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1.
Pesqui. bras. odontopediatria clín. integr ; 22: e210153, 2022. tab, graf
Article in English | LILACS, BBO | ID: biblio-1386813

ABSTRACT

Abstract Objective: To analyze the fluoride concentration in the public water supply in Manaus, Brazil. Material and Methods: Water samples were collected in 50 mL polyethylene bottles, identified, and labeled. The collection was performed from September 2016 to August 2018. For the selection of collection points, all neighborhoods of the city of Manaus, divided into four health districts (North, South, East, and West), were mapped. From each district, 30 samples were collected, totaling 120 monthly samples. Water samples were analyzed using an ion analyzer, ORION 720-A, and a specific electrode, ORION 96-09. The ion analyzer and electrode were calibrated in standard solutions. The levels were classified in intervals based on technical consensus to guide the health surveillance agencies. Results: Of the 2,874 water samples, 50.3% were within the recommended range, and 49.7% were inadequate, with 31.6% considered above the parameters and 18.1% below. Among the districts, the North had the highest percentages of unsatisfactory samples, resulting in limited action to prevent tooth decay. During the 24 months of analysis, there were large oscillations in the values in all four districts of Manaus. Conclusion: Results reinforce the importance of heterocontrol for the city to guarantee the effectiveness of this public health measure.


Subject(s)
Health Surveillance , Fluoridation/statistics & numerical data , Dental Caries/prevention & control , Fluorides/analysis , Health Policy , Oral Health/education , Public Health , Cross-Sectional Studies/methods
2.
São Paulo; s.n; 2022. 88 p.
Thesis in Portuguese | LILACS | ID: biblio-1392652

ABSTRACT

A cárie dentária não tratada é uma das doenças mais prevalentes afetando os dentes permanentes de aproximadamente 2,3 bilhões de pessoas no mundo. Cerca de 370 milhões de pessoas (5% da população mundial) tem acesso à água fluoretada (usualmente entre 0,5 a 1,0 mgF/L), que é considerada a maneira mais eficiente de prevenção da cárie. No entanto, concentrações acima de 1,5 mg/L de fluoreto acarretam um risco crescente de fluorose dentária e níveis muito mais altos levam à fluorose esquelética. Por isso, mecanismos regulatórios devem ser implementados para assegurar o monitoramento e o nível de qualidade da água em relação ao parâmetro fluoreto com a finalidade de alcançar o máximo de prevenção da cárie com o mínimo de fluorose dentária. Investigar o desenho e o tipo de arranjo institucional adotado em cada contexto pode auxiliar a compreender os diferentes efeitos produzidos por esses mecanismos e identificar limitações e oportunidades de aprimoramento. O objetivo foi descrever e comparar o modelo de regulação e o arranjo institucional para assegurar a qualidade da água a fim de garantir a segurança e efetividade do ajuste da concentração do fluoreto em três países selecionados. Foi realizado um estudo descritivo por meio de pesquisa documental utilizando fontes oficiais do Brasil, Estados Unidos da América (EUA) e Inglaterra. Foram elaborados quadros síntese comparando-se as agências e organizações, as missões, as funções, os mecanismos regulatórios, os dispositivos normativos e os instrumentos de disseminação da informação adotados em cada um dos países selecionados. Embora em todos os países sejam adotados dispositivos normativos para o controle da qualidade da fluoretação da água, os modelos regulatórios, os arranjos institucionais e as formas de vigilância e divulgação eram distintos. O valor máximo permitido para fluoreto de ocorrência natural era 4,0 mgF/L nos EUA enquanto nos demais países era 1,5 mgF/L. Os procedimentos de controle operacional eram definidos centralmente nos três países, mas sua aplicação podia variar entre as unidades federativas dos EUA. Inglaterra e EUA preconizam a coleta de amostras na rede de abastecimento, enquanto o Brasil apenas na saída do tratamento. Do ponto de vista da vigilância, Inglaterra e EUA utilizam dados que dependem das empresas responsáveis pelo tratamento da água, enquanto o Brasil, embora ainda em processo de implementação, adota um sistema vigilância independente que utiliza dados coletados na rede de distribuição pela autoridade sanitária local. Um ponto em comum entre EUA e Brasil é a construção de um sistema de informação que, sob os princípios da vigilância em saúde, propicie a produção de informações e sua divulgação a fim de atender as exigências para assegurar um elevado nível de qualidade da fluoretação da água. Embora os dispositivos normativos e as medidas regulatórias possuam diferentes abordagens e graus de centralização/descentralização nos países pesquisados, observou-se que há importante espaço para troca de informações e intercâmbio de tecnologias a fim de elevar o desempenho dos serviços, a efetividade da vigilância da qualidade da água para que os benefícios máximos de redução dos índices de cárie dentária em nível populacional sejam atingidos.


Untreated tooth decay is one of the most prevalent diseases affecting the permanent teeth of approximately 2.3 billion people worldwide. About 370 million people (5% of the world population) have access to fluoridated water (usually between 0.5 to 1.0 mgF/L), which is considered the most efficient way of preventing caries. However, concentrations above 1.5 mg/L of fluoride carry an increased risk of dental fluorosis, and much higher levels lead to skeletal fluorosis. Therefore, regulatory mechanisms must be implemented to ensure monitoring and the level of water quality in relation to the fluoride parameter in order to achieve maximum caries prevention with minimum dental fluorosis. Investigating the design and type of institutional arrangement adopted in each context can help to understand the different effects produced by these mechanisms and identify limitations and opportunities for improvement. The objective was to describe and compare the regulatory model and the institutional arrangement to ensure water quality in order to guarantee the safety and effectiveness of fluoride concentration adjustment in three selected countries. A descriptive study was carried out through documentary research using official sources from Brazil, the United States and England. Summary tables were prepared comparing agencies and organizations, missions, functions, regulatory mechanisms, regulatory provisions and information dissemination instruments adopted in each of the selected countries. Although regulatory provisions are adopted in all countries to control the quality of water fluoridation, the regulatory models, institutional arrangements and forms of surveillance and disclosure were different. The maximum allowable value for naturally occurring fluoride was 4.0 mgF/L in the US while in other countries it was 1.5 mgF/L. Operational control procedures were centrally defined in the three countries, but their application could vary across US states. England and the USA advocate the collection of samples in the supply network, while Brazil only at the end of the treatment. From a surveillance point of view, England and the USA use data that depend on the companies responsible for water treatment, while Brazil, although still in the process of implementation, adopts an independent surveillance system that uses data collected in the distribution network by the local health authority. A common point between the USA and Brazil is the construction of an information system that, under the principles of health surveillance, promotes the production of information and its dissemination in order to meet the requirements to ensure a high level of quality in the fluoridation of Water. Although normative provisions and regulatory measures have different approaches and degrees of centralization/decentralization in the countries surveyed, it was observed that there is important space for exchanging information and exchanging technologies in order to increase the performance of services, the effectiveness of surveillance of the water quality so that the maximum benefits of reducing dental caries rates at the population level are achieved.


Subject(s)
Social Control, Formal , Fluoridation , Dental Caries/prevention & control , Regulatory Frameworks for Health , Health Policy
3.
Braz. dent. j ; 32(3): 75-83, May-June 2021. tab
Article in English | LILACS, BBO | ID: biblio-1345499

ABSTRACT

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.


Subject(s)
Humans , Child, Preschool , Child , Adolescent , Dental Caries/epidemiology , Dentifrices , Fluorosis, Dental/epidemiology , DMF Index , Fluoridation , Prevalence , Cross-Sectional Studies , Fluorides
4.
Rev. Cient. CRO-RJ (Online) ; 6(1): 2-11, abr. 2021.
Article in Portuguese | LILACS, BBO | ID: biblio-1357550

ABSTRACT

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


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


Subject(s)
Fluoridation , Dental Caries , Intelligence
5.
J. oral res. (Impresa) ; 10(1): 1-10, feb. 24, 2021. tab
Article in English | LILACS | ID: biblio-1178770

ABSTRACT

Fluoridation has been shown to be an effective measure against caries in children. The present study evaluates the cost-benefit of the fluoridated water program for the reduction of dental caries in 12-year-old children in the Biobío Region, the only region in Chile that has not implemented this program. An economic cost-benefit evaluation was carried out, comparing two alternative interventions: non-fluoridated drinking water versus fluoridated drinking water. The prevalence of caries, direct and indirect costs of the treatments, the cost of implementing the programs and the benefits of both interventions were estimated. From this study it is concluded that the savings in oral health costs in 12-year-old children when using fluoridating drinking water in the Biobío region is significantly higher than the cost involved in implementing the water fluoridation program, resulting in total savings for the Chilean state of $129,861,645 (USD$ 152,833) as well as an estimated reduction of 15% in the history of caries in the study population.


Se ha demostrado que la fluoración es una medida efectiva contra disminución de la caries en la población infantil. La presente investigación buscó evaluar cual es el costo-beneficio del programa del agua fluorada para la disminución de caries dental en niños de 12 años de la Región del Biobío, única región de Chile que no adhiere a este programa. Se realizó una evaluación económica de costo-beneficio, comparando dos intervenciones alternativas: agua potable no fluorada versus agua potable fluorada. Para tal fin se estimó la prevalencia de caries, costos directos e indirectos de los tratamientos, el costo de implementación de los programas y el beneficio de ambas intervenciones. De este estudio se concluye que el ahorro en costos de salud bucal en niños de 12 años al fluorar el agua potable en la región del Biobío, es significativamente mayor al costo que implica la implementación del programa de fluoración de aguas, lográndose un ahorro total para el Estado de $129.861.645 (USD $152.833) así como una estimación de reducción del 15% en la historia de caries en la población de estudio.


Subject(s)
Humans , Child , Fluoridation , Dental Caries/prevention & control , Drinking Water/analysis , Chile , Prevalence , Health Care Costs , Fluorides/analysis
6.
Braz. oral res. (Online) ; 35: e041, 2021. tab, graf
Article in English | LILACS, BBO | ID: biblio-1249372

ABSTRACT

Abstract: This study analyzed the association between sedentary behavior (SB), unhealthy food consumption, and dental caries amongst 12-year-old schoolchildren. An epidemiological survey was carried out in the five largest cities (> 80,000 inhabitants) of the State of Mato Grosso do Sul, Brazil. Data were collected on decayed, missing and filled teeth index (DMFT), sociodemographic characteristics, SB, unhealthy food consumption, and water fluoridation status. The analysis was based on the theoretical framework established by J Sisson. Structural equation models were performed to test the association of dental caries experience with sociodemographic, contextual, and behavioral factors. The mean DMFT index in the five cities was 1.02 (95%CI: 0.39-1.66). Higher sedentary behavior (more than 2 hours/day) [standardized coefficient (SC) = 0.21 95%CI: 0.07-0.39] and higher unhealthy food consumption (more than 4 times/week) [SC = 0.23 (0.10-0.45)] were associated with higher DMFT index than their counterparts. Also, cities with fluoridated water were associated with lower DMFT index [SC = −0.85 (-1.20--0.50)]. Families who had a per capita income above the poverty line had a direct association with unhealthy food consumption [SC = −0.24 (-0.38--0.11)]. Unhealthy food consumption mediated the association of sedentary behavior on DMFT index [SC=0.07 (0.02-0.13)]. Sensitivity analysis confirmed the findings. Sedentary behavior mediated by unhealthy food consumption had a significant association with dental caries experience. Public policies must address transdisciplinary actions to reduce sedentary behavior and unhealthy food consumption and promote water fluoridation.


Subject(s)
Humans , Child , Dental Caries/etiology , Dental Caries/epidemiology , Brazil/epidemiology , DMF Index , Fluoridation , Prevalence , Sedentary Behavior
7.
Cad. Saúde Pública (Online) ; 37(12): e00320720, 2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1350414

ABSTRACT

Objetivou-se analisar estratégias de implantação da Política Nacional de Saúde Bucal (PNSB) e sua possível influência sobre a morbidade bucal em capitais do Brasil na primeira década do século XXI. Trata-se de um estudo de avaliação de políticas. Os dados de morbidade bucal foram obtidos nos bancos das Pesquisas Nacionais de Saúde Bucal em 2003 e 2010 (SBBrasil 2003 e SBBrasil 2010), sendo calculada a modificação percentual anual de variáveis relativas às condições de saúde bucal como variáveis dependentes para as capitais brasileiras. A PNSB foi investigada relativamente às suas bases conceituais: modelo de atenção em saúde bucal, organização da oferta de serviços de saúde bucal, implementação de estratégias de promoção da saúde bucal e existência de fluoretação nas águas de abastecimento público. Para isso, foram utilizados dados dos sistemas de informação em saúde nacionais e aplicação de questionário face a face com coordenadores de saúde bucal de 13 capitais selecionadas. As análises foram controladas e ajustadas pelas condições socioeconômicas da população investigada. Observou-se uma associação entre as características de promoção de saúde bucal, da oferta de serviços e do modelo de atenção, o que representa que a dinâmica dos serviços públicos é dependente das prioridades de gestão e da condução da política. Conclui-se que a PNSB é implementada de forma diferente nas capitais brasileiras e o modo de condução de suas diretrizes, em cada capital, favorece ou não o desenvolvimento de melhores práticas e estratégias na atenção à saúde bucal. Contudo, a influência da PNSB sobre a modificação nos indicadores de saúde bucal entre 2003 e 2010 ainda é pouco clara.


The study aimed to analyze strategies for the implementation of the Brazilian National Oral Health Policy (PNSB) and its influence on oral health conditions in state capitals in the first decade of the 21st century. This is a policy assessment study. Data on oral health conditions were obtained from the databases of the Brazilian National Oral Health Surveys in 2003 and 2010 (SBBrasil 2003 and SBBrasil 2010), calculating the annual percent change in variables pertaining to oral health conditions as dependent variables for Brazilian state capitals. The PNSB was analyzed according to its conceptual foundations: oral healthcare model, organization of the supply of oral health services, implementation of oral health promotion strategies, and existence of fluoridation of the public water supply. Data were obtained from the national health databases and face-to-face interviews with oral health coordinators in 13 state capitals. The analyses were controlled and adjusted by the target population's socioeconomic conditions. An association was observed between the characteristics of oral health promotion, services supply, and model of care, indicating that the public services' dynamic is dependent on the management priorities and the policy's conduction. In conclusion, the PNSB is implemented differently in Brazil's state capitals according to the ways its guidelines are conducted in each capital and whether it favors best practices and strategies in oral healthcare. However, the influence of the PNSB is still not clear on the modification of oral health indicators from 2003 to 2010.


El objetivo fue analizar estrategias de implantación de la Política Nacional de Salud Bucal (PNSB) y su posible influencia sobre la morbilidad bucal en capitales de Brasil, durante la primera década del siglo XXI. Se trata de un estudio de evaluación de políticas. Los datos de morbilidad bucal se obtuvieron en los bancos de datos de las Encuestas Nacionales de Salud Bucal en 2003 y 2010 (SBBrasil 2003 y SBBrasil 2010), calculándose la modificación del porcentaje anual de variables relacionadas con las condiciones de salud bucal, como variables dependientes para las capitales brasileñas. Se investigó la PNSB respecto a sus bases conceptuales: modelo de atención en salud bucal, organización de la oferta de servicios de salud bucal, implementación de estrategias de promoción de la salud bucal y existencia de fluoración en las aguas de abastecimiento público. Para eso, se utilizaron datos de los sistemas de información en salud nacionales y la aplicación de un cuestionario cara a cara con coordinadores de salud bucal de 13 capitales seleccionadas. Se controlaron los análisis y se ajustaron por las condiciones socioeconómicas de la población investigada. Se observó una asociación entre las características de promoción de salud bucal, oferta de servicios y modelo de atención, lo que indica que la dinámica de los servicios públicos es dependiente de las prioridades de gestión, así como de su dirección de la política. Se concluye que la PNSB se implementa de forma diferente en las capitales brasileñas, y la forma en la que se implementan sus directrices, en cada capital, favorece o no el desarrollo de mejores prácticas y estrategias de atención en salud bucal. No obstante, la influencia de la PNSB sobre la modificación de los indicadores en salud bucal entre 2003 y 2010 todavía es poco clara.


Subject(s)
Humans , Oral Health , Health Policy , Brazil , Fluoridation , Health Promotion
8.
Ciênc. Saúde Colet ; 25(7): 2653-2662, Jul. 2020. tab, graf
Article in English, Portuguese | LILACS, ColecionaSUS, SES-SP | ID: biblio-1133077

ABSTRACT

Resumo Sendo a fluoretação das águas uma medida de saúde pública consagrada na prevenção de cárie dentária e considerando que a vigilância do método é fundamental para o seu sucesso, este estudo objetivou analisar os resultados das análises dos teores de flúor das águas de abastecimento público de 40 municípios do estado de São Paulo, de novembro de 2004 a dezembro de 2016. A análise das amostras foi realizada mensalmente por meio do método potenciométrico. De 32.488 amostras, 50,94% continham níveis de flúor dentro do intervalo recomendado. Em 2004, verificou-se que 21 cidades (52,50%) apresentaram teores médios dentro do parâmetro recomendado, passando, em 2016, para 32 cidades (80,00%). Observou-se que 15 municípios que possuíam inicialmente níveis de flúor abaixo de 0,55 mgF/L em suas águas de abastecimento adequaram-se no decorrer do projeto. No primeiro ano do estudo, 47,76% das amostras possuíam valores no intervalo preconizado e, em 2016, houve um aumento para 58,22%. Foi verificado que no decorrer dos anos, a maioria dos municípios adequou os níveis de flúor em suas águas, evidenciando a atuação dos programas de heterocontrole como importantes estratégias que auxiliam na vigilância do método, tendo participação fundamental no controle da qualidade da água ofertada à população.


Abstract Since fluoridation of water is an established public health measure for the prevention of dental caries and considering that monitoring of the method is crucial to its success, this study aimed to analyze the results of the analysis of the fluorine content of public water supply of 40 municipalities in the state of São Paulo, from November 2004 to December 2016. Samples were analyzed monthly using the potentiometric method. Of the 32,488 samples, 50.94% contained fluoride levels within the recommended range. In 2004, it was verified that 21 cities (52.50%) had mean levels within the recommended parameter, increasing to 32 cities (80.00%) in 2016. It was observed that 15 municipalities that initially had levels of fluoride below 0.55 mgF/L in their water supply adjusted to adequate levels during the project. In the first year of the study, 47.76% of the samples had values in the recommended range, which increased to 58.22% in 2016. Most of the municipalities adjusted the levels of fluoride in their waters over the years, evidencing the performance of heterocontrol programs as important strategies that assist in the monitoring of the method and have significant participation in the control of the water quality supplied to the population.


Subject(s)
Humans , Dental Caries/prevention & control , Dental Caries/epidemiology , Water Supply , Brazil , Fluoridation , Cities , Fluorides/analysis
9.
Ciênc. Saúde Colet ; 25(4): 1507-1518, abr. 2020. tab
Article in Portuguese | LILACS | ID: biblio-1089535

ABSTRACT

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.


Subject(s)
Cariostatic Agents/analysis , Fluoridation/statistics & numerical data , Cross-Sectional Studies/standards , Fluorides/analysis , Water Supply , Brazil , Cross-Sectional Studies , Cities/statistics & numerical data
10.
Article in English | LILACS, BBO | ID: biblio-1135551

ABSTRACT

Abstract Objective: To analyze the association between water sanitation and living conditions and dental caries in Brazilian schoolchildren. Material and Methods: A list containing names of children enrolled in 18 urban public schools was obtained. Then, data registered by community health agents from the family health strategy were consulted, aiming to obtain information about socio-environmental variables such as house type, number of rooms in the house, water supply, water treatment, waste, feces and urine disposal. For sample calculation, 95% confidence level, 80% test power and 5% error rate were used A total of 199 5-year-old and 137 12-year-old schoolchildren participated in the research. For examinations, World Health Organization recommendations for epidemiological surveys of dental caries were followed. Results: For 5-year-old children, dental caries prevalence was related to municipality of origin, water supply system and sewage system. For 12-year-old children, untreated water and waste collection were related to higher dental caries rates. Conclusion: Dental caries was associated to house type and water sanitation.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Quality of Life , Water Supply , Fluoridation , Public Health , Dental Caries/prevention & control , Schools , Brazil/epidemiology , Chi-Square Distribution , Cross-Sectional Studies/methods , Surveys and Questionnaires , Health Surveys/methods , Statistics, Nonparametric
11.
Article in English | LILACS, BBO | ID: biblio-1135485

ABSTRACT

Abstract Objective: To determine the prevalence of dental fluorosis in a population not exposed to fluoridated water and to evaluate the effect of the sampling technique on this measurement. Material and Methods: This observational, cross-sectional and quantitative study was conducted in the city of Mariana, Brazil. The participants were selected based on age, so that they had access to fluoridated dentifrice during the formation of the permanent upper teeth. Based on a nominal survey of schoolchildren aged 14 to 19, a probabilistic sample of 304 such children was clinically examined. Dental fluorosis was measured by the Thylstrup-Fejerskov index. The prevalence of fluorosis identified in a previous study, conducted in 2011 in the same city, using the same methodology but employing convenience sampling, was used as a control to compare the effect of the two sampling techniques. Results: The prevalence of dental fluorosis was 3% based on the probabilistic sampling of the subjects. In the previous study, the prevalence of fluorosis was 7% (p<0.05) based on convenience sampling of the same age group. Both studies detected a Thylstrup-Fejerskov fluorosis index value of 1, corresponding to only a mild degree of dental fluorosis. Conclusion: The convenience sampling technique seems to have affected the prevalence of dental fluorosis identified, with a 4% difference between the two studies. The prevalence of dental fluorosis attributed to the use of fluoridated dentifrice in a population not exposed to fluoridation of the water supply was considered low.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Tooth , Water Supply , Epidemiologic Studies , Fluoridation , Dentifrices/chemistry , Fluorosis, Dental , Brazil/epidemiology , Chi-Square Distribution , Prevalence , Cross-Sectional Studies/methods , Surveys and Questionnaires
12.
Article in English | LILACS, BBO | ID: biblio-1101863

ABSTRACT

ABSTRACT OBJECTIVE To discuss the negative and positive concepts of liberty and postulate its interdependent and complementary relationship in the evaluation of public policy intersectoral actions, taking water fluoridation as a case. METHOD To describe scopes and limits regarding 1950s Isaiah Berlin's distinction, showing its validity in facing the harmful effects of an uncontrolled market economy and an autocratic political regime. RESULTS Both the rights that protect citizens against a powerful state and the rights that protect the state against powerful citizens were equally acknowledged as crucial. CONCLUSION We argued that, in a context in which negative and positive liberties are balanced, regulatory policies have double meaning. Thus, there should be a balance between the establishment of necessary rules for social protection and limits for them not to violate individuals' rights.


RESUMO OBJETIVO Discutir os conceitos negativo e positivo de liberdade e postular sua relação de interdependência e complementariedade na avaliação da política pública intersetorial, tomando como caso a fluoretação da água. MÉTODO Descrevem-se os alcances e limites relativos à distinção formulada por Isaiah Berlin nos anos 1950, demonstrando sua validade para enfrentar os efeitos nocivos decorrentes tanto de uma economia de mercado sem controle quanto de um regime político autocrático. RESULTADOS Reconhece-se que são igualmente cruciais tanto os direitos que protegem os cidadãos contra um Estado poderoso quanto os direitos que protegem o Estado contra os cidadãos poderosos. CONCLUSÃO Argumenta-se que, em um contexto de equilíbrio entre a liberdade negativa e positiva, a política regulatória tem duplo sentido, e deve buscar um balanço entre o estabelecimento de regras necessárias para a proteção do público e de limites além dos quais as regras não devem violar os direitos dos indivíduos.


Subject(s)
Humans , Public Policy , Fluoridation , Freedom , Right to Health , Socioeconomic Factors , Dental Caries/prevention & control
13.
Cad. Saúde Pública (Online) ; 36(4): e00208418, 2020. graf
Article in Portuguese | LILACS | ID: biblio-1100942

ABSTRACT

Resumo: O objetivo deste trabalho foi analisar os processos legislativos sobre políticas de fluoretação no Brasil, de 1963 a 2019. Utilizou-se o referencial teórico de Pierre Bourdieu. Foi realizada uma pesquisa documental sobre os processos legislativos que abordam o tema da fluoretação no Brasil como medida de saúde pública e as discussões que ocorreram no Congresso Nacional. As fontes de pesquisa para a construção do artigo foram os sítios eletrônicos oficiais da Câmara dos Deputados e do Senado Federal, para consultar os atos legislativos relacionados à fluoretação no Brasil. De 1963 a 2001 e em 2017, foi constatada uma disputa entre os métodos de fluoretação das águas de abastecimento, água mineral e fluoretação do sal. Entretanto, permeava a compreensão da importância e benefícios acerca da utilização do flúor sistêmico. De 2003 a 2013, os projetos contestavam a utilização do flúor sistêmico, propondo sua utilização apenas em meio tópico. Nos anos 1960, 1970 e em 2017, os atos legislativos apresentavam mais aproximação ao campo científico e foram propostos por parlamentares da oposição. Diferentemente do tema da fluoretação das águas, dos 6 atos legislativos favoráveis à fluoretação do sal, apenas um era proveniente de um profissional da saúde e apenas dois de legisladores do eixo Sudeste. Houve maior participação de projetos de legisladores do Centro-oeste e do Nordeste. Aqueles com formação na saúde apresentaram tomadas de posição em defesa de algum método de fluoretação sistêmica. Esta análise possibilita interpretar o processo histórico de construção em resposta ao problema constituído e suas distintas estratégias de enfrentamento.


Abstract: The aim of this study was to analyze legislative proceedings on fluoridation policies in Brazil from 1963 to 2019. The theoretical reference was Pierre Bourdieu. A document search was performed on legislative proceedings that address the theme of fluoridation in Brazil as a public health measure and the discussions in the National Congress. The sources for the article were the official websites of the Chamber of Deputies (lower house) and the Senate to consult the legislative acts related to fluoridation in Brazil. The study showed that from 1963 to 2001 and in 2017 there was a dispute between fluoridation methods for the water supply, mineral water, and table salt fluoridation. However, there was a crosscutting understanding of the importance and benefits of systemic fluoride use. From 2003 to 2013, the bills challenged the use of systemic fluoride, proposing its use only in topical applications. In the 1960s, 1970, and 2017, the legislative bills showed a closer approach to the scientific field and were submitted by opposition members of Congress. Unlike the issue of water fluoridation, of the 6 legislative bills in favor of salt fluoridation, only one was drafted by a health professional da health, and only two by legislators from the Southeast region. There were more bills by legislators from the Central and Northeast. Those with training in health exhibited positions in defense of some method of systemic fluoridation. The analysis allowed interpreting the historical process of developing the response to the caries problem and the different strategies employed in this process.


Resumen: El objetivo de este trabajo fue analizar los procesos legislativos sobre políticas de fluoración en Brasil, de 1963 a 2019. Se utilizó el marco referencial teórico de Pierre Bourdieu. Se realizó una investigación documental sobre los procesos legislativos que abordan el tema de la fluoración en Brasil, como medida de salud pública, y las discusiones que se produjeron en el Congreso Nacional. Las fuentes de investigación para la construcción del artículo fueron los sitios electrónicos oficiales de la Cámara de los Diputados y del Senado Federal para consultar las acciones legislativas relacionadas con la fluoración en Brasil. De 1963 a 2001 y en 2017 se constató una disputa entre los métodos de fluoración de las aguas de abastecimiento, agua mineral y fluoración de la sal. Mientras tanto, permeaba la comprensión de la importancia y beneficios a cerca de la utilización del flúor sistémico. De 2003 a 2013, los proyectos contestaban la utilización del flúor sistémico, proponiendo su utilización solamente como medio tópico. En los años 1960, 1970 y en 2017 las acciones legislativas presentaban más aproximación al campo científico y fueron propuestos por parlamentarios de la oposición. A diferencia del tema de la fluoración de las aguas, de las 6 acciones legislativas favorables a la fluoración de la sal, solamente una provenía de un profesional de la salud, y solamente dos de legisladores del eje sudeste. Hubo una mayor participación en proyectos de legisladores del Centro-oeste y del Nordeste. Aquellos con formación en salud presentaron toma de posición en defensa de algún método de fluoración sistémica. Este análisis posibilita interpretar el proceso histórico de construcción, en respuesta al problema planteado, y sus distintas estrategias de combate al mismo.


Subject(s)
Humans , History, 20th Century , Fluoridation/history , Dental Caries/prevention & control , Fluorides/therapeutic use , Brazil , Oral Health , Public Health , Health Policy , Legislation as Topic
14.
Braz. oral res. (Online) ; 34: e010, 2020. tab, graf
Article in English | LILACS | ID: biblio-1055526

ABSTRACT

Abstract Relevant public policies in oral health have been implemented in Brazil since 2004. Changes in the epidemiological status of dental caries are expected, mainly in the child population. This study aimed to assess the dental caries experience and associated factors among 12-year-old children in the state of São Paulo, Brazil. A cross-sectional population-based study was conducted with data obtained from 415 cities, including a total of 26,325 schoolchildren who were included by the double-stage cluster technique, by lot and by systematic sampling. The statistical model included data from the São Paulo Oral Health Survey (SBSP 2015), the Human Development Index (HDI) and the Social Vulnerability Index (SVI). A theoretical-conceptual model categorized the variables into three blocks, namely, contextual (HDI, SVI, region of residence and fluoridation of water), individual (sex and ethnicity) and periodontal conditions (gingival bleeding, dental calculus and the presence of periodontal pockets), for association with the experience of caries (DMFT). Statistically significant associations were verified by hierarchical multivariate logistic (L) and Poisson (P) regression analyses (p < 0.05). The results showed that 57.7% of 12-year-old children had caries experience. Factors that determined a greater prevalence of dental caries in both models were nonwhite ethnicity (ORL = 1.113, ORP = 1.154) and the presence of gingival bleeding (ORL = 1.204, ORP = 1.255). Male children (ORL = 0.920 ORP = 0.859) and higher HDI (ORL = 0.022), ORP = 0.040) were associated with a lower prevalence of dental caries experience. Water fluoridation was associated with a lower DMFT index (ORP = 0.766). Dental caries experience is still associated with social inequalities at different levels. Policymakers should direct interventions towards reducing inequalities and the prevalence of dental caries among 12-year-old children.


Subject(s)
Humans , Male , Female , Child , Dental Caries/epidemiology , Socioeconomic Factors , Brazil/epidemiology , Logistic Models , Periodontal Index , DMF Index , Fluoridation/statistics & numerical data , Prevalence , Cross-Sectional Studies , Multivariate Analysis , Risk Factors , Sex Distribution , Dental Caries/ethnology , Vulnerable Populations/statistics & numerical data
15.
Saúde Soc ; 29(1): e190048, 2020. tab
Article in Portuguese | LILACS | ID: biblio-1094486

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Public Policy , Sanitation , Fluoridation , Intersectoral Collaboration , Right to Health , Health Policy
16.
Rev. bras. epidemiol ; 23: e200086, 2020. tab
Article in English, Portuguese | LILACS | ID: biblio-1126036

ABSTRACT

RESUMO: Introdução: Avaliou-se o efeito ajustado das características das empresas de saneamento na provisão da fluoretação da água de abastecimento público nos municípios brasileiros. Métodos: Estudo ecológico transversal com base no Censo Demográfico 2010, Pesquisa Nacional de Saneamento Básico 2008 e Atlas de Desenvolvimento Humano 2010. As variáveis independentes foram as características das empresas e dos municípios e o desfecho foi a falta de provisão da fluoretação. Estimou-se a razão de prevalência por meio de regressão de Poisson com variância robusta. Resultados: Incluíram-se 5.565 municípios brasileiros. Na análise ajustada, o desfecho foi independente e positivamente associado com municípios das macrorregiões Norte, Nordeste, Centro-Oeste e Sudeste, que tinham taxas de cobertura de serviços de água e esgoto abaixo do valor mediano, menos de 10 mil habitantes e índice médio e baixo/muito baixo de desenvolvimento humano. Quanto ao efeito independente das características das empresas, tiveram maior probabilidade de não ofertar fluoretação todas as empresas classificadas como de administração indireta do poder público, ou sociedade de economia mista, ou economia mista de caráter público; as municipais e intermunicipais (razão de prevalência - RP = 1,21; intervalo de confiança de 95% - IC95% 1,19 - 1,23); e a prefeitura, quando única executora (RP = 1,22; IC95% 1,20 - 1,25). Conclusão: A falta de provisão da fluoretação da água foi maior quando o serviço era prestado preponderantemente por administrações municipais e empresas privadas, associadas ou não a entidades públicas, independentemente das características dos municípios.


ABSTRACT: Introduction: The adjusted effect of the characteristics of sanitation companies on the provision of fluoridation into public water supply in Brazilian municipalities was evaluated. Methods: Cross-sectional and ecological study based on the 2010 Demographic Census, 2008 National Survey on Basic Sanitation (PNSB), and 2010 Atlas of Human Development. The independent variables were the characteristics of utilities and municipalities, and the outcome was the lack of provision of fluoridation. Prevalence ratio was estimated with Poisson regression with robust variance. Results: 5,565 Brazilian municipalities were included. In the adjusted analysis, the outcome was independently and positively associated to municipalities in the North, Northeast, Central-West and Southeast macro-regions, with coverage rates for water and sewage services below the median value, with less than 10,000 inhabitants, medium and low/very low in human development. Regarding the independent effect of the utilities' characteristics, they were more likely not to provide fluoridation, all the companies that were not classified as indirect administration of the government or mixed-capital company or mixed-capital company of public character; municipal and intermunicipal (PR=1.21; 95%CI 1.19-1.23); and when the municipal government is the only provider (PR=1.22; 95%CI 1.20-1.25). Conclusion: The lack of provision of water fluoridation was greater when the service was mainly provided by municipal administrations and private companies associated or not to public entities, regardless of the characteristics of the municipalities.


Subject(s)
Humans , Sanitation/statistics & numerical data , Fluoridation/statistics & numerical data , Brazil , Cross-Sectional Studies , Cities
17.
Braz. dent. j ; 30(5): 421-428, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1039143

ABSTRACT

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..


Subject(s)
Humans , Dental Caries , Fluorosis, Dental , Fluoridation , Dental Enamel , Fluorides
19.
Int. j. odontostomatol. (Print) ; 13(1): 46-50, mar. 2019. tab, graf
Article in English | LILACS | ID: biblio-990063

ABSTRACT

ABSTRACT: One of the most effective and studied measures in the prevention of caries is the use of fluoride, which has the property to reduce their incidence and severity. In Chile, 75 % of the population receives it the drinking water. In 1984, WHO recommended the use of milk as an alternative vehicle. In Chile, the Fluoridated School Feeding Program (FSFP) was introduced in 1994, using this alternative in rural areas without fluoride in water. The objective of the study was to compare prevalence and severity of dental caries and dental fluorosis in 8-year-old children of four state schools: two with fluoride supplementation in drinking water or milk and two without any fluoride program. Epidemiological, descriptive, comparative, observational and cross-sectional study with a sample of 140 8-year-old children, with no systemic diseases and who had lived in the same place since birth: 50 schoolchildren from an area with fluoridated water; 40 from an area with fluoridated milk and 50 from a zone without supplementation of F. The percentage of caries-free children was obtained with the methodology described by the WHO, for severity the dmft and DMFT indexes were used. To quantify the prevalence and severity of dental fluorosis, Dean Index was used. 38 % of the children were caries-free in the community with fluoridated water (CFW); 0 % in the community with fluoridated milk (FSFP) and 10 % in the community with no fluoride program established (CNF). The difference between CFW with CNF is statistically significant (p<0.05). The prevalence of fluorosis is significantly higher for CFW (48.8 %) than FSFP (35 %) and CNF (16 %). Conclusion: The contribution of fluoride in drinking water causes a decrease in the prevalence and severity of dental caries in children of 8 years of age, and an increase in the prevalence of dental fluorosis.


RESUMEN: Una de las medidas más efectivas y estudiadas en la prevención de caries es el uso de fluoruros, que tiene la propiedad de reducir su incidencia y severidad. 75 % de la población chilena lo recibe al incluirlo en el agua potable. La OMS en 1984 recomendó el uso de leche como un vehículo alternativo. En Chile, el Programa de Alimentación Escolar con leche fluorada fue implementado en 1994 como alternativa en zonas rurales sin fluoruro en el agua. El objetivo de este estudio fue comparar la prevalencia y severidad de la caries dental y la fluorosis dental en niños de 8 años en tres escuelas públicas, con suplementación de fluoruro en el agua potable o en la leche y con aquella que no tiene ningún programa de fluoración. Estudio epidemiológico, descriptivo, comparativo, observacional y de corte transversal con una muestra de 140 niños de 8 años, sin enfermedades sistémicas y que han vivido en el mismo lugar desde su nacimiento: 50 escolares en el área con agua fluorada, 40 en el área con leche fluorada y 50 en la zona sin suplementación de fluoruro. El porcentaje de niños libres de caries fue obtenido con la metodología descrita por la OMS, usando índices ceo-d y CPO-D para evaluar severidad. Para cuantificar la prevalencia y severidad de la fluorosis dental se ocupó el índice de Dean. Niños libres de caries fueron 38 % en la comunidad con agua fluorada (CWF); 0 % en la comunidad con leche fluorada (FSFP) y 10 % en la comunidad sin programa de fluoración (CNF). La diferencia entre CWF y CNF es estadísticamente significativa (p<0,05). La prevalencia de fluorosis es significativamente mayor en CWF (48,8 %) que FSFP (35 %) y CNF (16 %). La contribución del fluoruro en el agua potable causa una disminución en la prevalencia y severidad de la caries dental en niños de 8 años, y un aumento en la prevalencia de fluorosis dental.


Subject(s)
Humans , Child , Cariostatic Agents/administration & dosage , Dental Caries/epidemiology , Fluorides/administration & dosage , Severity of Illness Index , Chile/epidemiology , Fluoridation , Prevalence , Cross-Sectional Studies , Dental Caries/pathology , Dental Caries/prevention & control , Dental Enamel Hypoplasia/pathology , Fluorosis, Dental/epidemiology
20.
Cad. Saúde Pública (Online) ; 35(6): e00250118, 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1011688

ABSTRACT

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


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


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


Subject(s)
Humans , Fluoridation/statistics & numerical data , Water Purification/methods , Data Accuracy , Public Policy , Socioeconomic Factors , Brazil , Residence Characteristics , Sanitation , Public Health , Data Collection
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