[Dental caries in 12-year-old schoolchildren from a non-fluoridated municipality in the Western Brazilian Amazon, Brazil, 2010]. / Cárie dentária em escolares de 12 anos de idade em município sem água fluoretada na Amazônia Ocidental brasileira, 2010.

OBJECTIVE: to describe dental caries occurrence and dental care received among 12-year-old schoolchildren in a small town in the Amazon region according to sex and area of residence. METHODS: this was a descriptive study conducted in Acrelandia-AC, Brazil, in 2010; DMFT and dental care indexes were estimated in accordance with World Health Organization recommendations. RESULTS: 186 schoolchildren participated, 47.8% were girls and 41.4% lived in the rural area; DMFT was 2.15 (1.77;2.52) without differences between the categories; the care index was 32.8%, with higher rates for the rural area (p<0.001). CONCLUSION: although they lived in a non-fluoridated area, the schoolchildren had a caries experience and dental care pattern closer to that of Brazil as a whole rather than that of the Northern region; the hypothesis of association with the level of human development and the performance of Family Health Strategy Oral Health teams is discussed.

Cárie dentária em escolares de 12 anos de idade em município sem água fluoretada na Amazônia Ocidental brasileira, 2010 / Dental caries in 12-year-old schoolchildren from a non-fluoridated municipality in the Western Brazilian Amazon, Brazil, 2010 / Caries dental en escolares de 12 años de edad en municipio sin agua fluorada en la Amazonia Occidental brasileña, 2010

OBJETIVO: descrever a ocorrência da cárie dentária e o cuidado odontológico recebido por escolares de 12 anos de idade em município de pequeno porte na região amazônica, segundo sexo e área de residência. MÉTODOS: estudo descritivo realizado em Acrelândia-AC, Brasil, em 2010; foram estimados o CPOD e o índice de cuidados odontológicos, segundo recomendações da Organização Mundial da Saúde. RESULTADOS: participaram 186 escolares, sendo 47,8% meninas e 41,4% residentes na zona rural; o CPOD foi de 2,15 (1,77;2,52), sem diferenças entre as categorias; o índice de cuidados foi de 32,8%, com valores mais elevados para a zona rural (p<0,001). CONCLUSÃO: embora não beneficiados por água fluoretada, os escolares apresentaram padrão de cárie e de cuidado odontológico mais próximo ao do conjunto Brasil que ao da região Norte; hipótese de associação com o nível de desenvolvimento humano e atuação das equipes de saúde bucal na Estratégia Saúde da Família foi discutida.

OBJECTIVE: to describe dental caries occurrence and dental care received among 12-year-old schoolchildren in a small town in the Amazon region according to sex and area of residence. METHODS: this was a descriptive study conducted in Acrelandia-AC, Brazil, in 2010; DMFT and dental care indexes were estimated in accordance with World Health Organization recommendations. RESULTS: 186 schoolchildren participated, 47.8% were girls and 41.4% lived in the rural area; DMFT was 2.15 (1.77;2.52) without differences between the categories; the care index was 32.8%, with higher rates for the rural area (p<0.001). CONCLUSION: although they lived in a non-fluoridated area, the schoolchildren had a caries experience and dental care pattern closer to that of Brazil as a whole rather than that of the Northern region; the hypothesis of association with the level of human development and the performance of Family Health Strategy Oral Health teams is discussed.

OBJETIVOS: describir la presencia de caries dental y atención odontológica recibida por escolares de 12 años de edad, en un pequeño municipio en la región amazónica según sexo y área de residencia. MÉTODOS: estudio descriptivo realizado en Acrelandia-AC, Brasil, en 2010, fueron estimados el CPOD e el índice de cuidados odontológicos según recomendaciones de la Organización Mundial de la Salud. RESULTADOS: participaron 186 escolares, siendo 47,8% mujeres y 41,4% residentes de zona rural; el CPOD fue 2,15 (1,77;2,52), sin diferencias entre las categorías; el índice de cuidados odontológicos fue 32,8%, con valores superiores para la zona rural (p<0,000). CONCLUSIÓN: a pesar no ser beneficiarios de agua fluorada, los escolares mostraron un padrón de caries y cuidados odontológicos más próximo al de todo Brasil que al de la región norte; se discute la hipótesis de asociación con el nivel de desarrollo humano y el desempeño de los equipos de Salud Bucal de la Estrategia Salud de la Familia.

[Public water supply fluoridation in Brazil according to health sector leaders]. / Fluoretação das águas de abastecimento público no Brasil: o olhar de lideranças de saúde.

Various groups have opposed water supply fluoridation in Brazil, while others have supported the measure based on scientific evidence. This article describes the perceptions of delegates to the 13th National Health Conference on mandatory fluoridation of the country's public water supply. Interviews were processed using collective subject discourse analysis. A certain degree of misinformation persists regarding basic characteristics of water fluoridation, which is frequently confused with chlorination. The delegates' discourses showed a continuing need for public awareness-raising regarding fluoridation and the delegates' desire that the National Congress not take measures impacting public health without consulting society's stakeholders. However, most of the interviewees agreed that to repeal mandatory water fluoridation or loosen the control of its implementation could increase the incidence of tooth decay in the population.

Fluoretação das águas de abastecimento público no Brasil: o olhar de lideranças de saúde / Public water supply fluoridation in Brazil according to health sector leaders / Fluorización de las aguas de abastecimiento público en Brasil: el punto de vista de los líderes en salud

Desde sua implantação, a fluoretação das águas tem enfrentado oposição de alguns grupos, enquanto outros, baseados em evidência científica, apoiam a medida. Neste artigo, descrevem-se as percepções dos delegados à 13ª Conferência Nacional de Saúde sobre a obrigatoriedade da fluoretação das águas de abastecimento público no Brasil. Como técnica de processamento de depoimentos, utilizou-se o Discurso do Sujeito Coletivo. Constata-se que, mais do que dúvidas, persiste certo grau de desinformação sobre aspectos básicos da fluoretação das águas, frequentemente confundida com a cloração. Torna-se evidente também a necessidade de permanente divulgação à sociedade de dados sobre a fluoretação da água e o desejo de que medidas que afetam a saúde pública não sejam tomadas pelo Congresso Nacional sem que se ouçam os setores interessados. Conforme a percepção majoritária dos participantes deste estudo, a revogação da obrigatoriedade de fluoretar as águas ou deficiências no controle sanitário de sua aplicação poderiam, no contexto brasileiro, piorar os índices populacionais de cárie dentária.

Various groups have opposed water supply fluoridation in Brazil, while others have supported the measure based on scientific evidence. This article describes the perceptions of delegates to the 13th National Health Conference on mandatory fluoridation of the country’s public water supply. Interviews were processed using collective subject discourse analysis. A certain degree of misinformation persists regarding basic characteristics of water fluoridation, which is frequently confused with chlorination. The delegates’ discourses showed a continuing need for public awareness-raising regarding fluoridation and the delegates’ desire that the National Congress not take measures impacting public health without consulting society’s stakeholders. However, most of the interviewees agreed that to repeal mandatory water fluoridation or loosen the control of its implementation could increase the incidence of tooth decay in the population.

Desde su implantación, la fluorización del agua se ha encontrado con la oposición de diversos grupos, mientras que otros, basándose en evidencias científicas, sí apoyan la medida. En el presente artículo se describen las opiniones de los participantes en la 13ª Conferencia Nacional de Salud sobre la obligatoriedad de la fluorización de las aguas de abastecimiento público en Brasil. El método utilizado de procesamiento de testimonios ha sido el Discurso del Sujeto Colectivo. Parece que, más que dudas, lo que persiste en la actualidad es cierto grado de desinformación sobre los aspectos básicos de fluorización del agua. Resulta evidente la necesidad de la divulgación pública permanente de los datos sobre la fluorización del agua, así como el deseo de que el Congreso Nacional se abstenga de tomar medidas que afectan a la salud pública, sin antes escuchar a los sectores afectados. De acuerdo con la percepción mayoritaria de los participantes, la revocación de la obligatoriedad de fluorizar las aguas o las deficiencias en el control podrían aumentar los índices de caries dentales.

Aspectos éticos e o uso de produtos fluorados na visão de lideranças de saúde / Ethical aspects and the use of fluoride products in the viewpoint of health leaders

O flúor tem sido empregado na prevenção da cárie dentária, principalmente em águas de abastecimento e dentifrícios. Um efeito indesejável, a fluorose leve, tem suscitado preocupações entre especialistas. Este trabalho descreve as percepções dos delegados na 13ª Conferência Nacional de Saúde no que se refere aos aspectos éticos relacionados ao uso de substâncias e produtos fluorados. Realizou-se pesquisa exploratória, descritiva, com abordagem qualitativa, utilizando-se como técnica de processamento de depoimentos o Discurso do Sujeito Coletivo (DSC). A população de estudo foi definida por conveniência, e o critério de escolha foi participar da Conferência como delegado. Ao todo, foram 310 respondentes. Os dados foram coletados por meio de questionários semiestruturados e analisados pela análise do discurso. Nos discursos dos participantes da pesquisa, estiveram presentes aspectos éticos relacionados à falta de liberdade de escolha, à falta de informação disponível aos usuários sobre os produtos fluorados e sobre o controle dos níveis de flúor nesses produtos. Houve também quem acreditasse que o custo-benefício da fluoretação supera qualquer aspecto ético que possa estar presente. Questões éticas são frequentemente vistas pelos participantes da pesquisa como algo desconhecido ou complexo. Existe a crença de que a população em geral está despreparada para discutir o assunto com propriedade, já que este é mais bem compreendido pela parcela da sociedade composta por gestores e profissionais de saúde. Não houve consenso quanto à presença ou não de fatores éticos no uso de produtos fluorados...

Fluoride has been used in the prevention of dental caries, especially in drinking water and toothpaste. An undesirable effect, mild fluorosis, has raised concerns among experts. This paper describes the perceptions of the delegates at the 13th Brazilian National Health Conference concerning ethical issues related to the use of substances and fluorinated products. We conducted exploratory, descriptive study with a qualitative approach, using as processing technique testimonials the Collective Subject Discourse (CSD). The study population was defined by convenience, and the choice criterion was attending the conference as a delegate. In all, there were 310 respondents. Data were collected through semi-structured questionnaires and analyzed by discourse analysis. In the speeches of participants, there were ethical aspects related to the lack of freedom of choice, the lack of information available to users on fluorinated products and the control of fluoride levels in these products. Also there were people who believed that the cost-effectiveness of fluoridation outweighs any ethical aspect that may be present. Ethical issues are often seen by the research participants as something unknown or complex. There is the belief that the general population is unprepared to discuss it properly, as this is best understood by managers and health professionals. There was no consensus as to the presence or absence of ethical factors in the use of fluorinated products...

Oral cancer calibration and diagnosis among professionals from the public health in São Paulo, Brazil.

UNLABELLED: Oral cancer is a public health problem responsible for 13% of deaths worldwide in 2008 and screening programs can be useful to detect individuals more vulnerable to the disease, improving its prognosis. OBJECTIVES: The aim of the present study was to evaluate oral cancer calibration (in lux and in vivo methodologies) and diagnosis processes performed by dental surgeons (DSs) of the public health system in São Paulo, Brazil. MATERIAL AND METHODS: Thirty-three oral cancer photographs were examined during in lux calibration, while 560 individuals were examined during in vivo calibration. Oral conditions were coded as "0 - sound tissues", "1 - buccal lesions without malignant potential" and "2 - buccal lesions with malignant potential". The final sample for oral cancer screening was composed of 336 individuals, age-range 40 years or older. RESULTS: Kappa values for interexaminer agreement were 0.67 and 0.45 for in lux and in vivo respectively. The accuracy of both methodologies was over 80%. Oral cancer screening revealed 48 healthy individuals, 273 oral lesions coded as "1" and 12 oral lesions coded as "2". CONCLUSION: In spite of the low reproducibility, the validity of the visual examination in oral cancer screening was satisfactory, showing its importance as part of preventive oral cancer programs and public health system campaigns.

Significados da água na visão de lideranças de saúde / The meanings of water in the vision of health care leaders

Este estudo apresenta as percepções dos delegados à 13ª Conferência Nacional de Saúde sobre os significados da água, no contexto da saúde pública, e sobre o papel do Estado na garantia do acesso à água tratada. Trata-se de uma pesquisa descritiva, com abordagem qualitativa, utilizando-se como técnica de processamento de depoimentos o Discurso do Sujeito Coletivo. A população de estudo consistiu dos delegados à 13ª Conferência Nacional de Saúde. Ao todo, participaram 310 desses delegados, distribuídos da seguinte maneira: 56 na etapa municipal, em Fortaleza (CE), 143 na estadual (Ceará) e 111 na nacional. Os dados foram coletados por meio de questionários e analisados utilizando-se, como estratégia metodológica, a análise do discurso. Os delegados percebem a água tratada como um bem essencial à saúde e à qualidade de vida, reconhecendo o problema da crescente escassez e degradação dos recursos hídricos, assim como as deficiências no acesso e no tratamento da água. Acreditam, ainda, que o Estado deve ter um papel protetor no provimento de água tratada, garantindo o acesso universal a esse bem. Pelos discursos, detectam-se fragilidades no tratamento da água e na vigilância sanitária, bem como nos mecanismos de informação sobre assuntos relativos à água de abastecimento público, o que aponta para a necessidade de uma participação mais efetiva da sociedade nos espaços deliberativos que lhe são concedidos para o exercício de sua cidadania.

This study presents the delegates to the 13th National Health Conference perceptions on the meanings of water in the context of public health, and of the state's role in ensuring access to clean water. This is a descriptive study of qualitative approach, using the Discourse of Collective Subject as technique for processing the statements. The study population comprised 310 delegates to the 13th National Conference on Health, distributed as follows: 56 in municipal stage, Fortaleza (CE), 143 in the state stage (Ceará) and 111 in national stage. Data were collected by questionnaires and analyzed using discourse analysis as a methodological strategy. The delegates perceive treated water as an essential good for health and quality of life and welfare, whilst recognizing the problem of increasing scarcity and degradation of water resources and the deficiencies in access and treatment of water. They also believe that the state must have a protective role in providing clean water, ensuring universal access to that good. By the speeches, weaknesses could be detected in water treatment and health surveillance, as well as on the mechanisms of information on matters relating to public water supply; these indicatethe need for more effective participation of society in deliberative spaces that are granted for the exercise of their citizenship.

Desigualdades sociais e doenca periodontal no estudo SBBrasil 2010: abordagem multinivel / Desigualdades sociales y enfermedad periodontal en el estudio SBBrasil 2010: abordaje multinivel / Social inequalities and periodontal disease: multilevel approach in SBBrasil 2010 survey

OBJETIVO: Estimar a prevalência e a distribuição geográfica da doença periodontal na população adulta brasileira e sua associação com desigualdades sociais contextuais e individuais. MÉTODOS: Foram utilizados dados dos adultos de 35 a 44 anos de idade da Pesquisa Nacional de Saúde Bucal – SBBrasil 2010 (n = 9.564). O Índice Periodontal Comunitário (CPI) e o Índice de Perda Periodontal (PIP) foram usados para definir a doença periodontal em “moderada a grave” (CPI > 2 e PIP > 0) e “grave” (CPI > 2 e PIP > 1). As desigualdades sociais contextuais incluíram o índice de desenvolvimento humano e a desigualdade de renda (Índice de Gini). Outras variáveis contextuais foram a cobertura de equipes de saúde bucal da Estratégia de Saúde da Família e o percentual de adultos fumantes. Modelos de regressão logística multinível para os participantes com dados completos (n = 4.594) foram usados para estimar odds ratios (OR) e intervalos de 95% de confiança (IC95%) entre desigualdades sociais e doença periodontal. RESULTADOS: A prevalência da doença periodontal “moderada a grave” em brasileiros adultos foi de 15,3% e 5,8% para a condição “grave”, com variações consideráveis entre os municípios. Dentre as variáveis contextuais, a desigualdade de renda foi independentemente associada com a doença periodontal “grave” (OR = 3,0; IC95% 1,5;5,9). A menor cobertura de equipes de saúde bucal foi associada com as duas formas de doença periodontal, enquanto o percentual de fumantes manteve-se associado com a doença periodontal “moderada a grave”. Adultos com idade mais avançada, de cor de pele parda, sexo masculino, menor renda familiar e menor escolaridade apresentaram ...

OBJETIVO: Estimar la prevalencia y la distribución geográfica de la enfermedad periodontal en la población adulta brasileña y su asociación con desigualdades sociales contextuales e individuales. MÉTODOS: Se utilizaron datos de adultos de 35 a 44 años de edad de la Investigación Nacional de Salud Bucal – SBBrasil 2010 (n= 9.564). El Índice Periodontal Comunitario (CPI) y el Índice de Pérdida Periodontal (PIP) fueron usados para definir la enfermedad periodontal en “moderada a grave” (CPI>2 y PIP>0) y “grave” (CPI>2 y PIP>1). Las desigualdades sociales contextuales incluyeron el índice de desarrollo humano y la desigualdad de renta (Índice de Gini). Otras variables contextuales fueron la cobertura de equipos de salud bucal de la Estrategia de Salud de la Familia y el porcentaje de adultos fumadores. Modelos de regresión logística multinivel para los participantes con datos completos (n= 4.594) fueron usados para estimar odds ratios (OR) e intervalos de 95% de confianza (IC95%) entre desigualdades sociales y enfermedad periodontal. RESULTADOS: La prevalencia de la enfermedad periodontal “moderada a grave” en brasileños adultos fue de 15,3% y 5,8% para la condición “grave”, con variaciones considerables entre los municipios. Entre las variables contextuales, la desigualdad de renta fue independientemente asociada con la enfermedad periodontal “grave” (OR=3,0; IC95% 1,5;5,9). La menor cobertura de equipos de salud bucal fue asociada con las dos formas de enfermedad periodontal, mientras que el porcentaje de fumadores se mantuvo asociado con la enfermedad periodontal “moderada a grave”. Adultos con edad más avanzada, de color de piel parda, sexo masculino, menor renta familiar y menor escolaridad presentaron mayores chances para ambas condiciones periodontales ...

OBJECTIVE: To estimate the prevalence and geographical distribution of periodontal disease in the Brazilian adult population and its associations with contextual and individual social inequalities. METHODS: Data from adults aged 35 to 44 who participated in the 2010 Brazilian Brazilian Oral Health Survey (SBBrasil 2010) (n = 9,564) were used. The Community Periodontal Index (CPI) and clinical attachment loss (CAL) were used to define “moderate to severe” periodontal disease (CPI > 2 and CAL > 0) and “severe” periodontal disease (CPI > 2 and CAL > 1). Contextual social inequalities assessed were Human Development Index and income inequalitiy (Gini Index). Other contextual variables were integration of oral health teams in the Family Health Programme and the percentage of adult smokers. Multilevel logistic regression models for participants with complete data (n = 4,594) were used to estimate odds ratios (OR) and 95% confidence intervals (95%CI) between social inequalities and periodontal disease. RESULTS: The prevalence of “moderate to severe” and “severe” periodontal disease in Brazilian adults was 15.3% and 5.8%, respectively, with considerable variation across municipalities. Of the contextual variables, income inequality was independently associated with “severe” periodontal disease (OR = 3.0, 95%CI 1.5;5.9). Lower oral health teams coverage was associated with both definitions of periodontal disease whereas the percentage of smokers remained associated with “moderate to severe” periodontal disease. Older adults, brown skin color, males and those with lower family income and less schooling were more likely to both periodontal conditions. CONCLUSIONS: In Brazil, the prevalence of periodontal disease varied across the municipalities and according to definition of periodontal disease. Income inequality played a significant role in the occurrence ...

Prevalencia e extensao da carie dentaria radicular em adultos e idosos brasileiros / Prevalencia y extension de la caries dentaria radicular en adultos y ancianos / Root caries prevalence and severity in Brazilian adults and older people

OBJETIVO: Estimar a prevalência e a extensão da cárie radicular na população adulta e idosa do Brasil. MÉTODOS: A partir dos dados da Pesquisa Nacional de Saúde Bucal (SBBrasil 2010) foram examinados 9.564 adultos e 7.509 idosos em domicílios das 26 capitais e no Distrito Federal e de 150 municípios do interior de cada macrorregião. Adotaram-se os critérios de diagnóstico preconizados pela Organização Mundial da Saúde. Para estudo da prevalência e de extensão utilizou-se o índice de cárie radicular e o índice de raízes cariadas e obturadas. RESULTADOS: A prevalência de cárie radicular foi de 16,7% nos adultos e 13,6% nos idosos; o índice de raízes cariadas e obturadas foi de 0,42 e 0,32, respectivamente, a maior parte composta por cárie não tratada. Observaram-se diferenças na experiência de cárie radicular entre capitais e macrorregiões, com valores maiores em capitais do Norte e Nordeste. O índice de cárie radicular nos adultos variou de 1,4% em Aracaju (SE) a 15,1% em Salvador (BA) e nos idosos de 3,5% em Porto Velho (RO) a 29,9% em Palmas (TO). Verificou-se incremento da cárie radicular com a idade e maior expressividade da doença em homens de ambos os grupos etários. CONCLUSÕES: Identificou-se uma grande variação da prevalência e extensão da cárie radicular entre e dentro das regiões do Brasil, tanto em adultos quanto em idosos, e a maior parte da cárie radicular encontra-se não tratada. Recomenda-se a incorporação deste agravo ao sistema de vigilância em saúde bucal, devido à sua tendência crescente. .

OBJETIVO: Estimar la prevalencia y la extensión de la caries radicular en la población adulta y anciana de Brasil. MÉTODOS: A partir de los datos de la Investigación Nacional de Salud Bucal (SBBrasil 2010) se examinaron 9.564 adultos y 7.509 ancianos en domicilios de las 26 capitales y en el Distrito Federal y de 150 municipios del interior de cada macro región. Se implementaron criterios de diagnóstico establecidos por la Organización Mundial de la Salud. Para estudio de la prevalencia y de extensión se utilizó el índice de caries radicular y el índice de raíces cariadas y obturadas. RESULTADOS: La prevalencia de caries radicular fue de 16,7% en los adultos y 13,6% en los ancianos; el índice de raíces cariadas y obturadas fue de 0,42 y 0,32 respectivamente, siendo la mayor parte compuesta por caries no tratadas. Se observaron diferencias en la experiencia de caries radicular entre capitales y macro regiones, con valores mayores en capitales del Norte y Noreste. El índice de caries radicular en los adultos varió de 1,4% en Aracaju (SE) a 15,1% en Salvador (BA) y en los ancianos de 3,5% en Porto Velho (RO) a 29,9% en Palmas (TO). Se verificó incremento de caries radicular con la edad y mayor expresividad de la enfermedad en hombres de ambos grupos etarios. CONCLUSIONES: Se identificó una gran variación de la prevalencia y extensión de la caries radicular entre y dentro de las regiones de Brasil, tanto en adultos como en ancianos, y la mayor parte de la caries radicular se encuentra no tratada. Se recomienda la incorporación de este agravio al sistema de vigilancia en salud bucal, debido a su tendencia creciente. .

OBJECTIVE: To estimate the prevalence of root caries in Brazilian adults and elderly. METHODS: We assessed data from the Brazilian Oral Health Survey (SBBrasil 2010). Dental examinations were performed on 9,564 adults and 7,509 elderly individuals in households in the 26 state capitals, the Federal District and 150 provincial towns. Diagnostic criteria and data assessment tools were those standardized by the World Health Organization. The outcome was measured by using root caries index and the index of decayed and filled dental roots. RESULTS: The prevalence of root caries was 16.7% in adults and 13.6% in the elderly. The index of decayed and filled dental roots was 0.42 and 0.32 for adults and the elderly respectively, with most of the index represented by untreated caries. The prevalence of root caries differed significantly among states capitals and provincial towns, with higher values being reported in the state capitals in the North and Northeastern Brazilian regions. In adults, the root caries index ranged from 1.4% in Aracaju to 15.1% in Salvador (both in the Northeast). Among the elderly, this index ranged from 3.5% in Porto Velho to 29.9% in Palmas (both North). Root caries was more prevalent in men than in women in both age groups. CONCLUSIONS: There is a wide variation in root caries indices in adults and in the elderly, and between and within Brazilian regions. Most root caries is untreated. We recommend the incorporation of this disease into the oral health surveillance system. .

Fluorose dentaria em criancas de Sao Paulo, SP, 1998-2010 / Fluorosis dentaria en ninos de Sao Paulo, SP, 1998-2010 / Dental fluorosis in children from Sao Paulo, Southeastern Brazil, 1998-2010

OBJETIVO: Analisar a tendência de prevalência de fluorose dentária em crianças de 12 anos em contexto de exposição a múltiplas fontes de flúor. MÉTODOS: Realizou-se análise de tendência da prevalência de fluorose dentária no período de 1998 a 2010 na cidade de São Paulo, SP. As prevalências foram calculadas para diferentes anos (1998, 2002, 2008 e 2010), a partir de dados secundários obtidos em levantamentos epidemiológicos com amostras representativas da população de 12 anos de idade. A ocorrência de fluorose foi avaliada sob luz natural utilizando o índice de Dean, preconizado pela Organização Mundial da Saúde e categorizada em normal, questionável, muito leve, leve, moderada e severa. Em 1998 foram examinadas 125 crianças; 249 em 2002; 4.085 em 2008; e 231 em 2010. RESULTADOS: Em 1998 a prevalência de fluorose foi de 43,8% (IC95%35,6;52,8), em 2002 de 33,7% (IC95% 28,2;39,8), de 40,3% (IC95% 38,8;41,8) em 2008 e de 38,1% (IC95% 32,1;44,5) em 2010. As categorias muito leve + leve registraram 38,4% (IC95%30,3;47,6) em 1998, 32,1% (IC95% 26,6;38,2) em 2002, 38,0% (IC95% 36,5;39,5) em 2008 e 36,4% (IC95%30,4;42,7) em 2010. Não se observou fluorose severa com significância estatística. CONCLUSÕES: A prevalência de fluorose dentária em crianças paulistanas pode ser classificada como estacionária no período de 1998 a 2010, tanto em geral quanto ao se considerarem apenas as categorias muito leve + leve. .

OBJETIVO: Analizar la tendencia de prevalencia de fluorosis dentaria en niños de 12 años en contexto de exposición a múltiples fuentes de flúor. MÉTODOS: Se realizó análisis de tendencia de la prevalencia de fluorosis dentaria en el período de 1998 a 2010 en la ciudad de Sao Paulo, SP, Brasil. Las prevalencias fueron calculadas para diferentes años (1998, 2002, 2008 y 2010), a partir de datos secundarios obtenidos en pesquisas epidemiológicas con muestras representativas de la población de 12 años de edad. La ocurrencia de fluorosis fue evaluada bajo la luz natural utilizando el índice de Dean, recomendado por la Organización Mundial de la Salud y, categorizada como normal, cuestionable, muy leve, leve, moderada y severa. En 1998 fueron examinadas 125 niños; 249 en 2002; 4.085 en 2008 y 231 en 2010. RESULTADOS: En 1998 la prevalencia de fluorosis fue de 43,8% (IC95%35,6;52,8), en 2002 de 33,7% (IC95% 28,2;39,8), de 40,3% (IC95% 38,8;41,8) en 2008 y de 38,1% (IC95% 32,1;44,5), en 2010. Las categorías muy leve+leve registraron 38,4% (IC95%30,3;47,6) en 1998, 32,1% (IC95% 26,6;38,2) en 2002, 38,0% (IC95% 36,5;39,5) en 2008 y 36,4% (IC95%30,4;42,7) en 2010. No se observo fluorosis severa con significancia estadística. CONCLUSIONES: La prevalencia de fluorosis dentaria en niños paulistanos pudo ser clasificada como estacionaria en el período de 1998 a 2010, tanto en general como al considerar sólo las categorías muy leve+leve. .

OBJECTIVE: To assess the trend of dental fluorosis prevalence in 12-year-old children, in the context of exposure to multiple sources of fluoride. METHODS: An analysis was carried out of the trends in prevalence of dental fluorosis in the city of São Paulo, Southeastern Brazil, between 1998 and 2010. The rates of prevalence were calculated for different years (1998, 2002, 2008 and 2010) using secondary data obtained from epidemiological surveys of representative samples of 12-year-old children. Occurrence of fluorosis was assessed in natural light using the Dean index, recommended by the World Health Organization and categorized into normal, questionable, very mild, mild, moderate and severe. In 1998, 125 children were examined, 249 in 2002, 4,085 in 2008 and 231 in 2010. RESULTS: In 1998 the prevalence of fluorosis was 43.8% (95%CI 35.6;52.8) in 2002 it was 33.7% (95%CI 28.2;39.8), it was 40.3% (95%CI 38.8;41.8) in 2008 and 38.1% (95%CI 32.1;44.5) in 2010.The categories very mild + mild totaled 38.4% (95%CI 30.3;47.6) in 1998, 32.1% (95%CI 26.6;38.2) in 2002, 38.0% (95%CI 36.5;39.5) in 2008 and 36.4% (95%CI 30.4;42.7) in 2010. Severe fluorosis was not observed, with statistical significance, in the analyzed period. CONCLUSIONS: The prevalence of dental fluorosis in children from São Paulo can be classified as stationary between 1998 and 2010, both when considering all categories, and when considering only the categories very mild + mild. .

[Multiple aspects of the use of fluorine in public health from the viewpoint of healthcare leaders]. / Múltiplos aspectos do uso do flúor em saúde pública na visão de lideranças da área de saúde.

The article describes the perceptions of health care leaders on issues relating to the use of fluorine in public health. This is a descriptive study with a qualitative approach, using Collective Subject Discourse (DCS) as technique for processing the statements. The study population was comprised of delegates to the 13th National Health Conference; the sample was defined by convenience and consisted of 310 delegates: 56 at municipal level in Fortaleza (CE), 143 at state level (Ceará) and 111 at national level. Data were collected by semi-structured questionnaires. There were gaps in knowledge about various aspects of the use of fluorine in public health, which indicates the need to improve the level of information of society on issues relating to fluoridation. The lack of knowledge of delegates, together with the data found in the literature about the shortcomings in the monitoring and control of fluorine levels in water, are indicative of the need to reassess the role of social actors and the mechanisms used in social control.

Múltiplos aspectos do uso do flúor em saúde pública na visão de lideranças da área de saúde / Multiple aspects of the use of fluorine in public health from the viewpoint of healthcare leaders

O artigo descreve as percepções de lideranças da área de saúde sobre aspectos relativos ao uso do flúor em saúde pública. Trata-se de uma pesquisa descritiva, com abordagem qualitativa, utilizando-se como técnica de processamento de depoimentos o Discurso do Sujeito Coletivo (DSC). A população de estudo foi constituída pelos delegados à 13ª Conferência Nacional de Saúde, sendo a amostra definida por conveniência e composta por 310 delegados: 56 na etapa municipal, em Fortaleza (CE), 143 na estadual (Ceará) e 111 na nacional. Os dados foram coletados por meio de questionários semiestruturados. Verificaram-se lacunas de conhecimento sobre diversos aspectos do uso do flúor em saúde pública, o que indica a necessidade de se melhorar o nível de informação da sociedade sobre questões relativas à fluoretação. O desconhecimento dos delegados aliado aos dados encontrados na literatura sobre as deficiências no monitoramento e controle dos níveis de flúor na água são indicativos da necessidade de se reavaliar o papel dos atores sociais e dos mecanismos utilizados no controle social.

The article describes the perceptions of health care leaders on issues relating to the use of fluorine in public health. This is a descriptive study with a qualitative approach, using Collective Subject Discourse (DCS) as technique for processing the statements. The study population was comprised of delegates to the 13th National Health Conference; the sample was defined by convenience and consisted of 310 delegates: 56 at municipal level in Fortaleza (CE), 143 at state level (Ceará) and 111 at national level. Data were collected by semi-structured questionnaires. There were gaps in knowledge about various aspects of the use of fluorine in public health, which indicates the need to improve the level of information of society on issues relating to fluoridation. The lack of knowledge of delegates, together with the data found in the literature about the shortcomings in the monitoring and control of fluorine levels in water, are indicative of the need to reassess the role of social actors and the mechanisms used in social control.

Fluoretação da água e insuficiências no sistema de informação da política de vigilância à saúde / Water fluoridation and shortcomings within information system for the health surveillance policy

Controle da qualidade da água consumida pela população é atribuição do Programa de Vigilância da Qualidade da Água para Consumo Humano, e o fluoreto é um dos parâmetros registrados pelo Sistema de Informação (SISAGUA). Objetivo: Analisar a adequação do instrumento utilizado pelo SISAGUA, para registro de dados relacionados ao fluoreto e dimensionar sua cobertura no território brasileiro. Método: Foram utilizadas técnicas de análise documental, com descrição e crítica do conteúdo relacionado especificamente com o parâmetro fluoreto a partir de relatórios obtidos nas páginas do sistema na rede mundial de computadores. Dados fornecidos pelo Ministério da Saúde relativos à alimentação do sistema no ano de 2008 foram analisados segundo características dos municípios. Resultados: Constatou-se subalimentação e ausência dos dados requeridos para ações de vigilância. Em 2008, 62,7% (n=3.489) dos municípios brasileiros não estava cadastrado ou não alimentava o sistema ao menos quatro vezes/ano. Falta de cadastro e de alimentação do sistema foi associada a municípios com piores indicadores sanitários, econômicos e de desenvolvimento humano. O teor de fluoreto, em mg/L é informado no sistema por meio dos valores médio mensal e máximo mensal. Muitos municípios informam apenas a média mensal gerando estatísticas insuficientes para avaliar a adequação dos teores. O sistema não possibilita identificar interrupções no processo da fluoretação. Conclusão: Há problemas com a estrutura do SISAGUA e com o seu uso pelos municípios. Em decorrência, os dados disponíveis são insuficientes para a vigilância da fluoretação da água, recomendando-se alterações no sistema, com vistas ao seu aperfeiçoamento e cumprimento da finalidade.

The control of drinking water quality in Brazil is due to the Drinking Water Quality Surveillance Program and the fluoride is one of the parameters monitored by the information system (SISAGUA). Objective. To analyze the appropriateness of the tool used by SISAGUA for registering of data related to fluoride and to estimate its coverage in Brazil. Method. Procedures of documental analysis and description of the content related to fluoride parameter based on outputs provided by electronic system were utilized. Data obtained from Brazilian Ministry of Health related to system feeding at 2008 were analyzed according to characteristics at municipal leveI. Results. Underfeeding and lack of required data for surveillance were observed. In 2008, 62.7% (n=3,489) of Brazilian municipalities was not registered or did not feed the system at least four times per year. Lack of register and system feeding was associated to worst indicators of sanitary, economic and human development at municipal leve I. The concentration of fluoride, in mg/L is informed within the system by monthly average and maximum values. Many counties inform only monthly average values generating insufficient statistics for fluoride concentration assessment. The system does not enable to identify interruptions of water fluoridation. Conclusion. The structure and use of SISAGUA showed problems at levei municipal. The available data are insufficient for water fluoridation surveillance. Changes for improving the information system are strongly recommended.

[Social inequalities and periodontal disease: multilevel approach in SBBrasil 2010 survey]. / Desigualdades sociais e doença periodontal no estudo SBBrasil 2010: abordagem multinível.

OBJECTIVE: To estimate the prevalence and geographical distribution of periodontal disease in the Brazilian adult population and its associations with contextual and individual social inequalities. METHODS: Data from adults aged 35 to 44 who participated in the 2010 Brazilian Brazilian Oral Health Survey (SBBrasil 2010) (n = 9,564) were used. The Community Periodontal Index (CPI) and clinical attachment loss (CAL) were used to define "moderate to severe" periodontal disease (CPI > 2 and CAL > 0) and "severe" periodontal disease (CPI > 2 and CAL > 1). Contextual social inequalities assessed were Human Development Index and income inequalitiy (Gini Index). Other contextual variables were integration of oral health teams in the Family Health Programme and the percentage of adult smokers. Multilevel logistic regression models for participants with complete data (n = 4,594) were used to estimate odds ratios (OR) and 95% confidence intervals (95%CI) between social inequalities and periodontal disease. RESULTS: The prevalence of "moderate to severe" and "severe" periodontal disease in Brazilian adults was 15.3% and 5.8%, respectively, with considerable variation across municipalities. Of the contextual variables, income inequality was independently associated with "severe" periodontal disease (OR = 3.0, 95%CI 1.5;5.9). Lower oral health teams coverage was associated with both definitions of periodontal disease whereas the percentage of smokers remained associated with "moderate to severe" periodontal disease. Older adults, brown skin color, males and those with lower family income and less schooling were more likely to both periodontal conditions. CONCLUSIONS: In Brazil, the prevalence of periodontal disease varied across the municipalities and according to definition of periodontal disease. Income inequality played a significant role in the occurrence of "severe" periodontal disease. Individual characteristics of social position were associated with both forms of periodontal disease.

[Root caries prevalence and severity in Brazilian adults and older people]. / Prevalência e extensão da cárie dentária radicular em adultos e idosos brasileiros.

OBJECTIVE: To estimate the prevalence of root caries in Brazilian adults and elderly. METHODS: We assessed data from the Brazilian Oral Health Survey (SBBrasil 2010). Dental examinations were performed on 9,564 adults and 7,509 elderly individuals in households in the 26 state capitals, the Federal District and 150 provincial towns. Diagnostic criteria and data assessment tools were those standardized by the World Health Organization. The outcome was measured by using root caries index and the index of decayed and filled dental roots. RESULTS: The prevalence of root caries was 16.7% in adults and 13.6% in the elderly. The index of decayed and filled dental roots was 0.42 and 0.32 for adults and the elderly respectively, with most of the index represented by untreated caries. The prevalence of root caries differed significantly among states capitals and provincial towns, with higher values being reported in the state capitals in the North and Northeastern Brazilian regions. In adults, the root caries index ranged from 1.4% in Aracaju to 15.1% in Salvador (both in the Northeast). Among the elderly, this index ranged from 3.5% in Porto Velho to 29.9% in Palmas (both North). Root caries was more prevalent in men than in women in both age groups. CONCLUSIONS: There is a wide variation in root caries indices in adults and in the elderly, and between and within Brazilian regions. Most root caries is untreated. We recommend the incorporation of this disease into the oral health surveillance system.

[Dental fluorosis in children from São Paulo, Southeastern Brazil, 1998-2010]. / Fluorose dentária em crianças de São Paulo, SP, 1998-2010.

OBJECTIVE: To assess the trend of dental fluorosis prevalence in 12-year-old children, in the context of exposure to multiple sources of fluoride. METHODS: An analysis was carried out of the trends in prevalence of dental fluorosis in the city of São Paulo, Southeastern Brazil, between 1998 and 2010. The rates of prevalence were calculated for different years (1998, 2002, 2008 and 2010) using secondary data obtained from epidemiological surveys of representative samples of 12-year-old children. Occurrence of fluorosis was assessed in natural light using the Dean index, recommended by the World Health Organization and categorized into normal, questionable, very mild, mild, moderate and severe. In 1998, 125 children were examined, 249 in 2002, 4,085 in 2008 and 231 in 2010. RESULTS: In 1998 the prevalence of fluorosis was 43.8% (95%CI 35.6;52.8) in 2002 it was 33.7% (95%CI 28.2;39.8), it was 40.3% (95%CI 38.8;41.8) in 2008 and 38.1% (95%CI 32.1;44.5) in 2010.The categories very mild + mild totaled 38.4% (95%CI 30.3;47.6) in 1998, 32.1% (95%CI 26.6;38.2) in 2002, 38.0% (95%CI 36.5;39.5) in 2008 and 36.4% (95%CI 30.4;42.7) in 2010. Severe fluorosis was not observed, with statistical significance, in the analyzed period. CONCLUSIONS: The prevalence of dental fluorosis in children from São Paulo can be classified as stationary between 1998 and 2010, both when considering all categories, and when considering only the categories very mild + mild.

[Relevant methodological issues from the SBBrasil 2010 Project for national health surveys]. / Aspectos metodológicos do Projeto SBBrasil 2010 de interesse para inquéritos nacionais de saúde.

The SBBrasil 2010 Project (SBB10) was designed as a nationwide oral health epidemiological survey within a health surveillance strategy. This article discusses methodological aspects of the SBB10 Project that can potentially help expand and develop knowledge in the health field. This was a nationwide survey with stratified multi-stage cluster sampling. The sample domains were 27 State capitals and 150 rural municipalities (counties) from the country's five major geographic regions. The sampling units were census tracts and households for the State capitals and municipalities, census tracts, and households for the rural areas. Thirty census tracts were selected in the State capitals and 30 municipalities in the countryside. The precision considered the demographic domains grouped by density of the overall population and the internal variability of oral health indices. The study evaluated dental caries, periodontal disease, malocclusion, fluorosis, tooth loss, and dental trauma in five age groups (5, 12, 15-19, 35-44, and 65-74 years).

[Evolution in access to fluoridated water in São Paulo State, Brazil, from the 1950s to the early 21st century]. / Evolução do acesso à água fluoretada no Estado de São Paulo, Brasil: dos anos 1950 à primeira década do século XXI.

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 São 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.

Aspectos metodológicos do Projeto SBBrasil 2010 de interesse para inquéritos nacionais de saúde / Relevant methodological issues from the SBBrasil 2010 Project for national health surveys

O Projeto SBBrasil 2010 (SBB10) foi concebido como um levantamento epidemiológico em saúde bucal, de base nacional, dentro da estratégia de vigilância em saúde. O objetivo deste artigo é apresentar aspectos da metodologia do SBB10 que possam contribuir para ampliar e desenvolver conhecimentos na área de saúde. Com relação ao plano amostral, trata-se de uma pesquisa por conglomerados e com múltiplos estágios. Capitais e municípios do interior das cinco regiões brasileiras compõem os domínios da amostra, cujas unidades amostrais foram, respectivamente, setor censitário e domicílio para as capitais, e município, setor censitário e domicílio para o interior. Nas capitais foram sorteados 30 setores e, no interior de cada região, 30 municípios. A precisão considerou os domínios agrupados segundo o grau de densidade no total da população e a variabilidade interna dos índices. Foram avaliadas as condições de cárie dentária, doença periodontal, oclusopatias, fluorose, traumatismo dentário e edentulismo em cinco grupos etários (5, 12, 15 a 19, 35 a 44 e 65 a 74 anos).

The SBBrasil 2010 Project (SBB10) was designed as a nationwide oral health epidemiological survey within a health surveillance strategy. This article discusses methodological aspects of the SBB10 Project that can potentially help expand and develop knowledge in the health field. This was a nationwide survey with stratified multi-stage cluster sampling. The sample domains were 27 State capitals and 150 rural municipalities (counties) from the country's five major geographic regions. The sampling units were census tracts and households for the State capitals and municipalities, census tracts, and households for the rural areas. Thirty census tracts were selected in the State capitals and 30 municipalities in the countryside. The precision considered the demographic domains grouped by density of the overall population and the internal variability of oral health indices. The study evaluated dental caries, periodontal disease, malocclusion, fluorosis, tooth loss, and dental trauma in five age groups (5, 12, 15-19, 35-44, and 65-74 years).