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

Caries and fluoridated water in two Brazilian municipalities with low prevalence of the disease

OBJECTIVE

To analyze the association between exposure to fluoridated water and dental caries in a context of widespread use of fluoride toothpaste in Brazil, in a scenario of low prevalence of the disease.

METHODS

This is a cross-sectional observational study, of the census type, in the form of a double population-based epidemiological survey carried out in two municipalities of the state of São Paulo in 2014. The sample consisted of adolescents aged 11 and 12 years, exposed (n = 184) or not exposed (n = 128) to fluoridated water for at least five years. The populations studied lived in communities of the same geographic region and had small demographic size and similar socioeconomic classification, differing only in the exposure (Silveiras) or not exposure (São José do Barreiro) to fluoridated water. The experience, magnitude, and degree of polarization of dental caries in these populations were analyzed using the DMFT and SiC indexes, and the association was tested using Pearson’s chi-square statistics and prevalence ratio between those not exposed and those exposed to fluoridated water.

RESULTS

Although caries experience (DMFT ≥ 1) was not associated with exposure to fluoridated water (chi-square = 1.78; p = 0.18; α = 5%), a significant difference was observed in the magnitude with which the disease reached the population: the means of DMFT were 1.76 in those exposed and 2.60 in those not exposed and the means of SiC were 4.04 and 6.16, respectively. The degree of polarization, indicated by the percentage of subjects with DMFT = 0, was different, being it higher (41.8%) in subjects exposed and lower (34.3%) in subjects not exposed. The prevalence ratio between those not exposed and those exposed was 1.13, indicating little expressiveness in prevalence difference.

CONCLUSIONS

Exposure to fluoridated water implied lower mean values for the DMFT and SiC indexes, even in the presence of the concomitant exposure to fluoridated toothpaste, in a scenario of low prevalence of the disease, and with a similar pattern of caries distribution in the populations analyzed.

Nível de fluoretação na água de abastecimento de Passo Fundo

A fluoretação da água de abastecimento é uma das principais medidas preventivas de saúde pública para controle de cárie dentária. O objetivo do presente trabalho foi conhecer o nível de fluoretação da água de abastecimento da cidade de Passo Fundo. O presente trabalho possui uma abordagem quantitativa, cujo delineamento foi transversal e teve como objetivo verificar os níveis de fluoretação da água de abastecimento da cidade de Passo Fundo, Rio Grande do Sul, Brasil. Os dados foram coletados de relatórios públicos da Corsan, constando os valores mínimos, máximos e médios de flúor na água, nos anos de 2014 e 2015 totalizando 72 amostras. As avaliações consideradas inadequadas não ultrapassaram 5% do total de análises realizadas. Concluindo que a média da concentração de flúor apresentou-se de acordo com a legislação vigente durante os dois anos pesquisados.

Factors associated with last dental visit or not to visit the dentist by Brazilian adolescents: A population-based study

Objectives

We investigated the factors associated with no dental visit within the last two years by adolescents in the state of São Paulo, Brazil, by using data from the Oral Health Conditions of São Paulo state population Project (SBSP-2015) conducted in 2015.

Methods

This was a cross-sectional epidemiological study with a representative sample of adolescents aged 15 to higher years residing in São Paulo State. The examiners were calibrated and dental visits were measured categorically as 1- Less than 1 year, 2- One to two years, 3 - Three years or more, 4- I have never visited the dentist. Based on the literature we dichotomized the outcome in two groups: response 1 plus 2 against response 3 plus 4. Then, Multilevel Poisson Regression (MPR) was used to estimate the prevalence ratios of last dental visit three years or had never been to a dentist by adolescents compared with those who had visited the dentist within the past two years, with contextual variables as the distal level; sociodemographic variables, mesial; and individual variables, proximal level.

Results

A high percentage of adolescents (84.9%) reported visiting the dentist in the last 2 years. Whereas, 626 (11.6%) had not visited the dentist for over 3 years and 188 (3.4%) had never been. A significantly higher proportion of females than males reported visiting the dentist in the past 2 years (p = 0.003). The oral and dental condition was reported as satisfactory by 4,350 respondents (80.6%), and when they accessed the health service, 2,286 (42.3%) went to the public service. Lower mean family income (1.62PR;95%CI;1.36–1.94); ≥ 1,000 inhabitant/Dental Surgeons (1.25PR;95%IC;1.03–1.56);male (1.26PR;95%CI; 1.11–1.43) non-Caucasian ethnicity (Mulatto:1.30PR;95%CI;1.13–1.50 and Black:1.58PR;95%CI;1.29–1.93); dissatisfaction with the oral health condition (1.20PR;95%CI;1.01–1.45),last visit to the public service versus private service (2.26PR; 95%CI;1.91–2.65) and presenting with periodontal disease in the form of dental calculus as the worst situation (1.38PR; 95%CI; 1.16–1.53) were associated with last visit to the dentist.

Conclusions

A high proportion of adolescents had visited the dentist in the last two years. No dental visit within the last two years by adolescents were associated with contextual, health care system, sociodemographic, personal and oral health status, demonstrating that this is a complex phenomenon. Actions to promote regular dental visits by adolescents in Brazil should take these factors into consideration.

Conhecimento de alunos do Curso de Odontologia sobre o uso racional do flúor

INTRODUÇÃO: O uso do flúor sob a forma de fluoreto é o principal fator de proteção no controle da cárie dentária, em todo o mundo. O flúor pode ser oferecido à população de diversas formas, sendo as mais utilizadas a fluoretação da água de abastecimento e os dentifrícios fluoretados. Entretanto, a exposição ao flúor também pode ocorrer por meio das soluções para bochechos; de géis e materiais de uso odontológico, e da dieta, por meio de alimentos e bebidas industrializados. OBJETIVO: Este estudo objetivou verificar o conhecimento dos alunos de diferentes semestres do curso de Odontologia da Universidade Estadual do Sudoeste da Bahia sobre o uso racional do flúor. MATERIAL E MÉTODO: Realizou-se um estudo transversal, sendo a amostra composta por acadêmicos de diferentes semestres do curso de Odontologia, que responderam a um questionário para verificar seus conhecimentos em relação ao flúor. RESULTADO: Dos acadêmicos entrevistados, 58,16% consideraram o alto risco à cárie e a hipersensibilidade dentinária como os principais fatores para a indicação do flúor. Para 64,29%, o gel foi o produto fluoretado mais indicado na sua prática diária, e 67,35% indicaram o dentifrício fluoretado para crianças com idade superior a seis anos. Parte significativa da amostra afirmou saber sobre a presença de flúor em alimentos industrializados (91,84%) e reconhecer que o flúor é tóxico (93,88%). CONCLUSÃO: Apesar das informações sobre flúor adquiridas no decorrer do curso, expressiva parte dos alunos ainda não possui domínio sobre o assunto e mostrou-se insegura para poder recomendá-lo na sua prática clínica diária.