Municipality-Level Characteristics Associated with Very Low to Good Quality of Water Fluoridation in São Paulo State, Brazil, in 2015.

INTRODUCTION: Community water fluoridation (CWF) is a measure of recognized importance due to its effectiveness in preventing tooth decay at the population level. However, for the maximum benefit to be achieved, the high-quality standard of CWF must be maintained over time. OBJECTIVE: To analyze the municipality-level characteristics associated with quality of water fluoridation in São Paulo state, Brazil. METHODS: An ecological study was performed using official data sources on fluoride concentration surveillance in 2015. The outcome was municipalities that have not met the quality standard, identified as those with less than 80% of water samples within the optimal level for caries prevention. The independent variables were municipality-level indicators related to demographics, economics, and sanitation characteristics. Crude and adjusted prevalence ratios were estimated using Poisson regression with robust variance. RESULTS: In total, 43.4% municipalities exhibited the outcome. Adjusted by Gini index, the prevalence ratio was 32% higher in municipalities with lower annual gross domestic product per capita. Adjusted by social responsibility index and earlier variables, the prevalence was higher in the municipalities with higher per capita expenditure on sanitation and health surveillance, where the urban population rate was lower, and with a human development index ≤0.761. Adjusted by earlier variables, the prevalence ratio was twice and 3.5 times higher for municipalities, respectively, with per capita income less than or equal to US$574 and where the type of sanitation utility was municipal and private; 50% higher in those with less than 100,000 habitants; and 20% higher in those with a chlorine concentration nonconformity rate above 0.82%. CONCLUSIONS: To ensure high quality of CWF, additional management measures should be implemented in municipalities with less than 100,000 habitants, a higher chlorine concentration nonconformity rate, a lower per capita income, and where the type of sanitation utility was municipal or private. KNOWLEDGE TRANSFER STATEMENT: The study showed that the quality of fluoridation was associated with municipality-level characteristics. The findings can be used by policy makers to identify and support municipalities that will need to improve fluoridation quality if they are to reach oral health goals.

Trends and spatial distribution of oral cancer mortality in São Paulo, Brazil, 1980-1998.

We assessed oral cancer mortality data in São Paulo to study trends of the disease and its distribution by areas of the city. We standardized death rates by gender and age group, and also supplied complementary information regarding oral cancer incidence. Oral cancer mortality remained stationary at high levels during the study period. Site-specific death rates revealed high figures for two categories of site: tongue and unspecified parts of mouth. Gum cancer death rates--the most easily diagnosed site-specific oral cancer at a routine dental examination--fell sharply, possibly as a consequence of the recent expansion in community dental health services in the city. In spite of this observation, the increase of death rates related to unspecified parts of the mouth points to the deficiencies of health services in detecting most of oral cancer cases early. Spatial data analysis enabled indication of areas and socio-economic factors associated with poorer profile in oral cancer mortality, important information for the targeting of health resources directed to the screening, prevention and education in oral cancer.

[Dental caries prevalence in permanent teeth of schoolchildren in the Municipality of Sao Paulo, Brazil, 1970-1996]. / Prevalência de cárie em dentes permanentes de escolares do Município de São Paulo, SP, 1970-1996.

OBJECTIVE: To assess the evolution of dental caries in permanent teeth of schoolchildren in S. Paulo City, Brazil, during the period of 1970-1996. METHODS: The World Health Organization methodology for oral health surveys was applied in 2,491 schoolchildren, both male and female from 103 public and private schools. A probabilistic sample stratified by age, school category, and city zones was obtained by the Education State Service data system. Computational resources were used. RESULTS: Data from the 1996 S. Paulo survey were compared with others data provided by studies such as the one conducted in the same city and the reference-population in the second half of the 20th century. In the 60s and 70s the DMF-T Index among 12-year-old schoolchildren was around 7.0. In 1986 it was 6.5 and in 1996 it was registered 2.1, a decline of 68%. CONCLUSION: Dental caries in permanent teeth among S. Paulo City 12-year-old schoolchildren changed from a "very high" to "low" prevalence.

[The national health system and health policies in the Brazilian dentistry literature, 1986-1993]. / O sistema de saúde e as políticas de saúde na produção científica odontológica brasileira no período 1986-1993.

The Brazilian scientific literature on social and preventive dentistry from 1986 to 1993 was identified and analyzed to verify whether themes of papers referred to health policy and the national health system. Published scientific articles were used as the unit of analysis for the study. An analytical survey was conducted considering the following variables, amongst others: author's institutional affiliation; author's title; author's areas of interest; type of research; type of article; and research funding sources. Articles reviewed were published between the First and Second National Oral Health Conferences. There were 386 articles published in 19 journals, by at least 866 authors. More than 75% of the studies came from public universities. RGO was the largest publisher in this field, followed by Revista da APCD. Original articles accounted for 56.7% of the studies, while 30.3% were reviews and essays. The majority of the authors were from the State of São Paulo. Male writers predominated. A 'quantitative deficiency' was identified, since scientific production remained below 50% of its potential. Health policy was considered a specific issue in only 3 articles (0.8%) while 7 (1.8%) discussed the national health system.

[Prevalence of dental caries in 12-year-old children in localities of the State of São Paulo, Brazil, in 1990-1995]. / Prevalência de cárie dentária em crianças aos doze anos de idade, em localidades do Estado de São Paulo, Brasil, período 1990-1995.

INTRODUCTION: Dental caries is the most prevalent disease of the oral cavity, leading to serious economic and social consequences. Studies on the prevalence of dental caries should be undertaken periodically for the adequate planning of oral health services and action. This research project sought to discover the prevalence of dental caries in the counties of S. Paulo State, Brazil, measured by means of the DMF-T rate on the 12 year-old bracket from 1990-1995. MATERIAL AND METHOD: Data originally produced by Municipal Health Departments, collected by means of an instrument devised for this purpose, sent to 625 counties in the state, were used. The counties concerned were grouped according to their size and geographical region. RESULTS: The total of 625 counties of S. Paulo State, 237 (37.9%) provided the information required, and 125 (20.0%) had data on DMF-T corresponding to about 5,000 12 year-old children available examined. The study revealed that the prevalence of dental caries is low in only 4.0% of the counties, and is high or very high in approximately 80% of them. The DMF-T index values varied from 1.3 to 13.6, and the estimated average for all the counties was 4.8. Further, it was discovered that "large" counties recorded 54.6% of their population classified in the categories of low or moderate prevalence of caries; while in "small" counties 87.8% of the population corresponded to the high or very high caries prevalence range. CONCLUSIONS: This research project has shown that the country services for oral health in S. Paulo State have made little use of the basic resources that epidemiology can provide. This indicates the need for an appropriate professional background for oral health in epidemiology, especially for those who fulfil duties in the coordination of the services.