Evolution in access to fluoridated water in Sao Paulo State, Brazil, from the 1950s to the early 21st century

Access to fluoridated water is a known protective factor against dental caries. In 1974, fluoridation of the public water supply became mandatory by law in Brazil, resulting in improved coverage, especially in more developed regions of the country. Coverage increased across the country as a priority under the national oral health policy. This article systematizes information on the implementation and expansion of fluoridation in Sao Paulo State from 1956 to 2009, using secondary data from technical reports, official documents, and the Information System for Surveillance of Water Quality for Human Consumption (SISAGUA). In 2009, fluoridation covered 546 of 645 counties in Sao Paulo State (84.7%), reaching 85.1% of the total population and 93.5% of the population with access to the public water supply. The results indicate that fluoridation has been consolidated as part of State health policy. However, the challenge remains to implement and maintain fluoridation in 99 counties, benefiting 6.2 million inhabitants that are still excluded from this service.

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.

A contribuição dos cirurgiões-dentistas para a prevenção e tratamento da cárie em adolescentes nas capitais brasileiras.

Esta tese é composta por três estudos ecológicos que incluíram as 27 capitais brasileiras. Esses três estudos foram os seguintes: 1- A associação entre a disponibilidade de cirurgiões-dentistas e a quantidade de procedimentos odontológicos nos serviços públicos de odontologia; 2- A associação entre a disponibilidade de cirurgiões-dentistas e a proporção de dentes restaurados (em relação ao total de dentes atacados pela cárie) em indivíduos de 15 a 19 anos ; 3- A associação da disponibilidade de cirurgiões-dentistas com a prevalência e severidade da cárie em indivíduos de 15 a 19 anos. As três investigações são apresentadas sob forma de artigos. Foram utilizados diversos bancos de dados secundários, disponíveis gratuitamente na internet. No primeiro estudo foi identificada associação do número de Equipes de Saúde Bucal do programa Saúde da Família (ESB) e de cirurgiões-dentistas no SUS de uma forma geral com o número de procedimentos odontológicos no serviço público; quanto mais ESB e cirurgiões-dentistas mais procedimentos odontológicos, tanto preventivos quanto restauradores. Mais dentistas no serviço público de odontologia significaram mais procedimentos preventivos e coletivos, porém um número relativamente pequeno a mais de restaurações. É preocupante a quantidade relativamente pequena de restaurações realizadas pelos dentistas do serviço público no Brasil diante do grande número de dentes com cárie não tratada, identificado pela pesquisa nacional de saúde bucal. O segundo estudo revelou que a quantidade de dentistas nas capitais brasileiras é muito grande e que, portanto, há capacidade instalada para atender todas as necessidades de tratamentos restauradores. Entretanto, o índice de cuidado odontológico em jovens de 15 a 19 anos revelou que menos da metade dos dentes atacados pela cárie tinham recebido o cuidado adequado, i.e., estavam restaurados. Este estudo concluiu que, o grande investimento da sociedade brasileira em odontologia, seja no setor público ou privado, não está tendo o retorno esperado, pelo menos para jovens de 15 a 19 anos. O terceiro estudo concluiu que fatores socioeconômicos amplos e flúor na água foram os principais determinantes da variação na prevalência e severidade da cárie em jovens de 15 a 19 anos e que a contribuição do dentista foi relativamente pequena. Diante do papel relativamente pequeno do dentista na prevenção da cárie, o esforço clínico do mesmo deveria, portanto, enfatizar tratamentos de maior complexidade, visando a restauração e reabilitação de danos relevantes para a função e bem estar (Serviço Pessoal de Saúde). Esforços efetivos para evitar a cárie dentária ocorrem principalmente no âmbito de estratégias preventivas populacionais (Serviço não Pessoal de Saúde), com uma contribuição relativamente pequena do trabalho clínico.

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

Prevalência de cárie dentária em escolares de 7 a 12 anos de idade, na cidade de Araraquara, SP (Brasil), 1979

São apresentados os resultados de levantamento epidemiológico de cárie dentária em escolares de 7 a 12 anos de idade da cidade de Araraquara, SP, Brasil, cuja água de abastecimento público é fluoretada. O objetivo do estudo é verificar a prevalência de caria dentária e o nível de assistência odontológica oferecido a esta população. A população de estudo compõe-se de escolares nascidos e sempre residentes na cidade e escolares não nascidos e/ou nem sempre residentes na cidade; são comparados os índices CPO-D obtidos para os dois grupos.

Analysis of fluoride concentration in mother's milk substitutes

The aim of the present study was to determine the fluoride concentration in some brands of mother's milk substitutes and evaluate the possibility of developing dental fluorosis by consuming these products. The products, all powdered, were divided into 3 groups: infant formulae (group I, n = 7), milk-based (group M, n = 8) and soy-based (group 8, n = 3). Samples from 3 cans of different batches of each brand were reconstituted in deionized water and analyzed using the specific electrode method, after hexamethyldisiloxane (HMDS) facilitated diffusion. The fluoride content (mg F/L) of the products ranged from 0.044 to 0.326 (I), 0.014 to 0.045 (M) and 0.253 to 0.702 (S). There was significant difference in the fluoride content of cans from distinct batches (p < 0.05) in most of the brands. The reconstitution of all products in water with optimal fluoride concentration for consumption during the mineralization phase of the primary teeth could result in daily fluoride intake above 0.07 mg F/kg body weight/day. Therefore, the consumption of these products, especially when reconstituted with optimally fluoridated water, could increase the risk of developing dental fluorosis.

Resistência à corrosão das ligas de 'TI-'MO' em meios contendo íons cloreto e fluoreto, visando à aplicação biomédica

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

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”.

Evolução do acesso à água fluoretada no Estado de São Paulo, Brasil: dos anos 1950 à primeira década do século XXI

Ter acesso à água fluoretada é um reconhecido fator de proteção contra a cárie dentária. No Brasil, a fluoretação da água de abastecimento público tornou-se obrigatória por lei em 1974, seguindo-se a esta regulamentação acentuada expansão da cobertura, sobretudo nas regiões de maior desenvolvimento socioeconômico. A ampliação dessa cobertura em todo o país é uma das prioridades da política nacional de saúde bucal. Neste artigo, sistematizam-se informações sobre a implantação e expansão da fluoretação no Estado de São Paulo, no período de 1956 a 2009, utilizando-se dados secundários obtidos em relatórios técnicos, documentos oficiais e no sistema SISAGUA. Em 2009, a cobertura se estendia por 546 (84,7%) dos 645 municípios paulistas, chegando a 85,1% da população total e a 93,5% da população com acesso à rede de distribuição de água. Tais resultados indicam que a medida está consolidada como parte da política estadual de saúde. No entanto, persiste o desafio de implantar e manter a fluoretação em 99 municípios, beneficiando cerca de 6,2 milhões de habitantes excluídos do benefício.

Le cycle hydrosocial et la fluoration de l'eau : la production des eaux fluorées

La fluoration artificielle de l’eau est une méthode employée en tant que moyen de prévention de la carie dentaire. Il s’agit d’un traitement de l’eau dont le but est d’ajuster de façon « optimale » la concentration en fluorure dans l’eau potable pour la prévention de la carie dentaire, par l’ajout d’un composé fluoré. La fluoration de l’eau fait l’objet d’un débat de société depuis le début des années 1950. La théorie du cycle hydrosocial nous invite à réfléchir sur la manière dont l’eau et la société se définissent et se redéfinissent mutuellement dans le temps et dans l’espace. Cette théorie nous permet d’aborder l’étude du sujet de la fluoration avec une nouvelle perspective d’analyse. Il y a peu d’études en sciences sociales qui portent sur le sujet de la fluoration, généralement abordé d’un point de vue des sciences de la santé. Nous proposons de décrire le processus de production des eaux fluorées dans un contexte hydrosocial. Ce mémoire est structuré en quatre chapitres. Nous commençons par familiariser le lecteur avec la théorie du cycle hydrosocial. Ensuite, nous faisons une mise en contexte de la fluoration de l’eau, d’une part en présentant un état des lieux, et d’autre part en présentant ce en quoi consiste la pratique de la fluoration de l’eau. Après avoir familiarisé le lecteur avec les thèmes généraux concernant la fluoration de l’eau, nous proposons de reconstituer une histoire hydrosociale de la fluoration. Cette histoire nous permet de mettre en évidence les relations hydrosociales desquelles découle la production des eaux fluorées. L’histoire hydrosociale de la fluoration comporte une phase contemporaine que nous abordons en présentant les principales idées de l’opposition à la fluoration artificielle de l’eau à l’aide notamment d’une analyse iconographique d’images portant sur le thème de la fluoration. Finalement, nous discutons des implications de la théorie du cycle hydrosocial pour étudier la problématique de la fluoration.

Prevalence and severity of dental fluorosis among students from João Pessoa, PB, Brazil

The aim of this study was to determine the prevalence and severity of dental fluorosis among 12-15-year-old students from João Pessoa, PB, Brazil before starting a program of artificial fluoridation of drinking water. The use of fluoridated dentifrice was also surveyed. A sample of 1,402 students was randomly selected. However, 31 students refused to participate and 257 were not permanent residents in João Pessoa, thus leaving a final sample of 1,114 students. Clinical exams were carried out by two calibrated dentists (Kappa = 0.78) under natural indirect light. Upper and lower front teeth were cleaned with gauze and dried, and then examined using the TF index for fluorosis. A questionnaire on dentifrice ingestion and oral hygiene habits was applied to the students. The results revealed that fluorosis prevalence in this age group was higher than expected (29.2%). Most fluorosis cases were TF = 1 (66.8%), and the most severe cases were TF = 4 (2.2%). The majority of the students reported that they had been using fluoridated dentifrices since childhood; 95% of the participants preferred brands with a 1,500 ppm F concentration, and 40% remembered that they usually ingested or still ingest dentifrice during brushing. It was concluded that dental fluorosis prevalence among students in João Pessoa is higher than expected for an area with non-fluoridated water. However, although most students use fluoridated dentifrices, and almost half ingest slurry while brushing, the majority of cases had little aesthetic relevance from the professionals' point of view, thus suggesting that fluorosis is not a public health problem in the locality.

ANÁLISE MICROBIANA E DO TEOR DE FLÚOR ADICIONADO À ÁGUA DE ABASTECIMENTO EM UM ESTADO DO NORDESTE DO BRASIL

Objetivo: Analisar os teores de íons de fluoreto e o padrão microbiológico encontrado nas águas de abastecimento público dos municípios alagoanos que fluoretam suas águas. Métodos: Estudo transversal descritivo realizado no período de 2012 a 2014, no qual se analisaram todos os laudos emitidos pelo Laboratório Central de Saúde Pública de Alagoas (LACEN-AL) com os resultados da análise da qualidade da água para consumo humano dos onze municípios alagoanos que fluoretaram suas águas, totalizando 3.089 laudos. Avaliouse o número total de amostras enviadas para análise da qualidade da água, a quantidade de amostras em que foi solicitada a análise de fluoreto, teores e variações dos íons de fluoreto e o padrão microbiológico das amostras fluoretadas. Realizou-se a análise descritiva dos dados, obtendo-se as frequências absolutas e relativas percentuais. Resultados: Foram encontradas 429 (83,9%) amostras coletadas no intervalo 0,0-0,5 mgF/L, número considerado abaixo do recomendável, além de grande variação na concentração dos íons de fluoreto e 128 (26,3%) amostras de água fluoretada fora dos padrões de potabilidade. Conclusão: Os dados mostraram uma grande variação e um alto percentual de amostras com baixas concentrações de fluoreto, assim como a necessidade de melhoria da qualidade da água ofertada, de modo a garantir para a população o acesso contínuo à água potável.

Le cycle hydrosocial et la fluoration de l'eau : la production des eaux fluorées

La fluoration artificielle de l’eau est une méthode employée en tant que moyen de prévention de la carie dentaire. Il s’agit d’un traitement de l’eau dont le but est d’ajuster de façon « optimale » la concentration en fluorure dans l’eau potable pour la prévention de la carie dentaire, par l’ajout d’un composé fluoré. La fluoration de l’eau fait l’objet d’un débat de société depuis le début des années 1950. La théorie du cycle hydrosocial nous invite à réfléchir sur la manière dont l’eau et la société se définissent et se redéfinissent mutuellement dans le temps et dans l’espace. Cette théorie nous permet d’aborder l’étude du sujet de la fluoration avec une nouvelle perspective d’analyse. Il y a peu d’études en sciences sociales qui portent sur le sujet de la fluoration, généralement abordé d’un point de vue des sciences de la santé. Nous proposons de décrire le processus de production des eaux fluorées dans un contexte hydrosocial. Ce mémoire est structuré en quatre chapitres. Nous commençons par familiariser le lecteur avec la théorie du cycle hydrosocial. Ensuite, nous faisons une mise en contexte de la fluoration de l’eau, d’une part en présentant un état des lieux, et d’autre part en présentant ce en quoi consiste la pratique de la fluoration de l’eau. Après avoir familiarisé le lecteur avec les thèmes généraux concernant la fluoration de l’eau, nous proposons de reconstituer une histoire hydrosociale de la fluoration. Cette histoire nous permet de mettre en évidence les relations hydrosociales desquelles découle la production des eaux fluorées. L’histoire hydrosociale de la fluoration comporte une phase contemporaine que nous abordons en présentant les principales idées de l’opposition à la fluoration artificielle de l’eau à l’aide notamment d’une analyse iconographique d’images portant sur le thème de la fluoration. Finalement, nous discutons des implications de la théorie du cycle hydrosocial pour étudier la problématique de la fluoration.

Fluoridated drinking water : proficiency testing, September 1984.

Mode of access: Internet.

Fluoride Intake from Meals Served in Daycare Centres in Municipalities with Different Fluoride Concentrations in the Water Supply

Purpose: The aim of this study was (1) to determine the fluoride content in the meals served to children aged up to 36 months in daycare centres of two municipalities with different levels of fluoride in the water supply, (2) to calculate the mean fluoride ingested daily by the children when consuming those meals and (3) to analyse the contribution of this consumption to the development of dental fluorosisMaterials and Methods: Samples of the meals served to the children were collected during a whole week. The fluoride content of the samples of solid foods and milk was analysed using an ion-specific electrode combined with reference electrode after diffusion facilitated by hexamethyldisiloxane Samples of beverages were buffered with an equal volume of total ionic strength adjustment buffer and analysed using a combined electrode. The results were compared using the Mann Whitney testResults: Mean fluoride contents of the meals were of 0.204 +/- 0 179 and 0.322 +/- 0.242 mu g F/mL (P < 0.05), respectively, in the municipalities with low and adequate fluoride content. Daily fluoride intake in the former was 0.013 +/- 0.003 mg/kg body weight/day and in the latter was 0.012 +/- 0 001 mg/kg body weight/day (P > 0 05)Conclusions: The children were not exposed to dental fluorosis in the daycare centres However, the risk cannot be ignored, considering the meals and the use of fluoridated dentifrices at home may also contribute to fluoride intake.