Avaliação do processo de fluoretação nos sistemas de abastecimento de água da região de Araçatuba, São Paulo

This paper focuses on the drinking-water fluoridation process in Araçatuba region water supply systems by means of 5.157 fluoride concentration data from 2001 to 2005. These data were studied based on the water source, the administration and the structure of the water supply system, according to the population of the county and the type of management. Almost half of samples did not comply the fluoridation standard and the higher compliance was verified in the water supply systems operated by Sabesp (69%), followed by the group of Large counties (52%), statistically similar to the Medium ones (51.4%), and better than the Small ones (28%). The systems with surface intakes showed statistically higher performance in the compliance to the standard (60%) compared to the ones that use groundwater (42.9%). In this last group, those that explore the Guarani aquifer were superior (52.3%) than the others (46.6%).

Comparação do estado de saúde bucal da população de Baixo Guandu-ES, 50 anos após a fluoretação das águas e de Itarana-ES

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

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.

Fluoretação das águas de abastecimento público no município de Araçatuba/SP

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

Relação das condições socioeconômicas com as condições de saúde bucal em capitais brasileiras

Despite the improvement of Brazilian s living conditions in recent decades, this improvement occurred in a polarized way between groups of better social position. Then, there is still a health inequity´s panorama in Brazil which encompasses the oral health state. This panorama instigated the attainment of this ecological study that aimed to evaluate the relationship of socioeconomic conditions, and public health policies with oral health status in Brazilian capitals. Thus, we performed factor analysis and linear regression using oral health indicators collected from SB Brasil 2010, of socioeconomic conditions from Brazilian Census 2010 and related to water´s supply fluoridation from SISAGUA. Factor analysis with indicators of living conditions revealed two common factors, economic deprivation and socio-sanitary condition. Economic deprivation showed statistically significant positive correlation with DMFT 12 years (p= 0,03) and mean missing teeth (p = 0,002) and negative correlation with caries-free population (p=0,012). Socio-sanitary negatively correlated with DMFT (p <0,0001) and a positive correlation with caries-free population (p = 0.002). Fluoridated water had a significant association with DMFT (p <0,0001), mean missing teeth (p <0,0001) and caries free population (p <0.0001). Multiple linear regression analysis for the DMFT of capital was estimated by socio-sanitary condition and fluoridation, adjusted by economic deprivation, whereas the model for the mean missing teeth was estimated only by fluoridation and economic deprivation, and finally the model the rate for the population free of caries in Brazilian capitals was estimated by economic and socio-sanitary status adjusted fluoridated water supply. Therefore, factors related to living conditions and public policies are intrinsically linked to tooth decay issues. Thus, actions, beyond dental care assistance, must be development to impact positively in social and economic conditions, especially, between the most vulnerable populations

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.

Influência de diferentes concentrações de flúor na água em indicadores epidemiológicos de saúde/doença bucal

O objetivo deste estudo foi avaliar o acesso a fontes de fluoreto e as condições de saúde bucal de 237 escolares de nove a dezesseis anos, de três localidades com diferentes concentrações de fluoreto na água. O teor de flúor na água de cada região foi analisado pela técnica do eletrodo seletivo para o íon flúor e a foi avaliada prevalência de cárie e fluorose, respectivamente, pelo índice CPOD e TSIF, apresentando diferença estatisticamente significante (ANOVA; p < 0,05) nas três localidades: área sem fluoretação artificial (CPOD 5,32 ± 3,49) e 16% de fluorose; área com fluoretação artificial de 0,8 ppmF (CPOD 1,88 ± 2,22) e 94% de fluorose; área com fluoretação natural de 2,54 ppmF (CPOD 3,96 ± 2,38) e 100% de fluorose. Os achados sugerem que os indicadores epidemiológicos de saúde/doença bucal estudados são influenciados pela presença de fluoreto na água de consumo e que a supervisão e a orientação são fundamentais na correta utilização dos compostos fluoretados, aproveitando-se o máximo benefício no controle da cárie dentária com o mínimo risco de ocorrência de fluorose.

Fluorose dentária e concentração de flúor nas unhas de crianças residentes em diferentes áreas fluoretadas

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Diagnóstico da concentração de flúor nos sistemas públicos de água da região de Araçatuba

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Avaliação da qualidade da água no sistema de abastecimento da cidade de Santa Lúcia - SP

água que abastece uma cidade se não for tratada pode tornar-se importante veículo de transmissores de doenças. O controle da qualidade é uma medida que visa, principalmente, garantir a saúde da população. O objetivo desta pesquisa foi avaliar a qualidade da água distribuída pelo sistema de abastecimento da cidade de Santa Lúcia – SP. A água proveniente desse sistema chega até as residências e, muitas vezes, é consumida sem nenhum tratamento doméstico complementar. A cidade de Santa Lúcia é abastecida por três poços profundos (P2, P3, e P4). Com o intuito de avaliar a qualidade da água captada desses poços e distribuídas para consumo humano foram coletadas amostras diretamente dos poços e de um ponto de consumo nas áreas abastecidas por cada poço. Foram feitas três coletas em cada ponto, em três diferentes épocas do ano. Realizaram-se análises físico-químicas e bacteriológicas em todas as amostras. As análises bacteriológicas foram feitas para determinação da presença de coliformes totais, E. coli e contagem padrão de bactérias heterotróficas em placa. As análises físico-químicas avaliaram cloro residual livre, fluoreto, turbidez, pH, cor aparente e sólidos totais dissolvidos. Duas amostras foram positivas para coliformes totais, apenas uma amostra coletada no poço 2 foi positiva para E. coli. Para bactérias heterotróficas todas a amostras apresentaram contagem em placa inferior a 500 UFC/mL. Todas as amostras estavam dentro do padrão determinado pela legislação para pH, turbidez e sólidos totais dissolvidos. Todas as amostras coletadas no poço 2 tiveram como resultado ausência de cloro residual livre, o mesmo resultado para os demais pontos na segunda coleta de amostras. Todas as amostras apresentaram fluoreto com valores abaixo do VMP estabelecido pela legislação brasileira porém apenas cinco com concentrações dentro da faixa estabelecida pela legislação do Estado de São Paulo ...

Influência das variações pluviais nos teores de flúor em águas de poços

Introduction: The fluoridation surveillance in the public water supply came up with the need to develop mechanisms that would help society in the control of water quality. To perform reliable analysis, variables such as depth of the wells and pluvial variations should be subject of research and study. Objectives: To analyze the fluoride levels of deep wells in periods of rain and drought, corresponding to four brazilian cities and compare the results. Methodology: It was made the mapping of the water supply network and the identification of the sampling points according to the number of deep wells in each locality, selecting those who had the natural fluoride level. Three points were defined for each source of water supply, and the addresses were randomly selected. The samples were analyzed in duplicate at the laboratory of the Center for Research in Public Health of the Dentistry School of Araçatuba – UNESP, during 8 months, in periods of rain and drought (total absence of rain). Results: 174 analysis were conducted, the mean fluoride levels for rain and drought times were, respectively: 0,71 and 0,73. It was used the Student’s t test (p <0.05). Conclusion: There wasn’t statistically significant differences for the periods of rain and drought in any of the cities, at the year of 2010. This study highlights the importance of health surveillance, because beyond of ensuring social control, there is also the search for investigating variables that may have directly and / or indirectly influence on the results of the analysis.

A experiência da saúde coletiva na formação profissional: retrato da extensão universitária

The guidelines of National Curriculum for Dental courses highlights the necessity in providing for the professional the ability to analyze and assess community’s problems and needs, and to create solutions for the society. The continuing education may be considered a useful tool for the teaching and learning because it favors the diversification of learning environments, which allows the insertion of undergraduate and graduate students into the real scenarios. This current study aimed to assess the Public Health projects and programs of the UNESP – Araçatuba Dental School, by describing the interaction experiences between faculty and health services in the professional career development. Historical, documentary and descriptive searches were performed based on the faculty archives such as official documents, reports, databases from the Pro-rector of continuing education and published papers in the period between 1964 and 2011. The following experiences were noted: the Extra-Muro Dental Service (SEMO), established in 1964, that focused in providing dental treatment to the rural population, highlighted the social inclusion of discriminated society groups since that time. In 1972, this service was expanded to several specific populations living in the urban areas. In the '60s, many educational campaigns were performed as homemade water filter and construction of wells and septic tanks which demonstrate the concern with the determinants of healthdisease process. At that time, the campaign of fluoridation of public water supplies in several counties started as Araçatuba, Birigui, Penápolis, Guararapes, Valparaíso and so on. The Campaign of “Good Teeth” from the '70s became wider over time and it was transformed in the "Oral Health Education Program" and it was continuously developed in all public schools of Araçatuba and some neighboring towns, benefiting children aged from 6 to 10 years-old. Several epidemiological studies of caries, periodontal diseases, malocclusion and fluorosis were conducted in cooperation with local governments, and counted with the participation of undergraduate and graduate students. Pereira Barreto – SP was the precursor city in Brazil to carry out fluorosis study. Currently, 12 projects of Public Health from the Institution of Higher Education in the Pro-rector of continuing education are being developed. The concern in qualifying the human resources in health is confirmed with the development of training courses and workshops for professionals, highlighting the training for people enrolled in the Family Health program; Community Health Agent training - Solidarity University, and Municipal Health Counselors training. The Graduate Program in Social and Preventive Dentistry, created in 1993, has an important role to train several professionals for the Unified Health System, and provides education to create researchers, professors and administrators, and enucleates research groups in several Brazilian states. In all activities showed herein, a dynamic participation of undergraduate and graduate students has been observed, and several books, guidelines, articles, brochures and booklets have been published as a result of the continuing education activities.. It was concluded that different projects and programs have been developed by the Public Health of UNESP –Araçatuba Dental School, which allow the exchange of experience between the university and health services, and benefit all participants enrolled in these activities.

A comparative analysis of caries and fluorosis among cities with and without public water supply fluoridation in São Paulo State, Brazil

Purpose: This population-based, cross-sectional study aimed to record the DMFT index for 12 year-old children with dental caries and fluorosis levels in cities with and without public water supply fluoridation. Methods: From the 101 municipalities belonging to the Health Regional Department XV (DRSXV-SJRP) of the São Paulo state in the Southeast region of Brazil, 85 cities were selected after exclusion of those with incomplete data and less than ten years of fluoridation treatment in 2004. The criteria adopted for the assessment of dental caries and fluorosis levels were based on the guidelines published in the WHO Manual 4th edition. The data were analyzed using Fisher’s exact tests at a significance level of 5%. Results: The prevalence of caries in 12 year-old children had no significant association with fluoridated water, and was considered “moderate” and “high” in cities without fluoridation and “low” and “moderate” in cities with fluoridation. A significant association was found between water fluoridation and fluorosis (P=0.001), but not between water fluoridation and the DMFT index (P=0.119). Conclusion: The prevalence of fluorosis was related to water fluoridation in this study. However, fluorosis was also observed in non-fluoridated cities, which may result from fluoride intake through other sources.

Concentração de flúor em águas envasadas: análise laboratorial e da legislação relacionada

Fluoridation of water for human consumption is a method of caries prevention that brings great social benefit, if kept at optimal levels. The increase in the production of bottled water emphasizes the need to verify whether fluoride presence in these waters occurs in sufficient quantity to prevent decay, or if it represents a significant risk of fluorosis. Objective: to compare the concentrations of fluoride present in bottled water to those declared on the labels, and to make a critical analysis of legal norms on the subject. Materials and method: this was a cross-sectional study, through which 22 samples of bottled water sold in state of Ceará, Brazil, were analyzed. Analyses were performed in duplicate by the electrometric method, and results were compared to those printed on the labels. Detailed searches by laws, resolutions, ordinances, and other official documents in force, related to the topic were performed. Results: the fluoride concentrations found ranged from 0.01 to 0.36 mgF/l. Although 72.7% of the samples were classified as fluoridated, the fluoride concentrations observed were shown to be insufficient for caries prevention. As for the rules, situations where they are not clear or even divergent were found. Conclusion: the current legislation on the subject requires updates to become more objective and to create new criteria on the use of the term “fluoridated water”.

Estudo comparativo de diferentes metodologias analíticas para a determinação de fluoreto

The problem of dental caries in Brazil and around the world took major considerably over the years. In recent decades, with the advent of fluoridation, this problem has been alleviated. Studies have shown, however, that the lack of control in fluoridation leads to several health of the population. The strict control of fluoride levels in the water distributed, therefore, is essential. The objective of this study is to gather information on the status of fluoridation in some area of Brazil and compare different methods for the quantification of that analyte