Fluorose dental: ficção epidemiológica? / Dental fluorosis: epidemiological fiction?

RESUMO

Objetivo. Revisar a literatura a respeito da fluorose dental e avaliar sua presença em escolares da rede pública da Cidade de Curitiba, Paraná, Brasil. Métodos. Realizamos uma revisäo da literatura internacional, com ênfase nas revisöes críticas sistemáticas listadas em fontes eletrônicas (Medline, Lilacs, Biblioteca Cochrane e Scielo Saúde Pública) e publicadas entre 1998 e 2001. Além disso, realizamos um estudo transversal, no ano de 2000, com escolares de 12 anos (n = 1 494). Resultados. A literatura mostra que ainda existe controvérsia acerca do impacto da fluorose e dos benefícios da suplementaçäo de flúor. Em nosso estudo, observamos uma prevalência média de fluorose de 23 por cento, incluindo os níveis 2, 3, 4 e 5 do índice de Dean. A fluorose observada teve pouco impacto sobre a saúde biopsicossocial dos escolares estudados, como mostrou a análise multivariada com regressäo logística, que revelou que a presença de fluorose näo se associou significativamente ao incômodo com a cor dos dentes. Houve, contudo, associaçäo entre o local de residência (variável independente) e a presença de fluorose (P= 0,00), tanto na análise bivariada como na multivariada. Conclusöes. É possível concluir que a fluorose dental, por ora, näo constitui um problema epidemiológico relevante para a populaçäo estudada, e que as iniciativas para controlar a fluorose devem levar em conta a autopercepçäo do problema da fluorose pela própria populaçäo. Mesmo assim, ainda é de extrema importância o monitoramento rigoroso dos teores de flúor na água de abastecimento

ABSTRACT

ective. To review the scientific literature concerning dental fluorosis and to evaluate its occurrence among children attending public schools in the city of Curitiba, which is in the state of Paraná in Brazil. Methods. We reviewed the international literature on fluorosis that was published between 1998 and 2001, focusing on systematic critical reviews that were listed in such electronic bibliographical sources as MEDLINE, LILACS, the Cochrane Library, and SciELO Public Health. In addition, in 2000 we carried out a cross-sectional study with 12-year old schoolchildren (n = 1 494) in Curitiba. Results. Our literature review found that there is still much controversy regarding the benefits associated with fluoride supplementation and the impact of fluorosis. In our cross-sectional study with the Curitiba schoolchildren, we found a fluorosis prevalence of 23% for grade 2, 3, 4, or 5 on the Dean index. The observed fluorosis had little impact on the biopsychosocial health of the children studied, as shown by the multivariate logistic regression analysis. That analysis showed that the presence of fluorosis was not significantly associated with dissatisfaction with tooth color. However, there was an association between the independent variable of place of residence (sanitary district within Curitiba) and fluorosis (P = 0.00), in both the bivariate and multivariate analyses. Conclusions. Based on our results, we concluded that dental fluorosis is not now a crucial epidemiological problem for the population studied in Curitiba. Any initiatives to control fluorosis should take into account the population's perception of the problem. Nevertheless, it is still extremely important to monitor the levels of fluoride in drinking water