Consistency of information on the provision of water fluoridation in Brazil / Consistência das informações sobre a provisão da fluoretação da água no Brasil

ABSTRACT Objective: This study aimed to assess the consistency of data regarding the provision of fluoridation in Brazilian municipalities with water supply systems. Methods: Official data from the National Basic Sanitation Survey and the National Information System on Sanitation for 2017 were compared. Results: Out of 5,570 municipalities in Brazil, 4,546 (81.6%) had water supply systems. The agreement between data sources was 84%, with a Kappa of 0.668, indicating substantial agreement. However, the estimates of fluoridation provision exhibited an average discrepancy of 8.1 percentage points, ranging from 1.2 points in the Central-West region to 21.4 points in the Northeast region. Conclusion: To address these inconsistencies, it is essential to enhance information sources, ensuring more reliable data for health, sanitation authorities, and society at large.

RESUMO Objetivo: Avaliar a consistência dos dados sobre a provisão de fluoretação em municípios brasileiros com sistemas de abastecimento de água. Métodos: Foram comparados os dados da Pesquisa Nacional de Saneamento Básico e do Sistema Nacional de Informações sobre Saneamento referentes a 2017. Resultados: De 5.570 municípios no Brasil, 4.546 (81,6%) possuíam sistemas de água. A concordância entre as fontes foi de 84%, com Kappa de 0,668, indicando substancial concordância. Entretanto, as estimativas de provisão divergiram em média 8,1 pontos percentuais, variando de 1,2 ponto na região Centro-Oeste a 21,4 pontos na região Nordeste. Conclusão: Para superar essa inconsistência, é fundamental aprimorar as fontes de informação, garantindo dados mais confiáveis para as autoridades de saúde, saneamento e para a sociedade em geral.

Impact of water fluoridation on dental caries decline across racial and income subgroups of Brazilian adolescents.

OBJECTIVES: The aim of this study was to assess the impact of community water fluoridation (CWF) on differences in dental caries decline across racial and socioeconomic subgroups of Brazilian adolescents. METHODS: Two nationwide Brazilian population-based oral health surveys were used (Brazilian Oral Health Survey 2003 and 2010). In total, 7,198 adolescents from 15 years to 19 years old living in 50 cities investigated in both surveys were included. The mean numbers of untreated decayed teeth (DT) according to racial (Whites vs. Browns/Blacks) and socioeconomic subgroups (at or above the minimum wage per capita vs. under) were analysed. Difference-in-differences negative binomial regressions were adjusted by schooling, age, and sex. Decayed, missing, and filled teeth and DT prevalence, calculated as a categorical variable, were used in sensitivity analyses. RESULTS: The adjusted difference of reduction in DT was similar across socioeconomic subgroups (ß=-0.05; 95% confidence interval [CI], -0.45 to 0.35) and favoured, but not to a significant degree, Whites (ß=-0.34; 95% CI, -0.74 to 0.04) compared to Brown/Blacks in fluoridated areas. In non-fluoridated areas, significant differences were observed in the mean number of DT, favouring the higher socioeconomic subgroup (ß=-0.26; 95% CI, -0.53 to -0.01) and Whites (ß=-0.40; 95% CI, -0.69 to -0.11) in relation to their counterparts. The sensitivity analyses confirmed the findings. CONCLUSIONS: The similar reduction in DT across income subgroups suggests that CWF has had a beneficial effect on tackling income inequalities in dental caries within a 7-year timeframe.

Intersectoral collaboration and coordination mechanisms for implementing water fluoridation: Challenges from a case study in Brazil.

OBJECTIVES: Community water fluoridation has been associated with better oral health conditions globally and reduced dental caries. While oral health policies are governed by the health sector agenda, water fluoridation is undertaken by public, private, and mixed public/private companies of the sanitation sector. The first aim of this study was to investigate the degree of intersectoral collaboration, and the second was to investigate how the coordination mechanisms are perceived by the sanitation agents of the sectors involved in water quality management, for the potential establishment of water fluoridation in a central-west state in Brazil. METHODS: Semi-structured interviews were conducted with chief sanitation agents from nonprofit, profit, and mixed public/private companies responsible for water quality and fluoridation in a purposive sample. Theoretical frameworks of intersectoral collaboration and coordination mechanisms were used for analysis. RESULTS: Twelve interviews were conducted. Informal collaboration was identified in the sanitation sector within companies involved in water provision. The main coordination mechanisms were network-type mechanisms, which involve consultations and knowledge sharing, and market-type mechanisms, which explore new job opportunities and cost-effectiveness, especially in water quality measures. Enabling themes (enablers) were identified, such as positive attitude toward including water quality and fluoridation in a collaborative health and sanitation common agenda. Moreover, fluoridation did not meet the regulatory and surveillance agenda at the state level, and until that moment, there was no proposal of the health sector for water fluoridation. CONCLUSIONS: Partnership creation, consolidation, and shared mission, especially between health and sanitation sectors, were identified as main challenges for implementing water fluoridation policy.

Does water fluoridation influence ethnic inequalities in caries in Brazilian children and adolescents?

OBJECTIVES: This study aimed to investigate the influence of community water fluoridation on ethnic inequalities in untreated dental caries among children and adolescents in Brazil while taking the human development context into account. METHODS: Data from a nationwide Brazilian epidemiological population oral health survey were used (SB Brazil 2010). Outcomes were caries prevalence measured by the proportion of individuals with one or more untreated decayed teeth and caries severity defined by the mean number of untreated decayed teeth (DT). Three different contexts were considered: 1-cities with no water fluoridation; 2-cities with water fluoridation and low Human Development Index (HDI); and 3-cities with water fluoridation and high HDI. The exposure was ethnic/racial group (White, Pardo, Black) and covariates were age, sex and household income. Multilevel logistic and negative binomial regressions were performed with 6696 children (aged 5 years) and 11 585 adolescents (aged 12 and 15-19 years). RESULTS: For both children and adolescents, ethnic differences in caries prevalence and mean DT were found in the nonfluoridated cities with low HDI and also in cities with high HDI, most of which were fluoridated. For example in nonfluoridated cities with low HDI, 5-year-old Pardo children were more likely to have untreated decay (OR = 1.22; 95% CI: 1.02, 1.46) and had more decayed teeth (RR = 1.18; 95% CI: 1.04, 1.34) than their White counterparts after adjusting for sex and household income. No statistically significant differences were observed in fluoridated cities with low HDI. CONCLUSION: Water fluoridation appears to be associated with reduced ethnic inequalities in dental caries prevalence and mean DT among children and adolescents in more disadvantaged settings.

Street-level implementers of population-based oral health policies: the case of water fluoridation supply in Brazil's small towns.

BACKGROUND: Knowledge of conditions influencing the performance of street-level operators when implementing population-based policies could increase the understanding of local implementation dynamics. OBJECTIVE: We analyzed how street-level operators claim to act to implement fluoridation policy in the water treatment units of small Brazilian municipalities and identified conditions shaping behavior against adherence to policy. METHODS: A case study using narratives obtained through in-depth interviews with key informants in two pairs of municipalities with contrasting levels of implementation. Analysis identified themes in the data and in the street-level bureaucracy literature. RESULTS: Institutional characteristics such as administrative fragility of local entities, low priority given locally to policy, poor physical structure of the water treatment plants, isolated working relations, low effectiveness of monitoring devices, and local actors' uncertainties about the policy favored the expansion of the discretionary power of street-level operators configuring important barriers for water fluoridation. CONCLUSION: These data highlight the complexity of policy implementation and inform policymakers about the importance of inter-federal and inter-sectoral coordination when implementing population-based health policies in small towns.

Effect of fluoridated water on dental caries and fluorosis in schoolchildren who use fluoridated dentifrice

Abstract This cross-sectional study evaluated the prevalence and severity of dental caries and fluorosis in children and adolescents using fluoridated toothpaste, from areas with and without fluoridated water. Parents of 5-year-old children and 12-year-old adolescents from neighbourhoods that are supplied with and without fluoridated water answered questionnaires for determining socio-economic and demographic characteristics and habits related to oral health. The individuals were examined, and dental caries and fluorosis were measured by dmft/DMFT and TF indexes, respectively. Descriptive, bivariate and logistic regression analyses were performed (p < 0.05). Of 692 participants, 47.7% were 5-year-olds and 52.3% were 12-year-olds. The mean dmft/DMFT in the 5-year-olds/ 12-year-olds from Exposed and Not Exposed fluoridated water groups was 1.53 (± 2.47) and 3.54 (± 4.10) / 1.53 (± 1.81) and 3.54 (± 3.82), respectively. Children (OR = 2.86, 95% CI = 1.71-4.75) and adolescents (OR = 1.95, 95% CI = 1.24-3.05), who did not consume fluoridated water, had greater caries experience. Among adolescents, there was an association between fluoridated water and the prevalence of very mild/mild fluorosis (OR = 5.45, 95% CI: 3.23-9.19) and moderate fluorosis (OR = 11.11, 95% CI = 4.43-27.87). Children and adolescents, who consumed fluoridated water, presented lower prevalence and severity of dental caries compared to those who used only fluoridated toothpaste as the source of fluoride. There is an association between water fluoridation and very mild/mild and moderate fluorosis in adolescents.

Resumo Este estudo transversal avaliou a prevalência e severidade de cárie dentária e fluorose em crianças de 5 anos e adolescentes de 12 anos usuários de dentifrício fluoretado, em áreas com e sem água fluoretada. Os responsáveis pelas crianças e adolescentes responderam questionários para determinação de características socioeconômicas e demográficas e hábitos relacionados à saúde. Os indivíduos foram examinados e a cárie e a fluorose foram mensuradas pelos índices ceo-d / CPOD e TF, respectivamente. Foram realizadas análises descritivas, bivariadas e de regressão logística (p <0,05). Dos 692 participantes, 47,7% tinham 5 anos e 52,3% tinham 12 anos. A média de ceod / CPOD em crianças de 5/12 anos dos grupos de exposto e não exposto à água fluoretada foi 1,53 (± 2,47) e 3,54 (± 4,10) / 1,53 (± 1,81) e 3,54 (± 3,82), respectivamente. Crianças (OR = 2,86, IC 95% = 1,71-4,75) e adolescentes (OR = 1,95, IC 95% = 1,24-3,05) que não consumiram água fluoretada tiveram maior experiência de cárie. Entre os adolescentes, houve associação entre a água fluoretada e a prevalência de fluorose muito leve / leve (OR = 5,45, IC 95%: 3,23-9,19) e fluorose moderada (OR = 11,11, IC 95% = 4,43-27,87). Crianças e adolescentes que consumiram água fluoretada apresentaram menor prevalência e severidade de cárie dentária em comparação com aqueles que usaram apenas dentifrício fluoretado como fonte de flúor. Houve uma associação entre a fluoretação da água e fluorose muito leve / leve e moderada em adolescentes.

Princípios invocados numa política intersetorial de saúde: o caso da fluoretação da água no Brasil / Principles invoked in a population-based health policy: the case of water fluoridation in Brazil

Resumo O objetivo foi identificar princípios invocados numa política intersetorial de saúde, tomando como caso uma proposta legislativa de revogação da fluoretação da água no Brasil apresentada em 2003. Realizou-se estudo descritivo por meio de pesquisa documental, na qual foram selecionados registros gerados na tramitação do Projeto de Lei nº 510/2003 na Câmara dos Deputados. Buscou-se destacar estratégias discursivas utilizadas pelos atores conforme o jogo de interesses e o contexto conflitivo, utilizando-se o institucionalismo histórico como referencial teórico. O Projeto de Lei tramitou 13 meses, passando pelo Plenário, por três comissões, e sendo arquivado. Três deputados de partidos distintos, órgãos do Poder Executivo federal, agências reguladoras e entidades representativas da categoria odontológica, da saúde pública/coletiva, da engenharia sanitária e das empresas de saneamento participaram diretamente do debate em que emergiram os princípios da segurança da intervenção, dos custos econômicos e do direito à saúde. Em relação às estratégias discursivas utilizadas, os principais elementos invocados no debate da política intersetorial de saúde foram o princípio da incerteza, criando-se falsas categorias científicas a fim de sobrevalorizar os efeitos desfavoráveis e sustentar a implementação de medidas individualizantes; e os princípios morais que definem diferentes tipos de bens econômicos e dimensões de liberdade associadas ao exercício de direitos.

Abstract The objective was to identify principles invoked in a population-based health policy, taking as case a legislative proposal aimed at revoking water fluoridation in Brazil presented in 2003. We conducted a descriptive study through documentary research on records generated in the course of the Bill proposal No. 510/2003 in the Federal Chamber of Deputies. We highlighted discourse strategies used by the actors as per their own interests and the conflicting context by utilizing historical institutionalism as theoretical ground. The proposal was debated for 13 months, going through the House Plenary, three committees, and was finally filed. Three deputies from different parties, federal executive agencies, regulatory agencies, and entities representing dental, public/collective health, sanitary engineering, and sanitation companies participated directly in the debate in which the principles of intervention security, economic costs and the right to health emerged. Regarding the discourse strategies used, the main elements invoked in the debate on population-based health policy were: the principle of uncertainty, creating false scientific categories in order to overvalue unfavorable effects and to support the implementation of individualizing measures; and the moral principles that define different types of economic goods and dimensions of freedom associated with the exercise of rights.

Association of water fluoride and urinary fluoride concentrations with attention deficit hyperactivity disorder in Canadian youth.

BACKGROUND: Exposure to fluoride has been linked with increased prevalence of attention deficit hyperactivity disorder (ADHD) in the United States and symptoms of inattention in Mexican children. We examined the association between fluoride exposure and attention outcomes among youth living in Canada. METHOD: We used cross-sectional data collected from youth 6 to 17 years of age from the Canadian Health Measures Survey (Cycles 2 and 3). Urinary fluoride concentration adjusted for specific gravity (UFSG) was available for 1877 participants. Water fluoride concentration measured in tap water samples was available for 980 participants. Community water fluoridation (CWF) status was determined by viewing reports on each city's website or contacting the water treatment plant. We used logistic regression to test the association between the three measures of fluoride exposure and ADHD diagnosis. Linear regression was used to examine the relationship between the three measures of fluoride exposure and the hyperactivity/inattention score on the Strengths and Difficulties Questionnaire (SDQ). RESULTS: UFSG did not significantly predict ADHD diagnosis or hyperactive/inattentive symptoms. A 1 mg/L increase in tap water fluoride level was associated with a 6.1 times higher odds of an ADHD diagnosis (95% CI = 1.60, 22.8). A significant interaction between age and tap water fluoride level (p = .03) indicated a stronger association between tap water fluoride and hyperactivity/inattention symptoms among older youth. A 1 mg/L increase in water fluoride level was associated with a 1.5 SDQ score increase (95% CI: 0.23, 2.68, p = .02) for youth at the 75th percentile of age (14 years old). Similarly, there was a significant interaction between age and CWF. At the 75th percentile of age (14 years old), those living in a fluoridated region had a 0.7-point higher SDQ score (95% CI = 0.34, 1.06, p < .01) and the predicted odds of an ADHD diagnosis was 2.8 times greater compared with youth in a non-fluoridated region (aOR = 2.84, 95% CI: 1.40, 5.76, p < .01). DISCUSSION: Exposure to higher levels of fluoride in tap water is associated with an increased risk of ADHD symptoms and diagnosis of ADHD among Canadian youth, particularly among adolescents. Prospective studies are needed to confirm these results.

Systemic effects (risks) of water fluoridation

Abstract Since the 1950s, the benefits and risks of fluoridated water use have been debated worldwide. In the past, it was considered that the systemically ingested fluoride would exert its primary preventive effect after being incorporated into the enamel as fluorapatite, making the enamel more resistant to the caries process; however, it is now recognized that the main effect of water fluoridation is local and post eruptive. On the other hand, irrespective of the caries decline reported worldwide, the anticaries benefit of water fluoridation continues to be observed even in developed countries. Regarding the risks, water fluoridation is considered an acceptable community-based method for fluoride delivery, because the risk of developing dental fluorosis lesions due to the ingestion of fluoride during the enamel formation period has been deemed acceptable when contrasted to the anticaries benefits of fluoride. However, the use of fluoride in water to control caries has created a controversy due to data associating water fluoridation as the cause of some systemic diseases. Therefore, the aim of this descriptive review was to discuss the systemic effects (risks) of water fluoridation use.

Resumo Desde 1950, os benefícios e riscos do uso da água fluoretada têm sido debatidos mundialmente. No passado, foi considerado que o fluoreto ingerido sistemicamente exerceria seu efeito preventivo de cárie pela sua incorporação ao esmalte como fluorapatita, tornando o esmalte mais resistente ao processo de desenvolvimento de lesões de cárie; entretanto, é atualmente reconhecido que o principal efeito da fluoretação da água é local e pós-eruptivo. Por outro lado, independente do declínio de cárie que tem sido observado mundialmente, o benefício anticárie da fluoretação da água continua sendo observado mesmo em países desenvolvidos. Com relação aos riscos, fluoretação da água é considerada uma estratégia aceitável de saúde pública para uso de fluoreto, porque o risco de desenvolvimento de fluorose dental devido à ingestão de fluoreto durante o período de formação do esmalte foi considerado aceitável quando comparado aos benefícios anticárie do flúor. Entretanto, o uso de fluoreto na água para controlar cárie tem gerado controvérsias devido a dados de pesquisa que associam fluoretação da água como causa de algumas doenças sistêmicas. Assim, o objetivo dessa revisão descritiva foi discutir os efeitos sistêmicos (riscos) da fluoretação da água..

Low-level fluoride exposure reduces glycemia in NOD mice.

Water fluoridation is the most widespread measure to prevent dental caries but its relationship with the development of type-1 diabetes (T1D), which has been increasing by 2-5% worldwide, is not quite well understood. AIM: This study evaluated if fluoride (F) administered in the drinking water can prevent or reduce the development of T1D in non-obese diabetic (NOD) mice, as well as to explore the underlying mechanisms. MATERIALS AND METHODS: Twenty-four weaning NOD mice received water containing 0, 10 or 50 ppm F for 21 days. Plasma glucose and insulin were analyzed. Quantitative proteomic analysis was conducted in the liver and gastrocnemius muscle. RESULTS: Animals treated with 10 ppm F had significantly lower glucose levels than the control group, but there was no significant difference among the groups in relation to insulin. The % of ß-cell function was significantly higher in the 10 ppm F group. Changes in the proteomic profile of muscle and liver were seen among the groups. In the muscle, the 10 ppm F group presented, when compared with control, increased expression of proteins involved in energy metabolism. The 50 ppm F group, compared with control, presented increased expression of proteins related to muscle contraction, differentiation of brown adipose tissue and apoptosis. For the liver, the 10 ppm F group had increase in proteins involved in energy metabolism and protein synthesis, in respect to control. There was also an increase in isoforms of Glutathione S transferase, which was confirmed by Western blotting. In the group treated with 50 ppm F, proteins related to ROS metabolism and energetic metabolism were altered. CONCLUSION: Increased expression of antioxidant proteins by treatment with low F concentration may possibly help to explain protection against the development of T1D, which should be better explored in future mechanistic studies.

Heterocontrole da fluoretação nos municípios da Região Metropolitana de Curitiba nos anos de 2014 e 2015 / External control of fluoridation in the Metropolitan Region of Curitiba in the years of 2014 and 2015

Resumo Introdução O heterocontrole, que é o monitoramento da concentração de fluoreto na água de abastecimento, deve ser feito por instituições do Estado e tem sido motivado para garantir a eficácia e a segurança da fluoretação. Este estudo teve como objetivo analisar o heterocontrole de municípios com população acima de 50 mil habitantes da Região Metropolitana de Curitiba nos anos de 2014 e 2015. Metodologia Dados sobre o heterocontrole foram fornecidos pelos serviços de Vigilância em Saúde dos municípios do estudo e analisados de acordo com o critério técnico do CECOL para a concentração de fluoreto. Resultados Em alguns municípios e meses, houve falha na realização das coletas de amostras de água em relação ao número adequado para o parâmetro fluoreto. Do total de amostras analisadas, somente 51,5% estavam na faixa de melhor benefício-risco para a concentração de fluoreto, com 8% de benefício e risco insignificantes e 0,1% das amostras com concentração de fluoreto de alto risco, sem nenhum benefício. Conclusão Os municípios analisados realizaram o heterocontrole, com períodos em que o número de coletas não foi adequado. As concentrações de fluoreto na água de abastecimento dos municípios do estudo apresentaram resultado pouco satisfatório. O heterocontrole é fundamental para manter os teores de fluoreto em níveis adequados.

Abstract Introduction External control is the monitoring of fluoride concentration in the water supply that must be done by state institutions, and has been motivated to ensure the efficacy and safety of fluoridation. This study aimed to analyze the external control of municipalities with more than 50.000 inhabitants in the metropolitan region of Curitiba in the years 2014 and 2015. Methodology Health surveillance services of the studied municipalities provided external control data, which were analyzed according to the technical criterion of the CECOL for fluoride content. Results Collection of water samples failed in some municipalities and months for an adequate number for the fluoride parameter. From the total samples analyzed, only 51.5% were in the best benefit-risk range for the fluoride concentration. Eight percent of the samples presented insignificant benefit and risk and 0.1% showed a high-risk fluoride concentration, without any benefit. Conclusion the analyzed municipalities performed the external control, with periods of inadequate sample collections. Fluoride concentrations in the supply water of the study municipalities presented an unsatisfactory result. The main goal of external control is to maintain fluoride levels at adequate levels.

Access to Fluoridated Water and Adult Dental Caries: A Natural Experiment.

Systematic reviews have found no evidence to support a benefit of water fluoridation (WF) to prevent dental caries in adult populations. The aim of this natural experiment was to investigate whether lifetime access to fluoridated water is associated with dental caries experience among adults from Florianópolis, Brazil. The data originated from a population-based cohort study (EpiFloripa Adult) initiated in 2009 (n = 1,720) when participants were aged 20 to 59 years. The second wave was carried out in 2012 (n = 1,140) and included a dental examination and a face-to-face questionnaire. Participants residing at the same address since the age of 7 y or before were included in the primary analyses. Sensitivity analyses were also performed. WF was implemented in the city in 2 different periods of time: 1982 (60% of the population) and 1996. Dental caries was assessed by the decayed, missing, and filled teeth (DMFT) index. A combination of residential status, participant's age, and year of implementation of WF permitted the creation of participants' lifetime access to fluoridated water: >75%, 50% to 75%, and <50% of a participant's lifetime. Covariates included sex, age, socioeconomic mobility, educational attainment, income, pattern of dental attendance, and smoking. Participants who accessed fluoridate water <50% of their lifetime presented a higher mean rate ratio of DMFT (1.39; 95% CI, 1.05-1.84) compared with those living >75% of their lifetime with residential access to fluoridated water. Participants living between 50% and 75% and <50% of their lives in fluoridated areas presented a decayed and filled teeth mean ratio of 1.34 (95% CI, 1.02-1.75) and 1.47 (95% CI, 1.05-2.04) higher than those with residential access to fluoridated water >75% of their lifetime, respectively. Longer residential lifetime access to fluoridated water was associated with less dental caries even in a context of multiple exposures to fluoride.

Vigilância dos teores de fluoreto nas águas de consumo humano: uma revisão sistemática / Surveillance of fluoride levels in water for human consumption a systematic review

Introdução: O conhecimento sobre a concentração de fluoreto nas águas de consumo humano é importante para a prevenção e controle da cárie e da fluorose dentária nas populações. Objetivo: Descrever as características dos estudos e os resultados por eles produzidos sobre monitoramento dos teores de fluoreto nas águas de consumo humano publicados em revistas científicas especializadas no período de 2008 a 2012. Método: Foi realizada uma revisão sistemática da literatura científica na qual foram incluídos estudos na forma de artigos que apresentassem temática centrada no monitoramento da concentração do fluoreto na água de consumo humano. Os estudos foram identificados por busca bibliográfica nas bases de dados: LILACS, PUBMED/MEDLINE e EMBASE. Artigos, com qualquer tipo de desenho metodológico, publicados nos idiomas português, inglês e espanhol, foram incluídos. Resultados: Quarenta e oito artigos foram incluídos para a extração das características e resultados referentes à pergunta da pesquisa. Conclusão: A atividade de monitoramento estava articulada à vigilância como ação do Estado em dezoito estudos (37,5%). O método eletrométrico foi usado em 39 (81%) estudos. Apenas dois estudos utilizaram o método da Alizarina, sugerindo-se o seu desuso. A classificação em categorias de tipo "adequado" e "inadequado" (dicotômica), a qual reduz as opções de interpretação e atribuição de significado às características das amostras, predominou na apresentação dos resultados.

Introduction: Knowledge on the concentration of fluoride in water for human consumption is important for the prevention and control of dental caries and dental fluorosis in populations. Objective: To describe the characteristics of the studies and the results on monitoring of fluoride levels in water for human consumption published in specialized journals in the period 2008-2012. Methods: A systematic review of the scientific literature was performed. Only articles on monitoring of fluoride concentration in drinking water were included. Studies were identified by literature searching in databases: LILACS, PUBMED / MEDLINE and EMBASE. Articles with any type of methodological design, published in Portuguese, English and Spanish were included. Results: Forty-eight articles were included for the extraction of features and results related to the research question. Conclusion: The monitoring activity was articulated to the surveillance as an action provided by the State in eighteen studies (37,5%). The electrometric method was used in 39 (81%) studies. Only two studies used the method of Alizarin, suggesting its disuse. The dichotomous categorization "appropriate" and "in appropriate" which reduces the options of interpretation and attribution of meaning to the sample characteristics predominated in the presentation of the results.

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.

Vigilância da fluoretação da água de abastecimento público no Município de São Paulo, no período 1990-2011 / Health surveillance of drinking water fluoridation in the City of Sao Paulo, Brazil, in the period 1990-2011

Introdução - A política de fluoretação das águas de abastecimento público requer aplicação contínua desta medida em níveis adequados de flúor. O controle operacional é realizado pelas empresas de saneamento ao adicionar flúor às águas, cuja medida deve ser complementada pela ação dos sistemas de vigilância segundo o princípio do heterocontrole. Sistemas de vigilância lidam com informações de interesse público, nos marcos legais desenvolvidos pelos Estados. No mundo contemporâneo, tais marcos implicam contemplar o direito de acesso à informação. Objetivo - Descrever o sistema de vigilância da fluoretação da água no município de São Paulo, no período 1990-2011. Método - Pesquisa baseada em dados secundários disponibilizados pela Secretaria Municipal de Saúde de São Paulo, no período 1990-2011. Os teores de fluoreto nas amostras foram classificados segundo as dimensões de risco e benefício para fluorose e cárie dentária, avaliados concomitantemente. Adicionalmente, realizou-se revisão bibliográfica do marco legal brasileiro que trata da Lei de Acesso à Informação (LAI), tendo em vista que dados produzidos pelos sistemas de vigilância em saúde são de interesse público. Resultados - Foram analisadas 19.071 amostras. A média anual de registros identificados no período de pontos fixos atingiu 647 amostras, correspondendo a um valor acima do necessário para a cobertura total do sistema (n=180). A média anual de registros foi ainda maior para o período de pontos variáveis, com 1.340 amostras. A média geral dos teores de flúor foi de 0,66 mg/l. Com relação à prevenção da cárie, 44 por cento das amostras representam benefício moderado e 54 por cento benefício máximo. Quanto à fluorose dentária, 99 por cento das amostras representam risco mínimo...

Introduction - The policy of community water fluoridation requires continuous application of this measure by the adequate use of fluoride levels. Operational control is carried out by drinking-water suppliers to add fluoride to the water, which measure must be complemented by action of surveillance systems on the principle of external control. Surveillance systems deal with information of public interest, within the legal frameworks developed by the States. In the contemporary world, such landmarks contemplate the right of access to information. Objective - To describe the surveillance system of drinking-water fluoridation in the city of Sao Paulo, in the period 1990-2011. Method - Research based on secondary data provided by the Municipal Health Secretary of Sao Paulo, in the period 1990-2011. Fluoride levels in the samples were classified according to the dimensions of risk and benefit related to fluorosis and dental caries, concurrently assessed. Additionally, it was carried out a literature review of the Brazilian legal framework that deals with the Law on Access to Information (LAI), considering that data produced by health surveillance systems are of public interest. Results - It was analyzed 19,071 samples. The average annual records identified between fixed points period reached 647 samples, corresponding to a value higher than necessary to cover the entire system (n = 180). The average of the variable annual record points was even greater for the period, with 1,340 samples. The overall average fluoride concentration was 0.66 mg/l. With respect to the prevention of caries, 44 per cent of the samples represent moderate benefit and 54 per cent maximum benefit. As for dental fluorosis, 99 per cent of the samples represented minimal risk...

Caries and fluorosis in the Santiago metropolitan region in Chile: The impact of the fluoridation of the water / Cárie e fluorose na região metropolitana de Santiago, Chile: impacto da fluoretação da água

PURPOSE: To assess the damage and the prevalence of caries and fluorosis in children and adolescents in the metropolitan area after 8 years of drinking water fluoridation and to compare them with the baseline study. METHODS: This was a prevalence study. The sample was selected using two-step probability sampling and stratified according to socioeconomic level. Subjects included 2,323 schoolchildren aged 6 to 8 years and 12 years living within the metropolitan region. The parents of all students provided consent and were previously included in the study. The subjects were clinically examined by calibrated dentists, who used World Health Organization (WHO) screening criteria and indicators to determine the presence of caries and dental fluorosis. RESULTS: No cavity damage was found in 23.68 percent of the children. The average dmft was 3.18 for children aged 6 to 8 years. The DMFT was 0.59 in children aged 6 to 8 years and 2.6 in children 12 years compared with the baseline study. These differences were statistically significant. There were also significant differences in the DMFT index for each socioeconomic status group. The average number of dams was higher among children of low socioeconomic status. Of the studied children, 14.3 percent of children had dental fluorosis. Fluorosis was very mild in 12.35 percent of the cases, mild in 1.98 percent and moderate in 0.26 percent. There were no cases of severe fluorosis (classified according to Dean's index). CONCLUSION: We conclude that after 8 years drinking water fluoridation in the metropolitan area, the number of children with no history of caries has increased by approximately 100 percent. The number of cases significantly affected by caries has also decreased significantly. The incidence of dental fluorosis has increased, but to milder degrees.

OBJETIVO: Avaliar o dano e a prevalência de cárie e fluorose em crianças e adolescentes na região metropolitana do Chile, após oito anos de fluoretação da água potável, em comparação com o estudo de base em 1996. METODOLOGIA: Desenho: estudo de prevalência. A amostra probabilística, estratificada por nível socioeconômico, constituiu-se de 2.323 escolares de 6-8 e 12 anos na Região Metropolitana. Todos os alunos foram clinicamente examinados por dentistas calibrados, utilizando critérios de seleção e indicadores propostos pela OMS para determinar cárie e fluorose dentária. RESULTADOS: Cerca de 24 por cento das crianças estavam livres de cáries. A média de CPOD foi de 3,18 em escolares de 6 a 8 anos. O CPOD foi de 0,59 em crianças de 6 a 8 anos e de 2,6 em crianças de 12 anos em relação ao estudo de base, sendo essas diferenças estatisticamente significativas. Houve diferenças significativas devido ao nível socioeconômico, sendo que os valores médios foram maiores em crianças de baixo nível socioeconômico. Cerca de 14 por cento das crianças apresentaram fluorose dentária, em geral de grau muito leve. CONCLUSÃO: Após 8 anos de fluoretação da água potável na região metropolitana, observou-se um aumento de 100 por cento de crianças sem história de cárie e significativa diminuição de danos. A fluorose dentária aumentou, mas em graus mais leves.

Uso do flúor em saúde pública sob o olhar dos delegados à 13ª Conferência Nacional de Saúde / Use of fluoride in public health from the perspective of the delegates to the 13th National Health Conference

Sendo a cárie dentária um grave problema de saúde pública para a maioria dos indivíduos que moram em países do hemisfério Sul e para as populações com baixo status socioeconômico dos países de capitalismo desenvolvido, advoga-se o uso do flúor em saúde pública, como medida preventiva. Objetivo Descrever as percepções e opiniões dos delegados à 13ª Conferência Nacional de Saúde sobre o uso do flúor em saúde pública, com foco na fluoretação das águas de abastecimento público. Método - Realizou-se pesquisa exploratória, descritiva, com abordagem qualitativa, utilizando-se como técnica de processamento de depoimentos o Discurso do Sujeito Coletivo (DSC). Ao todo, foram 310 respondentes. Os dados foram coletados por meio de questionários semi estruturados e analisados por meio da análise do discurso. Resultados Constatou-se desinformação dos delegados no tocante a vários aspectos do uso do flúor em saúde pública e os mesmos sentem necessidade de meios de divulgação efetivos sobre a água para consumo e sobre os níveis de flúor da água. Considerações Finais - Ideias equivocadas ou lacunas de conhecimento acerca de vários aspectos do uso do flúor em saúde pública revelam 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 os mecanismos utilizados no controle social.

As tooth decay a serious public health problem for most residents of countries of the southern hemisphere and for populations of low socioeconomic status in developed capitalist countries, the use of fluoride in public health is advocated as a preventive measure. Objective: To describe the perceptions of the delegates to the 13th National Health Conference on the use of fluorides in public health, focusing on the fluoridation of public water supplies. Method - An exploratory and descriptive research was performed with a qualitative approach and utilizing as the processing technique of statements the Discourse of the Collective Subject (DCS). A total of 310 participants responded. The data was collected using semi-structured questionnaires and analysed by the discourse analysis method. Results - Misinformation of the delegates concerning several of the use of fluoride in public health and the need of these delegates for effective means of disseminating information on water suitable for consumption and the levels of fluoride in water was found. Final Considerations - Erroneous ideas and knowledge gaps regarding the various aspects of the use of fluoride in public health underscore the need to improve societys level of understanding of questions relating to water fluoridation. The lack of knowledge of delegates, together with the data available in the literature on the defective monitoring and control of fluoride levels in the water, indicates the need to further evaluate the role of the social actors and the mechanisms used in the societal control.

Análise da fluoretação da água de abastecimento público da zona urbana do município de Campo Grande (MS) / Water fluoridation analysis of Campo Grande (MS) urban zone public supply

O presente estudo teve por objetivo analisar a concentração de fluoreto na água que flui das torneiras da zona urbana do município de Campo Grande (MS). Para tanto, foram coletadas amostras de água de 21 escolas situadas nos sete subdistritos da cidade, em três oportunidades diferentes para análise do teor de fluoreto, determinada pelo método do eletrodo específico (medidor de fluoreto combinado Orion 9609 BN, acoplado a um potenciômetro digital EA-940 da Orion). Os resultados mostraram que 63,5 por cento das amostras coletadas apresentaram níveis aceitáveis (entre 0,6 a 0,8 ppm) de fluoreto e 36,5 por cento, níveis inaceitáveis. Em relação à condição dos locais de coleta, 76,2 por cento foram consideradas adequadas e 23,8 por cento, inadequadas.

The objective of this study was to analyze the fluoride concentration on the water that flows of the tap in the urban area of the city of Campo Grande (MS). For the fluoride concentration analysis, it was collected water samples of 21 schools placed in the 7 sub districts of the city, in 3 different opportunities, was made by the specific electrode method (using an Orion 9609 BN combined fluoride measuring electrode, coupled with an Orion EA-940 digital potentiometer). The results showed that 63.5 percent of the water samples presented acceptable fluoride levels (between 0.60 and 0.80 ppm) and 36.5 percent, unacceptable levels. In relation to the condition of the collect places, 76.2 percent were considered appropriate and 23.8 percent were inappropriate.

Análise do teor de fluoreto em àguas minerais comercializadas em Belém do Pará / Fluoride content of still bottled water in Belém of Pará

Objetivo: analisar a concentração do íon fluoreto em amostras de água mineral comercializadas na cidade de Belém do Pará, 2009 Método: transversal analítico. Colhidas 07 amostras das marcas comerciais, (Terra Alta, Belágua, Y Yamada, Indaiá, Schincariol, Nossa água, Prata) e realizada análise quantitativa de flúor (mg/l), utilizando o espectrofotômetro, Metrolab 330. As amostras estavam com a temperatura ambiente de 28ºC. Resultados: Indaiá =0,0ppm; Terra Alta=0,1ppm ; Belágua=0,02ppm ; Y Yamada=0,02ppm; Schincariol=0,04ppm; Nossa água =0,04 ppm ; Prata=0,26ppm. Considerações finais: os resultados mostraram uma insuficiência de fluoreto de sódio nas águas minerais, tanto para prevenção, quanto para a ocorrência de fluorose dentária

Objective: the objective of the present study was to determine the fluoride concentrations of 07 commercial marks mineral water (mg/l) in Belém of Pará , 2009 Methods: analytic transversal study . Espectrofotometro, Metrolab 33 0 , was utilized to determinate thefluoride concentration of 7 samples of mineral commercial water. The samples were with the ambient temperature of 28ºC. Results: Indaiá =0,0ppm, Terra Alta=0,1ppm , Belágua=0,02ppm , Y Yamada=0,02ppm , Schicariol=0,04ppm, Nossa água =0,04 ppm , Prata= 0,26ppm Conclusion: the results had in such a way shown an insufficiencies of sodium fluoride in mineral waters for prevention how much for the dental occurrence of fluorose.

Cárie dentária em adultos em locais com e sem água fluoretada da região de Campinas, São Paulo / Dental caries in adults caries in places with and without fluoridated water in the Campinas area, São Paulo

O objetivo deste trabalho foi descrever a prevalência de cárie dentária em população adulta da região de Campinas, São Paulo, segundo a condição de fluoretação da água e gênero, em 1998. Os critérios usados seguiram as recomendações da Organização Mundial da Saúde(1997). Foram examinados 535 adultos (35 a 44 anos), de 8 municípios representativos da região de Campinas, Estado de São Paulo. Foram usados os testes Mann-Whitney e Qui-quadrado (p<0,05). O CPOD foi de 21,3 (IC95%=20,7-21,9). Os componentes cariado e perdido foram maiores nos homens (p<0,05). O CPOD foi maior na região sem água fluoretada, bem como o componente perdido (p<0,05). A média de dentes presentes foi de 19,7 (IC95%=18,9-20,5), menor na região sem água fluoretada (p<0,05). Observa-se elevada experiência de cárie, porém, sugere-se um possível efeito benéfico da fluoretação da água neste grupo etário no controle da cárie dentária uma vez que a região fluoretada apresentou menores médias do CPOD e do componente perdido.

The objective of this article was to verify dental caries prevalence and treatment needs in the Campinas area, State of São Paulo, according to the gender and fluoridation of the public water supply, in 1998. The criteria used were in accordance with the recommendations of the World Health Organization (WHO). The sample comprised 535 adults (35 to 44 years of age), from 8 municipalities representative of the area of Campinas, State of São Paulo. The Mann-Whitney and Chi-squared tests were used (p<0.05). DFMT in this population was 21.3 (IC95%=20.7-21.9) The components decayed and missing were higherin the men (p<0.05). DMFT was higher in the area without fluoridation, as well as the missing component (p<0.05). The restored treatment needs were the most frequent. The number of teeth present was 19.7 (IC95%=18.9-20.5), being lower in the area without fluoridation (p<0.05). The results revealed high decay experience, however, it suggests a possible beneficial effect of the of water fluoridation in this group in the control of the decay once the area with fluoridation presented lower average of DMFT and of the lost component.