Comparison between the ion-specific electrode and SPADNS methods for analysis of fluoride concentration in the water supply

The maintenance of adequate fluoride (F) concentration in the public water supply is fundamental for ensuring that the community use of F can reach the maximum benefit for caries control and minimum risk for dental fluorosis. Thus, surveillance systems must use accurate and valid analytical methods to determine F concentration and, according to the literature, give preference to the ion-specific electrode (F- ISE) analysis. Aim: The objective of this study was to compare the accuracy of the ISE and SPADNS methods in the determination of the F concentration in the same water sample. Methods: Duplicate water samples were taken from 30 sampling sites in the municipality of Maringá, state of Paraná, monthly for 12 months, totaling 276 samples. An aliquot was analyzed by the FOP-UNICAMP Oral Biochemistry laboratory, using the F- ISE method, and the other one, by the SANEPAR laboratory in Maringá/PR, using the SPADNS method. Descriptive analysis and Pearson's correlation test were applied, with a significant level of p<0.05. Results: Results were expressed as ppm F (mg F/L), and a very strong positive correlation (r= 0.91; p<0.001) was detected between the two methods of analysis. Conclusion: Our findings suggest that the determination of f luoride concentration in water can be made with accuracy by the SPADNS method, a standardized analysis protocol

Anticaries potential of a fluoride foam

Abstract Foam has been used worldwide as a vehicle for the professional application of fluoride and hypothetically should have the same anticaries potential as conventional fluoride gel (F-gel) in terms of the formation of reaction products with enamel. Thus, the ability of Flúor Care® foam (FGM, Joinville, SC, Brazil, 12,300 ppm F, acidulated) to react with enamel was evaluated in comparison with Flúor gel® (DFL, Rio de Janeiro, RJ, Brazil, 12,300 ppm F, acidulated). Slabs (n=10/group) of sound enamel and with caries lesion were used, in which the concentrations of total fluoride (TF), and loosely (CaF2-like) and firmly (FAp) bound types were determined. The importance of agitation during application was previously tested. The determinations were made with fluoride ion-specific electrode and the results were expressed in μg F/cm² of the treated enamel area. ANOVA and Tukey tests were used to analyze the difference among treatments, independently for sound and carious enamel. The agitation of the products during application significantly increased the reactivity of the foam (p<0.05), but not that of the gel (p>0.05). The foam did not differ from F-gel (p>0.05) concerning the formation of TF and CaF2-like in sound or carious enamel. Regarding FAp, the foam did not differ from F-gel (p>0.05) in the carious enamel, but the concentration in the sound was lower (p<0.05). The results show that this commercial fluoride foam tested needs to be agitated during application to improve its reactivity with enamel, which raises a question about other brands.

Resumo A espuma tem sido utilizada mundialmente como veículo para aplicação profissional de fluoreto e hipoteticamente deveria ter o mesmo potencial anticárie que o gel fluoretado convencional (F-gel) em termos de formação de produtos de reação com o esmalte. Assim, a capacidade da espuma Flúor Care® (FGM, Joinville, SC, Brasil, 12.300 ppm F, acidulada) de reagir com o esmalte foi avaliada em comparação com o Flúor gel® (DFL, Rio de Janeiro, RJ, Brasil 12.300 ppm F, acidulado). Foram utilizados blocos (n=10/grupo) de esmalte hígido e com lesão de cárie, nos quais foram determinadas as concentrações de flúor total (FT), e os tipos de flúor fracamente (tipo-CaF2) e firmemente (FAp) ligados ao esmalte. A importância da agitação durante a aplicação foi previamente testada. As determinações foram feitas com eletrodo íon específico para fluoreto e os resultados foram expressos em μg F/cm² da área tratada do esmalte. A diferença entre os tratamentos foi analisada por ANOVA e Tukey (α=5%), independentemente para esmalte hígido e cariado. A agitação dos produtos durante a aplicação aumentou significativamente a reatividade da espuma (p<0,05), mas não a do gel (p>0,05). A espuma não diferiu do F-gel (p>0,05) quanto à formação de FT e tipo-CaF2 no esmalte hígido ou cariado. Em relação à FAp, a espuma não diferiu do F-gel (p>0,05) no esmalte cariado, mas a concentração no hígido foi menor (p<0,05). Os resultados mostram que esta espuma fluoretada comercial testada precisa ser agitada durante a aplicação para melhorar sua reatividade com o esmalte, o que levanta questão sobre outras marcas.

Effect of phenylmethylsulfonyl fluoride, a protease inhibitor, on enamel surface remineralization

Phenylmethylsulfonyl fluoride (PMSF) is a protease inhibitor widely used in research, but fluoride is released during its action and this knowledge has been neglected in dental research. Aim: to evaluate if fluoride released by salivary protease action on PMSF affects enamel remineralization and fluoride uptake. Methods: Groups of 10 enamel slabs, with caries-like lesions and known surface hardness (SH), were subjected to one of the following treatment groups: Stimulated human saliva (SHS), negative control; SHS containing 1.0 µg F/mL (NaF), positive control; and SHS containing 10, 50 or 100 µM PMSF. The slabs were subjected to a pH-cycling regimen consisting of 22 h/day in each treatment solution and 2 h/day in a demineralizing solution. After 12 days, SH was again measured to calculate the percentage of surface hardness recovery (%SHR), followed by enamel fluoride uptake determination. The time-related fluoride release from 100.0 µM PMSF by SHS action was also determined. Data were analyzed by ANOVA followed by Newman-Keuls test. Results: The release of fluoride from PMSF by SHS was rapid, reaching a maximum value after 10 min. Fluoride released from PMSF was more effective in enhancing %SHR and increasing fluoride uptake in enamel compared with SHS alone (p < 0.05); furthermore, it was equivalent to the positive control (p > 0.05). Conclusion: In conclusion, fluoride released by saliva from PMSF is available to react with enamel and needs to be taken into account in research using this protease inhibitor

Dose-response relationship between toothpaste soluble fluoride absorbed in the gastrointestinal tract and saliva fluoride secretion

Aim: This study aimed to evaluate if there is a dose-response relationship between toothpaste chemically soluble fluoride absorbed in the gastrointestinal tract and fluoride secreted by saliva, giving support to the use of saliva as surrogate for plasma fluoride. Methods: A 4-phase single blind study was conducted, in which 10 participants were subjected in each phase to one of the assigned treatment groups: group I: fresh sample of a Na2FPO3/CaCO3-based toothpaste with 1,334 µg F/g of total soluble fluoride (TSF) and groups II­IV: aged samples of this toothpaste presenting TSF concentrations of 1,128, 808, and 687 µg F/g, respectively. In all phases, the participants ingested an amount of toothpaste equivalent to 70.0 µg F/Kg body weight, as total fluoride (TF). Saliva and blood samples were collected before (baseline) and up to 180 min after toothpaste ingestion as indicator of fluoride bioavailability. F concentration in saliva and blood plasma was determined with a fluoride ion-specific electrode. The areas under the curve (AUC) of F concentration versus time (AUC = ng F/mL × min) and the peaks of fluoride concentration (Cmax) in saliva and plasma were calculated. Results: A significant correlation between mg of TSF ingested and the AUC (r=0.47; p<0.01), and Cmax (r=0.59; p<0.01) in saliva was found; for TF, the correlation was not significant (p>0.05). In addition, the correlations between plasma and saliva fluoride concentrations were statistically significant for AUC (r=0.55; p<0.01) as for Cmax (r=0.68; p<0.01). Conclusion: The findings support that saliva can be used as a systemic biomarker of bioavailable fluoride present in Na2FPO3/CaCO3-based toothpaste

Necessidade e urgência de revisão da regulamentação brasileira sobre dentifrícios fluoretados, e posicionamento da academia brasileira de odontologia / Necessity and urgency to change the brazilian regulation about fluoride toothpastes, and the statement of the brazilian academy of dentistry why the current brazilian regulation about fluoride toothpastes requires urgent revision?

Introdução: a primeira regulamentação sobre dentifrícios fluoretados do Brasil (Portaria no 22, de 20/12/1989, da ex-Secretaria Nacional de Vigilância Sanitária) estabelecia não só a concentração máxima de fluoreto total (1500 ppm F) que um dentifrício deveria conter em termos de segurança de produto de higiene, como a mínima de fluoreto quimicamente solúvel (potencialmente ativo contra cárie) para garantir o benefício anticárie da escovação dental. Objetivo: demonstrar a necessidade e urgência de revisão da vigente regulamentação brasileira sobre dentifrícios fluoretados e registrar o posicionamento da Academia Brasileira de Odontologia. Fonte de Dados: Lilacs, PubMed, SciELO e nos arquivos do laboratório de Bioquímica Oral da FOP-UNICAMP. Síntese dos Dados: desde 1994, a Portaria nº 22 sofreu contínuas modificações culminando com a resolução ANVISA RDC No 530 de 04/08/2021. As mudanças feitas não foram baseadas no conhecimento científico mundial, do qual a Odontologia brasileira é referência. Assim, desde a primeira mudança feita em 1994, não mais foi dada importância à qualidade do fluoreto de um dentifrício, priorizando apenas a quantidade máxima de fluoreto total que ele deveria conter. Dezenas de publicações científicas tem sido feitas alertando para esse erro histórico, mas até o momento se mostraram infrutíferas. Trata-se de problema de saúde pública, pois em acréscimo tem afetado a população mais vulnerável à cárie dentária. Conclusão: a necessidade e urgência da revisão da resolução ANVISA nº 530, requer ação da sociedade como um todo, razão desta revisão e posicionamento formal circunstanciado da Academia Brasileira de Odontologia (AcBO).

Introduction: the first Brazilian regulation on fluoride toothpastes (Ordinance No 22 of 12/20/1989, of the National Health Surveillance Secretariat) established not only the maximum concentration of total fluoride (1500 ppm F) that a toothpaste should contain in terms of safety oral hygiene product, but also the minimum concentration of fluoride chemically soluble fluoride (potentially active against caries) that should contain to have ensure the anticaries benefit of toothbrushing. Objective: to prove the need and urgency of reviewing the current Brazilian regulation on fluoridated toothpastes and record the statement of the Brazilian Academy of Dentistry. Sources of data: Lilacs, PubMed, and SciELO databases and in the files of the Laboratory of Oral Biochemistry from FOP-UNICAMP. Synthesis of data: since 1994, the Ordinance No. 22 underwent continuous changes, culminating in 08/04/2021 with the resolution ANVISA RDC No 530. The changes made were not based on the best scientific evidence of the subject, that has the Brazilian Dentistry as an international reference. Thus, since the first change made in 1994, less importance has been given to the quality of fluoride in a toothpaste than the maximum amount of total fluoride that it should contain. Dozens of scientific publications have been made warning of this historic mistake, but so far, they have been shown fruitless. It is a public health problem that affects mainly underprivileged populations, who are most vulnerable to dental caries. Conclusion: the need and urgency for a revision of the Brazilian regulation ANVISA RDC No 530 to ensure that the population receives fluoride toothpaste with a minimum concentration of soluble fluoride with anticaries potential is the reason of this review and the formal position of the Brazilian Academy of Dentistry (AcBO).

Fluoride concentration in toothpaste marketed to children in Brazil and Mexico, and discussion on current regulations

Resumo Os dentifrícios fluoretados comercializados para crianças devem conter concentração mínima de 1000 ppm de fluoreto (F), que deve ser quimicamente solúvel para ter efeito anticárie. Portanto, determinamos as concentrações de fluoreto total (FT) e fluoreto solúvel total (FST) em dentifrícios comercializados para crianças no Brasil e no México e analisamos as regulamentações vigentes em ambos os países. Vinte e quatro marcas foram encontradas e adquiridas no Brasil (19 formuladas com NaF/SiO2, três com Na2FPO3/CaCO3 e duas com Na2FPO3/SiO2) e seis no México (todas com NaF/SiO2). As concentrações de FT e FST foram determinadas após a compra (amostras frescas), e a estabilidade do fluoreto nas formulações de Na2FPO3/CaCO3 foi verificada após 18 meses. As análises foram realizadas com eletrodo íon-específico e os resultados expressos em ppm F (mg F/kg). As concentrações de FT encontradas variaram de 476,0 a 1.385,3 ppm F e foram próximas às declaradas pelos fabricantes (500 a 1.450 ppm F). As concentrações de FT encontradas não ultrapassaram 1.500 ppm F, de acordo com as regulamentações vigentes de ambos os países. No entanto, dentifrícios com concentrações de FST inferiores a 1.000 ppm F foram encontrados tanto em dentifrício com baixa concentração (500 ppm F) formulado com NaF/SiO2 como em dentifrícios com Na2FPO3/CaCO3 frescos e envelhecidos, originalmente fabricados com 1.000-1.100 ppm de FT. Em conclusão, embora a maioria dos dentifrícios analisados apresentasse concentração de FST superior a 1.000 ppm F, as regulamentações vigentes em ambos os países permitem que produtos que não estejam de acordo com a melhor evidência disponível estejam presentes no mercado.

Abstract Fluoride toothpastes market to children should contain a minimum concentration of 1000 ppm of fluoride (F), which must be chemically soluble to provide anti-caries effect. Therefore, we determined the concentrations of total fluoride (TF) and total soluble fluoride (TSF) in toothpastes marketed to children in Brazil and Mexico and analyzed the current regulations in force in both countries. Twenty-four brands were found and purchased in Brazil (19 formulated with NaF/SiO2, three with Na2FPO3/CaCO3 and two with Na2FPO3/SiO2) and six in Mexico (all with NaF/SiO2). TF and TSF concentrations were determined after the purchase (fresh samples) but fluoride stability in Na2FPO3/CaCO3-formulations was checked after 18 months. The analyses were performed with an ion-specific electrode and the results expressed in ppm F (mg F/kg). The TF concentrations found ranged from 476.0 to 1385.3 ppm F and they were close the declared by the manufactures (500 to 1450 ppm F). The TF concentrations found were not greater than 1500 ppm F, in accordance with the current regulations of both countries. However, toothpastes presenting TSF concentrations lower than 1000 ppm F were found either in low fluoride toothpaste (500 ppm F) formulated with NaF/SiO2 as in fresh and aged Na2FPO3/CaCO3-toothpastes, originally fabricated with 1000-1100 ppm of TF. In conclusion, although most toothpastes analyzed showed TSF concentration higher than 1000 ppm F, the regulations in force in both countries allow that products not in agreement with the best available evidence are available in the market.

Fluoride toothpaste, sanitary surveillance and the SUS: the case of Manaus-AM, Brazil / Dentifrício fluoretado, vigilância sanitária e o SUS: o caso de Manaus-AM

ABSTRACT OBJECTIVE To determine the anticaries potential of toothpastes distributed by the primary health care public clinics (UBS) of Manaus, AM. METHODS Ninety-nine tubes of toothpaste from four commercial brands were collected from October 7, 2019 to October 11, 2019 in 16 UBS. They were assigned a code by brand and source UBS. According to the information on the packaging, the four brands and their batches were formulated with sodium monofluorophosphate (Na2FPO3) and most (91%) had calcium carbonate (CaCO3) as an abrasive. We determined the concentrations of total fluoride (TF = TSF + InsF) and total soluble fluoride (TSF = F ions- or FPO32-), to certify whether they were in compliance with resolution ANVISA RDC No. 530 (maximum of 1,500 ppm TF) and whether they had anticaries potential (minimum of 1,000 ppm TSF). The analyses were performed with a ion- specific electrode. RESULTS The concentrations (ppm F) of TF [mean; standard deviation (SD); n] found in toothpaste brands A (1,502.3; SD = 45.6; n = 33), B (1,135.5; SD = 52.7; n = 48) and D (936.8; SD = 20.5; N = 8) were close to those stated on the package, 1,500, 1,100 and 1,000 ppm F, respectively. In toothpaste C, we found a mean of 274.1 ppm (SD = 219.7; n = 10) of TF, which diverges from the declared concentration of 1,500 ppm F. In addition, the five tubes of lot no. 11681118 of toothpaste C did not contain fluoride. Regarding TSF, with the exception of toothpaste D (937.9; SD = 40.29), the others had a lower concentration than their respective TF. CONCLUSION We found serious problems of quantity and quality of fluoride in toothpaste distributed by the SUS in Manaus, which shows the need for surveillance of these products and confirms the urgency of revising resolution RDC No. 530.

RESUMO OBJETIVO Determinar o potencial anticárie dos dentifrícios distribuídos pelas unidades básicas de saúde (UBS) de Manaus-AM. MÉTODOS Noventa e nove bisnagas de dentifrícios de quatro marcas comerciais foram coletadas de 7 de outubro de 2019 a 11 de outubro de 2019 em 16 UBS, que foram codificados por marca e UBS de origem. De acordo com a embalagem, os dentifrícios das quatro marcas e seus lotes foram formulados com monofluorofosfato de sódio (Na2FPO3) e a maioria (91%) tinha carbonato de cálcio (CaCO3) como abrasivo. Foram determinadas as concentrações de fluoreto total (FT = FST + Fins) e de fluoreto solúvel total (FST = íons F- ou FPO32-), para certificar se atendiam à resolução ANVISA RDC Nº 530 (máximo de 1.500 ppm de FT) e se tinham potencial anticárie (mínimo de 1.000 ppm de FST). As análises foram feitas com eletrodo íon específico. RESULTADOS As concentrações (ppm F) de FT [média; desvio padrão (DP); n] encontradas nos dentifrícios A (1.502,3; DP = 45,6; n = 33), B (1.135,5; DP = 52,7; n = 48) e D (936,8; DP = 20,5; n = 8) foram próximas ao descrito na embalagem, 1.500, 1.100 e 1.000 ppm F, respectivamente. No dentifrício C, foi encontrada média de 274,1 ppm (DP = 219,7; n = 10) de FT, divergindo da concentração declarada de 1.500 ppm F. Em acréscimo, as cinco bisnagas do lote no 11681118 do dentifrício C não foram fluoretadas. Quanto ao FST, à exceção do dentifrício D (937,9; DP = 40,29), os demais apresentaram concentração inferior ao seu respectivo FT. CONCLUSÃO Observou-se problemas graves de quantidade e qualidade do fluoreto nos dentifrícios distribuídos pelo SUS em Manaus, mostrando a necessidade de vigilância desses produtos e ratificando a urgência da revisão da resolução ANVISA RDC Nº 530.

Fluoride bioavailability on demineralized enamel by commercial mouth rinses

Abstract The ability of mouth rinses, available in the international market, to form reaction products on demineralized enamel (bioavailability test) was evaluated in vitro. Nine mouth rinses purchased in Chile were evaluated; eight formulated with NaF (one containing 100 µg F/mL and seven containing 226) and one with Na2FPO3 (226 µg F/mL as ion F). Demineralized enamel slabs (n=15 per mouth rinse) were sectioned; one half was subjected to the assigned mouth rinse treatment for 10 min and the other half was used to obtain baseline data. Loosely bound and firmly bound fluoride formed on enamel were determined with an ion-specific electrode and the values were expressed in µg F/cm2. The concentration of fluoride and the pH of the mouth rinses were previously determined. Concentrations of loosely bound and firmly bound fluoride formed on enamel were independently analyzed by ANOVA and Tukey's test (α=5%). The loosely bound and firmly bound fluoride concentrations (µg F/cm2) formed ranged from 3.2 to 36.2 and 0.4 to 1.7, respectively. Loosely bound fluoride formed on enamel was significantly more effective in discriminating the effect of different commercial mouth rinses than firmly bound fluoride. Mouth rinses with 226 ppm F as NaF and low pH presented significantly greater bioavailability of fluoride on enamel than those with higher pH or lower NaF concentration. The mouth rinse with Na2FPO3 showed low reactivity. Although further studies are necessary, the findings showed that commercial fluoride-containing mouth rinses have important variations in enamel fluoride bioavailability, which may result in differences on anticaries efficacy.

Resumo Os enxaguatórios bucais comerciais fluoretados diferem na concentração e tipo de sal de fluoreto, no pH e têm alguns ingredientes que podem interferir na reatividade do fluoreto com o esmalte desmineralizado. A capacidade de enxaguatórios bucais comerciais de formar produtos de reação em esmalte desmineralizado (teste de biodisponibilidade) foi avaliada in vitro. Nove enxaguatórios bucais adquiridos no Chile foram avaliados, oito formulados com NaF (um contendo 100 µg F/mL e sete contendo 226) e um com Na2FPO3 (226 µg F/mL como íon F). Os blocos de esmalte desmineralizados (n=15 por grupo) foram seccionados, uma metade foi submetida ao tratamento com o enxaguatório designado por 10 min e a outra metade foi usada para dados baseline. Fluoreto fracamente e firmemente ligados formados no esmalte foram determinados com um eletrodo íon-específico e os valores foram expressos em µg F /cm2. A concentração de fluoreto e o pH dos enxaguatórios foi previamente determinada. As concentrações de fluoreto tipo fluoreto fracamente ligado e fortemente ligado formadas no esmalte foram analisadas independentemente por ANOVA e teste de Tukey (α=5%). As concentrações de fluoreto fracamente ligado e fortemente ligado formados variaram de 3,2 a 36,2 e 0,4 a 1,7, respectivamente. O fluoreto fracamente ligado formado no esmalte foi significativamente mais eficaz para discriminar o efeito dos diferentes enxaguatórios bucais comerciais do que o fluoreto firmemente ligado. Enxaguatórios bucais com 226 ppm F na forma de NaF e baixo pH apresentaram significativamente maior biodisponibilidade de fluoreto no esmalte do que aqueles com maior pH ou menor concentração de NaF. O enxaguatório com Na2FPO3 apresentou reatividade muito baixa. Embora mais estudos sejam necessários, os resultados mostraram que os enxaguatórios bucais comerciais contendo fluoreto apresentam variações importantes na biodisponibilidade do fluoreto, o que poderia resultar em diferenças na eficácia anticárie.

Fluorose por ingestão voluntária de pasta fluoretada após os 5 anos de idade: relato de caso e discussão da importância da educação em saúde bucal na 1a infância / Fluorosis from voluntary ingestion of fluoride paste after 5 years of age: case report and discussion of the importance of health education in early childhood

Introdução: Preocupações com a ingestão de pasta fluoretada por crianças se limita à primeira infância devido ao risco de fluorose nos dentes permanentes anteriores, mas o processo educativo para garantir uma segurança para toda a dentição tem sido negligenciado. Objetivo: Relatar um caso de fluorose dentaria em dentes caninos, pré-molares e 2o molares por ingestão voluntária de pasta fluoretada Relato do caso: Paciente de 12 anos, 65 kg, procurou atendimento odontológico devido a insatisfação com a coloração dos dentes posteriores. Constatou-se que os dentes caninos, pré-molares e segundo molares, superiores e inferiores apresentavam opacidades tipo fluoróticas, estando os demais normais. Entre as possíveis causas, a principal recaiu sobre o modo que a criança passou a escovar os dentes após os 5 anos de idade. Foi relatado que ela voluntariamente escovava seus dentes 6x/dia sem cuspir. Foram feitas análises da concentração de fluoreto da água consumida pela paciente e nas pastas usadas. Também foi feito teste de excreção de fluoreto urinário pela paciente, solicitando para ela escovar os dentes cuspindo ou engolindo toda a pasta em uso. Resultados: Na água foi encontrado 0,74 mg F/L e nas pastas usadas 1.357 e 1.426 mg F solúvel/ kg. Na urina foi encontrado 0,90 e 1,35 mg F, respectivamente, cuspindo ou engolindo a pasta após as escovações. Foi estimado que a partir dos 5 anos de idade, a criança se submeteu à dose de 0,17 mg F/dia/kg de peso corpóreo, a qual é 2,4 vezes maior que o limite superior de risco de fluorose. Conclusão: O caso relatado sugere ser uma consequência de falha do processo de educação em saúde na 1a infância quanto ao uso racional de dentifrício fluoretado.

Introduction: Concerns about children's intake of fluoride toothpaste are limited to infancy due to the risk of fluorosis in the permanent anterior teeth, but the educational process to ensure safety for the entire dentition has been neglected. Objective: To report a case of dental fluorosis in canine, premolar and 2nd molar teeth caused by voluntary ingestion of fluoride toothpaste. Case report: A 12- year-old patient, 65 kg, search dental care due to dissatisfaction with the color of the posterior teeth. It was diagnosticated that the superior and inferior canine, premolar and second molar teeth had fluorotic opacities, and the other teeth are sound. Among the possible causes, the main one was the way the child started brushing their teeth after 5 years of age. It was reported that she voluntarily brushed her teeth 6x/day without spitting. Analyzes of the fluoride concentration in the water consumed by the patient and in the toothpastes used were performed. A urinary fluoride excretion test by the patient, requesting her to brush her teeth by spitting out or swallowing all the toothpaste in use, was made. Results: Fluoride concentration in the water was 0.74 mg F/L and 1,357 and 1,426 mg F/kg in the toothpastes pastes used. In urine test, 0.90 and 1.35 mg F were found, respectively, spitting or swallowing the toothpaste after brushing. It was estimated that from 5 years of age, the child was submitted a dose of 0.17 mg F/day/kg of body weight, which is 2.4 times the upper limit for an acceptable fluorosis. Conclusion: The reported case suggests that it is a consequence of the failure of the health education process in early childhood regarding the rational use of fluoride toothpaste.

Fluoreto e inteligência: avaliação crítica de um estudo de coorte prospectivo / Fluoride and intelligence: critical assessment of a prospective cohort study

Introdução: A fluoretação da água é considerada uma estratégia eficaz e segura para a prevenção de cárie dentária. Contudo, com base em um estudo de coorte realizado no Canadá que avaliou a associação entre exposição de gestantes a fluoreto (F) e inteligência (QI) da prole aos 3/4 anos de idade, publicações alarmistas nas redes sociais têm divulgado que o F adicionado à água reduz a inteligência de crianças. Objetivo: Avaliar a qualidade da evidência sobre exposição à F e inteligência proporcionada por esse estudo. Apresentar as principais características do estudo seguida de análise crítica da evidência. Síntese dos dados: A concentração de F na água consumida pelas gestantes expostas à água fluoretada foi 4,5 vezes maior do que na água consumida pelas gestantes que viviam em região sem água fluoretada; o escore médio de QI das crianças dos dois grupos foi o mesmo. Houve associação estatisticamente significante entre excreção urinária materna de F e menor QI de meninos. O aumento de 1 mg F/l na ingestão autorrelatada de F materna foi associado a um decréscimo de 3 pontos no QI da prole. A análise crítica identificou risco de viés de seleção e de informação e confundimento residual, com potencial de comprometer a validade dos resultados. Conclusão: O estudo não proporciona evidência robusta sobre exposição ao fluoreto e diminuição da inteligência. Sua conclusão não deve ser extrapolada como suporte científico para propostas de mudanças na fluoretação da água de abastecimento público.

Introduction: Water fluoridation is considered an effective and safe strategy for preventing dental caries. However, based on a cohort study conducted in Canada that evaluated the association between exposure of pregnant women to fluoride (F) and intelligence (IQ) of offspring at 3/4 years of age, alarmist publications on social networks have reported that F added to water reduces children's intelligence. Objective: To evaluate the quality of the evidence regarding exposure to F and intelligence provided by this study. To describe of the study's main characteristics followed by critical appraisal. Synthesis of data: The concentration of F in water consumed by pregnant women exposed to fluoridated tap water was 4.5 times higher than in water consumed by pregnant women not exposed to fluoridated tap water; mean IQ score of the children in the two groups was the same. There was a statistically significant association between maternal urinary excretion of F and lower IQ in boys. The increase of 1 mg F / l in the self-reported intake of maternal F was associated with a decrease of 3 points in the offspring's IQ. We identified the risk of selection and information bias, as well as potential for residual confounding, which might have affected the validity of the results. Conclusion: the study does not provide robust evidence on exposure to fluoride and impaired intelligence. Its conclusion should not be extrapolated as scientific support for proposals for changes in the fluoridation of public water supply.

Fluoride bioavailability on demineralized enamel by commercial mouthrinses

Abstract The ability of mouthrinses, available in the international market, to form reaction products on demineralized enamel (bioavailability test) was evaluated in vitro. Nine mouthrinses purchased in Chile were evaluated; eight formulated with NaF (one containing 100 µg F/mL and seven containing 226) and one with Na2FPO3 (226 µg F/mL as ion FPO3 ). Demineralized enamel slabs (n=15 per mouthrinse) were sectioned; one half was subjected to the assigned mouthrinse treatment for 10 min and the other half was used to obtain baseline data. Loosely bound and firmly bound fluoride formed on enamel were determined with an ion-specific electrode and the values were expressed in µg F/cm2. The concentration of fluoride and the pH of the mouthrinses were previously determined. Concentrations of loosely bound and firmly bound fluoride formed on enamel were independently analyzed by ANOVA and Tukey's test (α=5%). The loosely bound and firmly bound fluoride concentrations formed ranged from 3.2 to 36.2 and 0.4 to 1.7, respectively. Loosely bound fluoride formed on enamel was significantly more effective in discriminating the effect of different commercial mouthrinses than firmly bound fluoride. Mouthrinses with 226 ppm F as NaF and low pH presented significantly greater bioavailability of fluoride on enamel than those with higher pH or lower NaF concentration. The mouthrinse with Na2FPO3 showed low reactivity. Although further studies are necessary, the findings showed that commercial fluoride-containing mouthrinses have important variations in enamel fluoride bioavailability, which may result in differences on anticaries efficacy.

Resumo Os enxaguatórios bucais comerciais fluoretados diferem na concentração e tipo de sal de fluoreto, no pH e têm alguns ingredientes que podem interferir na reatividade do fluoreto com o esmalte desmineralizado. A capacidade de enxaguatórios bucais comerciais de formar produtos de reação em esmalte desmineralizado (teste de biodisponibilidade) foi avaliada in vitro. Nove enxaguatórios bucais adquiridos no Chile foram avaliados, oito formulados com NaF (um contendo 100 µg F/mL e sete contendo 226) e um com Na2FPO3 (226 µg F/mL como íon F). Os blocos de esmalte desmineralizados (n=15 por grupo) foram seccionados, uma metade foi submetida ao tratamento com o enxaguatório designado por 10 min e a outra metade foi usada para dados baseline. Fluoreto fracamente e firmemente ligados formados no esmalte foram determinados com um eletrodo íonespecífico e os valores foram expressos em µg F /cm2. A concentração de fluoreto e o pH dos enxaguatórios foi previamente determinada. As concentrações de fluoreto tipo fluoreto fracamente ligado e fortemente ligado formadas no esmalte foram analisadas independentemente por ANOVA e teste de Tukey (α=5%). As concentrações de fluoreto fracamente ligado e fortemente ligado formados variaram de 3,2 a 36,2 e 0,4 a 1,7, respectivamente. O fluoreto fracamente ligado formado no esmalte foi significativamente mais eficaz para discriminar o efeito dos diferentes enxaguatórios bucais comerciais do que o fluoreto firmemente ligado. Enxaguatórios bucais com 226 ppm F na forma de NaF e baixo pH apresentaram significativamente maior biodisponibilidade de fluoreto no esmalte do que aqueles com maior pH ou menor concentração de NaF. O enxaguatório com Na2FPO3 apresentou reatividade muito baixa. Embora mais estudos sejam necessários, os resultados mostraram que os enxaguatórios bucais comerciais contendo fluoreto apresentam variações importantes na biodisponibilidade do fluoreto, o que poderia resultar em diferenças na eficácia anticárie

Community interventions and strategies for caries control in Latin American and Caribbean countries

Abstract Dental caries remains highly prevalent in Latin American and Caribbean countries (LACC). However, this disease can be controlled through interventions that implement evidence-based strategies in an affordable manner and that target all population groups instead of the most affluent only. Therefore, the aim of this report was to summarize the main scientifically documented community interventions and strategies based on restriction of sugars consumption, use of fluoride, and the use of occlusal sealants for caries control in LACC. A critical literature review was carried out in a systematic manner that included defined search strategies, independent review of the identified publications, and compilation of results in this report. Three systematic searches were conducted using the PubMed, LILACS, and SciELO databases to identify studies related to community interventions and strategies for caries control in LACC. Of the 37 publications identified, twenty-six focused on fluoride use, eight on occlusal sealant use, and three on the restriction of sugar consumption. Documented community interventions for sugars restriction were scarce in the region and were based on food supplementation, sugar replacement, and education. Thus, local and/or national policies should prioritize investment in upstream, coherent, and integrated population-wide policies such as taxes on sugary drinks and stronger regulation of advertising and promotion of sugary foods and drinks mainly targeting children. The main fluoride-based strategies used drinking water, refined domestic salt, cow milk, toothpaste and, to a lesser extent, mouth-rinses, acidulated phosphate fluoride (APF) gels, and varnishes to deliver fluoride to the population. Evidence of fluoride use was seen in Argentina, Belize, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay, and Venezuela. Studies reporting the use of occlusal sealants were mainly located in Brazil, Chile, Colombia, Costa Rica, Peru, Mexico, and Venezuela. Community interventions restricting sugar consumption should be implemented at the individual level and through public policies. The use of fluoride must be monitored at the local, regional, and national levels so as to achieve maximum anti-caries effect while also minimizing the risk of dental fluorosis. Moreover, fluoridated water and salt programs, used as a mutually exclusive community level strategy for caries control, should expand their benefits to reach non-covered areas of the LACC while also simultaneously providing adequate surveillance of the fluoride concentration delivered to the population. Regulating the concentration of soluble fluoride (for anti-caries effect) in dentifrice formulations is also necessary in order to provide the population with an effective strategy for disease control. Targeting culturally appropriate, economically sustainable caries control interventions to rural populations and native ethnic groups such as indigenous people, quilombolas (African-origin), and riverside Amazonian people remains a crucial challenge.

Fluoride concentration in mouth rinses marketed in Chile and Brazil, and a discussion regarding their legislations

Abstract For fluoride to be effective in controlling caries, it should be bioavailable in commercial products, so that it can be released into the mouth in the products it contains. We chemically determined the available fluoride and pH in nine mouth rinses marketed in Chile, and eleven, in Brazil, and then discussed the legislation in force in both countries, regarding the anticaries potential of these oral hygiene products. The fluoride was analyzed with an ion-selective electrode (F-ISE), using the direct technique. The determinations were made in duplicate, and the results were expressed in ppm F (μg F/mL). The total fluoride concentration found in all the mouth rinses evaluated ranged from 94.7 to 233.5 ppm F, and closely matched what was declared by the manufacturers (100.0 to 226.2 ppm F). However, some mouth rinses showed lower fluoride concentrations (90 and 180 ppm F) in both countries. A Na2FPO3-formulated mouth rinse was found only in Chile, with 216.8 ppm F as the FPO32- ion, and 4.9 ppm F as the F-. The findings show that fluoride was potentially bioavailable in all the mouth rinses evaluated. Regarding the national legislations, although the mouthwashes sold in Brazil comply with the Brazilian legislation, discrepancies were found for Chile. However, neither country had a legislation matching the best available evidence on fluoride mouthwash efficacy for caries control. Thus, some products with low fluoride concentrations (below 226 ppm F), or manufactured with a fluoride salt other than NaF (Na2FPO3) are being sold in the Brazilian and Chilean markets.

Concentração do fluoreto em dentifrícios distribuídos pelo serviço público em Salvador, Bahia / Fluoride concentration in dentifrices distributed by the public service in Salvador, Bahia

Introdução: de acordo com a legislação brasileira, um dentifrício não pode conter mais que 1.500 ppm de flúor total (FT), e o fabricante deve declarar na embalagem a concentração e o tipo de sal de flúor que o produto contém. No entanto, para que possa exercer um efeito anticárie, o produto deve conter pelo menos 1.000 ppm F (mgF/kg) na forma quimicamente solúvel. Objetivo: avaliar as concentrações de flúor total (FT) e flúor solúvel total (FST) em dentifrícios distribuídos pelo serviço público de saúde da cidade de Salvador, Bahia. Materiais e métodos: três amostras de um dentifrício (MFP/CaCO3, 1.500 ppm F como FT) que estava sendo distribuído pelo serviço público de saúde de Salvador, BA, foram obtidas. Como controle, foi utilizado um dentifrício com a mesma formulação (1.450 ppm de FT) encontrado no comércio da cidade de Piracicaba, SP. As análises foram realizadas com eletrodo específico para fluoreto, empregando metodologia já validada e os resultados expressos em ppm F (mg F/kg). Resultados: em todas as amostras avaliadas, foram encontrados apenas 61,8 ppm F de FT, evidenciando que não foram fluoretadas, fato este nunca antes relatado no Brasil. De outro modo, no dentifrício utilizado como controle, havia 1404,7 ppm F de FT, do qual 1.270,0 ppm estavam solúveis (FST). Conclusão: os cremes dentais avaliados nesta pesquisa não são capazes de exercer um efeito anticárie, uma vez que não foram fluoretados. Esses dados mostram a urgência de modificação da regulamentação brasileira vigente e a necessidade de maior controle de qualidade desses produtos.(AU)

Introduction: according to Brazilian legislation, a toothpaste cannot contain more than 1500 ppm of total fluoride (TF), as well as the manufacturer must provide on the packaging the concentration and type of fluoride salt that the product contains. However, to have an anti-caries effect, it must contain at least 1,000 ppm F (mgF/kg) in its chemically soluble form. Research Aim: To evaluate the total fluoride (TF) and total soluble fluoride (TSF) concentrations in dentifrices distributed by the public health service in the city of Salvador, Bahia. Materials and methods: for the analyses, three samples of a dentifrice (MFP/CaCO3, 1,500 ppm F as TF) that was being distributed by Salvador's public health system were obtained. As a control, it was used a dentifrice of the same formulation (1,450 ppm of TF) found in commerce of the city of Piracicaba- -SP. The analyses were performed with a specific fluoride electrode using a validated methodology and the results were expressed in ppm F (mg F/ kg). Results: In all the samples evaluated, only 61.8 ppm F of TF were found, showing that it was not fluoridated, a fact that was never reported in Brazil before. On the other hand, in the dentifrice used as a control, there were 1404.7 ppm F of TF, of which 1270.0 ppm were soluble (TSF). Conclusion: the samples evaluated in this research are not able to exert an anti-caries effect, since they were not fluoridated. These data show the urgency to change the current Brazilian regulation and the need for a greater quality control of these products.(AU)

Dentifrícios fluoretados e o SUS-Brasil: o que precisa ser mudado? / Fluoride toothpastes and SUS-Brazil: what needs to be changed? / Pastas de dientes fluoradas y SUS-Brasil: ¿qué necesita ser cambiado?

O presente estudo aborda as mudanças necessárias que devem ser implementadas para que toda a população brasileira possa ser beneficiada pelo uso de dentifrícios fluoretados em termos de prevenção de cárie dentária. Foi realizada uma busca da literatura sobre concentração de fluoreto em dentifrícios brasileiros, nas bases de dados Lilacs, PubMed, SciELO e nos arquivos do laboratório de Bioquímica Oral da FOP-UNICAMP. Os resultados mostram que desde o início da década de 1980, quando se iniciou o acompanhamento das concentrações de fluoreto em dentifrícios brasileiros, muitos dentifrícios não são capazes de manter uma concentração mínima de fluoreto solúvel para fornecer benefício anticárie. Este é um problema recorrente não só com os dentifrícios de livre venda presentes no comércio, mas principalmente com aqueles comprados por licitação pública pelo SUS e distribuídos para a população. A regulamentação brasileira vigente (Resolução 79, Anvisa, 28/08/2000) estabelece apenas a concentração máxima de fluoreto total que um dentifrício deve conter, mas não a mínima solúvel necessária para garantir o benefício anticárie da formulação. Uma mudança, estabelecendo a concentração mínima de fluoreto solúvel que um dentifrício deveria manter por determinado tempo após sua fabricação, não só beneficiaria o consumidor brasileiro, mas principalmente todos os usuários do SUS, porque poderia ser referendada nos editais de licitação de compra de dentifrícios. (AU)

The present study explores the necessary changes that should be implemented to benefit the entire Brazilian population by using fluoride toothpastes in terms of dental caries prevention. A literature search on fluoride concentration in Brazilian toothpastes was performed in Lilacs, PubMed, and SciELO databases and in the files of the Laboratory of Oral Biochemistry from FOP-UNICAMP.The results show that since the early 1980s, when the monitoring of fluoride concentrations in Brazilian toothpastes began, many toothpastes have not been able to maintain a minimum concentration of soluble fluoride to provide anticaries benefit. This is a recurring problem not only with over-the-counter toothpastes present in the market, but especially with those purchased by public bidding by SUS and distributed to the population. The current Brazilian regulation (Resolution 79, Anvisa, 8/28/2000) establishes only the maximum total fluoride concentration that a toothpaste must contain, but not the minimum soluble fluoride necessary to ensure the anticaries benefit of the formulation. One change, establishing the minimum concentration of soluble fluoride that a toothpaste should maintain for a certain time after its manufacture, would not only benefit the Brazilian consumer, but mainly all SUS users, because it could be countersigned in the toothpaste bidding documents. (AU)

El presente estudio aborda los cambios necesarios que deben ser implementados para que toda la población brasileña pueda beneficiarse del uso de dentífricos con fluoruro en términos de prevención de la caries dental. Se realizó una búsqueda en la literatura sobre la concentración de fluoruro en dentífricos brasileños en las bases de datos Lilacs, PubMed, SciELO y en los archivos del laboratorio de Bioquímica Oral FOP-UNICAMP. Los resultados muestran que, desde principios de la década de 1980, cuando empezó el monitoreo de las concentraciones de fluoruro en los dentífricos brasileños, muchos dentífricos no son capaces de mantener una concentración mínima de fluoruro soluble para proporcionar beneficio contra la caries. Este es un problema recurrente no solo con los dentífricos presentes en el comercio, sino especialmente con aquellos comprados por el SUS y distribuidos a la población. La normativa brasileña actual (Resolución 79, Anvisa, 8/28/2000) establece solo la concentración máxima de fluoruro total que un dentífrico debe contener, pero no la mínima soluble necesaria para garantizar el beneficio anti-caries de la formulación. En cambio, estableciendo la concentración mínima de fluoruro soluble que un dentífrico debe mantener durante un cierto tiempo después de su fabricación, no solo beneficiaría al consumidor brasileño, sino que especialmente a todos los usuarios del SUS, ya que, podría ser refrendado en los documentos de licitación de dentífricos. (AU)

Fluoretação da água dos dez maiores municípios do estado do Tocantins, Brasil / Water fluoridation in the ten largest municipalities of the state of Tocantins, Brazil

Resumo Fluoretação da água é uma estratégia de controle da cárie, recomendada pela OMS. No Brasil ela é regulamentada por lei, mas não tem sido implementada com sucesso na região Norte. Os objetivos desta pesquisa foram levantar dados sobre a existência do heterocontrole nos 10 maiores municípios tocantinenses e analisar a concentração de fluoreto presente na água de abastecimento público destas cidades. A pesquisa foi realizada de maio-agosto/17 e teve como marco teórico-metodológico a análise quantitativa, descritiva e transversal. Coletas de água foram realizadas mensalmente, utilizando protocolo de amostragem de coleta de água da rede. A concentração de fluoreto nas águas foi feita com eletrodo íon específico pela técnica direta. Constatou-se que a vigilância da fluoretação da água está em operação na capital do estado desde 2016. Com relação a concentração de fluoreto na água, foi encontrado que 31,6% das amostras analisadas estavam adequadas para o máximo benefício de redução de cárie e 27,5% delas apresentavam risco alto ou muito alto de fluorose dentária. É necessário implementar um programa de controle da concentração de flúor na água no Tocantins, a fim de garantir que a população não seja privada dos benefícios anticárie da agregação de flúor à agua tratada.

Abstract Water fluoridation is a strategy for caries control recommended by the WHO. In Brazil, it is regulated by law but this program has not been successfully implemented in the North region. This research aimed to collect data on the existence of external control (heterocontrol) in the ten largest municipalities in the state of Tocantins, Brazil, and to analyze fluoride concentration in the public water supply of these cities. The study was conducted from May-August/17, and its theoretical-methodological framework was a quantitative, descriptive and cross-sectional analysis. Water collections were carried out monthly, using sampling protocol of water collection of the network. Fluoride concentration in the waters was determined with ion specific electrode by the direct technique. It was verified that water fluoridation monitoring is only been done in Palmas, capital of the state, starting in 2016. Thirty-two percent of waters samples analyzed showed fluoride concentration to obtain the maximum benefit of reduction caries and 27.5% of them presented a high or very high risk of dental fluorosis. It is necessary to implement a program to control the concentration of fluoride in the water of the municipalities of Tocantins, in order to ensure that the population is not deprived of the anticaries' benefits of the adjustment of fluoride concentration of the treated water.

Dispensing Device to Deliver Small and Standardized Amount of Fluoride Dentifrice on the Toothbrush

Abstract Objective: To evaluate the efficacy of a dispensing device specially developed to standardize the amount of fluoride dentifrice to be delivered on the toothbrush. The amount and variability of dentifrice applied using this device were compared with recommendations to apply dentifrice amounts equivalent to "rice size" or "pea-size". Material and Methods: Two dentifrices, one used by children (NaF/Silica-based) and one used by the entire family (MFP/CaCO3-based), and five methods to apply them on the toothbrush (pea and rice sizes, and three different amounts using the developed device) were tested by 12 volunteers. The amount of dentifrice placed on the toothbrush was weighed, and the experiment was repeated three times. Data were analyzed by two-way ANOVA and Tukey test. Results: No differences were observed between the dentifrices used (p>0.05), but the method of application significantly affected the amount of dentifrice applied (p<0.05). Smaller amounts (p<0.05) and less variability were observed when the volunteers used the dispenser device than when they were asked to apply a pea or rice size. Conclusion: The device can help parents and caregivers to safely use fluoride dentifrice on children.

A simplified protocol to determine total fluoride concentration in NaF/silica-based toothpastes

Aim: To determine total fluoride (TF) concentration in Na2FPO3/Ca-based toothpastes, using fluoride ion selective electrode (F-ISE) by the direct technique, it is necessary to use acid (Ac+) to hydrolyze the FPO32- ion and to dissolve insoluble fluoride salts bound to the abrasive. For NaF/silica-based toothpastes, the use of acid is not necessary (Ac-) and a simplified protocol could be followed. Methods: Thus, we evaluated TF concentration in seven brands of NaF/silica-based toothpastes, following the validated conventional Cury's protocol (Ac+) or a simplification of this protocol (Ac-).Fluoride was analyzed with ISE calibrated with fluoride standard solutions prepared in the same conditions as the samples (Ac+ or Ac-). Results: The mean (±SD; n=21) of TF concentrations (µg F/g) found by Ac+ (971.3±191.2) and Ac- (982.4±201.3) protocols were not statistically different (t test, p=0.22). The TF concentrations found agree with those declared by the manufacturers, except for one toothpaste imported from China. Conclusion: The findings suggest that the determination of fluoride in NaF/silica-based toothpastes can be accurately made using a simplified protocol of analysis

Fluoride content in children's dentifrices marketed in Lima, Peru

Abstract The aim of the present study was to determine the concentration of total fluoride (TF) and total soluble fluoride (TSF) in children's dentifrices marketed in the city of Lima, Peru. Three samples of 23 dentifrices (4 without fluoride and 19 with fluoride) were purchased in different pharmacies in Lima, Peru. The TF and TSF concentrations found in the dentifrices were determined by ion-selective electrode, expressed in ppm F (μg F/g of dentifrice). The TF concentration in the majority of the fluoride toothpastes matched that shown on the label, except for one declared as 1450 ppm F by the manufacturer, whereas only 515.1 ppm F was found. The concentration of TSF found in the fluoride toothpastes ranged from 457.5 to 1134.8 ppm F. All the dentifrices were formulated with silica, but one also presented calcium carbonate. In conclusion, 83% of the children's dentifrices marketed in Lima, Peru, were fluoridated, but only 53% contained a TSF concentration greater than 1000 ppm F, the minimum concentration required to provide an anticaries effect.

Fluoretação da água no Brasil: distribuição regional e acurácia das informações sobre vigilância em municípios com mais de 50 mil habitantes / Water fluoridation in Brazil: regional distribution and accuracy of information on surveillance in municipalities with more than 50 000 inhabitants / Fluorización del agua en Brasil: distribución regional y exactitud de la información sobre su vigilancia en municipios con más de 50 mil habitantes

Resumo: Dados de saneamento para 2008 indicavam que 74,4% dos municípios com mais de 50 mil habitantes recebiam água fluoretada, entretanto, critérios para a validação desta informação não foram adotados. O estudo objetivou verificar a acurácia da informação sobre a fluoretação da água, tomando-se por referência dados de vigilância da água em municípios com mais de 50 mil habitantes no ano de 2008 e no período de 2010-2015. Dados de diferentes fontes foram empregados comparando-se as informações relativas ao período. Amostras da água foram coletadas e a concentração de fluoreto foi obtida pelo método eletrométrico. O processo de verificação ocorreu pela confrontação dos dados obtidos por diferentes fontes. Seiscentos e um municípios (97,9%) tiveram os dados confrontados. A taxa de municípios que realizam vigilância com base no heterocontrole passou de 39,4% para 48,5%. Observou-se elevada taxa de falsos positivos ou negativos (15,1%) em relação aos dados de 2008. A cobertura municipal foi de 70,2%, 4,2 pontos abaixo da estimativa (74,4%) divulgada para 2008. Registros da prática da vigilância foram observados em 54,3% dos municípios fluoretados, cuja cobertura populacional alcança 50% ou mais da população que recebe água tratada. Houve sensível melhoria nos dados de vigilância em relação ao fluoreto, embora com porcentual importante de falsos positivos e negativos. Ainda são largas as diferenças inter-regionais relacionadas tanto à provisão da fluoretação da água quanto à implementação da vigilância nos municípios pesquisados, trazendo importantes desafios para a saúde pública.

Abstract: Sanitation data for 2008 indicated that 74.4% of Brazilian municipalities (counties) with more than 50,000 inhabitants were receiving fluoridated water, but no criteria were adopted to validate the information. The study aimed to verify the accuracy of information on water fluoridation, using as the reference water surveillance data from municipalities with more than 50,000 inhabitants in 2008 and during 2010-2015. Data from different sources were used, comparing the information pertaining to the period. Water samples were collected, and fluoride concentration was obtained by the electrometric method. Verification was performed by comparing the data obtained from different sources. Data were compared for 601 (97.9%) municipalities. The proportion of municipalities that performed surveillance based on external control increased from 39.4% to 48.5%. There was a high rate of false positives and false negatives (15.1%) in the data for 2008. Municipal coverage was 70.2%, or 4.2 percentage points below the published estimate (74.4%) for 2008. Surveillance records were observed in 54.3% of the fluoridated municipalities whose population coverage reached at least 50% of the population receiving treated water. There was an important improvement in fluoridation surveillance data, despite a high percentage of false positives and negatives. There are still wide interregional differences in the surveillance of water fluoridation in this sample of Brazilian municipalities, raising important public health challenges.

Resumen: Los datos de saneamiento en 2008 indicaban que un 74,4% de los municipios con más de 50 mil habitantes recibían agua fluorada, no obstante, no se adoptaron criterios para la validación de esta información. El estudio tuvo como objetivo verificar la exactitud de la información sobre la fluorización del agua, tomando como referencia datos de vigilancia del agua en municipios con más de 50 mil habitantes en el año 2008, y durante el período de 2010-2015. Se emplearon datos de diferentes fuentes comparando la información relativa a este período. Se recogieron muestras de agua y la concentración de fluoruro se obtuvo mediante un método electrométrico. El proceso de verificación se produjo por el contraste de datos obtenidos de diferentes fuentes. Se compararon los datos de 601 (97,9%) municipios. La tasa de municipios que realizan vigilancia en base al heterocontrol pasó de un 39,4% a un 48,5%. Se observó una elevada tasa de falsos positivos o negativos (15,1%), en relación con los datos de 2008. La cobertura municipal fue de un 70,2%, 4,2 puntos por debajo de la estimativa (74,4%) divulgada en 2008. Se observaron registros de la práctica de vigilancia en un 54,3% de los municipios fluorados, cuya cobertura poblacional alcanza a un 50% o más de la población que recibe agua tratada. Hubo una sensible mejoría en los datos de vigilancia respecto al fluoruro, a pesar de que había un porcentaje importante de falsos positivos y negativos. Todavía son grandes las diferencias interregionales relacionadas tanto respecto a la fluorización del agua, como a la implementación de vigilancia en los municipios investigados, implicando importantes desafíos para la salud pública.