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.

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)

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.

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.

Is the fluoride intake by diet and toothpaste in children living in tropical semi-arid city safe?

Abstract: Data about total fluoride intake in children living in a tropical semi-arid climate city is scarce, thus we conducted this study. Fifty-eight children aged two to five years, living in a Brazilian tropical city with optimally fluoridated water were selected. Dietary samples were collected using the duplicate diet method on two non-consecutive days in the children's home toothpaste was determined by subtracting the amount of fluoride recovered after brushing from the amount placed on the toothbrush. The mean total dose (SD) of fluoride intake was 0.043(0.016) mg F·kg-1·d-1, with the major (60.6%) contribution from water. The factors associated with the ingestion of fluoride from toothpaste were fluoride concentration of the toothpaste (p = 0.03) and the use of kids toothpaste (p = 0.02). The findings suggest that children have a low fluoride intake, measured by at-home meals and use of fluoride toothpaste; drinking water is the main source of fluoride ingestion.

Distribución geográfica de fluoruros en el agua de red de abastecimiento público en la provincia de Tucumán, Argentina / Geographical distribution of fluoride in the public water supply in the province of Tucumán, Argentina

RESUMEN Con el objetivo de estudiar la distribución geográfica del contenido de fluoruros en el agua de abastecimiento público de la provincia de Tucumán, Argentina, se recolectaron 1.210 muestras en 190 localidades de los 17 departamentos de la provincia durante el periodo 2008-2012. Las determinaciones analíticas de fluoruros se realizaron por el método SPANDS y, para el procesamiento de la información, se utilizó el programa QGis 2.16. Los requerimientos del contenido de fluoruros en el agua se identificaron de acuerdo al Código Alimentario Argentino. El 94% de la población estudiada consumía agua con concentraciones de fluoruros inferiores a los límites recomendados, un 5% estaba expuesta a concentraciones de fluoruros superiores al límite máximo requerido y el 1% consumía agua en concentraciones óptimas de fluoruros. En los mapas se visualiza una distribución geográfica heterogénea de fluoruros, diferenciada por áreas con déficit, exceso y valores recomendados de fluoruros que, en algunos departamentos, permite observar una relación inversa entre la red hidrológica y el parámetro de estudio. Para la Capital el valor promedio encontrado fue de 0,32 mg/l, con una distribución geográfica homogénea. La información obtenida es indispensable para el adecuado manejo del flúor y la mejora de la salud pública a través de políticas sanitarias.

ABSTRACT This work studied the geographical distribution of fluoride content in the public water supply in the province of Tucumán, Argentina. A total of 1,210 samples were collected in 190 localities of the 17 departments of the province during the 2008-2012 period. The analytical determination was performed using the SPADNS method and QGis 2.16 was used for processing the information. The fluoride content requirements in the studied localities were determined according to the Argentine Food Code. The results showed that 94% of population studied consumed water with fluoride concentrations below the recommended limits, 5% were exposed to fluoride concentrations above the required maximum limit and 1% consumed water at optimal fluoride concentrations. The maps showed a heterogeneous geographical distribution of fluorides, in which areas with deficit, excess and recommended values of fluorides can be differentiated; in some departments an inverse relationship between the density of the hydrological network and fluoride concentration can be observed. In the capital of the province, the average value found was 0.32 mg/l, presenting a homogeneous geographical distribution. The information obtained is indispensable for the proper management of fluoride, so as to improve public health through policy.

Fluoride stability in dentifrices stored in schools in a town of northern Brazil

The aim of this study was to analyze fluoride stability in dentifrices stored during nine months in schools from Careiro da Várzea, State of Amazonas, Brazil. Analysis of total fluoride concentration, total soluble fluoride, and ionic fluoride in the dentifrice samples was performed in four different time periods: at the time of purchase (baseline); after three months, after six months, and after nine months of storage. Fluoride concentration was determined using a specific electrode (Orion 96-09) connected to an ion analyzer (Orion A-720) and calibrated with fluoride standard solutions containing 2.0 to 32.0 ppm F. The results obtained during the measurements were analyzed by analysis of variance (one-way ANOVA), followed by Tukey’s test for comparison of the means. After nine months of storage, total soluble fluoride, the active form of fluoride, decreased by 21.9%. As total soluble fluoride was below the minimum required for anticaries efficacy (1,000 ppm F) in the fourth analysis, it may be concluded that anticaries potential decreased with storage time.

Necessity to review the Brazilian regulation about fluoride toothpastes / Necessidade de revisão da regulamentação brasileira sobre dentifrícios fluoretados

The aim of this study was to evaluate the adequacy of the Brazilian legislation about fluoride toothpaste. A search was conducted in LILACS, Medline and SciELO databases about the fluoride concentration found in Brazilians toothpastes, using descriptors on health. Publications since 1981 have shown that some Brazilian toothpastes are not able to maintain, during their expiration time, a minimum of 1,000 ppm F of soluble fluoride in the formulation. However, the Brazilian regulation (ANVISA, Resolution 79, August 28, 2000) only sets the maximum total fluoride (0.15%; 1,500 ppm F) that a toothpaste may contain but not the minimum concentration of soluble fluoride that it should contain to have anticaries potential, which according to systematic reviews should be 1,000 ppm F. Therefore, the Brazilian regulation on fluoride toothpastes needs to be revised to assure the efficacy of those products for caries control.

O presente estudo analisou a adequação da regulamentação brasileira vigente sobre dentifrícios fluoretados. Foi realizada busca da literatura sobre a concentração de flúor nos dentifrícios brasileiros, tendo como fontes Lilacs, Medline e SciELO, com uso de descritores em saúde. Publicações sobre a composição de dentifrícios fluoretados brasileiros têm mostrado desde 1981 que nem todos os dentifrícios são capazes de manter durante o prazo de validade uma concentração mínima de 1.000 ppm F. Esse problema ocorre não só com dentifrícios adquiridos no mercado como com aqueles distribuídos por serviços públicos de saúde. Entretanto, a legislação brasileira (Resolução 79, Anvisa, 28/8/2000) apenas estabelece que um dentifrício não pode conter mais que 0,15% (1.500 ppm F) de flúor total, sem estabelecer o mínimo de flúor solúvel que ele deveria conter para ter potencial anticárie, a qual de acordo com revisões sistemáticas deve ser igual ou maior que 1.000 ppm F. Concluiu-se que a regulamentação brasileira sobre dentifrícios fluoretados necessita ser revisada, garantindo a eficácia desses produtos para o controle da cárie.

Estimation of Toothpaste Fluoride Intake in Preschool Children

The objective of this study was to estimate the intake of toothpaste fluoride used by children aged 2 to 6 years (n=87) treated at a hospital of a medium-sized city (Campina Grande, PB) in the Northeastern region of Brazil. Data regarding sociodemographic characteristics of families and children's toothbrushing were collected from questionnaire-based interviews with parents/guardians, and the amount of fluoride used during toothbrushing was estimated using a precision scale for assessment of the risk of dental fluorosis, considering a cutoff value of 0.07 mgF/kg body weight/day. Fluoride content in the toothpastes was analyzed using a specific fluoride electrode. Data were analyzed using descriptive and inferential statistics using the chi-square and Fisher's exact tests (α=0.05). Considering the use of the derice, the risk of fluorosis in the children was 19.5%. There was significant association (p<0.05) between the risk of fluorosis, brushing frequency, type of derice and who performed the child's oral hygiene. It was concluded that a high percentage of children in the studied sample used toothpaste inappropriately and were at risk of developing dental fluorosis.

Resumo O objetivo do presente trabalho foi estimar a ingestão de flúor de derícios utilizados por crianças de 2 a 6 anos de idade (n=87) atendidas em um hospital de médio porte (Campina Grande, PB) na região nordeste do Brasil. Os dados envolveram características sócio-demográficas e escovação dentária das crianças através de uma entrevista com formulário específico, aplicado aos pais/responsáveis, e a quantidade de flúor utilizada na escovação da criança, por meio de balança de precisão, para avaliação do risco de fluorose dentária, considerando o ponto de corte 0,07 mgF/kg peso corporal/dia. O conteúdo de flúor nos cremes dentais foi analisado utilizando eletrodo específico. Os dados foram trabalhados sob a forma de estatística descritiva e inferencial usando o testes do Qui-quadrado de Pearson e Exato de Fisher (α= 0,05). Levando-se em consideração o uso do derício, o risco de fluorose das crianças pesquisadas foi 19,5%. Houve associação significativa entre o risco de fluorose, a frequência de escovação, o tipo de derício e quem realiza a higiene bucal da criança (p<0,05). Concluiu-se que elevada parcela das crianças usavam o derício de forma inadequada e apresentaram risco de fluorose. .

Fluoride concentration in public water supply: 72 months of analysis

Known as one of the ten most important advances on Public Health in the 20th century, fluoridation of public water supply is a measure of wide population coverage, which is effective on caries control. The city of Araçatuba, in the Northwest region of the São Paulo state, Brazil, started public water supply fluoridation in 1972 and, based on the average annual highest temperature, has kept the fluoride concentration between 0.6 to 0.8 mgF/L. The purpose of this study was to analyze monthly the fluoride concentration in public water supply in the city of Araçatuba during 72 months. Water samples were collected monthly on weekdays, directly from the water distribution network, on pre-established locations and analyzed in duplicate between November 2004 and October 2010 at the Research Laboratory of the Nucleus for Public Health (NEPESCO) of the Public Health Graduate Program from Araçatuba Dental School/UNESP, Brazil, using an fluoride-specific electrode connected to an ion analyzer. From the total of samples (n=591), 67.2% (n=397) presented fluoride concentration between 0.6 and 0.8 mgF/L; 20.6% (n=122) below 0.6 mgF/L; 11.5% (n=68) between 0.8 and 1.2 mgF/L and 0.7% (n=4) above 1.2 mgF/L. Most samples showed fluoride levels within the recommended parameters. Minimal variation was observed among the analyzed collection locations, showing that the city has been able to control the fluoride levels in the public water supply and reinforcing the importance of surveillance and constant monitoring to assure the quality of the water delivered to the population.

Reconhecida como um dos dez mais importantes avanços na Saúde Pública do século 20, a fluoretação das águas de abastecimento é uma medida de grande alcance populacional, eficaz no controle da cárie dentária. A cidade de Araçatuba, na região noroeste do estado de São Paulo, iniciou a fluoretação em 1972 e baseado na média da temperatura máxima anual, deve manter o teor de flúor entre 0,6 a 0,8 mgF/L. O objetivo deste estudo foi analisar mensalmente os teores de fluoretos nas águas de abastecimento público, no município de Araçatuba, durante 72 meses. Amostras de água foram coletadas mensalmente, em dias úteis, diretamente da rede de distribuição, nos pontos previamente estabelecidos e analisadas, em duplicata, de novembro de 2004 a outubro de 2010, no laboratório do Núcleo de Pesquisa em Saúde Coletiva do Programa de Pós-Graduação em Odontologia Preventiva e Social (NEPESCO) da Faculdade de Odontologia de Araçatuba/UNESP, utilizando-se um analisador de íons acoplado a um eletrodo específico para flúor. Do total das amostras (n=591), 67,2% (n=397) apresentaram teores de flúor entre 0,6 e 0,8 mgF/L; 20,6% (n=122) abaixo de 0,6 mgF/L; 11,5% (n=68) entre 0,8 e 1,2 mgF/L e 0,7% (n=4) acima de 1,2 mgF/L. A maioria das amostras apresentou teores de fluoreto dentro dos parâmetros recomendados. Observou-se variação mínima entre os pontos de coleta analisados, demonstrando que o município tem obtido êxito no controle dos níveis de flúor presentes na água e evidenciando a importância da vigilância e monitoramento constantes para garantir a qualidade da água fornecida à população.

Fluoride concentration in the top-selling Brazilian toothpastes purchased at different regions

To be relevant in terms of public health, widely-used toothpastes should have at least 1,000 ppm of soluble fluoride (F) concentration. Thus, the concentrations of total fluoride (TF) and total soluble fluoride (TSF) in the top-selling Brazilian toothpastes were evaluated. Samples (n=3) from toothpastes Colgate Anti-cáries®, Colgate Total 12 Clean Mint®, Colgate Tripla Ação Menta Original®, Colgate Tripla Ação Menta Suave® and Sorriso Dentes Brancos® were obtained from each of the five regions of the country. The concentrations of TF and TSF were analyzed with ion-specific electrode calibrated with F standards and the results were expressed in ppm (µg F/g). All toothpastes showed TF concentration lower than 1,500 ppm F (1,388.2 ± 25.8 to 1,483.2 ± 98.2). The TSF values were higher than 1,000 ppm F and ranged from 1,035.5 ± 61.5 to 1,221.8 ± 35.2 for calcium carbonate/monofluorophosphate-based toothpastes and from 1,455.6 ± 12.5 to 1,543.0 ± 147.3 for silica/sodium fluoride-based toothpaste. Top-selling Brazilian toothpastes presented available fluoride concentration to control caries regardless of the region where they are purchased.

Para ter relevância em termos de saúde pública, os cremes dentais amplamente utilizados pela população devem ter fluoreto (F) solúvel numa concentração mínima de 1.000 ppm F. Assim, as concentrações de fluoreto total (FT) e flureto solúvel total (FST) nos cremes dentais mais vendidos no Brasil foram avaliados. Os cremes dentais (n=3) Colgate Anti-cáries®, Colgate Total 12 Clean Mint®, Colgate Tripla Ação Menta Original®, Colgate Tripla Ação Menta Suave® e Sorriso Dentes Brancos® foram obtidos nas cinco regiões do país. As concentrações de FT e FST foram analisadas com eletrodo íon-específico calibrado com padrões de F e os resultados foram expressos em ppm (µg F/g). Todos os cremes dentais apresentaram concentração de FT inferior a 1.500 ppm F (1.388,2 ± 25,8 a 1.483,2 ± 98,2). Os valores de FST foram superiores a 1.000 ppm F e variaram de 1.035,5 ± 61,5 a 1.221,8 ± 35,2 para cremes dentais a base de carbonato de cálcio/monofluorfosfato e de 1.455,6 ± 12,5 a 1.543,0 ± 147,3 para o creme dental à base de sílica/fluoreto de sódio. Os cremes dentais mais vendidos no Brasil apresentaram concentração de fluoreto solúvel para controlar cárie, independentemente da região onde foram comprados.

Fluoride content in bottled drinking waters, carbonated soft drinks and fruit juices in Davangere city, India.

Background: The regular ingestion of fluoride lowers the prevalence of dental caries. The total daily intake of fluoride for optimal dental health should be 0.05-0.07 mg fluoride/kg body weight and to avoid the risk of dental fluorosis, the daily intake should not exceed a daily level of 0.10 mg fluoride/kg body weight. The main source of fluoride is from drinking water and other beverages. As in other countries, consumption of bottled water, juices and carbonated beverages has increased in our country. Objective: To analyze the fluoride content in bottled water, juices and carbonated soft drinks that were commonly available in Davangere city. Materials and Methods: Three samples of 10 commercially available brands of bottled drinking water, 12 fruit juices and 12 carbonated soft drinks were purchased. Bottled water and carbonated soft drinks were stored at a cold place until fluoride analysis was performed and a clear juice was prepared using different fruits without the addition of water. Then, the fluoride analysis was performed. Results: The mean and standard deviation of fluoride content of bottled water, fruit juices and carbonated soft drinks were measured, which were found to be 0.20 mg (±0.19) F/L, 0.29 mg (±0.06) F/L and 0.22 mg (±0.05) F/L, respectively. Conclusion: In viewing the results of the present study, it can be concluded that regulation of the optimal range of fluoride in bottled drinking water, carbonated soft drinks and fruit juices should be drawn for the Indian scenario.

Fluorosis in rats exposed to oscillating chronic fluoride doses

Considering that blood fluoride concentration varies according to fluoride exposure and that dental fluorosis is related to the amount of enamel formed under a given fluoride dose, the present study investigated whether the fluorosis produced by an oscillating chronic fluoride dose would be similar to that caused by exposure to a constant dose, representing the mean of the oscillation during a given time. Rats received during 78 days water with fluoride concentrations of 0, 12.5, 25 or 37.5 µg F/mL, or oscillating concentrations of 12.5 and 37.5 µg F/mL every 72 h (mean exposure=25 µg F/mL). The concentrations of fluoride in the plasma, femur and incisors of the rats were determined at the end of the experimental period. Also, the enamel dental fluorosis index was determined in the incisors using a quantitative method developed by our research group named Dental Fluorosis by Image Analysis (DFIA). Fluoride concentrations in plasma, femur and teeth, and DFIA increased linearly for constant fluoride concentrations in water (p<0.0001, r values=0.87-0.98). The results of the oscillating group and the groups receiving 25 µg F/mL did not differ significantly (p>0.05). The findings of this study suggest that in animals chronically exposed to symmetrically oscillating fluoride doses, the resulting dental fluorosis reflects the metabolic effect of the mean of the oscillating doses.

Considerando que a concentração de fluoreto no sangue varia de acordo com a exposição ao fluoreto, e que a fluorose dental está relacionada com a quantidade de esmalte formado sob determinada dose de fluoreto, este estudo avaliou se a fluorose resultante da exposição a doses oscilantes de fluoreto seria semelhante àquela causada pela exposição a uma dose constante, representativa da média das oscilações durante um determinado tempo. Durante 78 dias, ratos receberam água com concentrações constantes de fluoreto de 0; 12,5; 25 ou 37,5 µg F/mL, ou concentrações oscilantes de 12,5 e 37,5 µg F/mL alternados a cada 72 h (média de exposição = 25 µg F/mL). Concentrações de fluoreto no plasma, fêmur e dentes incisivos dos ratos foram determinadas após o período experimental. O índice de fluorose, observado nos incisivos dos ratos, foi quantificado usando um método de análise de imagem desenvolvido para essa pesquisa, denominado de índice de fluorose por análise de imagem (DFIA, em Inglês). A concentração de fluoreto no plasma, fêmur e incisivo dos ratos, assim como o DFIA, aumentaram de forma linear para as concentrações constantes de fluoreto na água (p<0,0001, r=0,87-0,98). Não houve diferença significativa entre o grupo que recebeu doses oscilantes e o grupo que recebeu 25 µg F/mL (p>0,05). Os resultados sugerem a fluorose dental decorrente de exposição crônica de animais a doses de fluoreto oscilantes e simétricas reflete o efeito metabólico da média da oscilação.

Available fluoride in toothpastes used by Brazilian children

Toothpastes should have a minimum concentration of 1000 ppm of fluoride (F) to control caries and also the active F agent must be chemically free (soluble) in the formulation. Thus, the aim of this study was to evaluate the concentration of soluble F in dentifrices used by 206 Brazilian children. The concentrations of total fluoride (TF), total soluble fluoride (TSF) and fluoride ion were determined. From these analyses, the concentrations of F as sodium monofluorophosphate (MFP) and percent of insoluble F were calculated. F was analyzed with an ion specific electrode in duplicates. The majority of dentifrices used (96 percent) contained F and in 84 percent of them, TF concentration was according to that declared by the manufacturers. In the F-toothpastes, 78 percent showed TSF concentration ≥1000 ppm, varying from 422.3 to 1432.3 ppm F (mean ± SD of 1017.6 ± 239.4). These findings suggest that most dentifrices used by Brazilian children present available fluoride concentration for caries control.

O requerimento mínimo para que um creme dental tenha potencial anticárie é ele ter fluoreto (F) na concentração de 1000 ppm, o qual porém deve estar solúvel na formulação. Assim, este estudo teve como objetivo conhecer a concentração de F solúvel em dentifrícios usados por 206 crianças brasileiras. Foram determinadas as concentrações de flúor total (FT), o qual representa a soma das concentrações de flúor solúvel (iônico e ionizável) mais o insolúvel (ligado ao abrasivo); de flúor solúvel total (FST), representando o iônico mais o ionizável na forma de monofluorfosfato de sódio (MFP) e de flúor solúvel na forma iônica (FI). A partir destas análises foram calculadas as concentrações de MFP e a por cento de F insolúvel (Fins). As análises foram feitas em duplicatas com eletrodo específico. A maioria dos dentifrícios usados (96 por cento) continham fluoreto e em 84 por cento desses a concentração de FT encontrada estava de acordo com a declarada na embalagem. Em 78 por cento dos cremes dentais fluoretados, a concentração de FST encontrada foi igual ou superior a 1000 ppm, variando de 422,3 a 1432,3 ppm F (média ± DP de 1017,6 ± 239,4). Os dados mostram que a maioria dos cremes dentais usados pela amostra de crianças brasileiras possui concentração de F potencialmente ativo para controlar cárie.

Enamel remineralization by fluoride-releasing materials: proposal of a pH-cycling model

This study proposes a pH-cycling model for verifying the dose-response relationship in fluoride-releasing materials on remineralization in vitro. Sixty bovine enamel blocks were selected for the surface microhardness test (SMH1). Artificial caries lesions were induced and surface microhardness test (SMH2) was performed. Forty-eight specimens were prepared with Z 100, Fluroshield, Vitremer and Vitremer » diluted - powder/liquid, and subjected to a pH-cycling model to promote remineralization. After pH-cycling, final surface microhardness (SMH3) was assessed to calculate percent recovery of surface microhardness ( percentSMHR). Fluoride present in enamel (μg F/mm3) and in the pH-cycling solutions (μg F) was measured. Cross-sectional microhardness was used to calculate mineral content (∆Z). There was no significant difference between Z 100 and control groups on analysis performed on - percentSMHR, ∆Z, μg F and mg F/mm3 (p>0.05). Results showed a positive correlation between percentSMHR and μg F/mm3 (r=0.9770; p=0.004), percentSMHR and μg F (r=0.9939; p=0.0000001), ∆ and μg F/mm3 (r=0.9853; p=0.0002), ∆ and μg F (r=0.9975; p=0.0000001) and between μg F/mm3 and μg F (r=0.9819; p=0.001). The pH-cycling model proposed was able to verify in vitro dose-response relationship of fluoride-releasing materials on remineralization.

Este trabalho propôs um modelo de ciclagem de pH verificando a relação dose-resposta de materiais que liberam flúor na remineralização in vitro. Foram selecionados 60 blocos de esmalte bovino pelo teste de microdureza de superfície (SMH1). Realizou-se indução de cárie e microdureza de superfície pós-cárie (SMH2). Corpos-de-prova (n=48) dos grupos Z 100, Fluroshield, Vitremer e Vitremer diluído » foram fabricados e submetidos à ciclagem de pH para promover a remineralização. Após, avaliou-se a microdureza de superfície final (SMH3) para cálculo da porcentagem de recuperação da microdureza de superfície ( por centoSMHR). Determinou-se o flúor presente no esmalte (μg F/mm3) e nas soluções de ciclagem (μg F). O teste de microdureza em secção longitudinal foi realizado para cálculo do conteúdo mineral (∆Z). Entre os grupos controle e Z100 não houve diferença significativa nas análises realizadas - por centoSMHR, ∆Z, μg F e μg F/mm3 (p>0,05). Houve correlação positiva entre a por centoSMHR e μg F/mm3 (r=0,9770; p=0,004), por centoSMHR e μg F (r=0,9939; p=0,0000001), ∆Z e μg F/mm3 (r=0,9853; p=0,0002), ∆Z e μg F (r=0,9975; p=0,0000001) e também entre μg F/mm3 e μg F (r=0,9819; p=0,001). O modelo de ciclagem de pH proposto foi adequado para verificar relação dose-resposta in vitro de materiais que liberam flúor na remineralização.

Fingernail may not be a reliable biomarker of fluoride body burden from dentifrice

Fingernail has been suggested as a biomarker of fluoride (F) body burden, but there is no consensus if it would be a reliable indicator of F exposure from dentifrice. Therefore, the present study was conducted to investigate if fingernails would have sensitivity to detect F exposure from dentifrice in young children. Twenty-three 1-3-year-old children living in the city of Piracicaba (0.72 ppm F in water), Brazil, were enrolled in two phases of different F exposure: in phase A (1st to 11th week), they were exposed to the combination of F from diet (solids and liquids) and dentifrice (1,500 µg F/g as MFP), and in phase B (12th to 29th week), only to F from diet (the use of F dentifrice was interrupted). Fingernails were weekly clipped during 35 weeks for F determination. F intake from diet and dentifrice in each phase was also determined. Both analyses were made with ion-specific electrode. F intake (Mean ± SD) was significantly higher (p<0.01) when the children were exposed to F from diet+dentifrice than only to F from diet (0.086 ± 0.032 and 0.040 ± 0.009 mg F/day/kg body weight, respectively). However, F concentrations in nails collected during the whole experimental period of 35 weeks presented great variation with no trend of decreasing after F dentifrice intake interruption. The findings suggest that fingernail may not be a reliable F biomarker of body burden from dentifrice.

As unhas têm sido consideradas um biomarcador para a exposição ao flúor (F), mas não há consenso se é um indicador confiável para exposição ao F a partir do dentifrício. Vinte e três crianças, com idade entre 1 a 3 anos, moradoras de Piracicaba (0,72 ppm F na água), Brasil, foram submetidas a duas fases de diferentes exposição ao F: fase A (1a a 11a semanas), as crianças foram expostas à combinação de F a partir da dieta (sólidos e líquidos) e dentifrício (1500 µg F/g como MFP); e na fase B (12ª a 29ª semanas), apenas ao F da dieta, uma vez que usaram dentifrício não fluoretado. As unhas das mãos foram coletadas semanalmente durante 35 semanas para determinação de F. A exposição ao F a partir da dieta e dentifrício foi também determinada. Ambas análises foram feitas com eletrodo específico para F. A exposição ao F foi significativamente maior (p<0,001) quando as crianças foram expostas ao F da dieta + dentifrício que ao F da dieta (0,086 ± 0,032 e 0,040 ± 0,009 mg F/kg corpóreo/dia, respectivamente). Entretanto, a concentração de F nas unhas coletadas durante todo o período experimental não diminuiu após a interrupção da ingestão do F a partir do dentifrício. Os resultados sugerem que as unhas das mãos não são um biomarcador confiável para refletir a exposição ao F pelo dentifrício.

Long-term fluoride release from resin-reinforced orthodontic cements following recharge with fluoride solution

The aim of this study was to test the hypothesis that there is no difference in the fluoride release behavior of resin-reinforced glass ionomer cements before or after fluoride recharge. The materials were divided into 5 groups: 2 resin-reinforced glass ionomer cements used for attaching orthodontic bands, that is, group FOB (Fuji Ortho Band) and group MCB (Multi-Cure Glass Ionomer Orthodontic Band Cement); 2 resin-reinforced glass ionomer cements and a composite used for bonding orthodontic brackets, that is, group OGLC (Ortho Glass LC), group FOLC (Fuji Ortho LC), and group TXT (Transbond XT), respectively. Fluoride release was measured during a 60-day period by using selective ion electrodes connected to an ionic analyser. After 4 weeks, the samples were exposed to 0.221 percent sodium fluoride solution. The results showed that cements achieved a maximum fluoride release 24 h after initial setting. No statistically significant differences were observed between groups FOB and OGLC regarding the amount of released fluoride following fluoride recharge from day 31 to day 36 (p>0.05). In conclusion, FOB and OGLC cements showed a higher capacity of capturing and releasing fluoride compared to the other cements studied.

O objetivo deste estudo foi testar a hipótese que não há diferença no desempenho dos cimentos de ionômero de vidro reforçados com resina entre si quanto à liberação de flúor antes e após recarga com flúor. Os materiais foram divididos em 5 grupos: 2 cimentos de ionômero de vidro reforçados com resina utilizados para cimentação de bandas ortodônticas: Grupo FOB (Fuji Ortho Band) e Grupo MCB (Multi-Cure Glass Ionomer Orthodontic Band Cement); 2 cimentos de ionômero de vidro reforçados com resina e 1 compósito utilizados para colagem de bráquetes ortodônticos: Grupo OGLC (Ortho Glass LC), Grupo FOLC (Fuji Ortho LC); e Grupo TXT (Transbond XT), respectivamente. A liberação de flúor foi medida durante 60 dias, através de eletrodo íon seletivo conectado a um analisador de íons. Após 4 semanas, os corpos de prova foram expostos a solução de fluoreto de sódio à 0,221 por cento. Os resultados evidenciaram que os cimentos atingiram o pico máximo de liberação de flúor com 24 h após presa inicial. Não houve diferença estatisticamente significante entre a quantidade de flúor liberado após as recargas de fluoreto de sódio entre os grupos FOB e OGLC do 31° ao 36° dia (p>0.05). Concluindo os cimentos FOB e OGLC apresentaram maior capacidade de captação e liberação de flúor comparada aos outros CIVRRs.

Fluoride content of bottled water commercialized in two cities of northeastern Brazil

Aim: The objectives of this study were to evaluate the fluoride content of bottled water commercialized intwo cities of northeastern Brazil and to compare the fluoride values measured in the water to the ones printed on the bottle label, considering risks (dental fluorosis) and benefits (caries control) of systemic fluoride exposure. Methods: Fifty-six water samples were collected from 20 brands available in severalsupermarkets with high turnover in different regions of the municipalities of São Luís (State of Maranhão)and João Pessoa (State of Paraíba) in 2009. Fluoride concentrations were determined by triplicate analysisusing an ion-specific electrode. Results: The measured mean fluoride content varied from 0.001 to 0.270 ppmF with a mean (±SD) of 0.037 (±0.041) for the 56 samples. The majority of samples were found to contain less than 0.043 ppmF (92%). Conclusion: These results emphasize the importance of controllingthe fluoride levels in bottled water enforced by the Brazilian Sanitary Surveillance Agency. Concerning therisks and benefits, fluoride concentrations in the evaluated bottled water samples were below the suggested concentration (0.7 mg F/l), having neither preventive effect nor the potential for causing dental fluorosis.

Effect of gamma irradiation on fluoride release and antibacterial activity of resin dental materials

This study evaluated the effect of gamma irradiation on fluoride release and antibacterial activity of FluroShield (FS) and Clearfil Protect Bond (CPB). Four groups were formed: G1-FS + gamma; G2-FS without gamma; G3-CPB + gamma; G4-CPB without gamma. For fluoride release analysis, 12 disks of each material were prepared and covered with nail polish, except for one side (50.4 mm² area). G1 and G3 were sterilized with a 14.5 KGy dose at 27ºC for 24 h, while G2 and G4 (controls) were not sterilized and were maintained under the same time and temperature conditions. Fluoride release measurements were made in duplicate (n=6) by an ion specific electrode. The antibacterial activity of the CPB and FS against Streptococcus mutans after gamma sterilization was evaluated by the agar-disc diffusion method. The diameter of the zones of microbial growth inhibition was recorded after 48 h. Data were analyzed statistically by ANOVA and Tukey's test (α=5 percent). Gamma sterilization decreased the fluoride release of FS by approximately 50 percent, while CPB was not affected. There was no statistically significant difference (p>0.05) in the antibacterial effect of CPB between gamma and non-gamma sterilization groups. FS presented no antibacterial activity. Gamma irradiation decreased the fluoride release of FS, but did not affect the antibacterial activity of the studied materials.

Este estudo avaliou o efeito da esterilização com raios-gama na liberação de flúor e atividade antibacteriana de materiais resinosos, Fluroshield (FS) e Clearfil Protect Bond (CPB). Quatro grupos foram formados: G1-FS e gama; G2-FS sem gama; G3-CPB e gama; G4-CPB sem gama. Doze discos de cada material foram preparados para análise de liberação de flúor, os quais foram cobertos com esmalte de unha, exceto em um lado com 50,4 mm² de área. G1 e G3 foram esterilizados com dose de 14,5 KGy por 24 h/27ºC, enquanto G2 e G4 (controles) não foram esterilizados e foram mantidos sob as mesmas condições de tempo e temperatura. As leituras de liberação de flúor foram feitas em duplicata (n=6) por um eletrodo específico. A atividade antibacteriana foi avaliada pelo teste de difusão em agar. Os halos de inibição foram medidos após 48 h. Os dados foram analisados pelos testes ANOVA e Tukey (α=5 por cento). A esterilização gama diminuiu a liberação de flúor de FS em cerca de 50 por cento, enquanto CPB não foi afetado. Não houve diferença estatisticamente significante entre os grupos esterilizados e controle no efeito antibacteriano do CPB. FS não apresentou atividade antibacteriana. A esterilização gama diminuiu a liberação de flúor de FS, mas não afetou a atividade antibacteriana dos materiais estudados.