-equity perspective as an intentional, political choice socially agreed upon with all of society for social justice. Finally, we propose recommendations for dismantling systemic racism in collective oral health.

Key words:
Black people; Oral Health; Systemic racism

Introduction

In Brazil, the 1988 Constitution provides health to everyone indiscriminately as an inalienable, non-market, universal, comprehensive, and equitable right¹1 Brasil. Constituição da República Federativa do Brasil de 1988. Diário Oficial da União 1988; 5 out.. Oral health is an indicator for all generations, a metric for quality of life²2 Peres MA, Macpherson LMD, Weyant RJ, Daly B, Venturelli R, Mathur MR, Listl S, Celeste RK, Guarnizo-Herreño CC, Kearns C, Benzian H, Allison P, Watt RG. Oral diseases: a global public health challenge. Lancet 2019; 394(10194):249-260. and evaluating health systems³3 Watt RG, Daly B, Allison P, Macpherson LMD, Venturelli R, Listl S, Weyant RJ, Mathur MR, Guarnizo-Herreño CC, Celeste RK, Peres MA, Kearns C, Benzian H. Ending the neglect of global oral health: time for radical action. Lancet 2019; 394(10194):261-272.^,44 Wang TT, Mathur MR, Schmidt H. Universal health coverage, oral health, equity and personal responsibility. Bull World Health Organ 2020; 98(10):719-721., including the Unified Health System (Sistema Único de Saúde, SUS)⁵5 Pucca GA, Gabriel Jr M, Araujo ME, Almeida FCS. Ten Years of a National Oral Health Policy in Brazil. J Dent Res 2015; 94(10):1333-1337.. In this sense, good oral health is an indicator of citizenship¹1 Brasil. Constituição da República Federativa do Brasil de 1988. Diário Oficial da União 1988; 5 out..

The report on the oral health condition of the population at a global level, published in November 2022 by the World Health Organization⁶6 Word Health Organization (WHO). Non-communicable diseases WHO team. Global oral health status report: towards universal health coverage for oral health by 2030 [Internet]. 2022 [cited 2023 maio 1]. p. 8. Available from: https://www.who.int/teams/noncommunicable-diseases//global-status-report-on-oral-health-2022.
https://www.who.int/teams/noncommunicabl... , reviewed the data on the oral health condition at a global level. It showed that oral diseases rank high in the causes of illness due to NCDs, affecting approximately half of the world’s population (45% or 3.5 billion people worldwide)⁷7 Word Health Organization (WHO). Non-communicable diseases WHO team. Global oral health status report: towards universal health coverage for oral health by 2030 [Internet]. 2022 [cited 2023 maio 1]. p. 15. Disponível em: https://www.who.int/teams/noncommunicable-diseases//global-status-report-on-oral-health-2022.
https://www.who.int/teams/noncommunicabl... . Populations in situations of greater social vulnerability, such as racialized groups or minorities, are the most affected, and this is also observed in Brazil⁸8 Fagundes MLB, Bastos LF, Amaral Júnior OLD, Menegazzo GR, Cunha ARD, Stein C, Iser BPM. Desigualdades socioeconômicas no uso de serviços odontológicos no Brasil: uma análise da Pesquisa Nacional de Saúde de 2019. Rev Bras Epidemiol 2021; 24:e210004..

Black people are seen as different⁹9 Kilomba G. Desobediências poéticas. Curadoria Jochen Volz e Valéria Piccoli. São Paulo: Pinacoteca de São Paulo; 2019. and, because this difference is problematic, they are left outside the power structures where the system is used to define everything, blocking spaces and narratives⁹9 Kilomba G. Desobediências poéticas. Curadoria Jochen Volz e Valéria Piccoli. São Paulo: Pinacoteca de São Paulo; 2019., conditions that evidence systemic racism⁹9 Kilomba G. Desobediências poéticas. Curadoria Jochen Volz e Valéria Piccoli. São Paulo: Pinacoteca de São Paulo; 2019.. Furthermore, like a lethal virus, permanently reissued and with global coverage¹⁰10 Paim P. Sobre 20 de novembro: com racismo, não há democracia [Internet]. Nexo Jornal, Coluna Tribuna; 2020 [acessado 2023 jan 7]. Disponível em: https://www.nexojornal.com.br/colunistas/tribuna/2020/Sobre-20-de-novembro-com-racismo-n%C3%A3o-h%C3%A1-democracia., in its institutional, interpersonal, and internalized¹¹11 Jones CP. Confronting institutionalized racism. Phylon 2003; 50(1-2):7-22.^,1212 Werneck J. Racismo institucional e saúde da população negra. Saude Soc 2016; 25(3):535-549. multidimensionality, racism is characterized as another global public health issue¹³13 Ford CL. CDC Director Declares Racism a Public Health Issue - My Initial Reflections [Internet]. Center for the Study of Racism, Social Justice & Health; 2021 [cited 2023 jan 07]. Available from: https://www.racialhealthequity.org/blog/2021/4/9/cdc-director-declares-racisma-public-health-issue-my-initial-reflections.^,1414 Eschner K. Racism is undeniably a public health issue [Internet]. Popular Science; 2020. [cited 2023 ago 9]. Available from: https://www.popsci.com/story/health/racism-public-health/.
https://www.popsci.com/story/health/raci... , violates rights to health and life and makes democracy unfeasible¹⁵15 Coalizão Negra por Direitos. Manifesto: "Enquanto houver RACISMO, não haverá DEMOCRACIA" [Internet]. Geledés; 2020 [acessado 2023 jan 7]. Disponível em: https://www.geledes.org.br/manifesto-enquanto-houver-racismo-nao-haverademocracia/.
https://www.geledes.org.br/manifesto-enq... . As a system, racism materializes by naturalized illness and normalized death, the lack of even fragility of effective public policies for racially marginalized populations over time¹⁰10 Paim P. Sobre 20 de novembro: com racismo, não há democracia [Internet]. Nexo Jornal, Coluna Tribuna; 2020 [acessado 2023 jan 7]. Disponível em: https://www.nexojornal.com.br/colunistas/tribuna/2020/Sobre-20-de-novembro-com-racismo-n%C3%A3o-h%C3%A1-democracia.

11 Jones CP. Confronting institutionalized racism. Phylon 2003; 50(1-2):7-22.

12 Werneck J. Racismo institucional e saúde da população negra. Saude Soc 2016; 25(3):535-549.

13 Ford CL. CDC Director Declares Racism a Public Health Issue - My Initial Reflections [Internet]. Center for the Study of Racism, Social Justice & Health; 2021 [cited 2023 jan 07]. Available from: https://www.racialhealthequity.org/blog/2021/4/9/cdc-director-declares-racisma-public-health-issue-my-initial-reflections.

14 Eschner K. Racism is undeniably a public health issue [Internet]. Popular Science; 2020. [cited 2023 ago 9]. Available from: https://www.popsci.com/story/health/racism-public-health/.
https://www.popsci.com/story/health/raci...

15 Coalizão Negra por Direitos. Manifesto: "Enquanto houver RACISMO, não haverá DEMOCRACIA" [Internet]. Geledés; 2020 [acessado 2023 jan 7]. Disponível em: https://www.geledes.org.br/manifesto-enquanto-houver-racismo-nao-haverademocracia/.
https://www.geledes.org.br/manifesto-enq...

16 Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional por Amostra de Domicílios Contínua (PNAD) [Internet]. Rio de Janeiro: IBGE; 2023 [acessado 2023 ago 7]. Disponível em: https://www.ibge.gov.br/estatisticas/sociais/populacao/17270-pnad-continua.html?=&t=notas-tecnicas.^-1717 Instituto Brasileiro de Geografia e Estatística (IBGE). Desigualdades sociais por cor ou raça no Brasil. Estudos e Pesquisas. Informação Demográfica e Socioeconômica. 2ª ed. Rio de Janeiro: IBGE; 2022. who are left to their own devices and blamed and stigmatized.

The denial of racism is camouflaged in the mistaken concept of racial democracy, the narcissistic pact of whiteness, and the production of oppression, neglect, and annihilation⁹9 Kilomba G. Desobediências poéticas. Curadoria Jochen Volz e Valéria Piccoli. São Paulo: Pinacoteca de São Paulo; 2019.^,1313 Ford CL. CDC Director Declares Racism a Public Health Issue - My Initial Reflections [Internet]. Center for the Study of Racism, Social Justice & Health; 2021 [cited 2023 jan 07]. Available from: https://www.racialhealthequity.org/blog/2021/4/9/cdc-director-declares-racisma-public-health-issue-my-initial-reflections.

14 Eschner K. Racism is undeniably a public health issue [Internet]. Popular Science; 2020. [cited 2023 ago 9]. Available from: https://www.popsci.com/story/health/racism-public-health/.
https://www.popsci.com/story/health/raci... ^-1515 Coalizão Negra por Direitos. Manifesto: "Enquanto houver RACISMO, não haverá DEMOCRACIA" [Internet]. Geledés; 2020 [acessado 2023 jan 7]. Disponível em: https://www.geledes.org.br/manifesto-enquanto-houver-racismo-nao-haverademocracia/.
https://www.geledes.org.br/manifesto-enq... . It is directly related to preserved racial inequalities in oral health⁸8 Fagundes MLB, Bastos LF, Amaral Júnior OLD, Menegazzo GR, Cunha ARD, Stein C, Iser BPM. Desigualdades socioeconômicas no uso de serviços odontológicos no Brasil: uma análise da Pesquisa Nacional de Saúde de 2019. Rev Bras Epidemiol 2021; 24:e210004., reflected in the more significant accumulation of oral diseases in the Black population, such as tooth decay, periodontal disease, and tooth loss⁸8 Fagundes MLB, Bastos LF, Amaral Júnior OLD, Menegazzo GR, Cunha ARD, Stein C, Iser BPM. Desigualdades socioeconômicas no uso de serviços odontológicos no Brasil: uma análise da Pesquisa Nacional de Saúde de 2019. Rev Bras Epidemiol 2021; 24:e210004., and the insistent disregard for actions to implement public policies, including oral health, for this majority group¹²12 Werneck J. Racismo institucional e saúde da população negra. Saude Soc 2016; 25(3):535-549. in the Brazilian population¹⁶16 Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional por Amostra de Domicílios Contínua (PNAD) [Internet]. Rio de Janeiro: IBGE; 2023 [acessado 2023 ago 7]. Disponível em: https://www.ibge.gov.br/estatisticas/sociais/populacao/17270-pnad-continua.html?=&t=notas-tecnicas.^,1717 Instituto Brasileiro de Geografia e Estatística (IBGE). Desigualdades sociais por cor ou raça no Brasil. Estudos e Pesquisas. Informação Demográfica e Socioeconômica. 2ª ed. Rio de Janeiro: IBGE; 2022..

The assumption of equity as a principle is imperative to reduce racial inequalities¹⁸18 Welch VA, Petkovic J, Jull J, Hartling L, Klassen T, Kristjansson E, Pardo JP, Petticrew M, Stott DJ, Thomson D, Ueffing E, Williams K, Young C, Tugwell P. Chapter 16. Equity and specific populations. In: Higgins J, Thomas J, Chandler J, Cumpston M, Li T, Page M, Welch V, editors. Cochrane Handbook for Systematic Reviews of Interventions. 2nd ed. Hoboken: John Wiley & Sons; 2019. p. 435-449.. It has already been stated by the National Comprehensive Health Policy for the Black Population approximately a decade and a half ago¹⁹19 Brasil. Ministério da Saúde (MS). Portaria nº 992, de 13 de Maio de 2009. Institui a Política Nacional de Saúde Integral da População Negra. Diário Oficial da União 2009; 14 maio.. Although it is not a new recommendation in Brazil¹⁹19 Brasil. Ministério da Saúde (MS). Portaria nº 992, de 13 de Maio de 2009. Institui a Política Nacional de Saúde Integral da População Negra. Diário Oficial da União 2009; 14 maio., its implementation has not been effective, and this is fundamental to combat racism. The results of the 2019 National Health Survey²⁰20 Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa nacional de saúde 2019: percepção do estado de saúde, estilos de vida, doenças crônicas e saúde bucal: Brasil e grandes regiões. Rio de Janeiro: IBGE; 2020. exemplify this need by showing that if, on the one hand, Black men and women had a smaller number of dental appointments, on the other, the percentage of people aged 18 or over who lost 13 or more teeth in Brazil was higher in the Black population (i.e., both sexes of brown and Black people together)²⁰20 Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa nacional de saúde 2019: percepção do estado de saúde, estilos de vida, doenças crônicas e saúde bucal: Brasil e grandes regiões. Rio de Janeiro: IBGE; 2020.. The situation is even more severe when considering only self-declared Black men and women since this population had more teeth lost than the other groups analyzed, even when they are minorities in the Brazilian North, Southeast, and South. In other words, besides being a minority and going to the dentist less frequently, the Black population had higher tooth losses than the Brazilian population as a whole²⁰20 Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa nacional de saúde 2019: percepção do estado de saúde, estilos de vida, doenças crônicas e saúde bucal: Brasil e grandes regiões. Rio de Janeiro: IBGE; 2020..

Racial inequalities in oral health regarding tooth decay, tooth loss, pain, and the need for prostheses, to the detriment of the Black population (Black and brown) compared to white people, have already been reported in Brazil²¹21 Guiotoku SK, Moysés ST, Moysés SJ, França BHS, Bisinelli JC. Iniquidades raciais em saúde bucal no Brasil. Rev Panam Salud Publica 2012; 31(2):135-141., with cumulative intersectional disadvantages when considering gender, generation, and territory intersections. One study²² showed a significant interaction between ethnicity and sex in tooth loss, with a disadvantage for Black women who had a 19% higher prevalence of tooth loss compared to white men (PR: 1.19; 95%CI: 1.05-1.34); 26% higher compared to white women (PR: 1.26; 95%CI: 1.13-1.42), and 14% higher compared to Black men (PR: 1.14; 95%CI: 1.02-1.27)²²22 Terra e Souza LH, Diaz-Quijano FA, Barros MBA, Lima MG. Race (blackwhite) and sex inequalities in tooth loss: A population-based study. PLoS One 2022; 17(10):e0276103.. On the other hand, the likelihood of never having been to the dentist is twice as high for the Black elderly population than for older white adults, and the probability of having used oral health services in the last year is lower for Black older adults compared to older white adults²³23 Souza EHAD, Oliveira PAPD, Paegle AC, Goes PSAD. Raça e o uso dos serviços de saúde bucal por idosos. Cien Saude Colet 2012; 17(8):2063-2070.. The need for a prosthesis or pain did not curb the difficulty in using the dental service for Black older adults²³23 Souza EHAD, Oliveira PAPD, Paegle AC, Goes PSAD. Raça e o uso dos serviços de saúde bucal por idosos. Cien Saude Colet 2012; 17(8):2063-2070.. This setting is comparable to that of older adults of the traditional quilombola communities, particularly concerning high tooth loss frequency and the difficult access to dental services²⁴24 Miranda LDP, Oliveira TL, Queiroz PDSF, Oliveira PSD, Fagundes LS, Rodrigues Neto JF. Saúde bucal e acesso aos serviços odontológicos em idosos quilombolas: um estudo de base populacional. Rev Bras Geriatr Gerontol 2020; 23(2):e200146..

In a study²⁵25 Celeste RK, Darin-Mattsson A, Lennartsson C, Listl S, Peres MA, Fritzell MA. Social Mobility and Tooth Loss: A Systematic Review and Meta-analysis. J Dent Res 2022; 101(2):143-150. that aimed to systematically review the association between social mobility throughout life and tooth loss among adults and older adults, the authors showed that downward social mobility had a stronger association with tooth loss than upward social mobility. The findings also showed that being persistently at lower social levels throughout life had the most detrimental impact on tooth loss. However, downward and upward trajectories have also been associated with a greater likelihood of having tooth loss than persistently high social status, which means that socioeconomic disadvantage at any period of life leads to tooth loss, corroborating the accumulation hypothesis²⁵25 Celeste RK, Darin-Mattsson A, Lennartsson C, Listl S, Peres MA, Fritzell MA. Social Mobility and Tooth Loss: A Systematic Review and Meta-analysis. J Dent Res 2022; 101(2):143-150.. However, we should underscore that the worst socioeconomic conditions have historically been experienced by racialized or minority groups⁷7 Word Health Organization (WHO). Non-communicable diseases WHO team. Global oral health status report: towards universal health coverage for oral health by 2030 [Internet]. 2022 [cited 2023 maio 1]. p. 15. Disponível em: https://www.who.int/teams/noncommunicable-diseases//global-status-report-on-oral-health-2022.
https://www.who.int/teams/noncommunicabl... , which is no different for the Black Brazilian population¹⁷17 Instituto Brasileiro de Geografia e Estatística (IBGE). Desigualdades sociais por cor ou raça no Brasil. Estudos e Pesquisas. Informação Demográfica e Socioeconômica. 2ª ed. Rio de Janeiro: IBGE; 2022., reflecting structural racism. Failure to incorporate the perspective of ethnic-racial equity in studies, particularly in Brazil, does not contribute to a better understanding of socially determined phenomena for health outcomes²⁶26 Santos RV, Bastos JL, Kaingang JD, Batista LE. Cabem recomendações para usos de "raça" nas publicações em saúde? Um enfático "sim", inclusive pelas implicações para as práticas antirracistas. Cad Saude Publica 2022; 38(3):00021922. and, therefore, hampers effective interventions to promote the improved health status of these populations.

Opting for tooth loss as a highlight to illustrate the deprivation of oral health among the Black population was not random and is grounded on its use as an indicator of quality of life²⁷27 GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396(10258):1204-1222.. Tooth loss is used to calculate the indicator of years of life lost due to disability²⁷27 GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396(10258):1204-1222.. Furthermore, tooth loss weighs heavily on the estimation of years of life lost due to disability when associated with other morbidities common to the Black population, such as sickle cell disease, stroke, cardiovascular disease, kidney disease, cancer, or metabolic diseases. Oral diseases associated with other diseases deteriorate the quality of life and reduce life expectancy²⁷27 GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396(10258):1204-1222.. Keeping this setting of racial inequality in oral health is a way of anticipating death in the Black population.

The horizon of death embodied by Black genocide and the result of necropolitics is expressed in body objectification and disposal²⁸28 Mbembe A, Corcoran S. Necropolitics. Durham: Duke University Press; 2019.. It is yet another structural racism hallmark. Assuming such a concept and making an analogy to oral health, we can infer that such tooth loss, which is more frequent among the Black population, still implements, even today, a colonizing logic of successive and cumulative mutilations and, consequently, an induced slow death. We should add that the failure to make efforts to implement actions or strategies that promote “oral health rehabilitation” and, above all, expand access to oral health for the Black population confirms intentionality and violates rights. Furthermore, it is imperative to question a different care rationale for the same need in which racialized groups receive simpler, cheaper, or mutilating treatments²⁹29 Chrisini LA, Noronha, TG, Santos-Junior RB, Sampaio KH, Faria-E-Silva AL, Corrêa MB. Does the skin color of patients influence the treatment decision-making of dentists? A randomized questionnaire-based study. Clin Oral Investig 2019; 23(3):1023-1030.. We should also be aware of how discriminatory treatment manifests in providing oral health care. Recent research conducted in Brazil³⁰30 Lamenha-Lins RM, Paiva SM, Prado IM, Assis Vieira AC, Pithon MM, Maia LC, Serra-Negra JM. Facial Type, Sex and Skin Color of Pediatric Patients Are Associated with Dental Students' Empathy and Self-Confidence During Dental Care. J Dent Child (Chic) 2022; 89(2):75-82. showed that, dentistry students reported less confidence (more insecure/less prepared/more concerned about getting it right) for the same therapeutic proposal when treating white pediatric patients compared to Black ones. The highest level of self-confidence evidenced by dentistry students was for Black girls and shows how the subjectivity of racism materializes in racial discrimination. Increasing self-confidence is, intuitively or not, preconceiving simplification, devaluation, and objectification (unimportance) for those Black children bodies. This finding is not limited to dentistry regarding managing racially marginalized populations within the clinic³¹31 Jones CP. In National Academies of Sciences, Engineering, and Medicine; Policy and Global Affairs; Health and Medicine Division; Roundtable on Black Men and Black Women in Science, Engineering, and Medicine. In: Alexander M, Jones CP, Marrett CB, Bright C, Gamble VN, Hammonds EM, Laurencin CT, editors. COVID-19 and the Present and Future of Black Communities: The Role of Black Physicians, Engineers, and Scientists: Proceedings of a Workshop. Washington, D.C.: National Academies Press; 2021

32 Fanon F. Os condenados da terra. São Paulo: Companhia das Letras; 2022.^-3333 Sevalho GD, Santos JV. Frantz Fanon, descolonização e o saber em saúde mental: contribuições para a saúde coletiva brasileira. Cien Saude Colet 2022; 27(3):937-946.. In other words, the colonizer’s logic of offering inferior treatment or treatment marked by more significant difficulties for specific population segments is reproduced. It is necessary to decolonize minds³²32 Fanon F. Os condenados da terra. São Paulo: Companhia das Letras; 2022. to produce oral health care since the consequences of racism are unquestionably harmful.

The “presumed” irrelevance of the theme of ethnic-racial relations is another form of systemic racism, observed in the systematic lack of this content in training curricula at different educational levels, in political-pedagogical projects, scientific or technological knowledge production spaces, management and care spaces, different discussion forums, meetings of societies and class representative associations³⁴34 Gomes NL. Relações étnico-raciais, educação e descolonização dos currículos. Curriculo Fronteiras 2012; 12(1):98-109.^,3535 Santos Júnior MB, Correa MAC. Reflexões imagéticas: entre modelo educacional e práticas antirracistas. BOCA 2022; 9(27):98-114.. A “hallucinating” and “disturbing” silence needs to be interrupted by an anti-racist ethos³⁶36 Flanagin A, Frey T, Christiansen SL. AMA Manual of Style Committee. Updated Guidance on the Reporting of Race and Ethnicity in Medical and Science Journals. JAMA 2021; 326(7):621-627.

37 Jamieson LM. Racism and oral health inequities; an introduction. Community Dental Health 2021; 131:38.^-3838 Jamieson L, Peres MA, Guarnizo-Herreño CC, Bastos JL. Racism and oral health inequities: An overview. EClinicalMedicine 2021; 34:100827. for racial equity¹⁸18 Welch VA, Petkovic J, Jull J, Hartling L, Klassen T, Kristjansson E, Pardo JP, Petticrew M, Stott DJ, Thomson D, Ueffing E, Williams K, Young C, Tugwell P. Chapter 16. Equity and specific populations. In: Higgins J, Thomas J, Chandler J, Cumpston M, Li T, Page M, Welch V, editors. Cochrane Handbook for Systematic Reviews of Interventions. 2nd ed. Hoboken: John Wiley & Sons; 2019. p. 435-449., impelling the change from this silenced status to the anti-racist ethos through collective voices for oral health such as possible pro-equity path, seeking citizenship and democracy, with attention to the specificities of the Brazilian reality, given the heterogeneous Black population and its connections with global populations and the world.

The hegemonic ethos in our country, that is, the sociocultural ethos intertwined with structural racism, introjected into all parts of society, infiltrating its values and counter-values at all levels, arises from the particularity of the Brazilian socio-historical reality resulting from four hundred years of slavery and how the dynamics occurred, which now brings this heritage to the construction and preservation of a social praxis³⁹39 Moura C. Escravismo, colonialismo, imperialismo e racismo. Afro Asia 1983; 14:124-137.. In this logic, the history of non-whites is traversed by the treble process of delegitimization as it almost completely removes the presence of epistemological contributions from other ethnic and cultural sources, leading to the invisibility and stereotyping of social groups once again³²32 Fanon F. Os condenados da terra. São Paulo: Companhia das Letras; 2022.. The advent of democratic republics acts similarly to past colonialism since it is historically impossible to consider for these inferior groups all their demands in democratic action. On the contrary, exercising hegemonic power occurs through the right of veto as an expression of hatred. It is directly antagonistic to a (loving) human relationship, which should lead to the relationships between people and their counterparts⁴⁰40 Estrada MM. Cap. 92. Frente al odio el amor: del imperio de la diferencia a un ethos decolonial. In: Olivero Guidobono S, Martínez González AJ, coordinadores. Identidades, segregación, vulnerabilidad. Hacia la construcción de sociedades inclusivas? Un reto pluridisciplinar. Madrid: Dykinson; 2021. p. 1843-1859.. Establishing a coherent social praxis requires imperatively (re)recognizing that the ties inherent in and resulting from enslavement by the forms of agency of subjectivities and a way of being and leading conducts underlies the subjectivization and constitution of social subjects that reify the current ethos³²32 Fanon F. Os condenados da terra. São Paulo: Companhia das Letras; 2022.^,3939 Moura C. Escravismo, colonialismo, imperialismo e racismo. Afro Asia 1983; 14:124-137.

40 Estrada MM. Cap. 92. Frente al odio el amor: del imperio de la diferencia a un ethos decolonial. In: Olivero Guidobono S, Martínez González AJ, coordinadores. Identidades, segregación, vulnerabilidad. Hacia la construcción de sociedades inclusivas? Un reto pluridisciplinar. Madrid: Dykinson; 2021. p. 1843-1859.^-4141 Walsh C, organizador. Pedagogías Decoloniales: prácticas insurgentes de resistir, (re)existir y (re)vivir. 1ª ed. Equador: Abya Yala; 2013..

The anti-racist ethos is a civilized way of resisting and opposing the hegemonic ethos (status quo) and the incivility of Brazilian policies by proposing to break with the coloniality that still plagues us⁴¹41 Walsh C, organizador. Pedagogías Decoloniales: prácticas insurgentes de resistir, (re)existir y (re)vivir. 1ª ed. Equador: Abya Yala; 2013.. In practice, it means questioning the current asymmetries of power and knowledge coloniality: recognizing and strengthening what one’s own is, assuming one’s thinking, experimenting with inversions, and questioning identities and colonial differences. This insurgency allows self-decolonization or implies new social conditions of power, knowledge, and being⁴¹41 Walsh C, organizador. Pedagogías Decoloniales: prácticas insurgentes de resistir, (re)existir y (re)vivir. 1ª ed. Equador: Abya Yala; 2013.. In other words, it is the awareness of the evils caused by oppression. Kostuczenko et al.⁴²42 Kostuczenko K, Figueiredo DG, Figueiredo JW. Contribuições de franz fanon e Paulo Freire para a emersão de uma educação antirracista. Rev Inter Ação 2021; 46(ed. esp.):930-945. argues that Freire and Fanon propose the unveiling of this oppressive reality through a community praxis in which cooperation and participation are the driving axes for developing an anti-racist education enshrined in curricular decolonization through the denunciation of racism concomitantly with the announcement of pedagogical and political practices embodied in commandments in favor of the enjoyment of a full life for all human beings, lived out of compassion and solidarity with the entire community of life. They translate into possible teaching-learning experiences grounded on what is our own⁴³43 Freire P. Pedagogia do Oprimido. 84ª ed. Rio de Janeiro: Paz e Terra; 2019. whether in academic spaces, but above all, outside; in territories, African religion temples, the streets, prisons, quilombos, that is, the mobilizer is what emanates from popular education³²32 Fanon F. Os condenados da terra. São Paulo: Companhia das Letras; 2022.^,4141 Walsh C, organizador. Pedagogías Decoloniales: prácticas insurgentes de resistir, (re)existir y (re)vivir. 1ª ed. Equador: Abya Yala; 2013.

42 Kostuczenko K, Figueiredo DG, Figueiredo JW. Contribuições de franz fanon e Paulo Freire para a emersão de uma educação antirracista. Rev Inter Ação 2021; 46(ed. esp.):930-945.^-4343 Freire P. Pedagogia do Oprimido. 84ª ed. Rio de Janeiro: Paz e Terra; 2019.. As long we are imprisoned by outdated theories or by habits of rigid practices, we will not truly transform reality and propose equity in our daily lives, highlighting the need for theory and practice to go hand in hand so that a liberating action can be produced in societies historically marked by inequalities⁴⁴44 hooks b. Ensinando a transgredir: a educação como prática da liberdade. São Paulo: Martins Fontes; 2013.. An anti-racist ethos as a brand differentiates itself, therefore, by establishing a practical link with theoretical devices, considering the latter not as theorizations removed from reality but as transformative technologies; and, secondly, by its ability to link and unlink with other post-emancipation movements and ideas. In this sense, the anti-racist ethos is flexible and open to dialogue from a place of critical and practical enunciation and, above all, functionally as a technology of and for social transformation.

As clues to the anti-racist ethos, it is suggested to incorporate Law No. 11,645 of March 10, 2008, which amended Law No. 9,394 of December 20, 1996, modified by Law No. 10,639 of January 9, 2003, which establishes the guidelines and bases of national education, to include in the official curriculum of the education network, the mandatory theme “Afro-Brazilian and Indigenous History and Culture”⁴⁵45 Brasil. Presidência da República. Casa Civil. Subchefia para Assuntos Jurídicos. Lei nº 11.645, de 10 de março de 2008. Altera a Lei nº 9.394, de 20 de dezembro de 1996, modificada pela Lei nº 10.639, de 9 de janeiro de 2003, que estabelece as diretrizes e bases da educação nacional, para incluir no currículo oficial da rede de ensino a obrigatoriedade da temática "História e Cultura Afro-Brasileira e Indígena". Diário Oficial da União; 2008. in communion with the National Comprehensive Health Policy for the Black Population (PNSIPN)¹⁹19 Brasil. Ministério da Saúde (MS). Portaria nº 992, de 13 de Maio de 2009. Institui a Política Nacional de Saúde Integral da População Negra. Diário Oficial da União 2009; 14 maio. as de-silencing tools-resources. The PNSIPN¹⁹19 Brasil. Ministério da Saúde (MS). Portaria nº 992, de 13 de Maio de 2009. Institui a Política Nacional de Saúde Integral da População Negra. Diário Oficial da União 2009; 14 maio. points to six guidelines:

The status quo of Public Oral Health and confronting (or not) racism

Despite the worst oral health conditions of the Black population and their link with racism at various conceptual levels, the dominant interpretations of racial inequalities in the area are still based on biological conceptions of the division of humanity into genetically distinct races³¹31 Jones CP. In National Academies of Sciences, Engineering, and Medicine; Policy and Global Affairs; Health and Medicine Division; Roundtable on Black Men and Black Women in Science, Engineering, and Medicine. In: Alexander M, Jones CP, Marrett CB, Bright C, Gamble VN, Hammonds EM, Laurencin CT, editors. COVID-19 and the Present and Future of Black Communities: The Role of Black Physicians, Engineers, and Scientists: Proceedings of a Workshop. Washington, D.C.: National Academies Press; 2021

32 Fanon F. Os condenados da terra. São Paulo: Companhia das Letras; 2022.

33 Sevalho GD, Santos JV. Frantz Fanon, descolonização e o saber em saúde mental: contribuições para a saúde coletiva brasileira. Cien Saude Colet 2022; 27(3):937-946.

34 Gomes NL. Relações étnico-raciais, educação e descolonização dos currículos. Curriculo Fronteiras 2012; 12(1):98-109.

35 Santos Júnior MB, Correa MAC. Reflexões imagéticas: entre modelo educacional e práticas antirracistas. BOCA 2022; 9(27):98-114.

36 Flanagin A, Frey T, Christiansen SL. AMA Manual of Style Committee. Updated Guidance on the Reporting of Race and Ethnicity in Medical and Science Journals. JAMA 2021; 326(7):621-627.^-3737 Jamieson LM. Racism and oral health inequities; an introduction. Community Dental Health 2021; 131:38.. These interpretations range from specific oral health problems to the use/access to health services and often blame Black populations for their worst conditions - whether due to biological aspects or culturally determined behaviors³¹31 Jones CP. In National Academies of Sciences, Engineering, and Medicine; Policy and Global Affairs; Health and Medicine Division; Roundtable on Black Men and Black Women in Science, Engineering, and Medicine. In: Alexander M, Jones CP, Marrett CB, Bright C, Gamble VN, Hammonds EM, Laurencin CT, editors. COVID-19 and the Present and Future of Black Communities: The Role of Black Physicians, Engineers, and Scientists: Proceedings of a Workshop. Washington, D.C.: National Academies Press; 2021

32 Fanon F. Os condenados da terra. São Paulo: Companhia das Letras; 2022.

33 Sevalho GD, Santos JV. Frantz Fanon, descolonização e o saber em saúde mental: contribuições para a saúde coletiva brasileira. Cien Saude Colet 2022; 27(3):937-946.

34 Gomes NL. Relações étnico-raciais, educação e descolonização dos currículos. Curriculo Fronteiras 2012; 12(1):98-109.

35 Santos Júnior MB, Correa MAC. Reflexões imagéticas: entre modelo educacional e práticas antirracistas. BOCA 2022; 9(27):98-114.

36 Flanagin A, Frey T, Christiansen SL. AMA Manual of Style Committee. Updated Guidance on the Reporting of Race and Ethnicity in Medical and Science Journals. JAMA 2021; 326(7):621-627.^-3737 Jamieson LM. Racism and oral health inequities; an introduction. Community Dental Health 2021; 131:38.. Such interpretations are invalid from a scientific viewpoint and ethically reprehensible³¹31 Jones CP. In National Academies of Sciences, Engineering, and Medicine; Policy and Global Affairs; Health and Medicine Division; Roundtable on Black Men and Black Women in Science, Engineering, and Medicine. In: Alexander M, Jones CP, Marrett CB, Bright C, Gamble VN, Hammonds EM, Laurencin CT, editors. COVID-19 and the Present and Future of Black Communities: The Role of Black Physicians, Engineers, and Scientists: Proceedings of a Workshop. Washington, D.C.: National Academies Press; 2021

32 Fanon F. Os condenados da terra. São Paulo: Companhia das Letras; 2022.

33 Sevalho GD, Santos JV. Frantz Fanon, descolonização e o saber em saúde mental: contribuições para a saúde coletiva brasileira. Cien Saude Colet 2022; 27(3):937-946.

34 Gomes NL. Relações étnico-raciais, educação e descolonização dos currículos. Curriculo Fronteiras 2012; 12(1):98-109.

35 Santos Júnior MB, Correa MAC. Reflexões imagéticas: entre modelo educacional e práticas antirracistas. BOCA 2022; 9(27):98-114.

36 Flanagin A, Frey T, Christiansen SL. AMA Manual of Style Committee. Updated Guidance on the Reporting of Race and Ethnicity in Medical and Science Journals. JAMA 2021; 326(7):621-627.^-3737 Jamieson LM. Racism and oral health inequities; an introduction. Community Dental Health 2021; 131:38.. There is abundant scientific literature showing the non-existence of biological distinctions between racial groups, on the one hand, and on the other, the role of racism in the genesis of health inequalities¹⁴14 Eschner K. Racism is undeniably a public health issue [Internet]. Popular Science; 2020. [cited 2023 ago 9]. Available from: https://www.popsci.com/story/health/racism-public-health/.
https://www.popsci.com/story/health/raci... ^,3131 Jones CP. In National Academies of Sciences, Engineering, and Medicine; Policy and Global Affairs; Health and Medicine Division; Roundtable on Black Men and Black Women in Science, Engineering, and Medicine. In: Alexander M, Jones CP, Marrett CB, Bright C, Gamble VN, Hammonds EM, Laurencin CT, editors. COVID-19 and the Present and Future of Black Communities: The Role of Black Physicians, Engineers, and Scientists: Proceedings of a Workshop. Washington, D.C.: National Academies Press; 2021

32 Fanon F. Os condenados da terra. São Paulo: Companhia das Letras; 2022.

33 Sevalho GD, Santos JV. Frantz Fanon, descolonização e o saber em saúde mental: contribuições para a saúde coletiva brasileira. Cien Saude Colet 2022; 27(3):937-946.

34 Gomes NL. Relações étnico-raciais, educação e descolonização dos currículos. Curriculo Fronteiras 2012; 12(1):98-109.

35 Santos Júnior MB, Correa MAC. Reflexões imagéticas: entre modelo educacional e práticas antirracistas. BOCA 2022; 9(27):98-114.

36 Flanagin A, Frey T, Christiansen SL. AMA Manual of Style Committee. Updated Guidance on the Reporting of Race and Ethnicity in Medical and Science Journals. JAMA 2021; 326(7):621-627.^-3737 Jamieson LM. Racism and oral health inequities; an introduction. Community Dental Health 2021; 131:38.. From an ethical perspective, if the ultimate reasons for racial inequalities in oral health are issues linked to biology or culturally determined behaviors, interventions on the problem are automatically limited and ineffective and preserve a general framework of racial inequalities in oral health.

Thus, racial inequalities in oral health must be analyzed in the context of racist societies, which adopt numerous strategies (e.g., symbolic/cultural, material, political, and social) to unfairly distribute power and resources under an arbitrary and hierarchical structure of the population into racial groups. We call these symbolic/cultural, material, political, and social processes systemic racism and are at the heart of racial inequalities in oral health. Conceiving racial inequalities in oral health from scientifically based and ethically positioned perspectives implies focusing on racism as its origin and implementing strategies, policies, and actions to combat it¹⁵15 Coalizão Negra por Direitos. Manifesto: "Enquanto houver RACISMO, não haverá DEMOCRACIA" [Internet]. Geledés; 2020 [acessado 2023 jan 7]. Disponível em: https://www.geledes.org.br/manifesto-enquanto-houver-racismo-nao-haverademocracia/.
https://www.geledes.org.br/manifesto-enq... ^,1818 Welch VA, Petkovic J, Jull J, Hartling L, Klassen T, Kristjansson E, Pardo JP, Petticrew M, Stott DJ, Thomson D, Ueffing E, Williams K, Young C, Tugwell P. Chapter 16. Equity and specific populations. In: Higgins J, Thomas J, Chandler J, Cumpston M, Li T, Page M, Welch V, editors. Cochrane Handbook for Systematic Reviews of Interventions. 2nd ed. Hoboken: John Wiley & Sons; 2019. p. 435-449.^,2929 Chrisini LA, Noronha, TG, Santos-Junior RB, Sampaio KH, Faria-E-Silva AL, Corrêa MB. Does the skin color of patients influence the treatment decision-making of dentists? A randomized questionnaire-based study. Clin Oral Investig 2019; 23(3):1023-1030.^,3030 Lamenha-Lins RM, Paiva SM, Prado IM, Assis Vieira AC, Pithon MM, Maia LC, Serra-Negra JM. Facial Type, Sex and Skin Color of Pediatric Patients Are Associated with Dental Students' Empathy and Self-Confidence During Dental Care. J Dent Child (Chic) 2022; 89(2):75-82.

31 Jones CP. In National Academies of Sciences, Engineering, and Medicine; Policy and Global Affairs; Health and Medicine Division; Roundtable on Black Men and Black Women in Science, Engineering, and Medicine. In: Alexander M, Jones CP, Marrett CB, Bright C, Gamble VN, Hammonds EM, Laurencin CT, editors. COVID-19 and the Present and Future of Black Communities: The Role of Black Physicians, Engineers, and Scientists: Proceedings of a Workshop. Washington, D.C.: National Academies Press; 2021

32 Fanon F. Os condenados da terra. São Paulo: Companhia das Letras; 2022.

33 Sevalho GD, Santos JV. Frantz Fanon, descolonização e o saber em saúde mental: contribuições para a saúde coletiva brasileira. Cien Saude Colet 2022; 27(3):937-946.

34 Gomes NL. Relações étnico-raciais, educação e descolonização dos currículos. Curriculo Fronteiras 2012; 12(1):98-109.^-3535 Santos Júnior MB, Correa MAC. Reflexões imagéticas: entre modelo educacional e práticas antirracistas. BOCA 2022; 9(27):98-114.^,4545 Brasil. Presidência da República. Casa Civil. Subchefia para Assuntos Jurídicos. Lei nº 11.645, de 10 de março de 2008. Altera a Lei nº 9.394, de 20 de dezembro de 1996, modificada pela Lei nº 10.639, de 9 de janeiro de 2003, que estabelece as diretrizes e bases da educação nacional, para incluir no currículo oficial da rede de ensino a obrigatoriedade da temática "História e Cultura Afro-Brasileira e Indígena". Diário Oficial da União; 2008.^,4646 Brasil. Presidência da República. Casa Civil. Lei nº 12.288, de 20 de julho de 2010. Institui o Estatuto da Igualdade Racial; altera as Leis nos 7.716, de 5 de janeiro de 1989, 9.029, de 13 de abril de 1995, 7.347, de 24 de julho de 1985, e 10.778, de 24 de novembro de 2003. Diário Oficial da União; 2010..

Discussing through the concept of health equity in the contemporary world of blatant socioeconomic-racial-geographical and environmental inequalities is urgent¹⁷17 Instituto Brasileiro de Geografia e Estatística (IBGE). Desigualdades sociais por cor ou raça no Brasil. Estudos e Pesquisas. Informação Demográfica e Socioeconômica. 2ª ed. Rio de Janeiro: IBGE; 2022.. Hence, radicalizing the adoption of ethnicity/skin color is an essential pro-equity social marker resulting from a political choice, from ethics (ethos) in search of social justice that permeates the production of scientific knowledge incorporating this social marker²⁶26 Santos RV, Bastos JL, Kaingang JD, Batista LE. Cabem recomendações para usos de "raça" nas publicações em saúde? Um enfático "sim", inclusive pelas implicações para as práticas antirracistas. Cad Saude Publica 2022; 38(3):00021922.. The concept of buccality⁴⁷47 Botazzo C. Sobre a bucalidade: notas para a pesquisa e contribuição ao debate. Cien Saude Colet 2006; 11(1):7-17. establishes as a reference for oral health its inseparability from the right to life and citizenship. Thus, collective (oral) health as a core and praxis must prioritize epidemiological studies that exceed merely measuring factors and consider their inseparable link with the social dimension since no epidemiology is non-social; likewise, evaluations of public policies and services must be based on solving detected problems to strengthen the Unified Health System and, consequently, benefits for most of society. Therefore, they need to be part of the State and Society discussion, increasingly requiring Social Sciences⁴⁸48 Ferreira EF, Ferreira RC, Botazzo C, Gomes VE, Rodrigues LG, Vargas AMD. A ciência da saúde coletiva por escrito: contribuição para estudos em saúde bucal coletiva. Cien Saude Colet 2020; 25(12):4875-4886.. To account for this complex relationship between the mouth and the world, Botazzo⁴⁷47 Botazzo C. Sobre a bucalidade: notas para a pesquisa e contribuição ao debate. Cien Saude Colet 2006; 11(1):7-17. elaborates on the concept of buccality, where mouth-life articulates with generic social life or as part of the biopsychosocial nexus, resulting from subjectivities in which oral health derives from life opportunities, as a manifestation of the body as a whole and not isolated, compartmentalized, reduced to teeth/organs/body cavity, a subject in its entirety in its determinations, limits and possibilities, all of which are closely related to the fight for rights, equity, and democracy. This understanding is another analytical key to understanding and incorporating the anti-racist ethos into collective oral health.

We should remember the importance of health conferences to guide and incorporate regulations for the Unified Health System into their documents, assuming the premises listed for the effective achievement of citizenship and democracy. Like health, health equity must be understood as a state determined by multiple factors, and its measurement is made by comparing established parameters. The content on health equity is consolidated by explaining parameters that allow comparing social groups against given needs, with repercussions on health status. The construction of health equity takes on a political dimension when analyzing the acceptable scientific and moral standards that prevail in a given State. Equity is assumed to be an ethical value and can be considered the most political of virtues⁴⁹49 Pinheiro MC, Westphal MF, Akerman M. Eqüidade em saúde nos relatórios das conferências nacionais de saúde pós-Constituição Federal brasileira de 1988. Cad Saude Publica 2005; 21(2):449-458.. No doubt, breaking the reproduction of health inequalities requires a very proactive stance from everyone based on an ethic of responsibility³²32 Fanon F. Os condenados da terra. São Paulo: Companhia das Letras; 2022.. Demolishing barriers imposed by racism is an ethical choice in favor of life inherent to a new social pact, in which the fight against systemic racism is the (re)connecting link⁵⁰50 Grupo Temático Racismo e Saúde. Documento de planejamento [Internet]. Rio de Janeiro: Abrasco; 2018 [acessado 2023 jan 7]. Disponível em: https://www.abrasco.org.br/site/wp-content/uploads/2019/02/Planejamento-01-2018.pdf..

Practical notes for building an anti-racist ethos in collective oral health and confronting systemic racism

The advances in public policies for the oral health of Brazilians are recognized. The National Oral Health Policy within the Unified Health System is a concrete example⁵¹51 Brasil. Ministério da Saúde (MS). Lei nº 14.572, de 8 de maio de 2023. Institui a Política Nacional de Saúde Bucal no âmbito do Sistema Único de Saúde (SUS) e altera a Lei nº 8.080, de 19 de setembro de 1990, para incluir a saúde bucal no campo de atuação do SUS. Diário Oficial da União; 2023.. Incorporating the anti-racist perspective in its implementation and operationalization will reduce racial inequalities and include the Black population in the right to oral health (Chart 1). The case of oral health care for people with sickle cell disease is an example of how actions inherent to public policy for people’s oral health need to incorporate the racial dimension⁵²52 Santos MPA, Limia R, Masterson DT, Dias KHC. Sickle Cell Disease Literature. JADA 2021; 152(4):256- 257.. The adequate provision of dental services must address systemic racism as a producer of inequalities⁵³53 Power-Hays A, McGann PT. When actions speak louder than words - racism and sickle cell disease. N Engl J Med 2020; 383(20):1902-1903.

54 Bulgin D, Tanabe P, Jenerette C. Stigma of sickle cell disease: A systematic review. Issues Ment Health Nurs 2018; 39(8):675-686.^-5555 Royal CDM, Babyak M, Shah N, Srivatsa S, Stewart KA, Tanabe P, Wonkam A, Asnani M. Sickle cell disease is a global prototype for integrative research and healthcare. Adv Genet (Hoboken) 2021; 2(1):e10037..

The following is proposed for a movement towards an anti-racist ethos in Dentistry:

To be effective, such propositions must transcend the health domain and be articulated between other sectors, including human rights, racial equality, justice, housing, work, social assistance, food and nutrition, sports, culture, and education. For Higher Education, Resolution CNE/CES No. 3 of June 21, 2022, established the national curricular guidelines for the undergraduate course in Dentistry⁵⁷57 Brasil. Ministério da Educação (MEC). Conselho Nacional de Educação. Câmara de Educação Superior. Resolução nº 3, de 21 de junho de 2021. Institui as Diretrizes Curriculares Nacionais do curso de graduação em Odontologia e dá outras providências. Diário Oficial da União 2021; 22 jun., with a proposal to contribute to the formation of a critical-reflective, humanistic, and self-aware professional and society and include the racial perspective among the graduate’s competencies⁵⁷57 Brasil. Ministério da Educação (MEC). Conselho Nacional de Educação. Câmara de Educação Superior. Resolução nº 3, de 21 de junho de 2021. Institui as Diretrizes Curriculares Nacionais do curso de graduação em Odontologia e dá outras providências. Diário Oficial da União 2021; 22 jun.. It is a strong ally for an anti-racist ethos when considering the ethnic-racial dimension in its implementation⁵⁷57 Brasil. Ministério da Educação (MEC). Conselho Nacional de Educação. Câmara de Educação Superior. Resolução nº 3, de 21 de junho de 2021. Institui as Diretrizes Curriculares Nacionais do curso de graduação em Odontologia e dá outras providências. Diário Oficial da União 2021; 22 jun..

Most Black people are SUS clients. Thus, supervised internships in Dentistry at the SUS are another opportunity for this anti-racist ethos, given its intentionality, responsibilities, and objectives⁵⁸58 Noro L, Narvai PC. Estágio curricular supervisionado: o Sistema Único de Saúde no centro do processo. Rev ABENO 2021; 21(1):1744.. Trad et al.⁵⁹59 Trad LAB, Mota CS, López YAA. O ensino das ciências sociais e humanas na graduação em saúde coletiva: entre desafios e oportunidades de transgressões. Saude Soc 2019; 28(2):11-24. propose breaking with the disciplinary format and focusing on practices in territories as the central axis of training, based on the questions: Which territories can provide significant learning? What do we take to the territory, and what do we intend to learn from it? How will we build knowledge with people instead of bringing information to people?

In Public Health, the stimulus in the teaching-learning process stems from sensitive and respectful listening to the Other, the critical and dialogical stance, and epistemological surveillance to foster interdisciplinary and interprofessional views among teachers and students that enhance the understanding of the health amid social, cultural, political and ideological processes⁵⁹59 Trad LAB, Mota CS, López YAA. O ensino das ciências sociais e humanas na graduação em saúde coletiva: entre desafios e oportunidades de transgressões. Saude Soc 2019; 28(2):11-24.. The challenge to be overcome and which also limits the teaching staff refers to the existence of racially illiterate university staff or even a low presence of Black teachers. Thus, a contribution to an anti-racist ethos in collective oral health is the Quota Policy adopted in Brazil as affirmative action to reduce such racial inequalities.

A final practical note

Agents working for collective oral health must pay attention to this call to catalyze this change by promoting a space for dialogue and articulation between researchers, health professionals, managers, social participation, educators, social movements, and society in general in search of equity, social justice, and democracy. To do this, in the face of any situation³¹31 Jones CP. In National Academies of Sciences, Engineering, and Medicine; Policy and Global Affairs; Health and Medicine Division; Roundtable on Black Men and Black Women in Science, Engineering, and Medicine. In: Alexander M, Jones CP, Marrett CB, Bright C, Gamble VN, Hammonds EM, Laurencin CT, editors. COVID-19 and the Present and Future of Black Communities: The Role of Black Physicians, Engineers, and Scientists: Proceedings of a Workshop. Washington, D.C.: National Academies Press; 2021, look at the problem and analyze it carefully, especially the structures of decision-making - for “who, what, when, and where” -, policies - “how” it is written -, practices and norms - “how” it is not inscribed -, and values - “why”. Collective oral health is called upon to drive the antiracism ethos as an imperative.

Our reflection aimed to establish links between the anti-racist ethos and buccality, both as opportunities for collective oral health to confront the deep-seated dynamics of structural racism. Walsh⁴¹41 Walsh C, organizador. Pedagogías Decoloniales: prácticas insurgentes de resistir, (re)existir y (re)vivir. 1ª ed. Equador: Abya Yala; 2013. made this invitation to us by indicating that it is necessary to explore the links between the “pedagogical” and the “decolonial”, realizing the inclusion of experiences defined in the path taken. We should consider initiatives based on solidarity and cooperation in the subversion favored by the community and disobedient practices. Therefore, any educational proposal will have to start from a sensitive listening (in the sense of reviewing its insufficiencies in terms of what we have been unable to denaturalize, including in the curricula) - something that is confronted, that denounces the also epistemic violence and can generate proposals for strategies that lead us to decolonize our bodies and discursive practices. Such an association is fundamental to the collective oral health we desire.

References

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History