Community Participation and the Making of Brazil’s National Oral Health Policy

INTRODUCTION AND AIMS: Community participation is recognized as a core attribute of equitable and effective health systems, yet its concrete influence on national oral health policy remains underexplored. Brazil offers a unique case of a large, universal health system in which oral health policy has been shaped by institutionalized social participation. This study analyses how community participation influenced the formulation, implementation and institutionalization of Brazil's National Oral Health Policy (Política Nacional de Saúde Bucal - PNSB, "Brasil Sorridente"). METHODS: We conducted a qualitative documentary policy analysis guided by the public policy cycle model. We examined final reports of the three National Oral Health Conferences, minutes of the National Health Council and its Intersectoral Oral Health Commission (2003-2024), key legal and regulatory documents, and relevant academic literature. Documents were coded according to six policy phases-problem recognition and agenda setting, formulation, decision-making, implementation, evaluation and institutionalization-with particular attention to the role of participatory institutions and the tension between Collective Oral Health and Market Dentistry. RESULTS: Community participation was pivotal in defining oral health as a public problem and in placing it on the national health agenda during Brazil's democratic transition. Health conferences and councils later served as deliberative arenas where civil society, social movements and professional groups formulated and validated policy alternatives, culminating in the adoption of PNSB and its incorporation into the National Health Plan. During implementation, participatory institutions contributed to expanding the Oral Health Care Network, strengthening intersectoral actions such as water fluoridation, and sustaining epidemiological surveillance, while also contesting funding instability and market pressures. The enactment of Law No. 14,572/2023 consolidated PNSB as a State policy, explicitly reaffirming the role of community participation. CONCLUSION: Institutionalized community participation shaped all phases of Brazil's national oral health policy, contributing to its resilience and alignment with universal, equity-oriented principles despite political and economic fluctuations. CLINICAL RELEVANCE: Brazil's experience shows that participatory governance can help integrate oral health into universal health systems, support preventive and equity-focused care, and offer practical lessons for countries seeking to move beyond market-driven, treatment-centred dental services.