Effect of fluoridated water on dental caries and fluorosis in schoolchildren who use fluoridated dentifrice

Abstract This cross-sectional study evaluated the prevalence and severity of dental caries and fluorosis in children and adolescents using fluoridated toothpaste, from areas with and without fluoridated water. Parents of 5-year-old children and 12-year-old adolescents from neighbourhoods that are supplied with and without fluoridated water answered questionnaires for determining socio-economic and demographic characteristics and habits related to oral health. The individuals were examined, and dental caries and fluorosis were measured by dmft/DMFT and TF indexes, respectively. Descriptive, bivariate and logistic regression analyses were performed (p < 0.05). Of 692 participants, 47.7% were 5-year-olds and 52.3% were 12-year-olds. The mean dmft/DMFT in the 5-year-olds/ 12-year-olds from Exposed and Not Exposed fluoridated water groups was 1.53 (± 2.47) and 3.54 (± 4.10) / 1.53 (± 1.81) and 3.54 (± 3.82), respectively. Children (OR = 2.86, 95% CI = 1.71-4.75) and adolescents (OR = 1.95, 95% CI = 1.24-3.05), who did not consume fluoridated water, had greater caries experience. Among adolescents, there was an association between fluoridated water and the prevalence of very mild/mild fluorosis (OR = 5.45, 95% CI: 3.23-9.19) and moderate fluorosis (OR = 11.11, 95% CI = 4.43-27.87). Children and adolescents, who consumed fluoridated water, presented lower prevalence and severity of dental caries compared to those who used only fluoridated toothpaste as the source of fluoride. There is an association between water fluoridation and very mild/mild and moderate fluorosis in adolescents.

Resumo Este estudo transversal avaliou a prevalência e severidade de cárie dentária e fluorose em crianças de 5 anos e adolescentes de 12 anos usuários de dentifrício fluoretado, em áreas com e sem água fluoretada. Os responsáveis pelas crianças e adolescentes responderam questionários para determinação de características socioeconômicas e demográficas e hábitos relacionados à saúde. Os indivíduos foram examinados e a cárie e a fluorose foram mensuradas pelos índices ceo-d / CPOD e TF, respectivamente. Foram realizadas análises descritivas, bivariadas e de regressão logística (p <0,05). Dos 692 participantes, 47,7% tinham 5 anos e 52,3% tinham 12 anos. A média de ceod / CPOD em crianças de 5/12 anos dos grupos de exposto e não exposto à água fluoretada foi 1,53 (± 2,47) e 3,54 (± 4,10) / 1,53 (± 1,81) e 3,54 (± 3,82), respectivamente. Crianças (OR = 2,86, IC 95% = 1,71-4,75) e adolescentes (OR = 1,95, IC 95% = 1,24-3,05) que não consumiram água fluoretada tiveram maior experiência de cárie. Entre os adolescentes, houve associação entre a água fluoretada e a prevalência de fluorose muito leve / leve (OR = 5,45, IC 95%: 3,23-9,19) e fluorose moderada (OR = 11,11, IC 95% = 4,43-27,87). Crianças e adolescentes que consumiram água fluoretada apresentaram menor prevalência e severidade de cárie dentária em comparação com aqueles que usaram apenas dentifrício fluoretado como fonte de flúor. Houve uma associação entre a fluoretação da água e fluorose muito leve / leve e moderada em adolescentes.

Prevalence of Dental Fluorosis and Its Associated Factors After Cessation of Water Fluoridation

@#Introduction: Water fluoridation (WF) was ceased in the state of Pahang, Malaysia, in July 2012. Any changes in fluoride exposure during childhood can influence the development of fluorosis. Thus, this study aimed to compare the prevalence of fluorosis between WF-ceased and WF-continued areas in Malaysia, and its associated factors among 7 and 12-year-old children. Methods: A cross-sectional study was conducted among children in WF-ceased and WF areas (n=1211). The 12-year-olds in WF-ceased areas were exposed to WF between 4.5 to 6.5 years before cessation, and it was hypothesised they would have similar fluorosis prevalence as their counterparts who lived in WF areas. The 7-year olds were born during the cessation period. Examination of fluorosis was performed by a calibrated dentist using Dean’s criteria and a parental questionnaire was utilised to collect information about demographics and exposure to fluoride. Results: Fluorosis prevalence (Dean’s≥2) was significantly lower among children in WF-ceased areas than WF areas (p< 0.001). Intra-area comparison indicated that the 12-year olds have higher prevalence of fluorosis than the 7-year-olds, except for anterior fluorosis scores among those in WF areas. The majority of fluorosis cases were very mild in both areas. Simple logistic regression indicated that duration of exposure to WF, age, mother’s income and education, age started toothbrushing with toothpaste, and frequency of toothbrushing were associated with fluorosis. Conclusions: Fluorosis prevalence decreased following water fluoridation cessation. The null hypothesis that 12-year-olds in both areas would have similar prevalence of fluorosis was rejected. Several factors were associated with fluorosis.

Princípios invocados numa política intersetorial de saúde: o caso da fluoretação da água no Brasil / Principles invoked in a population-based health policy: the case of water fluoridation in Brazil

Resumo O objetivo foi identificar princípios invocados numa política intersetorial de saúde, tomando como caso uma proposta legislativa de revogação da fluoretação da água no Brasil apresentada em 2003. Realizou-se estudo descritivo por meio de pesquisa documental, na qual foram selecionados registros gerados na tramitação do Projeto de Lei nº 510/2003 na Câmara dos Deputados. Buscou-se destacar estratégias discursivas utilizadas pelos atores conforme o jogo de interesses e o contexto conflitivo, utilizando-se o institucionalismo histórico como referencial teórico. O Projeto de Lei tramitou 13 meses, passando pelo Plenário, por três comissões, e sendo arquivado. Três deputados de partidos distintos, órgãos do Poder Executivo federal, agências reguladoras e entidades representativas da categoria odontológica, da saúde pública/coletiva, da engenharia sanitária e das empresas de saneamento participaram diretamente do debate em que emergiram os princípios da segurança da intervenção, dos custos econômicos e do direito à saúde. Em relação às estratégias discursivas utilizadas, os principais elementos invocados no debate da política intersetorial de saúde foram o princípio da incerteza, criando-se falsas categorias científicas a fim de sobrevalorizar os efeitos desfavoráveis e sustentar a implementação de medidas individualizantes; e os princípios morais que definem diferentes tipos de bens econômicos e dimensões de liberdade associadas ao exercício de direitos.

Abstract The objective was to identify principles invoked in a population-based health policy, taking as case a legislative proposal aimed at revoking water fluoridation in Brazil presented in 2003. We conducted a descriptive study through documentary research on records generated in the course of the Bill proposal No. 510/2003 in the Federal Chamber of Deputies. We highlighted discourse strategies used by the actors as per their own interests and the conflicting context by utilizing historical institutionalism as theoretical ground. The proposal was debated for 13 months, going through the House Plenary, three committees, and was finally filed. Three deputies from different parties, federal executive agencies, regulatory agencies, and entities representing dental, public/collective health, sanitary engineering, and sanitation companies participated directly in the debate in which the principles of intervention security, economic costs and the right to health emerged. Regarding the discourse strategies used, the main elements invoked in the debate on population-based health policy were: the principle of uncertainty, creating false scientific categories in order to overvalue unfavorable effects and to support the implementation of individualizing measures; and the moral principles that define different types of economic goods and dimensions of freedom associated with the exercise of rights.

Systemic effects (risks) of water fluoridation

Abstract Since the 1950s, the benefits and risks of fluoridated water use have been debated worldwide. In the past, it was considered that the systemically ingested fluoride would exert its primary preventive effect after being incorporated into the enamel as fluorapatite, making the enamel more resistant to the caries process; however, it is now recognized that the main effect of water fluoridation is local and post eruptive. On the other hand, irrespective of the caries decline reported worldwide, the anticaries benefit of water fluoridation continues to be observed even in developed countries. Regarding the risks, water fluoridation is considered an acceptable community-based method for fluoride delivery, because the risk of developing dental fluorosis lesions due to the ingestion of fluoride during the enamel formation period has been deemed acceptable when contrasted to the anticaries benefits of fluoride. However, the use of fluoride in water to control caries has created a controversy due to data associating water fluoridation as the cause of some systemic diseases. Therefore, the aim of this descriptive review was to discuss the systemic effects (risks) of water fluoridation use.

Resumo Desde 1950, os benefícios e riscos do uso da água fluoretada têm sido debatidos mundialmente. No passado, foi considerado que o fluoreto ingerido sistemicamente exerceria seu efeito preventivo de cárie pela sua incorporação ao esmalte como fluorapatita, tornando o esmalte mais resistente ao processo de desenvolvimento de lesões de cárie; entretanto, é atualmente reconhecido que o principal efeito da fluoretação da água é local e pós-eruptivo. Por outro lado, independente do declínio de cárie que tem sido observado mundialmente, o benefício anticárie da fluoretação da água continua sendo observado mesmo em países desenvolvidos. Com relação aos riscos, fluoretação da água é considerada uma estratégia aceitável de saúde pública para uso de fluoreto, porque o risco de desenvolvimento de fluorose dental devido à ingestão de fluoreto durante o período de formação do esmalte foi considerado aceitável quando comparado aos benefícios anticárie do flúor. Entretanto, o uso de fluoreto na água para controlar cárie tem gerado controvérsias devido a dados de pesquisa que associam fluoretação da água como causa de algumas doenças sistêmicas. Assim, o objetivo dessa revisão descritiva foi discutir os efeitos sistêmicos (riscos) da fluoretação da água..

Caries reduction effect of permanent teeth from community water fluoridation program for 17 years in Jinju city / 대한구강보건학회지

OBJECTIVES: The community water fluoridation program was implemented in 1998 in Jinju city. The aim of the present study was to evaluate the effect of this 17-year community water fluoridation program on caries reduction in permanent teeth. METHODS: Evaluation surveys were conducted in 2015 on subjects aged 8, 10, 12, and 15 years in Jinju city. The examined dental data were compared with that of subjects of the same age groups living in the medium-sized cities from the 6th Korea National Health and Nutrition Examination Survey (KNHANES) (2013–2015). The total number of subjects was 1,026 in Jinju city and 453 in the control group. The odds ratio of caries experience rate and untreated tooth rate on permanent teeth in Jinju city compared to control group was estimated based on the differences in DMF and untreated teeth rates after adjusting for gender, age, and mean number of fissure-sealed teeth. The effect of community water fluoridation program on caries reduction in permanent teeth was estimated by the differences in adjusted DMFT scores between the program and control groups. RESULTS: The odds ratio of caries experience rate and untreated tooth rate on permanent teeth in Jinju city compared to control group was estimated as 0.501 and 0.178, respectively. The effect of community water fluoridation program on caries reduction in permanent teeth was estimated as 40.0%. CONCLUSIONS: These results suggested that the effect of community water fluoridation program on caries reduction in permanent teeth in Jinju city was so high that similar programs should be developed in other regions in Korea.

A systematic analysis on possibility of water fluoridation causing hypothyroidism

Community water fluoridation is widely used worldwide and its role in preventive dental health care is well established. However, there is sufficient evidence of the ill effects of excessive fluoride content in water, causing skeletal and dental fluorosis. Alongside, there was also extraskeletal and dental manifestations of excessive fluorides reported. They include the effect on thyroid function, but the literature regarding this is sparse. Aim: The present systematic review aims to analyze the data from controlled studies about the effect of fluoride on thyroid function. Materials and Methods: A systematic literature search was performed using PUBMED, MEDLINE, EMBASE, COCHRANE Library, EBSCO search, and the internet search, with language restriction to English. The search included published studies which dealt with the association of fluorine with hypothyroidism, from January 1981 to November 2015. Literature search was done using keywords: fluoride and hypothyroidism, dental fluorosis and thyroid disorders, systemic fluorosis and thyroid disease, excessive water fluoridation and hypothyroidism, thyroid and fluoride, fluorosis and its adverse effects. Results: Out of 166 publications, related to search strategy, 37 full articles which were related with the association of fluoride and hypothyroidism were acquired for further inspection. Out of the 37 articles, 10 articles met the inclusion criteria. The data were extracted and placed in an excel sheet and were analyzed. The analysis suggested a positive correlation of excess fluoride and hypothyroidism. Conclusion: The present systematic review suggests a positive correlation between excess fluoride and hypothyroidism. This calls the need for further well-controlled studies in this otherwise emerging alarming issue. It also calls for considerable community network through health informatics for problem sensitization.

Heterocontrole da fluoretação nos municípios da Região Metropolitana de Curitiba nos anos de 2014 e 2015 / External control of fluoridation in the Metropolitan Region of Curitiba in the years of 2014 and 2015

Resumo Introdução O heterocontrole, que é o monitoramento da concentração de fluoreto na água de abastecimento, deve ser feito por instituições do Estado e tem sido motivado para garantir a eficácia e a segurança da fluoretação. Este estudo teve como objetivo analisar o heterocontrole de municípios com população acima de 50 mil habitantes da Região Metropolitana de Curitiba nos anos de 2014 e 2015. Metodologia Dados sobre o heterocontrole foram fornecidos pelos serviços de Vigilância em Saúde dos municípios do estudo e analisados de acordo com o critério técnico do CECOL para a concentração de fluoreto. Resultados Em alguns municípios e meses, houve falha na realização das coletas de amostras de água em relação ao número adequado para o parâmetro fluoreto. Do total de amostras analisadas, somente 51,5% estavam na faixa de melhor benefício-risco para a concentração de fluoreto, com 8% de benefício e risco insignificantes e 0,1% das amostras com concentração de fluoreto de alto risco, sem nenhum benefício. Conclusão Os municípios analisados realizaram o heterocontrole, com períodos em que o número de coletas não foi adequado. As concentrações de fluoreto na água de abastecimento dos municípios do estudo apresentaram resultado pouco satisfatório. O heterocontrole é fundamental para manter os teores de fluoreto em níveis adequados.

Abstract Introduction External control is the monitoring of fluoride concentration in the water supply that must be done by state institutions, and has been motivated to ensure the efficacy and safety of fluoridation. This study aimed to analyze the external control of municipalities with more than 50.000 inhabitants in the metropolitan region of Curitiba in the years 2014 and 2015. Methodology Health surveillance services of the studied municipalities provided external control data, which were analyzed according to the technical criterion of the CECOL for fluoride content. Results Collection of water samples failed in some municipalities and months for an adequate number for the fluoride parameter. From the total samples analyzed, only 51.5% were in the best benefit-risk range for the fluoride concentration. Eight percent of the samples presented insignificant benefit and risk and 0.1% showed a high-risk fluoride concentration, without any benefit. Conclusion the analyzed municipalities performed the external control, with periods of inadequate sample collections. Fluoride concentrations in the supply water of the study municipalities presented an unsatisfactory result. The main goal of external control is to maintain fluoride levels at adequate levels.

The caries preventive effect on permanent teeth adjusted for number of fissure-sealed teeth and surfaces from 6-year community water fluoridation program in Geoje City / 대한구강보건학회지

OBJECTIVES: The water fluoridation program has been implemented since 2008, in a region of Geoje City. This study aimed to evaluate the effectiveness of the water fluoridation program on caries prevention in the permanent dentition. METHODS: Evaluation surveys were conducted on 8-, 10- and 12-year-old children in the fluoridated and non-fluoridated regions of Geoje City, in 2015. The survey included 834 children from the fluoridated regions and 703 from the non-fluoridated regions. The data obtained from the survey were analyzed using the IBM SPSS statistical package version 23.0. The effectiveness of community water fluoridation in caries prevention was estimated by the differences in the decayed, missing, filled teeth (DMFT) and decayed, missing, filled surfaces (DMFS) scores, between the program and control groups. The mean numbers of fissure-sealed teeth and surfaces were adjusted to reduce their confounding effect. RESULTS: The mean DMFT and DMFS scores (0.69 and 0.91, respectively) of 10-year-olds from the fluoridated regions, after adjusting for the numbers of fissure-sealed teeth and surfaces, were significantly lower than those of the 10 year olds (DMFT: 0.95, DMFS: 1.32) from the non-fluoridated regions. The effectiveness of water fluoridation on caries prevention in the permanent dentition, estimated based on the differences in the mean DMFT and DMFS scores, adjusted for the number of fissure-sealed teeth and surfaces, between the program and control groups of 10-year-old children, was 27.4% and 31.1%, respectively. CONCLUSIONS: These results suggest that the effectiveness of water fluoridation on caries prevention in the permanent dentition, in Geoje City was so high that this program should be implemented in other regions in Korea as well.

Residents' opinions on the introduction of water fluoridation program in the district of Namdong water treatment plant, Incheon Metropolitan City / 대한구강보건학회지

OBJECTIVES: This study details a survey taken to ascertain the residents' opinions on the introduction of a community water fluoridation program (WFP) at the water treatment plant in the district of Namdong, Incheon Metropolitan City. METHODS: This cross-sectional study was conducted by a specialized institution and was based on a public opinion poll. The views of 1,000 adults who had lived in the district where tap water was supplied by the Namdong water treatment plant, Incheon were collected over a 1-year period. The dependent variable was the assent of the WFP. The independent variables were demographic and socioeconomic characteristics (sex, age, education, residence period, and income), awareness of WFP, drinking and cooking water, and decisional organization of WFP introduction. Statistical analysis was performed using chi-squared test with SPSS statistics 23.0 (SPSS Inc., Chicago, IL, USA). Variables related to the approval of the WFP were analyzed using a multivariate logistic regression model. One hundred and twenty-seven respondents who selected 'doesn't matter' were excluded. The significance level was set at α=0.05. RESULTS: The responses citing approval for the introduction of WFP comprised 58.7%, while the 'dissent' group accounted for 28.6%, and 12.7% stated that it does not matter. Respondents citing approval who were in the age group beyond fifties accounted for 66.0%; further, 67.6% of respondents aware of the WFP were in favor of the approval for WFP introduction. The decision to undertake water fluoridation was favored by the Regional Head and city council. There were no significant differences in the assent of WFP based on the respondents' sex, education level, job, and drinking and cooking water. The strongest correlation was observed between the awareness of WFP and the approval rate for WFP. CONCLUSIONS: To promote the introduction of WFP, active measures are required for educating people regarding effectiveness of caries prevention and safety of WFP.

Caries-preventing effects of a suburban community water fluoridation program on permanent dentition after adjusting for the number of fissure-sealed teeth / 대한구강보건학회지

OBJECTIVES: The aim of this study is to evaluate the effect of suburban community water fluoridation programs on preventing caries in permanent teeth. METHODS: In 2012, surveys were administered to children aged 8, 12, and 15 years residing in fluoridated Habcheon township area. Samples collected during the national survey in 2012 from children of the same age residing in non-fluoridated township areas were used as the control, and the caries prevalence data from this sample were used to estimate the caries preventive effect in the studied regions. This study included 457 subjects from the Habcheon township area and 1,792 in the control group. The data obtained from the survey were analyzed using the IBM SPSS statistical package version 21.0. The caries preventive effect exerted by fluoride in the community water supply was determined by calculating the differences in the DMFT and DMFS indices between the study and control groups. The cofounders of the mean number of fissure-sealed teeth and surfaces were controlled to estimate the effectiveness of caries prevention. RESULTS: The odds ratio of subjects with no dental caries in the fluoridated region was 0.75 compared to that in the control group. The mean DMFT scores or DMFS scores adjusted for the number of fissuresealed teeth or tooth surfaces were lower than those in the control group. The caries prevention fraction was estimated to be 23.4% based on the difference in the adjusted mean DMFT scores between the control and study groups. CONCLUSIONS: These results suggest that fluoridation of the community water in the suburban area was highly effective in preventing dental caries in permanent teeth, and therefore, this community water fluoridation program should be implemented in other regions in Korea.

Vigilância dos teores de fluoreto nas águas de consumo humano: uma revisão sistemática / Surveillance of fluoride levels in water for human consumption a systematic review

Introdução: O conhecimento sobre a concentração de fluoreto nas águas de consumo humano é importante para a prevenção e controle da cárie e da fluorose dentária nas populações. Objetivo: Descrever as características dos estudos e os resultados por eles produzidos sobre monitoramento dos teores de fluoreto nas águas de consumo humano publicados em revistas científicas especializadas no período de 2008 a 2012. Método: Foi realizada uma revisão sistemática da literatura científica na qual foram incluídos estudos na forma de artigos que apresentassem temática centrada no monitoramento da concentração do fluoreto na água de consumo humano. Os estudos foram identificados por busca bibliográfica nas bases de dados: LILACS, PUBMED/MEDLINE e EMBASE. Artigos, com qualquer tipo de desenho metodológico, publicados nos idiomas português, inglês e espanhol, foram incluídos. Resultados: Quarenta e oito artigos foram incluídos para a extração das características e resultados referentes à pergunta da pesquisa. Conclusão: A atividade de monitoramento estava articulada à vigilância como ação do Estado em dezoito estudos (37,5%). O método eletrométrico foi usado em 39 (81%) estudos. Apenas dois estudos utilizaram o método da Alizarina, sugerindo-se o seu desuso. A classificação em categorias de tipo "adequado" e "inadequado" (dicotômica), a qual reduz as opções de interpretação e atribuição de significado às características das amostras, predominou na apresentação dos resultados.

Introduction: Knowledge on the concentration of fluoride in water for human consumption is important for the prevention and control of dental caries and dental fluorosis in populations. Objective: To describe the characteristics of the studies and the results on monitoring of fluoride levels in water for human consumption published in specialized journals in the period 2008-2012. Methods: A systematic review of the scientific literature was performed. Only articles on monitoring of fluoride concentration in drinking water were included. Studies were identified by literature searching in databases: LILACS, PUBMED / MEDLINE and EMBASE. Articles with any type of methodological design, published in Portuguese, English and Spanish were included. Results: Forty-eight articles were included for the extraction of features and results related to the research question. Conclusion: The monitoring activity was articulated to the surveillance as an action provided by the State in eighteen studies (37,5%). The electrometric method was used in 39 (81%) studies. Only two studies used the method of Alizarin, suggesting its disuse. The dichotomous categorization "appropriate" and "in appropriate" which reduces the options of interpretation and attribution of meaning to the sample characteristics predominated in the presentation of the results.

Múltiplos aspectos do uso do flúor em saúde pública na visão de lideranças da área de saúde / Multiple aspects of the use of fluorine in public health from the viewpoint of healthcare leaders

O artigo descreve as percepções de lideranças da área de saúde sobre aspectos relativos ao uso do flúor em saúde pública. Trata-se de uma pesquisa descritiva, com abordagem qualitativa, utilizando-se como técnica de processamento de depoimentos o Discurso do Sujeito Coletivo (DSC). A população de estudo foi constituída pelos delegados à 13ª Conferência Nacional de Saúde, sendo a amostra definida por conveniência e composta por 310 delegados: 56 na etapa municipal, em Fortaleza (CE), 143 na estadual (Ceará) e 111 na nacional. Os dados foram coletados por meio de questionários semiestruturados. Verificaram-se lacunas de conhecimento sobre diversos aspectos do uso do flúor em saúde pública, o que indica a necessidade de se melhorar o nível de informação da sociedade sobre questões relativas à fluoretação. O desconhecimento dos delegados aliado aos dados encontrados na literatura sobre as deficiências no monitoramento e controle dos níveis de flúor na água são indicativos da necessidade de se reavaliar o papel dos atores sociais e dos mecanismos utilizados no controle social.

The article describes the perceptions of health care leaders on issues relating to the use of fluorine in public health. This is a descriptive study with a qualitative approach, using Collective Subject Discourse (DCS) as technique for processing the statements. The study population was comprised of delegates to the 13th National Health Conference; the sample was defined by convenience and consisted of 310 delegates: 56 at municipal level in Fortaleza (CE), 143 at state level (Ceará) and 111 at national level. Data were collected by semi-structured questionnaires. There were gaps in knowledge about various aspects of the use of fluorine in public health, which indicates the need to improve the level of information of society on issues relating to fluoridation. The lack of knowledge of delegates, together with the data found in the literature about the shortcomings in the monitoring and control of fluorine levels in water, are indicative of the need to reassess the role of social actors and the mechanisms used in social control.

Vigilância da fluoretação da água de abastecimento público no Município de São Paulo, no período 1990-2011 / Health surveillance of drinking water fluoridation in the City of Sao Paulo, Brazil, in the period 1990-2011

Introdução - A política de fluoretação das águas de abastecimento público requer aplicação contínua desta medida em níveis adequados de flúor. O controle operacional é realizado pelas empresas de saneamento ao adicionar flúor às águas, cuja medida deve ser complementada pela ação dos sistemas de vigilância segundo o princípio do heterocontrole. Sistemas de vigilância lidam com informações de interesse público, nos marcos legais desenvolvidos pelos Estados. No mundo contemporâneo, tais marcos implicam contemplar o direito de acesso à informação. Objetivo - Descrever o sistema de vigilância da fluoretação da água no município de São Paulo, no período 1990-2011. Método - Pesquisa baseada em dados secundários disponibilizados pela Secretaria Municipal de Saúde de São Paulo, no período 1990-2011. Os teores de fluoreto nas amostras foram classificados segundo as dimensões de risco e benefício para fluorose e cárie dentária, avaliados concomitantemente. Adicionalmente, realizou-se revisão bibliográfica do marco legal brasileiro que trata da Lei de Acesso à Informação (LAI), tendo em vista que dados produzidos pelos sistemas de vigilância em saúde são de interesse público. Resultados - Foram analisadas 19.071 amostras. A média anual de registros identificados no período de pontos fixos atingiu 647 amostras, correspondendo a um valor acima do necessário para a cobertura total do sistema (n=180). A média anual de registros foi ainda maior para o período de pontos variáveis, com 1.340 amostras. A média geral dos teores de flúor foi de 0,66 mg/l. Com relação à prevenção da cárie, 44 por cento das amostras representam benefício moderado e 54 por cento benefício máximo. Quanto à fluorose dentária, 99 por cento das amostras representam risco mínimo...

Introduction - The policy of community water fluoridation requires continuous application of this measure by the adequate use of fluoride levels. Operational control is carried out by drinking-water suppliers to add fluoride to the water, which measure must be complemented by action of surveillance systems on the principle of external control. Surveillance systems deal with information of public interest, within the legal frameworks developed by the States. In the contemporary world, such landmarks contemplate the right of access to information. Objective - To describe the surveillance system of drinking-water fluoridation in the city of Sao Paulo, in the period 1990-2011. Method - Research based on secondary data provided by the Municipal Health Secretary of Sao Paulo, in the period 1990-2011. Fluoride levels in the samples were classified according to the dimensions of risk and benefit related to fluorosis and dental caries, concurrently assessed. Additionally, it was carried out a literature review of the Brazilian legal framework that deals with the Law on Access to Information (LAI), considering that data produced by health surveillance systems are of public interest. Results - It was analyzed 19,071 samples. The average annual records identified between fixed points period reached 647 samples, corresponding to a value higher than necessary to cover the entire system (n = 180). The average of the variable annual record points was even greater for the period, with 1,340 samples. The overall average fluoride concentration was 0.66 mg/l. With respect to the prevention of caries, 44 per cent of the samples represent moderate benefit and 54 per cent maximum benefit. As for dental fluorosis, 99 per cent of the samples represented minimal risk...

Related factors of the approval for the community water fluoridation program in Incheon Metropolitan City / 대한구강보건학회지

OBJECTIVES: The purpose of this study was to heighten the community residents' support and approval on the community water fluoridation program, which presents the basic data in devising strategies that will expand the program. METHODS: The research subjects of this study were 700 adults, over the age of 20, who resided in the Incheon Metropolitan City. In order to analyze the factors that were related to the approval on administering the community water fluoridation program, the data were analyzed using a chi-squared test and a multiple logistic regression analysis. RESULTS: Respondents approving the implementation of the community water fluoridation program, in Incheon Metropolitan City, were 58.7%. Major reasons for opposing the program were 'harmful', 'influence the taste and color of water', and 'objections without a particular reason'. The approval rate for implementation of the program was higher in the group who perceived that oral health was good and practiced oral health behaviors, like visiting the dental clinics on a regular basis. Also, it was higher in the group who had the experience of hearing of this program at least once and a higher knowledge of the community water fluoridation program. Especially, the strongest correlations were found between the knowledge of community water fluoridation program and the approval rate for implementation the program. CONCLUSIONS: In order to enhance the rate of approval on administrating the community water fluoridation program, it is necessary to publicize the purpose, effect, and stability of this program, through a diverse mass media and reinforce the health education program to oral health management.

Caries and fluorosis in the Santiago metropolitan region in Chile: The impact of the fluoridation of the water / Cárie e fluorose na região metropolitana de Santiago, Chile: impacto da fluoretação da água

PURPOSE: To assess the damage and the prevalence of caries and fluorosis in children and adolescents in the metropolitan area after 8 years of drinking water fluoridation and to compare them with the baseline study. METHODS: This was a prevalence study. The sample was selected using two-step probability sampling and stratified according to socioeconomic level. Subjects included 2,323 schoolchildren aged 6 to 8 years and 12 years living within the metropolitan region. The parents of all students provided consent and were previously included in the study. The subjects were clinically examined by calibrated dentists, who used World Health Organization (WHO) screening criteria and indicators to determine the presence of caries and dental fluorosis. RESULTS: No cavity damage was found in 23.68 percent of the children. The average dmft was 3.18 for children aged 6 to 8 years. The DMFT was 0.59 in children aged 6 to 8 years and 2.6 in children 12 years compared with the baseline study. These differences were statistically significant. There were also significant differences in the DMFT index for each socioeconomic status group. The average number of dams was higher among children of low socioeconomic status. Of the studied children, 14.3 percent of children had dental fluorosis. Fluorosis was very mild in 12.35 percent of the cases, mild in 1.98 percent and moderate in 0.26 percent. There were no cases of severe fluorosis (classified according to Dean's index). CONCLUSION: We conclude that after 8 years drinking water fluoridation in the metropolitan area, the number of children with no history of caries has increased by approximately 100 percent. The number of cases significantly affected by caries has also decreased significantly. The incidence of dental fluorosis has increased, but to milder degrees.

OBJETIVO: Avaliar o dano e a prevalência de cárie e fluorose em crianças e adolescentes na região metropolitana do Chile, após oito anos de fluoretação da água potável, em comparação com o estudo de base em 1996. METODOLOGIA: Desenho: estudo de prevalência. A amostra probabilística, estratificada por nível socioeconômico, constituiu-se de 2.323 escolares de 6-8 e 12 anos na Região Metropolitana. Todos os alunos foram clinicamente examinados por dentistas calibrados, utilizando critérios de seleção e indicadores propostos pela OMS para determinar cárie e fluorose dentária. RESULTADOS: Cerca de 24 por cento das crianças estavam livres de cáries. A média de CPOD foi de 3,18 em escolares de 6 a 8 anos. O CPOD foi de 0,59 em crianças de 6 a 8 anos e de 2,6 em crianças de 12 anos em relação ao estudo de base, sendo essas diferenças estatisticamente significativas. Houve diferenças significativas devido ao nível socioeconômico, sendo que os valores médios foram maiores em crianças de baixo nível socioeconômico. Cerca de 14 por cento das crianças apresentaram fluorose dentária, em geral de grau muito leve. CONCLUSÃO: Após 8 anos de fluoretação da água potável na região metropolitana, observou-se um aumento de 100 por cento de crianças sem história de cárie e significativa diminuição de danos. A fluorose dentária aumentou, mas em graus mais leves.

Uso do flúor em saúde pública sob o olhar dos delegados à 13ª Conferência Nacional de Saúde / Use of fluoride in public health from the perspective of the delegates to the 13th National Health Conference

Sendo a cárie dentária um grave problema de saúde pública para a maioria dos indivíduos que moram em países do hemisfério Sul e para as populações com baixo status socioeconômico dos países de capitalismo desenvolvido, advoga-se o uso do flúor em saúde pública, como medida preventiva. Objetivo Descrever as percepções e opiniões dos delegados à 13ª Conferência Nacional de Saúde sobre o uso do flúor em saúde pública, com foco na fluoretação das águas de abastecimento público. Método - Realizou-se pesquisa exploratória, descritiva, com abordagem qualitativa, utilizando-se como técnica de processamento de depoimentos o Discurso do Sujeito Coletivo (DSC). Ao todo, foram 310 respondentes. Os dados foram coletados por meio de questionários semi estruturados e analisados por meio da análise do discurso. Resultados Constatou-se desinformação dos delegados no tocante a vários aspectos do uso do flúor em saúde pública e os mesmos sentem necessidade de meios de divulgação efetivos sobre a água para consumo e sobre os níveis de flúor da água. Considerações Finais - Ideias equivocadas ou lacunas de conhecimento acerca de vários aspectos do uso do flúor em saúde pública revelam a necessidade de se melhorar o nível de informação da sociedade sobre questões relativas à fluoretação. O desconhecimento dos delegados, aliado aos dados encontrados na literatura sobre as deficiências no monitoramento e controle dos níveis de flúor na água são indicativos da necessidade de se reavaliar o papel dos atores sociais e os mecanismos utilizados no controle social.

As tooth decay a serious public health problem for most residents of countries of the southern hemisphere and for populations of low socioeconomic status in developed capitalist countries, the use of fluoride in public health is advocated as a preventive measure. Objective: To describe the perceptions of the delegates to the 13th National Health Conference on the use of fluorides in public health, focusing on the fluoridation of public water supplies. Method - An exploratory and descriptive research was performed with a qualitative approach and utilizing as the processing technique of statements the Discourse of the Collective Subject (DCS). A total of 310 participants responded. The data was collected using semi-structured questionnaires and analysed by the discourse analysis method. Results - Misinformation of the delegates concerning several of the use of fluoride in public health and the need of these delegates for effective means of disseminating information on water suitable for consumption and the levels of fluoride in water was found. Final Considerations - Erroneous ideas and knowledge gaps regarding the various aspects of the use of fluoride in public health underscore the need to improve societys level of understanding of questions relating to water fluoridation. The lack of knowledge of delegates, together with the data available in the literature on the defective monitoring and control of fluoride levels in the water, indicates the need to further evaluate the role of the social actors and the mechanisms used in the societal control.

Análise da fluoretação da água de abastecimento público da zona urbana do município de Campo Grande (MS) / Water fluoridation analysis of Campo Grande (MS) urban zone public supply

O presente estudo teve por objetivo analisar a concentração de fluoreto na água que flui das torneiras da zona urbana do município de Campo Grande (MS). Para tanto, foram coletadas amostras de água de 21 escolas situadas nos sete subdistritos da cidade, em três oportunidades diferentes para análise do teor de fluoreto, determinada pelo método do eletrodo específico (medidor de fluoreto combinado Orion 9609 BN, acoplado a um potenciômetro digital EA-940 da Orion). Os resultados mostraram que 63,5 por cento das amostras coletadas apresentaram níveis aceitáveis (entre 0,6 a 0,8 ppm) de fluoreto e 36,5 por cento, níveis inaceitáveis. Em relação à condição dos locais de coleta, 76,2 por cento foram consideradas adequadas e 23,8 por cento, inadequadas.

The objective of this study was to analyze the fluoride concentration on the water that flows of the tap in the urban area of the city of Campo Grande (MS). For the fluoride concentration analysis, it was collected water samples of 21 schools placed in the 7 sub districts of the city, in 3 different opportunities, was made by the specific electrode method (using an Orion 9609 BN combined fluoride measuring electrode, coupled with an Orion EA-940 digital potentiometer). The results showed that 63.5 percent of the water samples presented acceptable fluoride levels (between 0.60 and 0.80 ppm) and 36.5 percent, unacceptable levels. In relation to the condition of the collect places, 76.2 percent were considered appropriate and 23.8 percent were inappropriate.

Análise do teor de fluoreto em àguas minerais comercializadas em Belém do Pará / Fluoride content of still bottled water in Belém of Pará

Objetivo: analisar a concentração do íon fluoreto em amostras de água mineral comercializadas na cidade de Belém do Pará, 2009 Método: transversal analítico. Colhidas 07 amostras das marcas comerciais, (Terra Alta, Belágua, Y Yamada, Indaiá, Schincariol, Nossa água, Prata) e realizada análise quantitativa de flúor (mg/l), utilizando o espectrofotômetro, Metrolab 330. As amostras estavam com a temperatura ambiente de 28ºC. Resultados: Indaiá =0,0ppm; Terra Alta=0,1ppm ; Belágua=0,02ppm ; Y Yamada=0,02ppm; Schincariol=0,04ppm; Nossa água =0,04 ppm ; Prata=0,26ppm. Considerações finais: os resultados mostraram uma insuficiência de fluoreto de sódio nas águas minerais, tanto para prevenção, quanto para a ocorrência de fluorose dentária

Objective: the objective of the present study was to determine the fluoride concentrations of 07 commercial marks mineral water (mg/l) in Belém of Pará , 2009 Methods: analytic transversal study . Espectrofotometro, Metrolab 33 0 , was utilized to determinate thefluoride concentration of 7 samples of mineral commercial water. The samples were with the ambient temperature of 28ºC. Results: Indaiá =0,0ppm, Terra Alta=0,1ppm , Belágua=0,02ppm , Y Yamada=0,02ppm , Schicariol=0,04ppm, Nossa água =0,04 ppm , Prata= 0,26ppm Conclusion: the results had in such a way shown an insufficiencies of sodium fluoride in mineral waters for prevention how much for the dental occurrence of fluorose.

Cárie dentária em adultos em locais com e sem água fluoretada da região de Campinas, São Paulo / Dental caries in adults caries in places with and without fluoridated water in the Campinas area, São Paulo

O objetivo deste trabalho foi descrever a prevalência de cárie dentária em população adulta da região de Campinas, São Paulo, segundo a condição de fluoretação da água e gênero, em 1998. Os critérios usados seguiram as recomendações da Organização Mundial da Saúde(1997). Foram examinados 535 adultos (35 a 44 anos), de 8 municípios representativos da região de Campinas, Estado de São Paulo. Foram usados os testes Mann-Whitney e Qui-quadrado (p<0,05). O CPOD foi de 21,3 (IC95%=20,7-21,9). Os componentes cariado e perdido foram maiores nos homens (p<0,05). O CPOD foi maior na região sem água fluoretada, bem como o componente perdido (p<0,05). A média de dentes presentes foi de 19,7 (IC95%=18,9-20,5), menor na região sem água fluoretada (p<0,05). Observa-se elevada experiência de cárie, porém, sugere-se um possível efeito benéfico da fluoretação da água neste grupo etário no controle da cárie dentária uma vez que a região fluoretada apresentou menores médias do CPOD e do componente perdido.

The objective of this article was to verify dental caries prevalence and treatment needs in the Campinas area, State of São Paulo, according to the gender and fluoridation of the public water supply, in 1998. The criteria used were in accordance with the recommendations of the World Health Organization (WHO). The sample comprised 535 adults (35 to 44 years of age), from 8 municipalities representative of the area of Campinas, State of São Paulo. The Mann-Whitney and Chi-squared tests were used (p<0.05). DFMT in this population was 21.3 (IC95%=20.7-21.9) The components decayed and missing were higherin the men (p<0.05). DMFT was higher in the area without fluoridation, as well as the missing component (p<0.05). The restored treatment needs were the most frequent. The number of teeth present was 19.7 (IC95%=18.9-20.5), being lower in the area without fluoridation (p<0.05). The results revealed high decay experience, however, it suggests a possible beneficial effect of the of water fluoridation in this group in the control of the decay once the area with fluoridation presented lower average of DMFT and of the lost component.

Estudo da incidência de fluorose dentária na dentição permanente no município de Joinville / Evaluated the incidence of dental fluoroses in school children the public net education in Joinville

Este estudo avaliou a incidência de fluorose dentária em 640 escolares, de 6 a 12 anos, da rede pública de ensino. Os dados obtidos permitiram determinar e estabelecer os índices comunitário e individual de fluorose, como preconizado por Dean e Arnold (1943), a prevalência de cárie dentária e o índice de CPO-D (dentes cariados, perdidos e obturados), relacionando cárie dentária e grau de fluorose. A utilização de água de abastecimento fluoretada, somada a pastas dentais, bochechos ou suplementos fluoretados em crianças de 6 a 12 anos, determinou baixos índices de cárie em Joinville, porém uma fluorose considerada entre leve e muito leve foi constatada na população estudada. A cidade apresentou fluorose média de 0,244 e CPO-D máximo de 2,6 aos 12 anos. O estudo concluiu que a fluoretação das águas e métodos tópicos de uso do flúor são medidas eficazes de combate a doença cárie, porém existe risco de fluorose, embora baixo. É prudente a realização de mais estudos para acompanhar a prevalência e a severidade da anomalia em Joinville, bem como o controle da concentração adequada de flúor nos sistemas públicos de fornecimento de água

This study evaluated the incidence of dental fluorosis in 640 six to twelve year-old school children of the public education net. The data allow the delimitation and establishment of community and individual fluorosis rates as preconized by Dean and Arnold (1943) [1], the prevalence of dental caries and the CPO-D rate, considering the ratio between dental caries and the fluorosis degree. It must be remembered that this net is submitted to the fluorine water application with topical application methods of fluoride. Besides this, the utilization of tooth paste, mouth rinse, or supplements, by the users, are efficient measures to prevent the caries disease, so there was a low denta lcaries rate in the studied population of Joinville, however there is alow risk of fluorosis. The city presented average fluorosis rate of 0.244 and CPO-D 2.6 to 12 years old. More studies are recommended inorder to observe the severity and prevalence of anomalies in Joinville as well as the control of the adequate fluoride concentration in thepublic water supply.