RESUMO
DATA SOURCES: Human, animal, and in vitro studies. Extensive literature search of multiple bibliographic databases, trial registries, major grey literature sources and bibliographies of identified studies. STUDY SELECTION: The authors aimed to identify studies which could be used to determine the maximum safe level for fluoride in drinking water. To identify new studies published since a 2016 Australian review, the search period was 2016 to July 2021. Studies which evaluated the association between either naturally or artificially fluoridated water (any concentration) and any health outcomes were included. No restrictions on study design or publication status. Articles published in a 'non-Latin language' were excluded. Screening of abstracts and full texts was in duplicate. For IQ and dental fluorosis, a top-up search was conducted between 2021 and Feb 2023. DATA EXTRACTION AND SYNTHESIS: Extensive data extraction. Risk of bias assessment using the OHAT tool. A narrative synthesis of the results was carried out. RESULTS: The review included 89 studies in humans, 199 in animals and 10 reviews of in vitro studies. Where there was consistent evidence of a positive association, in relation to a water fluoride concentration of <20 ppm (mg F/L), and where studies were judged to be acceptable or high quality, health effects were taken forwards for further examination of causality using Bradford Hill's 9 criteria. Of the 39 health outcomes reviewed, 4 were further assessed for causality. The authors reported 'strong' evidence of causality for dental fluorosis and reductions in children's IQ scores, 'moderate' strength evidence for thyroid dysfunction, 'weak' for kidney dysfunction, and 'limited' evidence for sex hormone disruption. CONCLUSIONS: The authors conclude that moderate dental fluorosis and reductions in children's IQ scores are the most appropriate health outcomes to use when setting an upper safe level of fluoride in drinking water. For reductions in children's IQ, the authors acknowledge a biological mechanism of action has not been elucidated, and the dose response curve is not clear at lower concentrations, limiting the ability to set an upper safe threshold.
Assuntos
Fluoretação , Fluoretos , Fluorose Dentária , Inteligência , Humanos , Criança , Fluoretos/efeitos adversos , Fluoretação/efeitos adversos , Fluorose Dentária/etiologia , Inteligência/efeitos dos fármacos , Animais , Água PotávelRESUMO
OBJECTIVE: To assess the evidence presented in a set of articles that use the Canadian Maternal-Infant Research on Environmental Chemicals (MIREC) study database to claim that community water fluoridation (CWF) is associated with harm to foetal and infant cognitive development. METHODS: Critical appraisal of measurements and processes in the MIREC database, and articles derived therefrom. MIREC's cohort is approximately 2000 pregnant women recruited in 10 centres across Canada, 2008-2011, leading to measuring 512 children aged 3-6 years in six cities. Fluoride exposure was measured by city fluoridation status, self-reports and maternal spot urine samples. Intelligence Quotient (IQ) was measured using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III) by different assessors in each city. RESULTS: MIREC's fluoride and IQ measurements are invalid and therefore cannot support the claim that CWF is associated with IQ decline in children. CONCLUSIONS: The MIREC fluoride-IQ articles' results should be considered unacceptable for legal and policy purposes; other water fluoridation studies and systematic reviews show no effect of fluoridation on cognition.
Assuntos
Fluoretação , Testes de Inteligência , Fluoretação/efeitos adversos , Humanos , Canadá , Pré-Escolar , Criança , Feminino , Gravidez , Fluoretos/análise , Fluoretos/urina , Inteligência/efeitos dos fármacos , Bases de Dados FactuaisRESUMO
A U.S. federal court is examining a controversial link between fluoride and neurotoxicity.
Assuntos
Encéfalo , Água Potável , Fluoretação , Fluoretos , Água Potável/química , Água Potável/legislação & jurisprudência , Fluoretos/toxicidade , Fluoretação/efeitos adversos , Fluoretação/legislação & jurisprudência , Humanos , Encéfalo/efeitos dos fármacos , Encéfalo/crescimento & desenvolvimento , Estados UnidosRESUMO
Purpose The purpose of this study was to determine dental hygiene students' perspectives regarding their knowledge and understanding about caries prevention strategies and their intention to use these regimens in clinical practice. Dental hygienists' knowledge and understanding of caries prevention is critical because they are the primary providers of these regimens and the relevant education.Methods This 2019 national cross-sectional online survey was designed by the University of Maryland (UMD), structured by the ADA staff for online administration, distributed and collected by the American Dental Hygienists' Association (ADHA) to 9533 email addresses, and de-identified response data were analyzed by UMD. The survey included questions on three caries preventive regimens: fluoride varnish, dental sealants, and silver diamine fluoride (SDF), and items on community water fluoridation (CWF), respondent's demographics and intent to use the regimens. Statistical analyses included descriptive statistics and analysis of variance. Significance was set at p<0.05.Results Of the 235 surveys returned (response rate 2.5%) the majority were female, White and born in the United States. Over half were in associate degree programs; nearly a third were in baccalaureate programs. Respondents reported greater knowledge/understanding and intention to use fluoride varnish and dental sealants than SDF. Less than half (44.7%) reported knowledge/understanding of SDF and only 22.6% had a high level of confidence regarding applying it. Additionally, only 31.1% indicated they were extremely likely to use SDF upon graduation.Conclusions To reduce the prevalence of caries, dental hygiene graduates must be well-versed with the latest science-based preventive procedures, including non-invasive caries prevention and control therapies. The results of this survey, albeit non representative of the general population of dental hygiene students, suggest a need for a more extensive review of the caries preventive regimen content, especially for silver diamine fluoride, of dental hygiene curricular programs.
Assuntos
Cárie Dentária , Fluoretos Tópicos , Compostos de Amônio Quaternário , Compostos de Prata , Humanos , Feminino , Masculino , Fluoretos Tópicos/uso terapêutico , Fluoretação/efeitos adversos , Higiene Bucal , Estudos Transversais , Selantes de Fossas e Fissuras/uso terapêutico , Suscetibilidade à Cárie Dentária , Cárie Dentária/prevenção & controle , Fluoretos/uso terapêutico , EstudantesRESUMO
Fluorosis, a chronic condition brought on by excessive fluoride ingestion which, has drawn much scientific attention and public health concern. It is a complex and multifaceted issue that affects millions of people worldwide. Despite decades of scientific research elucidating the causes, mechanisms, and prevention strategies for fluorosis, there remains a significant gap between scientific understanding and public health implementation. While the scientific community has made significant strides in understanding the etiology and prevention of fluorosis, effectively translating this knowledge into public health policies and practices remains challenging. This review explores the gap between scientific research on fluorosis and its practical implementation in public health initiatives. It suggests developing evidence-based guidelines for fluoride exposure and recommends comprehensive educational campaigns targeting the public and healthcare providers. Furthermore, it emphasizes the need for further research to fill the existing knowledge gaps and promote evidence-based decision-making. By fostering collaboration, communication, and evidence-based practices, policymakers, healthcare professionals, and the public can work together to implement preventive measures and mitigate the burden of fluorosis on affected communities. This review highlighted several vital strategies to bridge the gap between science and public health in the context of fluorosis. It emphasizes the importance of translating scientific evidence into actionable guidelines, raising public awareness about fluoride consumption, and promoting preventive measures at individual and community levels.
Assuntos
Fluoretos , Fluorose Dentária , Humanos , Fluoretos/toxicidade , Fluorose Dentária/epidemiologia , Fluorose Dentária/etiologia , Fluorose Dentária/prevenção & controle , Saúde Pública , Fluoretação/efeitos adversosRESUMO
Drinking water fluoridated at the level recommended by the U.S. Public Health Service (USPHS) reduces dental caries (cavities) by approximately 25% in children and adults (1). USPHS recommends fluoride levels to achieve oral health benefits and minimize risks associated with excess fluoride exposure. To provide the benefits of community water fluoridation, water systems should target a level of 0.7 mg/L and maintain levels ≥0.6 mg/L (2). The Environmental Protection Agency (EPA) sets a safety standard at 2.0 mg/L to prevent mild or moderate dental fluorosis, a condition that causes changes in the appearance of tooth enamel caused by hypermineralization resulting from excess fluoride intake during tooth-forming years (i.e., before age 8 years). During 2016-2021, fluoride measurements for 16.3% of population-weighted monthly fluoride measurements (person-months) reported by community water systems to CDC's Water Fluoridation Reporting System (WFRS) were <0.6 mg/L; only 0.01% of person-months exceeded 2.0 mg/L. More than 80% of population-weighted fluoride measurements from community water systems reporting to WFRS were above 0.6 mg/L. Although 0.7 mg/L is the recommended optimal level, ≥0.6 mg/L is still effective for the prevention of caries. A total of 4,080 community water systems safely fluoridated water 99.99% of the time with levels below the secondary safety standard of 2.0 mg/L. Water systems are encouraged to work with their state programs to report their fluoride data into WFRS and meet USPHS recommendations to provide the full benefit of fluoridation for caries prevention.
Assuntos
Cárie Dentária , Fluorose Dentária , Criança , Humanos , Estados Unidos/epidemiologia , Fluoretos/análise , Fluorose Dentária/epidemiologia , Fluorose Dentária/prevenção & controle , Fluorose Dentária/etiologia , Fluoretação/efeitos adversos , Cárie Dentária/epidemiologia , Cárie Dentária/prevenção & controle , Cárie Dentária/complicações , Saúde BucalRESUMO
Fluoride is added to drinking water in some countries to prevent tooth decay (caries). There is no conclusive evidence that community water fluoridation (CWF) at WHO recommended concentrations for caries prevention has any harmful effects. However, research is ongoing regarding potential effects of ingested fluoride on human neurodevelopment and endocrine dysfunction. Simultaneously, research has emerged highlighting the significance of the human microbiome in gastrointestinal and immune health. In this review we evaluate the literature examining the effect of fluoride exposure on the human microbiome. Unfortunately, none of the studies retrieved examined the effects of ingested fluoridated water on the human microbiome. Animal studies generally examined acute fluoride toxicity following ingestion of fluoridated food and water and conclude that fluoride exposure can detrimentally perturb the normal microbiome. These data are difficult to extrapolate to physiologically relevant human exposure dose ranges and the significance to humans living in areas with CWF requires further investigation. Conversely, evidence suggests that the use of fluoride containing oral hygiene products may have beneficial effects on the oral microbiome regarding caries prevention. Overall, while fluoride exposure does appear to impact the human and animal microbiome, the long-term consequences of this requires further study.
Assuntos
Fluorose Dentária , Microbiota , Animais , Humanos , Fluoretos/toxicidade , Fluoretação/efeitos adversos , AlimentosRESUMO
Fluorosis is a worldwide public health problem. One of the factors related to it is the type of water consumed, such as groundwater. High fluoride concentration in groundwater may be explained by contamination from local industries. Since fluoride and arsenic are the main pollutants of groundwater, some studies correlate groundwater consumption with high prevalence of fluorosis. Aim: The aim of this study was to conduct a systematic review to determine whether children's risk of fluorosis is related to drinking groundwater. Materials and Method: The protocol for this systematic review was registered at the National Institute of Health Research Database (CRD42021227298). A comprehensive search was conducted to identify potentially relevant studies by exploring a range of electronic databases (Medline via PubMed, Scopus, Cochrane Library, Science Direct, Web of Science Core Collection, Medline via Ovid, Lilacs, Embase, and grey literature). Results: A total 2189 articles were found. After reading titles and abstracts, 63 were selected for screening, and the final data was extracted from 15 articles. Conclusion: A relationship was identified between drinking fluoridated water from wells and the prevalence of fluorosis in individuals up to 18 years old. This is the first study to assess the issue systematically worldwide.
La fluorosis es un problema de salud pública a nivel mundial y el tipo de agua consumida es uno de los factores relacionados con ella, como el consumo de aguas subterráneas. La alta concentración de fluoruro en estas aguas puede justificarse por la contaminación por industrias locales y las características del suelo, donde algunos estudios correlacionan el consumo de aguas subterráneas con una alta prevalencia de fluorosis, ya que el fluoruro, junto con el arsénico, se consideran los principales contaminantes de estas aguas. Objetivo: El objetivo es realizar una revisión sistemática que relacione el riesgo de fluorosis en niños expuestos al consumo de agua procedente de pozos. Materiales y Método: El protocolo de esta revisión sistemática fue registrado en el National Institute of Health Research Database (CRD42021227298). Se realizó una búsqueda bibliográfica de estudios primarios explorando diversas bases de datos electrónicas (Medline vía PubMed, Scopus, Cochrane Library, Science Direct, Web of Science Core Collection, Medline vía Ovid, Lilacs, Embase y literatura gris). Resultados: Se encontraron 2189 artículos, tras la lectura de títulos y resúmenes se seleccionaron 63 referencias para examinar y, finalmente, se extrajeron los datos de 15 artículos. Conclusiones: Se identificó una relación entre el consumo de agua fluorada de pozo y la prevalencia de fluorosis en individuos de hasta 18 años, siendo este estudio el primero en evaluarlo sistemáticamente a nivel mundial.
Assuntos
Fluoretos , Fluorose Dentária , Água Subterrânea , Fluorose Dentária/epidemiologia , Fluorose Dentária/etiologia , Humanos , Água Subterrânea/análise , Água Subterrânea/química , Criança , Fluoretos/análise , Fluoretos/efeitos adversos , Prevalência , Adolescente , Água Potável/análise , Água Potável/química , Fluoretação/efeitos adversosRESUMO
OBJECTIVE: To determine the impact of water fluoridation on the prevalence and severity of dental caries and fluorosis in individuals aged 17-20 years exposed to fluoride toothpaste. METHODS: The study population consisted of 660 students from public schools, residents of areas supplied with fluoridated water (exposed group) or not (not exposed group). Students from both groups had access to fluoride toothpaste throughout life. A questionnaire about socioeconomic demographic aspects, conditions related to access and exposure to fluoridated water, and habits related to oral health was applied. Dental caries was measured by the DMFT index and dental fluorosis by the TF index. The chi-square test, t test, and subsequently logistic regression were applied for data analysis. RESULTS: Caries experience (DMFT≠0) was significantly higher in students from areas not exposed to fluoridated water, after adjustments to clinical conditions, demographic socioeconomic profile, and hygiene habits. The DMFT mean (±SD) was significantly higher in students from areas not exposed to fluoridated water than exposed (3.83 [±3.28] and 2.48 [±2.71] respectively). The prevalence of very mild/mild and moderate fluorosis was 41.1% and 21% for students either exposed to fluoridated water or not, respectively. CONCLUSION: Exposure to fluoridated water was associated with a lower prevalence and severity of tooth decay, in spite of the use of fluoridated toothpaste. The prevalence of dental fluorosis at all levels was higher in fluoridated areas, however, in both groups, there were few cases with esthetic implications.
Assuntos
Cárie Dentária , Fluorose Dentária , Humanos , Cárie Dentária/epidemiologia , Fluoretação/efeitos adversos , Fluoretos/análise , Fluorose Dentária/epidemiologia , Prevalência , Cremes DentaisRESUMO
OBJECTIVES: Previous studies have identified many demographic, socioeconomic, behavioural and clinical variables associated with subjective parental ratings of child oral health. This study investigated associations between children's lifetime exposure to fluoridated drinking water (LEFW) and dental caries prevalence and parental ratings. METHODS: Australia's National Child Oral Health Study 2012-2014 conducted oral epidemiological examinations for 24 664 children aged 5-14 and investigated risk factors for child oral health and disease through questionnaires. Parents also subjectively rated their child's oral health. This cross-sectional study estimated prevalence ratios for associations between LEFW and prevalence of dental caries in the primary and permanent dentitions and parental oral health ratings for 5-8 year old and 9-14 year old children. E-value sensitivity analyses helped assess whether observed effect sizes may have arisen through unmeasured confounding. RESULTS: Children aged 5-8 with 0%-10% or 11%-89% LEFW are respectively 1.5 (95% CI 1.2-1.8) and 1.5 (95% CI 1.1-2.0) times more likely than children with 90%-100% LEFW to receive a fair or poor parental oral health rating. Children aged 9-14 with 0%-10% or 11%-89% LEFW are 1.2 (95% CI 1.0-1.4) times more likely than children with 90%-100% LEFW to receive a fair or poor parental oral health rating. Children aged 5-8 with 0%-10% or 11%-89% LEFW are respectively 1.4 (1.3-1.6) and 1.3 (95% CI 1.1-1.4) times more likely than children with 90%-100% LEFW to experience caries in their primary teeth. Children aged 9-14 with 0%-10% or 11%-89% LEFW are respectively 1.4 (95% CI 1.3-1.5) and 1.1 (95% CI 1.0-1.2) times more likely than children with 90%-100% LEFW to experience caries in their permanent teeth. CONCLUSIONS: Longer lifetime exposure to fluoridated drinking water is causally associated with a lower childhood dental caries prevalence and more positive parental ratings of child oral health. The associations are stronger for younger children.
Assuntos
Cárie Dentária , Água Potável , Criança , Humanos , Pré-Escolar , Fluoretação/efeitos adversos , Índice CPO , Cárie Dentária/epidemiologia , Cárie Dentária/etiologia , Cárie Dentária/prevenção & controle , Saúde Bucal , Estudos Transversais , Prevalência , PaisRESUMO
Drinking water fluoridation was a mid-twentieth century innovation based on the medical hypothesis that consuming low doses of fluoride at the teeth forming years provided protection against dental decays. Numerous studies showed that high level exposure to fluoride could cause dental and skeleton fluorosis. However, there was limited study focusing on the fluorosis effect of low levels of exposure to fluoride. Therefore, our study aimed to examine whether the low level of fluoride exposure (measured in blood plasma and household tap water) was associated with the risk of dental fluorosis based on data of the National Health and Nutrition Examination Survey (NHANES) 2015-2016. We analyzed data in 2098 children and adolescents who had Dean's Index scores, and water and plasma fluoride measures. The Dean's Index score was measured by calibrated dental examiners using the modified Dean's fluorosis classification system. Fluoride was measured in plasma and household tap water. In this study, we found that the rate of fluoride concentration in water above the recommended level of 0.7 mg/L was 25%, but the prevalence of dental fluorosis was 70%. Binary logistic regression adjusted for covariates showed that higher water fluoride concentrations (0.31-0.50, 0.51-0.70, > 0.70 compared 0.00-0.30) were associated with higher odds of dental fluorosis (OR = 1.48, 95% CI: 1.13-1.96, p = 0.005; OR = 1.92, 95% CI: 1.44-2.58, p < 0.001, and OR = 2.30, 95% CI: 1.75-3.07, p < 0.001, respectively). The pattern of regression between plasma fluoride and dental fluorosis was similar. Inclusion, our study showed that even low level of water or plasma fluoride exposure was associated with increased the risk of dental fluorosis. The safety of public health approach of drinking water fluoridation for global dental caries reduction are urgently needed further research.
Assuntos
Fluoretos/toxicidade , Fluorose Dentária/etiologia , Adolescente , Criança , Pré-Escolar , Exposição Ambiental/efeitos adversos , Fluoretação/efeitos adversos , Humanos , Inquéritos Nutricionais , Prevalência , Dente/efeitos dos fármacos , Água/químicaRESUMO
OBJECTIVES: The aim of this study was to determine whether geographic location, socioeconomic status, infant mortality, and mortality from diarrheal disease in health regions are associated with the provision of community water fluoridation (CWF) in Brazilian municipalities. METHODS: A multilevel ecological study was conducted based on data from the National Survey of Basic Sanitation and Human Development Atlas. A multilevel analysis was carried out considering Brazilian municipalities as the first level and health regions as the second level, comprising sanitation, demographic, socioeconomic, and health characteristics. RESULTS: The observation units comprised 5,565 municipalities clustered in 438 health regions in Brazil. The lack of CWF provision was positively associated with the following municipal characteristics: a below-median proportion of inhabitants covered by the sewage network, medium to very low human development index, below-median per capita gross domestic product, and an above-median percentage of expenditures on sanitation. In relation to the health regions, the likelihood of a lack of CWF provision was greater in the municipalities belonging to the health regions located in the Northern and Northeastern areas of Brazil and in those where child mortality due to acute diarrheal disease and the proportion of people with low income were higher when adjusted by municipal indicators. CONCLUSIONS: Information on the characteristics associated with CWF provision constitutes important input for refocusing public policy to reduce inequalities among Brazilian municipalities and health regions. These findings may help policy-makers to understand the challenges facing CWF expansion in low-, middle-, and high-income countries.
Assuntos
Água Potável/química , Fluoretação/efeitos adversos , Disparidades nos Níveis de Saúde , Áreas de Pobreza , Política Pública , Brasil/epidemiologia , Pré-Escolar , Cidades/epidemiologia , Estudos Transversais , Diarreia/mortalidade , Geografia , Humanos , Lactente , Mortalidade Infantil , Análise Multinível , Classe Social , População Urbana/estatística & dados numéricosRESUMO
The study aimed to quantify the excess risk of interaction between high free sugars (sugars) intake and lack of exposure to water fluoridation on child dental caries. Data from the Australian National Child Oral Health Study, a population-based survey of 24,664 children aged 5 to 14 y, were collected using parental questionnaires and oral epidemiological examinations by trained examiners. Information on socioeconomic status, dental health behaviors, and dental service use was used as covariates. The number of servings of sugars-containing foods and drinks consumed in a usual day was assessed as the main exposure, categorized into 5 groups. Residential history was used to calculate lifetime exposure to fluoridated water (LEFW), categorized as low (<25%), medium (25% to <75%), or high (75%-100%). Caries prevalence (dmfs/DMFS >0) and experience (dmfs/DMFS) in the primary (ages 5-10 y) and permanent (ages 8-14 y) dentitions were the main dependent variables. The association of sugars intake and LEFW with each outcome was estimated in multivariable log-Poisson regression models with robust standard error estimation, adjusted for covariates. The relative excess risk due to interaction (RERI) between sugars intake and LEFW was estimated. Strong positive gradients in all outcomes were observed across sugars intake groups. Relative to the lowest intake group, the 3 highest intake groups had significantly higher adjusted prevalence ratios for having caries and higher adjusted mean ratios of caries experience in both dentitions, after controlling for all covariates. LEFW strongly and consistently attenuated the effects of all levels of sugars intake on the outcomes. RERI estimates indicated that a combination of lack of exposure to fluoridated water and high sugars intake resulted in greater excess risk of primary and permanent caries than if there was no interaction. Evidently, children with high sugars intakes and low exposure to water fluoridation are at disproportionately higher risk of dental caries.
Assuntos
Cárie Dentária , Fluoretação , Adolescente , Austrália/epidemiologia , Criança , Pré-Escolar , Índice CPO , Cárie Dentária/epidemiologia , Cárie Dentária/etiologia , Fluoretação/efeitos adversos , Humanos , Açúcares/efeitos adversosRESUMO
OBJECTIVES: To analyze changes in the dental fluorosis (DF) incidence according to a birth cohort and explore current exposure to DF in a case series. METHODS: Repeated cross-sectional study of two periods: 2015 and 2018. Two standardized examiners registered DF using the Thylstrup-Fejerskov index in permanent teeth of children aged 7-18 years. Period and birth cohort frequencies were estimated by a generalized linear model, binomial family, and logarithmic link function. Period estimates are presented as prevalence ratios (PR) and birth cohort estimates as cumulative incidence ratios (RR); 95% confidence intervals and P values are reported. In a subsample of 37 volunteers (12.29 ± 2.63 years), the fluoride (F) concentration in toenails was measured using the HMDS diffusion method and an ion-specific electrode. Other samples from the local environment such as food, soil, and coal were also collected. RESULTS: In 274 children, we found that nonsignificant increases between periods (PR = 1.17; 95% CI: 0.89-1.55) were not explained by birth cohort effects. A total of 37.8% of the subsample had a toenail F concentration ≥2 µg F/g. The salty snacks and seasoning had the highest F concentrations among local environmental samples. CONCLUSION: In this population with a high DF frequency according to birth cohort and the evaluated period, the study of soil, coal, and food samples indicated a continued F exposure. F concentration found in the toenails shows a moderate F exposure; nearly a third of the children and adolescents exceeded the adopted threshold of 2 µg F/g. It is important to monitor and explore changes in exposure in highly affected population.
Assuntos
Fluorose Dentária/epidemiologia , Adolescente , Fatores Etários , Criança , Carvão Mineral/análise , Estudos de Coortes , Colômbia/epidemiologia , Estudos Transversais , Água Potável/química , Doenças Endêmicas , Exposição Ambiental , Fluoretação/efeitos adversos , Fluoretos/análise , Humanos , Incidência , Unhas/química , Lanches , Solo/química , Especiarias/análiseRESUMO
OBJECTIVES: To determine the prevalence of dental fluorosis, and factors associated with its occurrence in two cohorts of children exposed to different fluoride concentrations in the Malaysian water supply. METHODS: A cross-sectional study was conducted among lifelong residents (n = 1,155) aged 9 and 12 years old living in fluoridated and nonfluoridated areas. Malaysian children aged 12 years were born when the level of fluoride in the public water supply was 0.7 ppm while those aged 9 years were born after the level was reduced to 0.5 ppm. Fluorosis was blind scored using standardized photographs of maxillary central incisors using Dean's criteria. Fluoride exposures and other factors were assessed by parental questionnaire. Data were analyzed using descriptive statistics, Chi-squared analyses, and logistic regression. RESULTS: Fluorosis prevalence was lower (31.9 percent) among the younger children born after the reduction of fluoride concentration in the water, compared to a prevalence of 38.4 percent in the older cohort. Early tooth brushing practices and fluoridated toothpaste were not statistically associated with fluorosis status. However, the prevalence of fluorosis was significantly associated with parents' education level, parents' income, fluoridated water, type of infant feeding method, age breast feeding ceased, use of formula milk, duration of formula milk intake, and type of water used to reconstitute formula milk via simple logistic regression. Fluoridated water remained a significant risk factor for fluorosis in multiple logistic regression. CONCLUSIONS: Fluorosis was lower among children born after the adjustment of fluoride concentration in the water. Fluoridated water remained as a strong risk factor for fluorosis after downward adjustment of its fluoride concentration.
Assuntos
Fluoretos , Fluorose Dentária , Criança , Estudos Transversais , Fluoretação/efeitos adversos , Fluoretos/efeitos adversos , Fluorose Dentária/epidemiologia , Humanos , Lactente , Prevalência , Abastecimento de ÁguaRESUMO
INTRODUCTION: Dental fluorosis is endemic in the Rift Valley in Africa, especially around volcanic areas, due to the high fluoride content in daily drinking water. OBJECTIVE: This study evaluates the oral health status and types of occlusion in a school population, and to assess the possible association between dental fluorosis and other pathologies such as decay, gingivitis and periodontitis. MATERIAL AND METHODS: An observational study of 581 individuals recruited from a public secondary school in Arusha, Northern Tanzania was undertaken. The indices used were: the Silness & Löe Plaque Index, the Community Periodontal Index and the Decayed/Missing/Filled index. Descriptive statistical analyses were performed and a chi-square test was used to assess the associations between independent variables. RESULTS: Almost all the school children evaluated (96.73%) presented Angle class I dental occlusion, and 75.22% presented some degree of dental fluorosis. Most of the population (511, 87.95%) showed bleeding on probing. A moderate/high degree of some dental pathology (DMF score) was recorded in 14.46%. The association between dental fluorosis, gingival bleeding and tooth decay indicated a higher concentration of pathology in groups with more severe fluorosis (p<0.05). CONCLUSION: In this large population sample, both tooth decay and gingivitis were significantly associated with moderate or severe dental fluorosis.
Assuntos
Cárie Dentária/epidemiologia , Fluoretação/efeitos adversos , Fluoretos/análise , Fluorose Dentária/epidemiologia , Gengivite/epidemiologia , Doenças Periodontais/epidemiologia , Abastecimento de Água , Criança , Estudos Transversais , Feminino , Fluoretos/efeitos adversos , Humanos , Masculino , Saúde Bucal , Classe Social , Doenças Dentárias/prevenção & controleRESUMO
OBJECTIVES: To investigate the dental caries experience of New Zealand children born with orofacial cleft (OFC), to compare this to age-specific national population-based data and to investigate any differences by demographic characteristics, cleft type and exposure to community water fluoridation. METHODS: Nationwide retrospective study of 554 dental records from 478 children born after 1 January 2000 with OFC were assessed at aged 5 (n = 333) and 12 years (n = 221), with 76 children (15.9%) having records at both ages. Community Oral Health Service records were analysed to determine dental caries experience (dmft/DMFT). Logistic regression was used to assess the likelihood of having experienced dental caries (d3 mft/D3 MFT ≥ 1) and multivariable models for variables including demographic characteristics, cleft type and exposure to community water fluoridation. RESULTS: A higher (49.6%) caries prevalence (dmft ≥ 1) and mean dmft at 5 years old (2.3; SD 3.6) were found in children with OFC than 5-year-olds in the general population (prevalence 40.4% and mean dmft 1.8). The 12-year-old (37.6%) caries prevalence (DMFT ≥ 1) and mean DMFT 0.8 (SD 1.4) were similar to population-based data (caries prevalence 37.3% and mean DMFT 0.9). Children with caries (dmf/DMF ≥ 1) had means of 4.8 (SD 3.8) at age 5 and 2.1 (SD 1.4) at age 12 years. Greater caries experience was associated Pacific and Maori ethnicity, and not receiving community water fluoridation. No differences were detected by sex or cleft type. CONCLUSION: The dental caries experience for 5-year-old children with OFC was poor in relation to population-based data and similar for 12-year-olds. Preventive guidelines for children with OFC from an early age should be a priority, along with the extension of community water fluoridation coverage.