Abstract

Brazil contests the hegemony of the biomedical model resulting from the historical colonization by Europe to the support of North American foundations, by creating its Brazilian Nacional Health System. The concept of “buccality” proposes a broader perspective beyond this model, highlighting the need for alternatives that respect universality, comprehensiveness, and equity. This study aims to analyze buccality via an integrative review and reflection on its decolonial epistemological potential, including eight studies in its final sample. As an epistemological alternative, buccality values the mouth as a territory of experiences, opposing objectification. This study engages with European theories while still being critical of Eurocentric bias of modernity and approaches a bordering epistemology. This review found that buccality may integrate subjectivity and enable future research focused on the interests of Brazilian and Latin American oral health.

Keywords:
Buccality; Oral Health; Public Health; Decoloniality; Integrative Review

Introduction

The impact of international relations in the field of health is not exactly recent, but its significant growth from the last century onwards is notorious, with the strengthening of global perspectives and historical milestones, such as the foundation of the United Nations and cooperation experiences of different countries (Santana, 2011SANTANA, J. P. Um olhar sobre a Cooperação Sul-Sul em Saúde. Ciência & Saúde Coletiva, Rio de Janeiro, v. 16, n. 6, p. 2993-3002, 2011.). In recent years, the global crisis experienced by the COVID-19 syndemic has highlighted these relations, as well as the political aspect of public health in its different coping strategies (Ungerer, 2020UNGERER, R. Movimento dos não alinhados e G77: o Sul Global e a Covid-19. In: BUSS, P. M.; FONSECA, L. E. (org.). Diplomacia da saúde e Covid-19: reflexões a meio caminho. Rio de Janeiro: Fiocruz, 2020. p. 173-184.; Santos, 2023SANTOS, C. A cooperação Sul-Sul e o multilateralismo multinormativo na criação do Centro de Pesquisa e Desenvolvimento de Vacinas do BRICS. Revista Tempo Do Mundo, Brasília, v. 31, p. 117-144, 2023. DOI: 10.38116/rtm31art4
https://doi.org/10.38116/rtm31art4... ).

However, such relations have not always occurred harmoniously, cooperatively, or multilaterally between different countries, which reflects the existing geopolitical tensions. A good example of this process was the historical hegemony of the biomedical model of health.

The biomedical model presents a Cartesian approach, separating subject and object to value objective distance, technology, technique, and specialization. Thus, it fragments the patient and reduces the organism and the disease process to mechanical, chemical, physical, and biological elements, centralizing care in the figure of the medical professional (Barros, 2002BARROS, J. A. C. Pensando o processo saúde doença: a que responde o modelo biomédico? Saúde e Sociedade, São Paulo, v. 11, n. 1, p. 67-84, 2002. DOI: 10.1590/S0104-12902002000100008
https://doi.org/10.1590/S0104-1290200200... ).

The establishment of this model was not a completely organic process. Based on ideas that emerged at the end of the nineteenth century and the beginning of the twentieth century, and in the face of the chaotic state of the medical education scenario, the American educator Abraham Flexner promoted, with grants from the Rockefeller and Carnegie Foundations, a reform in health education, strengthening the hospital as a training environment and the biomedical and disciplinary curriculum in the United States (Pagliosa; Da Ros, 2008PAGLIOSA, F. L.; DA ROS, M. A. O Relatório Flexner: Para o Bem e Para o Mal. Revista Brasileira de Educação Médica, Brasília, v. 32, n. 4, p. 492-499, 2008. DOI: 10.1590/S0100-55022008000400012
https://doi.org/10.1590/S0100-5502200800... ). From the 1920s to the 1960s, the Rockefeller Foundation actively participated in the global expansion of this scientific model, fomenting institutions and courses with technical and financial resources in several countries, including those in Latin America such as Brazil (Faria; Costa, 2006FARIA, L.; COSTA, M. C. Cooperação Científica Internacional: Estilos de Atuação da Fundação Rockefeller e da Fundação Ford. Revista de Ciências Sociais, Rio de Janeiro, v. 49, n. 1, p. 159-191. 2006. DOI: 10.1590/S0011-52582006000100007
https://doi.org/10.1590/S0011-5258200600... ).

However, the complexities of the health-disease process and the biomedical model results and cost-effectiveness have led to the emergence of questions and the development of new alternatives. According to the classic conceptual model of health by Earp and Ennet (1991EARP, J. A.; ENNETT, S. T. Conceptual Models for health education and practice. Health Education Research, Oxônia, v. 6, n. 2, p. 163-171, 1991. DOI: 10.1093/her/6.2.163
https://doi.org/10.1093/her/6.2.163... ), the health-disease process would actually comprise existing causal relations in a set of associated concepts, favoring the interpretation by different theories and levels of investigation. Other posterior conceptual approaches with important prominence were the transdisciplinary paradigm model by Albrecht, Freeman, and Higginbotham (1998ALBRECHT, G.; FREEMAN, S.; HIGGINBOTHAM, N. Complexity and Human Health: the case for a transdisciplinary paradigm. Culture, Medicine and Psychiatry, Cambridge, v. 22, n. 1, p. 55-92, 1998. DOI: 10.1023/A:1005328821675
https://doi.org/10.1023/A:1005328821675... ), as well as the unified theory of health-disease by Almeida-Filho (2013)ALMEIDA-FILHO, N. Para uma teoria unificada sobre saúde-doença: I. Saúde como objeto-modelo complexo. Revista de Saúde Pública, São Paulo, v. 47, n. 3, p. 433-450, 2013. DOI: 10.1590/rsp.v47i3.76649
https://doi.org/10.1590/rsp.v47i3.76649... and the health equity measurement by Dover and Belon (2019DOVER, D. C.; BELON, A. P. The health equity measurement framework: a comprehensive model tomeasure social inequities in health. International Journal for Equity in Health, Londres, v. 18, n. 36, 2019. DOI: 10.1186/s12939-019-0935-0
https://doi.org/10.1186/s12939-019-0935-... ).

In Brazil, no historical factor was more preponderant for changes in health than the Sanitary Reform Movement, influenced by the strengthening of Primary Health Care ideas, in an international debate in the 1970s. It entailed the reform on national public health policies, with the Federal Constitution of 1988 creating the Brazilian National Health System (SUS) (Matuda; Aaron; Frazão, 2013MATUDA, C. G.; AGUIAR, D. M. L.; FRAZÃO, P. Cooperação interprofissional e a Reforma Sanitária no Brasil: implicações para o modelo de atenção à saúde. Saúde & Sociedade, São Paulo, v. 22, n. 1, p. 173-186, 2013. DOI: 10.1590/S0104-12902013000100016
https://doi.org/10.1590/S0104-1290201300... ). For Brazilian public health, the SUS represented the democratic ideas that regained place in the national political scenario, since it held health as a right and had a decentralized, universal, integral, and equitable character.

In the context of oral health, traditional conceptual models were, in essence, transposed to this area’s particular reality (Scherer; Scherer, 2015SCHERER, C. I.; SCHERER, M. D. A. Avanços e desafios da saúde bucal após uma década de Programa Brasil Sorridente. Revista de Saúde Pública, São Paulo, v. 49, 2015. DOI: 10.1590/S0034-8910.2015049005961
https://doi.org/10.1590/S0034-8910.20150... ). Portuguese colonization, unfavorable socioeconomic conditions, precarious nutrition, and the lack of public policies shaped Brazil into a mutilated and edentulous country (Cunha, 1952CUNHA, E. S. História da Odontologia no Brasil: 1500-1900. Rio de Janeiro: Editora Científica, 1952.; Narvai; Frazão, 2008NARVAI, P.C; FRAZÃO, P. Políticas de Saúde Bucal no Brasil. In: MOYSÉS, S.T.; KRIGER, L.; MOYSÉS, S.J. (Org.). Saúde bucal das famílias: trabalhando com evidências. São Paulo: Artes Médicas, 2008. p. 1-20.; Chaves et al., 2017CHAVES, S. C. et al. Políticas de Saúde Bucal no Brasil 2003-2014: cenário, propostas, ações e resultados. Ciência & Saúde Coletiva, Rio de Janeiro, v. 22, n. 6, p. 1791-1803, 2017.).

In the twentieth century, Market Dentistry predominated, with its biologicist, welfare-centered, clinical-surgical, individualistic, and mercantilist character (Narvai, 2006aNARVAI, P. C. Saúde bucal coletiva: caminhos da odontologia sanitária à bucalidade. Revista de Saúde Pública, São Paulo, v. 40, n. spe., p. 141-147, 2006a. DOI: 10.1590/S0034-89102006000400019
https://doi.org/10.1590/S0034-8910200600... ). Water fluoridation was the first public policy with a real impact on the population’s oral health conditions (Narvai, 2000NARVAI, P. C. Cárie dentária e flúor: uma relação do século XX. Ciência & Saúde Coletiva, Rio de Janeiro, v. 5, n. 2, p. 381-392, 2000. DOI: 10.1590/S1413-81232000000200011
https://doi.org/10.1590/S1413-8123200000... ; Frazão, 2012FRAZÃO, P. Epidemiology of dental caries: when structure and context matter. Brazilian Oral Research, São Paulo, v. 26, n. 1, p. 108-1014, 2012. DOI: 10.1590/S1806-83242012000700016
https://doi.org/10.1590/S1806-8324201200... ). However, the lack of universality and the inequality in public water supply also aggravated regional inequities in the country (Antunes; Narvai, 2010ANTUNES, J. L. F.; NARVAI, P. C. Políticas de saúde pública no Brasil e seu impacto sobre as desigualdades em saúde. Revista de Saúde Pública, São Paulo, v. 44, n. 2, p. 360-365, 2010. DOI: 10.1590/S0034-89102010005000002
https://doi.org/10.1590/S0034-8910201000... ).

Brazilian oral health care only began to transcend the hegemonic social security care model with the creation of the SUS. From the first term of President Luiz Inácio Lula da Silva, oral health was central for the government agenda, with the creation of the National Oral Health Policy (Brasil Sorridente) in 2004 (Carvalho et al., 2009CARVALHO, L. A. C. et al. Procedimentos Coletivos de Saúde Bucal: gênese, apogeu e ocaso. Saúde e Sociedade, São Paulo, v. 18, n. 3, p. 490-499, 2009. DOI: 10.1590/S0104-12902009000300013
https://doi.org/10.1590/S0104-1290200900... ; Chaves et al., 2017CHAVES, S. C. et al. Políticas de Saúde Bucal no Brasil 2003-2014: cenário, propostas, ações e resultados. Ciência & Saúde Coletiva, Rio de Janeiro, v. 22, n. 6, p. 1791-1803, 2017.). Subsequent investments to increase oral health teams, the creation of Dental Specialty Centers, and the Regional Dental Prosthesis Laboratories made Brasil Sorridente the most significant public oral health policy worldwide (Cayetano et al., 2019CAYETANO, M. H. et al. Política Nacional de Saúde Bucal Brasileira (Brasil Sorridente): Um resgate da história, aprendizados e futuro. Universitas Odontológica, Bogotá, v. 38, n. 80, 2019.).

The naturalism in health-disease processes has grounded Western medicine in Latin America and, with the influence of colonialism, it has disqualified and suppressed the knowledge and practices of native peoples, in favor of the biomedical model and a capitalist epistemology in health processes (Nunes; Louvision, 2020NUNES, J. A.; LOUVISON, M. Epistemologias do Sul e decolonização da saúde: por uma ecologia do cuidado na saúde coletiva. Saúde & Sociedade, São Paulo, v. 29, n. 3, 2020. DOI: 10.1590/S0104-12902020200563
https://doi.org/10.1590/S0104-1290202020... ). On the other hand, the history of the SUS and popular movements in health reveals an important local response, as a set of public policies, acting as an alternative model to the almost absolute hegemony of the biomedical structure.

These existing tensions represent not only the different models of health care but also reflect the actions of different forces and interests in the geopolitical sphere, bringing to light another important issue: colonialism effects beyond the colonial period. Thinkers such as Walter Mignolo, Aníbal Quijano, and Enrique Dussel sought to expose and criticize the coloniality relations maintained in modernity confronting modern forms of domination, in a process that can be called decolonization, a non-Eurocentric social and political theory (Ballestrin, 2013BALLESTRIN, A. América e o giro decolonial. Revista Brasileira de Ciência Política, Brasília, n. 11, p. 89-117, 2013. DOI: 10.1590/S0103-33522013000200004
https://doi.org/10.1590/S0103-3352201300... ).

Coloniality is understood as a result of European modernity, reducing colonized peoples by classification systems especially grounded on ideas of race, gender, and labor. The Myth of Superiority was, thus, imposed by exploitation, domination, and conflicts. By considering peoples “primitive,” the violence and domination under the pretext of “civilizational liberation” was justified, and it was further spread by historical, political, economic, social, cultural, and epistemological processes (Grosfoguel, 2008GROSFOGUEL, R. Para descolonizar os estudos de economia política e os estudos pós-coloniais: Transmodernidade, pensamento de fronteira e colonialidade global. Revista Crítica de Ciências Sociais, Coimbra, v. 80, p. 115-147, 2008. DOI: 10.4000/rccs.697
https://doi.org/10.4000/rccs.697... ; Mignolo, 2008MIGNOLO, W. D. Desobediência epistêmica: a opção descolonial e o significado de identidade. Cadernos de Letras da UFF, Rio de Janeiro, n. 34, p. 287-324, 2008.; Ballestrin, 2013BALLESTRIN, A. América e o giro decolonial. Revista Brasileira de Ciência Política, Brasília, n. 11, p. 89-117, 2013. DOI: 10.1590/S0103-33522013000200004
https://doi.org/10.1590/S0103-3352201300... ; Kings; Andrade, 2018REIS, M. N.; ANDRADE, M. F. F. O pensamento decolonial: análise, desafios e perspectivas. Revista Espaço Acadêmico, Maringá, n. 202, p. 1-11, 2018.).

The decolonial school of thought emerges as a movement of theoretical, practical, political, and epistemological resistance. Opposed to modernity and coloniality impositions, the decolonial school of thought is based on the many thinkers and theories that turn to the colonized peoples for their diagnoses and prognoses, to detach itself from postmodernity and Eurocentrism (Ballestrin, 2013BALLESTRIN, A. América e o giro decolonial. Revista Brasileira de Ciência Política, Brasília, n. 11, p. 89-117, 2013. DOI: 10.1590/S0103-33522013000200004
https://doi.org/10.1590/S0103-3352201300... ; Olive tree; Lucini, 2021OLIVEIRA, E. S.; LUCINI, M. O Pensamento Decolonial: Conceitos para Pensar uma Prática de Pesquisa de Resistência. Boletim Historiar, Acaraju, v. 8, n. 1, p. 97-115).

It is, therefore, a set of constructions of thought, production, and valorization of knowledge that are alternative to the historically complex colonizing logic, and is based on critical reflections on power relations, focusing on liberation from colonial oppression (Zeifert; Agnoletto, 2019ZEIFERT, A. P. B.; AGNOLETTO, V. O pensamento decolonial e a teoria crítica dos direitos humanos: saberes e dignidade nas sociedades latino-americanas. Revista Húmus, São Luis, v. 9, n. 26, p. 197-218, 2019.; Torre et al., 2022TORRE, S. et al. O pensamento decolonial: das raízes do debate a uma proposta de método. Revista X, Curitiba, v. 17, n. 1, p. 341-371, 2022.).

In this sense, Quijano (2009QUIJANO, A. Colonialidade do poder e classificação social. In: SANTOS, B. de S.; MENESES, M. P. (org). Epistemologias do Sul. Coimbra: Edições Almedina, 2009. p. 73-117.) argues that Latin American cultural diversity must be translated into new models, presenting themselves as an alternative epistemology to the dominant epistemology. This perspective enables us to understand that, although decoloniality has been organized and strengthened as a movement in recent decades, its origins are the counterparts to the very foundation of coloniality (Ballestrin, 2013BALLESTRIN, A. América e o giro decolonial. Revista Brasileira de Ciência Política, Brasília, n. 11, p. 89-117, 2013. DOI: 10.1590/S0103-33522013000200004
https://doi.org/10.1590/S0103-3352201300... ).

For Mignolo, the decolonial alternative must be epistemic and detach itself from the Western model of knowledge accumulation, valuing a notion of geopolitics and state politics that belongs to people, religions, concepts, and subjectivities that were racialized by modern, imperial, and colonial reason (Mignolo, 2008MIGNOLO, W. D. Desobediência epistêmica: a opção descolonial e o significado de identidade. Cadernos de Letras da UFF, Rio de Janeiro, n. 34, p. 287-324, 2008.). In this way, decolonial alternatives can emancipate Latin American thought by an interdisciplinary articulation of philosophical, cultural, political, and economic elements (Reis; Andrade, 2018REIS, M. N.; ANDRADE, M. F. F. O pensamento decolonial: análise, desafios e perspectivas. Revista Espaço Acadêmico, Maringá, n. 202, p. 1-11, 2018.).

Despite the advances in public health, the area of oral health had few rupture attempts in the epistemological sphere. The work of researcher Carlos Botazzo (2013BOTAZZO, C. Diálogos sobre a boca. São Paulo: Hucitec, 2013.) stands out, presenting the concept of buccality, which comprises the ability of the mouth to perform all its functions. That ability is related to social formation, to oral functions, such as speech, manducation, and erotism, which transcends the traditional dental idea, in a broad process integrated with the totality of the subject’s experience.

These functions of the mouth are, therefore, the basis for understanding it as a mode of consumption and as production, to rescue the social being, the subjective, and the historicity. Thus, oral health constitutes a broader field of analysis than that allowed by the technical and biological view of Dentistry, or even by public oral health (Botazzo, 2006BOTAZZO, C. Sobre a bucalidade: notas para a pesquisa e contribuição ao debate. Ciência & Saúde Coletiva, Rio de Janeiro, v. 11, n. 1, p. 7-17, 2006. DOI: 10.1590/S1413-81232006000100002
https://doi.org/10.1590/S1413-8123200600... ).

Buccality is also a response to the crisis within the field, and seeks to integrate the dimensions related to human social life, by approaching the human sciences and by distancing itself from the predominant objectivity in the health sciences. Therefore, the mouth is no longer understood as an organ, but is considered a territory to reveal new discourses and new meanings beyond the biological being (Botazzo, 2006BOTAZZO, C. Sobre a bucalidade: notas para a pesquisa e contribuição ao debate. Ciência & Saúde Coletiva, Rio de Janeiro, v. 11, n. 1, p. 7-17, 2006. DOI: 10.1590/S1413-81232006000100002
https://doi.org/10.1590/S1413-8123200600... ).

In short, it is an approach that goes beyond the Cartesian segmentation of the biomedical model and Market Dentistry, attempting to be an alternative conception to such reductionism and, therefore, with potential as a decolonial epistemology, in the sense of strengthening the democratic principles of the SUS.

Based on the above, this study aims to promote an analysis of the current scientific knowledge on the subject of oral health, based on an integrative review and critical-reflective analysis of its potential as a postcolonial epistemological alternative.

Method

Considering the proposed objective, the methodology is divided into two stages: (1) an integrative review of the scientific knowledge production on oral health; (2) a critical reflection, contextualizing buccality within postcolonial theory.

Integrative literature review is a method of evidence-based practice, capable of contributing to the theoretical deepening of a given topic, as it systematically and orderly gathers and synthesizes research results. Thus, it brings a broad literature analysis to contribute to the incorporation of knowledge and the redirection of health care practices (Mendes; Scott; Galvão, 2008MENDES, K. D. S.; SILVEIRA, R. C. C. P.; GALVÃO, C. M. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto & Contexto Enfermagem, Florianópolis, v. 17, n. 4, p. 758-764, 2008. DOI: 10.1590/S0104-07072008000400018
https://doi.org/10.1590/S0104-0707200800... ). The relevance of an integrative review is not restricted to the formulation of policies, protocols, and procedures, but it also extends to the promotion of critical thinking that is essential for daily practice (Souza; Silva; Carvalho, 2010SOUZA, M. T.; SILVA, M. D.; CARVALHO, R. Revisão integrativa: o que é e como fazer. Einstein, São Paulo, v. 8, n. 1, p. 102-106, 2010.).

For this review preparation, six steps were followed, namely: (1) elaboration of a guiding question; (2) literature search, with inclusion and exclusion criteria for articles; (3) data collection and spreadsheet preparation in Microsoft Excel® program, with data related to scientific articles; (4) critical analysis of the included articles; (5) results discussion; and (6) final report preparation, comprising the literature qualitative synthesis (Souza; Silva; Carvalho, 2010SOUZA, M. T.; SILVA, M. D.; CARVALHO, R. Revisão integrativa: o que é e como fazer. Einstein, São Paulo, v. 8, n. 1, p. 102-106, 2010.).

The study began with the guiding question: “What is the available evidence on oral health as an epistemological alternative to Dentistry for the Brazilian and Latin American population?” The concept of buccality was defined by Botazzo (2013BOTAZZO, C. Diálogos sobre a boca. São Paulo: Hucitec, 2013.) as a possible “epistemological alternative to Dentistry,” which was considered by this review the aim of not only mapping the publications on the subject, but also investigating orality as an epistemological possibility, other than traditional Dentistry. Due to the objectives, the research was limited to the Brazilian and Latin American context, since buccality historically refers to these countries’ reality and their historically colonized communities.

The bibliographic survey included the databases PubMed (Public Medical Literature Analysis Online), LILACS (Latin American and Caribbean Literature on Health Sciences Literature), and SciELO (Scientific Electronic Library Online). The search was carried out simultaneously and independently by two reviewers, from December 2023 to January 2024, with the same criteria in all databases. The search key used comprised the following descriptors: (1) “bucality”; (2) “Brazilian oral health”; (3) “Latin American oral health,” using the Boolean operators “AND” and “OR,” in Portuguese, Spanish, and English, according to the database, as summarized in Figure 1.

All forms of evidence on oral health, without time frame, fully available online, in Portuguese, English, or Spanish were included. Articles without a direct relation between the study and the topic of oral health were excluded.

Articles were initially selected by reading the titles and abstracts and applying the inclusion and exclusion criteria. Duplicate articles were excluded. In cases of doubt or unavailable abstract, the full text was accessed. Each article was carefully read in full, evaluating the relation with the theme.

The articles selected to comprise the integrative review were organized in a Microsoft Excel® spreadsheet, considering the following elements: (1) study title; (2) authors; (3) journal; (4) language; (5) year of publication; (6) study methodological classification; (7) place where the research was conducted, if applicable; (8) concept of buccality; (9) observed results summary, if applicable; (10) authors’ considerations; and (11) other relevant information, if applicable. After extracting these data, they were submitted to descriptive statistical analysis. A synthesis table was also constructed to provide a map of publications on oral health.

Results were then analyzed by critical reflection technique, which is a process that starts from an object of reflection (the intersection of bucality and decoloniality), conducted by the continuous data reexamination and reevaluation, to explore new structures and perspectives, based on decoloniality theoretical references, with emphasis on Walter Mignolo and Aníbal Quijano. It means to identify possible zones of agreement and divergence between perspectives and the boundaries of buccality as a decolonial epistemological alternative (Kember et al., 2008KEMBER, D. et al. A four-category scheme for coding and assessing the level of reflection in written work. Assessment &Evaluation in Higher Education, Londres, v. 33, n. 4, p. 369-379, 2008. DOI: 10.1080/02602930701293355
https://doi.org/10.1080/0260293070129335... ).

Results

The search strategy application identified nine studies in the investigated databases, of which only one was a duplicate. In reading of the eight titles and abstracts, we found that all studies met inclusion criteria, and that none of them presented the single exclusion criterion. Therefore, the final sample comprised eight publications. The flowchart in Figure 2 represents the process and each of its steps.

Data collection process of the studies in the final sample identified that all of them were published in Portuguese and in Brazilian journals. Of the eight studies, five were part of a debate in a special issue of the journal Ciência & Saúde Coletiva, in 2006, and are directly related to each other. The other three articles were published in the journals Revista de Saúde Pública (1) and Revista Saúde & Sociedade (2), in 2006, 2017, and 2022, respectively.

Regarding the methodology used, six of the studies were essays and/or critical analyses of theoretical nature, reflecting on elements related to the concept of buccality. The research by Bortoli et al. (2017BORTOLI, F. R. et al. Percepção da saúde bucal em mulheres com perdas dentárias extensas. Saúde & Sociedade, São Paulo, v. 26, n. 2, p. 533-544, 2017. DOI: 10.1590/S0104-12902017162160
https://doi.org/10.1590/S0104-1290201716... ), in turn, adopted a qualitative methodology, conducted by interviews to investigate the perception of women in the face of extensive tooth loss, from the theoretical perspective of buccality.

Chart 1 presents a summary of the main elements of each of the studies included in the final sample of this integrative review.

Critical-reflective analysis

Buccality emerges as a theoretical alternative within the field of public oral health, especially due to the need to offer a theoretical and conceptual field capable of understanding the social element of the mouth in a broader way (Barros, 2002BARROS, J. A. C. Pensando o processo saúde doença: a que responde o modelo biomédico? Saúde e Sociedade, São Paulo, v. 11, n. 1, p. 67-84, 2002. DOI: 10.1590/S0104-12902002000100008
https://doi.org/10.1590/S0104-1290200200... ; Botazzo, 2006BOTAZZO, C. Sobre a bucalidade: notas para a pesquisa e contribuição ao debate. Ciência & Saúde Coletiva, Rio de Janeiro, v. 11, n. 1, p. 7-17, 2006. DOI: 10.1590/S1413-81232006000100002
https://doi.org/10.1590/S1413-8123200600... ; Kovaleski; Freitas, Botazzo, 2006KOVALESKI, D. F.; FREITAS, S. F. T.; BOTAZZO, C. Disciplinarização da boca, a autonomia do indivíduo na sociedade do trabalho. Ciência & Saúde Coletiva, Rio de Janeiro, v. 11, n. 1, p. 97-103, 2006. DOI: 10.1590/S1413-81232006000100017
https://doi.org/10.1590/S1413-8123200600... ).

In this sense, it can be characterized not as a scientific area, but as the conceptual field that considers the mouth a source of human experiences, from the perspective of the subject and the works that it manifests through the mouth, such as speech, manducation, and erotism (Botazzo, 2006BOTAZZO, C. Sobre a bucalidade: notas para a pesquisa e contribuição ao debate. Ciência & Saúde Coletiva, Rio de Janeiro, v. 11, n. 1, p. 7-17, 2006. DOI: 10.1590/S1413-81232006000100002
https://doi.org/10.1590/S1413-8123200600... , ²⁰¹³BOTAZZO, C. Diálogos sobre a boca. São Paulo: Hucitec, 2013.). It is, therefore, a comprehension that extrapolates the elements of a rigid and objectivizing dental science.

By valuing the role of the subject whose autonomy has been reduced, it produces a critique of the dental scientific model itself, offering a new way of understanding the knowledge associated with the mouth, not only from a technical-scientific perspective, but also in its historical, experiential, and social scope. In this sense, oral health can be more than a theoretical concept in the area of public oral health or a paradigm, as Freitas (2006FREITAS, S. F. T. Mais algumas notas para contribuição ao debate sobre a bucalidade. Ciência & Saúde Coletiva, Rio de Janeiro, v. 11, n. 1, p. 31-33, 2006. DOI: 10.1590/S1413-81232006000100007
https://doi.org/10.1590/S1413-8123200600... ) proposes, but mainly an epistemological alternative.

The dental science that reduces the subjects is the same science of the biological model that limits the phenomenon of the health-disease process. It is grounded on the assumption of neutrality, which in modernity was a vehicle for validating the superiority of a certain way of thinking, whose characteristic was historically Eurocentric.

For Walter Mignolo (2008MIGNOLO, W. D. Desobediência epistêmica: a opção descolonial e o significado de identidade. Cadernos de Letras da UFF, Rio de Janeiro, n. 34, p. 287-324, 2008.), the rhetoric of Modernity since the sixteenth century has sought, in a civilizing mission, to impose development and modernization, under the logic of coloniality, appropriating land massively and promoting the extermination of natural resources and lives.

The concept of coloniality, introduced by the Peruvian sociologist Aníbal Quijano, is also the dark side of modernity: modernity is a project that is not detached from the European invasion against the territories of other peoples and from a process of domination. The pre-modern world was a polycentric and non-capitalist world. With modernity, capitalism was imposed as a global form of organization, based on a structure to control resources, authority, economy, subjectivity, and norms, as well as racial, gender, and sex classification dividing Europeans and Westerners from other peoples, which was consummated by labor control (Mignolo, 2017MIGNOLO, W. D. Colonialidade: O lado mais escuro da modernidade. Revista Brasileira de Ciências Sociais, São Paulo, v. 32, n. 94, 2017. DOI: 10.17666/329402/2017
https://doi.org/10.17666/329402/2017... ).

Modernity has, therefore, produced a mirage, with a global racial structuring, separating Moors and Jews in Europe and Indigenous and Black peoples on other continents. It organized classes of labor based on a system of production and control of capital and separating the international division of labor between center and periphery. Thus, political and military organizations and other institutions of power were centralized among European men, producing -with a supposedly scientific character-a racial hierarchy, structured in part on the notion of progress, in addition to producing a hierarchy and classification of sex, gender, and a spiritual and aesthetic hierarchy. Finally, it produced also an epistemic hierarchy, among others (Mignolo, 2017MIGNOLO, W. D. Colonialidade: O lado mais escuro da modernidade. Revista Brasileira de Ciências Sociais, São Paulo, v. 32, n. 94, 2017. DOI: 10.17666/329402/2017
https://doi.org/10.17666/329402/2017... ).

Although all these elements are fundamental to understand the inseparability of Modernity from Coloniality and its effects that last even after the end of the colonial period, this last imposed hierarchy, the epistemic, is the one closely linked to the more immediate issue of public oral health. Western knowledge and cosmology were prioritized in relation to other forms of knowledge production, often considered worthless (Mignolo, 2017MIGNOLO, W. D. Colonialidade: O lado mais escuro da modernidade. Revista Brasileira de Ciências Sociais, São Paulo, v. 32, n. 94, 2017. DOI: 10.17666/329402/2017
https://doi.org/10.17666/329402/2017... ).

The European colonial perception that all non-European peoples were “backward” has produced a reasoning that ignored alternative (non-European, colonized) forms of knowledge, concealing their Eurocentric character in the form of a neutral and supposedly scientific/rational/modern discourse. The myth of evolutionism contributed to an interpretation that the America yet to be colonized was in the “past” and, therefore, would be less evolved, thus justifying the colonizing process as a kind of civilizing moral duty, even if under force and violence (Quijano, 2005QUIJANO, A. Colonialidade do poder, Eurocentrismo e América Latina. In: LANDER, E. (org.). A colonialidade do saber: eurocentrismo e ciências sociais. Perspectivas latino-americanas. Buenos Aires: Clacso, 2005. p. 107-126.).

By presenting its concern with the subjective aspect of the mouth, buccality opens the way for research to reveal the manifestations of the body of colonized peoples, offering a broader research path than the scientific limits of Dentistry. On the other hand, the concept of buccality, in essence, is still very much linked to theories produced within a perspective of Eurocentric epistemology, with the influence of European authors, such as Foucault and Freud, regarding the body.

At this point, it seems that buccality rather fits more into what Mignolo (2017MIGNOLO, W. D. Colonialidade: O lado mais escuro da modernidade. Revista Brasileira de Ciências Sociais, São Paulo, v. 32, n. 94, 2017. DOI: 10.17666/329402/2017
https://doi.org/10.17666/329402/2017... ) calls border epistemology, which is closely linked to the decolonial process, by the anthropos who does not want to submit to the humanitas imposed by Eurocentric thinking, even though this is inevitable. It is up to buccality to develop its own theoretical field, which will be able to demonstrate whether, in fact, it will become an alternative epistemology to that supposedly neutral and scientific language imposed by the sciences in general and, in particular, by dental science, or if the field will adapt to the frontier character of thought, transiting between both influences.

When we consider the doctrinal and organizational principles of the SUS, such as universality, integrality, equity, decentralization, regionalization, hierarchization, and social participation, it is clear that a model with individualized knowledge construction and focused on objective aspects does not seem able to offer a practice consistent with these principles. In this sense, as pointed out by Couto and Botazzo (2022COUTO, J. G. A.; BOTAZZO, C. “Prefiro mexer no coração a mexer na boca”: reflexões sobre o cuidado em saúde bucal. Saúde e Sociedade, São Paulo, v. 31, n. 2, 2022. DOI: 10.1590/S0104-12902022210709pt
https://doi.org/10.1590/S0104-1290202221... ), there is no longer room for a purely technocratic conception, which should be renounced as a model of oral health care.

When we think about the implementation history of the once hegemonic health care models, with technical and financial support by large North American institutions, it is necessary to reflect to what extent are these in fact representative of the realities experienced in countries such as Brazil and many others that make up the Global South, and how much they can represent, as identified by decolonial theories, the continuous effects of a colonization process to endure. Such an analysis becomes even more important in view of the resistance found in the very process of implementation and strengthening of the Unified Health System (SUS) and counter-hegemonic alternatives within the country itself in the field of oral health.

Final considerations

This integrative review enabled us to identify that buccality is an emerging theme and that it can provide a theoretical field for perceptions that go beyond the limits of Dentistry, with possibilities for investigating social and cultural aspects to integrate subjectivity beyond the individualistic model of oral health care. In this sense, buccality differs from forms of knowledge in the field of Dentistry and even public oral health, as it offers a new and unique field, full of possibilities.

The publications identified in this integrative review demonstrated a completely national character, which is in accordance with the idea that all the texts were in Portuguese, and it is a theory that also arises from national experiences. Considering the possibility of developing one’s own theories related to Latin American and Brazilian experiences, in opposition to the colonial power that still exists, the potential to value perspectives suppressed by the traditional epistemology of dental science was identified.

However, the current development of the concept of buccality does not allow us to understand it as a full decolonial alternative, since it maintains a very close dialogue with concepts and conceptions from modern/Eurocentric epistemology. By inhabiting both worlds, it is possible to consider that, currently, buccality is a border thinking, conferring an important value for the future of research in public oral health, especially those that are concerned with the context of the Brazilian and Latin American reality.

References

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