Avaliação da ação do trimetafosfato sobre o biofilme dentário, desmineralização e remineralização do esmalte: estudos in vitro e in situ

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Ocorrência de opacidade difusa em molares decíduos como fator preditivo no diagnóstico de fluorose dentária em dentes permanentes

Pós-graduação em Ciência Odontólogica - FOA

Fluoride concentrations of milk, infant formulae, and soy-based products commercially available in Brazil

To assess the fluoride (F) content in commercially available milk formulae in Brazil and to estimate the F intake in children from this source in the first year of life. Samples of cow's milk (n = 51), infant formulae (n = 15), powdered milk (n = 13), and soy-based products (n = 4) purchased in Araçatuba (Brazil) had their F content measured using an ion-specific electrode, after hexamethyldisiloxane-facilitated diffusion. Powdered milk and infant formulae were reconstituted with deionized water, while ready-to-drink products were analyzed without any dilution. Using average infant body masses and suggested volumes of formula consumption for infants 1-12 months of age, possible F ingestion per body mass was estimated. Data were analyzed by descriptive analysis. Mean F content ranged from 0.02 to 2.52 mg/L in all samples. None of the cow's milk provided F intake higher than 0.07 mg/kg. However, two infant formulae, one powdered milk, and one soy-milk led to a daily F intake above the suggested threshold for fluorosis when reconstituted with deionized water. Assuming reconstitution of products with tap water at 0.7 ppm F, two infant formulae, five powdered milk, and four soymilks led to daily F intake ranging from 0.108 to 0.851 mg/kg. The results suggest that the consumption of some brands of infant formulae, powdered milk, and soy-based milk in the first year of age could increase the risk of dental fluorosis, reinforcing the need for periodic surveillance of the F content of foods and beverages typically consumed by young children.

Fluoretação das águas de abastecimento público em um município com diferentes fontes de captação

Maintaining the levels of fluoride ion in public water supply within the parameters of adequacy it becomes essential so the measure carries a greater impact on caries prevention and control, without increasing the prevalence of dental fluorosis. Thus, it is necessary a rigorous control of the process, avoiding the undesired effects at levels above recommended levels, as well as avoiding levels below the recommended that do not offer the highest benefit. The aim of this study was to analyze the content of fluoride in public water supply in the city of Birigui, SP, with different sources of supply, checking if the fluoride levels are within the recommended. The samples were collected monthly from points previously established, with the knowledge of the distribution network of water and identifying the amount and location of supply sources and water treatment plant. Analyses were performed in duplicate in the period from January to December of 2009, in the laboratory - NEPESCO - of the Dental School of Araçatuba, Univ Estadual Paulista – UNESP, using an ion analyzer coupled to a specific electrode for fluoride. Of the total samples (n = 512), 44% (n = 224) had adequate levels and 56% (n = 288) inadequate levels, 10% (n = 49) lower levels and 46% (n = 239) showed levels above the recommended. There were differences in results when comparing the analysis of different sources. The fluoride concentration in the majority of the samples from deep wells was classified as inadequate not offering the desired benefit, or exposing the population to the risk of dental fluorosis.

Saúde bucal de adolescentes que receberam assistência odontológica na primeira década de vida

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Fluorose dentária em Araraquara-SP: prevalência, severidade e associação com fatores de risco

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Current issues regarding health surveillance of fluoride concentrations in foods

This study analyzed the position of the Federal (Brazil), State (Sao Paulo), and municipal (Bauru, Sao Paulo) governments, civil society representatives, the regulated sector, and research associations concerning issues with fluoride content in foods. Analysis of the interviews (N = 15) used a qualitative methodology (collective subject discourse theory). Various central ideas were identified, including the need for stronger health surveillance in monitoring and controlling fluoride levels, educational measures, and more research in the area. The study concludes that the health surveillance approach to fluoride levels in foods is necessary, but still incipient. There is a mismatch between research output and surveillance. Regulation alone does not suffice to solve all the issues. Health risk communication and health education measures need to be implemented. Issues with fluoride on food labels need further research for the intervention to be effective.

Seven years of external control of fluoride levels in the public water supply in Bauru, São Paulo, Brazil

Fluoridation of the public water supplies is recognized as among the top ten public health achievements of the twentieth century. However, the positive aspects of this measure depend on the maintenance of fluoride concentrations within adequate levels. To report the results of seven years of external control of the fluoride (F) concentrations in the public water supply in Bauru, SP, Brazil in an attempt to verify, on the basis of risk/benefit balance, whether the levels are appropriate. From March 2004 to February 2011, 60 samples were collected every month from the 19 supply sectors of the city, totaling 4,641 samples. F concentrations in water samples were determined in duplicate, using an ion-specific electrode (Orion 9609) coupled to a potentiometer after buffering with TISAB II. After the analysis, the samples were classified according to the best risk-benefit adjustment. Means (±standard deviation) of F concentrations ranged between 0.73±0.06 and 0.81±0.10 mg/L for the different sectors during the seven years. The individual values ranged between 0.03 and 2.63 mg/L. The percentages of the samples considered “low risk” for dental fluorosis development and of “maximum benefit” for dental caries prevention (0.55-0.84 mg F/L) in the first, second, third, fourth, fifth, sixth, and seventh years of the study were 82.0, 58.5, 37.4, 61.0, 89.9, 77.3, and 72.4%, respectively, and 69.0% for the entire period. Fluctuations of F levels were found in the public water supply in Bauru during the seven years of evaluation. These results suggest that external monitoring of water fluoridation by an independent assessor should be implemented in cities where there is adjusted fluoridation. This measure should be continued in order to verify that fluoride levels are suitable and, if not, to provide support for the appropriate adjustments

Reflexões metodológicas sobre prevalência da fluorose dentária nos inquéritos de saúde bucal

OBJETIVO: Analizar limitaciones del estudio de fluorosis dentaria en pesquisas transversales. MÉTODOS: Se utilizaron datos de estudios de de Condiciones de Salud Bucal de la Población Brasileña (SBBrasil 2003) y de la Investigación Nacional de la Salud Bucal (SBBrasil 2010). La estimativa de tendencia epidemiológica de la fluorosis en la población de 12 años, aspectos de la confiabilidad de los datos, así como la precisión de las estimativas, fueron evaluadas en estas dos investigaciones. La distribución de la prevalencia de la fluorosis fue hecha de acuerdo con los dominios de estudio (capitales y regiones) y el año estudiado. Se expresaron también los intervalos de confianza (IC95%) para la prevalencia simple (sin considerar las fases de la gravedad). RESULTADOS: La prevalencia de la fluorosis dentaria presentó una variación considerable, de 0 a 61% en 2003 y de 0 a 59% en 2010. Se observaron inconsistencias en los datos en términos individuales (por año y por dominio) y en el comportamiento de la tendencia. Considerando la expectativa de prevalencia y los datos disponibles en las dos investigaciones, el tamaño mínimo de la muestra debería ser de 1.500 individuos para obtener intervalos de 3,4% y 6,6% de confianza, considerando un coeficiente de variación mínimo de 15%. Dada la subjetividad en la naturaleza de su clasificación, exámenes de fluorosis dentaria pueden presentar más variación de los realizados para otras condiciones de salud bucal. El poder para establecer diferencias entre los dominios del estudio con la muestra de SBBrasil 2010 es bastante limitado. CONCLUSIONES: No fue posible analizar la tendencia de la fluorosis dentaria en Brasil con base en los estudios de 2003 y 2010; esos datos son sólo indicadores exploratorios de la prevalencia de la fluorosis. La comparación se hace imposible por el hecho de haber sido utilizado modelos de análisis diferentes en las dos pesquisas. La investigación de la fluorosis dentaria en pesquisas de base poblacional no es viable técnica y económicamente, la realización de estudios epidemiológicos localizados con plan de muestreo es más adecuada.

Epidemiology of fluorosis and dental caries according to different types of water supplies

O objetivo do presente artigo é investigar a relação fluorose/cáries em escolas, de acordo com o nível de fluoreto no abastecimento público de água. A amostra consistiu em 360 alunos de doze anos de idade, de ambos os sexos, que frequentam as escolas próximas da região em que nasceram. As escolas foram classificadas em três grupos de acordo com a presença de fluoreto no abastecimento de água: 1) fluoretação na Estação de Tratamento de Água (ETA); 2) fluoretação direta em poços; e 3) áreas não fluoretadas (ANF). Os testes deχe de Goodman (significância = 5%) foram utilizados para avaliar a associação entre a origem da água e o grau de fluorose. Os resultados mais predominantes foram presença de cáries em toda a amostra (P<0,05); ausência de fluorose em ambos gêneros, para indivíduos brancos e aqueles vivendo em áreas abastecidas com água fluoretada diretamente de poços e não fluoretadas (P<0,05). Não houve diferença no grau de severidade da fluorose entre as fontes de abastecimento de água (P>0,05). As cáries ainda são uma importante questão nessa população, apesar do estabelecimento de medida preventiva. A observação da fluorose em alunos vivendo em áreas não fluoretadas confirma a presença de outras fontes de fluorose.

Fluorosis endémica en el noroeste de la provincia de Cordoba: remoción de fluoruro del agua con filtros domiciliarios.

En el noroeste de la provincia de Córdoba, el agua utilizada para consumo humano contiene elevadas concentraciones de fluoruro (F-). La fluorosis endémica es un serio problema de salud pública que provoca principalmente fluorosis dental y esquelética, entre otras alteraciones. La fluorosis dental se caracteriza por la aparición de alteraciones en el esmalte dental, desde finas manchas blancas (grado leve) hasta manchas de color marrón oscuro con erosión del esmalte (grado moderado a severo). Integrantes del presente proyecto realizaron estudios en los establecimientos educacionales de Nivel Primario ubicados sobre la ruta nacional 38, al norte de Capilla del Monte, demostrando que el 86% de las superficies dentales estudiadas presentan distintos grados de fluorosis dental. Esta situación se traduce en serias consecuencias en la salud bucodental y en los aspectos psíquico y social de los individuos, detectándose en adolescentes de la zona acciones discriminatorias y auto-discriminatorias por razones estéticas, contribuyendo incluso a la deserción escolar. Hasta la actualidad, no se ha realizado el relevamiento en toda la población de las comunas comprendidas en esta zona con fluorosis endémica; sólo se ha investigado la salud bucodental de dos de sus comunas, que representan menos del 10% en los departamentos Punilla norte y Cruz del Eje. Ante la ausencia de una fuente alternativa de agua potable en la comuna de Charbonier y el bajo nivel socio-económico de sus habitantes, surge como alternativa la remoción del F- del agua mediante un procedimiento accesible a los pobladores. En otros países, una vía para solucionar esta problemática consiste en el uso de sistemas domiciliarios de remoción de flúor, basados en el uso de arcillas como adsorbentes de F-. Los análisis de la composición de los suelos de esta región (detallados por el INTA) son promisorios en este sentido. Las Hipótesis que guían el presente proyecto de investigación y desarrollo postulan la factibilidad de encontrar arcillas del lugar en estudio, que posean la capacidad de remover el F- del agua, y de diseñar un filtro domiciliario con dicho material adsorbente para ser aplicado por los pobladores. Como objetivo general se propone investigar y desarrollar un método de remoción de F- del agua potable que sea accesible a los habitantes de la zona con fluorosis endémica del noroeste cordobés. Para ello es necesario delimitar en una primera etapa la extensión del área total afectada por esta problemática, en los departamentos Punilla norte y Cruz del Eje, midiendo los niveles de F- en agua utilizada para el consumo en las diferentes comunidades. Además, se relevarán las consecuencias en la salud bucodental de sus pobladores, midiendo el grado de fluorosis dental en niños que concurren a los establecimientos educacionales de Nivel Primario. Esto permitirá identificar, de acuerdo al origen de los niños estudiados, las zonas de fluorosis endémicas más comprometidas. En cada zona se recolectará muestras de suelos arcillosos a fin de evaluar su capacidad de adsorción de F-. Una vez hallado el material óptimo se desarrollará un sistema domiciliario para la remoción de F- del agua mediante el diseño de un filtro con material adsorbente (arcillas) que permita obtener agua con niveles normales de F- para cada grupo familiar, de fácil uso, eficaz y económicamente accesible. El diseño del filtro se realizará con el asesoramiento de una empresa dedicada a este rubro. Los resultados del presente proyecto serán de utilidad para la salud pública y componen un potencial camino a seguir para solucionar la problemática de la región en estudio y otras regiones con fluorosis endémica del país.

Fluoride supplements (tablets, drops, lozenges or chewing gums) for preventing dental caries in children.

BACKGROUND: Dietary fluoride supplements were first introduced to provide systemic fluoride in areas where water fluoridation is not available. Since 1990, the use of fluoride supplements in caries prevention has been re-evaluated in several countries. OBJECTIVES: To evaluate the efficacy of fluoride supplements for preventing dental caries in children. SEARCH METHODS: We searched the Cochrane Oral Health Group's Trials Register (to 12 October 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3), MEDLINE via OVID (1950 to 12 October 2011), EMBASE via OVID (1980 to 12 October 2011), WHOLIS/PAHO/MEDCARIB/LILACS/BBO via BIREME (1982 to 12 October 2011), and Current Controlled Trials (to 12 October 2011). We handsearched reference lists of articles and contacted selected authors. SELECTION CRITERIA: We included randomised or quasi-randomised controlled trials comparing, with minimum follow-up of 2 years, fluoride supplements (tablets, drops, lozenges) with no fluoride supplement or with other preventive measures such as topical fluorides in children less than 16 years of age at the start. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces (DMFS). DATA COLLECTION AND ANALYSIS: Two review authors, independently and in duplicate, assessed the eligibility of studies for inclusion, and carried out risk of bias assessment and data extraction. In the event of disagreement, we sought consensus and consulted a third review author. We contacted trial authors for missing information. We used the prevented fraction (PF) as a metric for evaluating the efficacy of the intervention. The PF is defined as the mean caries increment in controls minus mean caries increment in the treated group divided by mean caries increment in controls. We conducted random-effects meta-analyses when data could be pooled. We assessed heterogeneity in the results of the studies by examining forest plots and by using formal tests for homogeneity. We recorded adverse effects (fluorosis) when the studies provided relevant data. MAIN RESULTS: We included 11 studies in the review involving 7196 children.In permanent teeth, when fluoride supplements were compared with no fluoride supplement (three studies), the use of fluoride supplements was associated with a 24% (95% confidence interval (CI) 16 to 33%) reduction in decayed, missing and filled surfaces (D(M)FS). The effect of fluoride supplements was unclear on deciduous or primary teeth. In one study, no caries-inhibiting effect was observed on deciduous teeth while in another study, the use of fluoride supplements was associated with a substantial reduction in caries increment.When fluoride supplements were compared with topical fluorides or with other preventive measures, there was no differential effect on permanent or deciduous teeth.The review found limited information on the adverse effects associated with the use of fluoride supplements. AUTHORS' CONCLUSIONS: This review suggests that the use of fluoride supplements is associated with a reduction in caries increment when compared with no fluoride supplement in permanent teeth. The effect of fluoride supplements was unclear on deciduous teeth. When compared with the administration of topical fluorides, no differential effect was observed. We rated 10 trials as being at unclear risk of bias and one at high risk of bias, and therefore the trials provide weak evidence about the efficacy of fluoride supplements.

Infant formula and enamel fluorosis A systematic review

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)