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Rosário BSM, Rosário HD, de Andrade Vieira W, Cericato GO, Nóbrega DF, Blumenberg C, Hugo FN, Costa MM, Paranhos LR. External control of fluoridation in the public water supplies of Brazilian cities as a strategy against caries: a systematic review and meta-analysis. BMC Oral Health 2021; 21:410. [PMID: 34412623 PMCID: PMC8377988 DOI: 10.1186/s12903-021-01754-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/23/2021] [Indexed: 11/21/2022] Open
Abstract
Background Among the methods currently available to provide fluoride in population levels, fluoridated water is the most successful for presenting high efficacy, safety and good cost–benefit. However, recent studies on external control have shown great variability of fluoride concentrations in the water from treatment stations in Brazilian cities, which must present concentration between 0.6 and 0.8 mg/L to be considered acceptable in most cities. Thus, this study aimed to perform a systematic review of the literature to assess the adequacy of fluoride concentration in the water in Brazilian cities using external control. Methods The protocol was registered in PROSPERO. Six databases were used as primary search sources and three databases were used to partially capture the "gray literature". Only observational studies that assessed the fluoride concentration of artificially fluoridated water from the public supply network were included. The JBI Critical Appraisal Tools for Systematic Reviews was used to assess the risk of bias of the studies. A proportion meta-analyses using random-effect models were performed. The heterogeneity between studies was determined by I2 statistic. Meta-regressions were conducted to identify relevant moderators to be used in stratified meta-analyses. Publication bias was investigated by Egger’s tests. Results The search provided 2038 results, from which 14 met the eligibility criteria and were included in the data extraction of the review. Overall, the water samples were collected from 449 different sources in three Brazilian regions. Thirteen studies presented a low risk of bias. The mean concentration of fluoride ranged from 0.17 to 0.89 ppmF. The meta-analyis demonstrated that more than half of the water samples analyzed had fluoride concentration levels outside the acceptable range (56.6%; 95% CI 45.5; 67.3), with high heterogeneity. Conclusion More than half of the public water supply analyzed in the studies selected had fluoride concentration levels outside the acceptable range, which may affect the risk of developing oral diseases in the Brazilian population, having an important impact on public health. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01754-2.
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Affiliation(s)
| | - Henrique Damian Rosário
- Department of Dentistry, Dental School, Universidade do Sul de Santa Cantarina (UNISUL), Tubarão, SC, Brazil
| | - Walbert de Andrade Vieira
- Endodontics Division, Department of Restorative Dentistry, School of Dentistry of Piracicaba, Universidade Estadual de Campinas (UNICAMP), Piracicaba, SP, Brazil
| | | | | | - Cauane Blumenberg
- Department of Social Medicine, Universidade Federal de Pelotas (UFPel), Pelotas, RS, Brazil
| | - Fernando Neves Hugo
- Department of Preventive and Social Dentistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Márcio Magno Costa
- Division of Department of Removable Prosthesis and Dental Materials, School of Dentistry, Universidade Federal de Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Luiz Renato Paranhos
- Division of Preventive and Community Dentistry, School of Dentistry, Universidade Federal de Uberlândia (UFU), Campus Umuarama, Av. Pará, 1720, Bloco 2G, sala 1, Uberlândia, MG, 38405-320, Brazil.
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Peres M, Peres K, Barbato P, Höfelmann D. Access to Fluoridated Water and Adult Dental Caries. J Dent Res 2016; 95:868-74. [DOI: 10.1177/0022034516643064] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- M.A. Peres
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, Australia
| | - K.G. Peres
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, Australia
| | - P.R. Barbato
- Postgraduate Program in Public Health, Federal University of Santa Catarina, Florianópolis, Brazil
| | - D.A. Höfelmann
- Department of Nutrition, Federal University of Parana, Curitiba, Brazil
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BERGAMO ETP, BARBANA M, TERADA RSS, CURY JA, FUJIMAKI M. Fluoride concentrations in the water of Maringá, Brazil, considering the benefit/risk balance of caries and fluorosis. Braz Oral Res 2015; 29:47. [DOI: 10.1590/1807-3107bor-2015.vol29.0047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 12/01/2014] [Indexed: 11/22/2022] Open
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Moimaz SAS, Saliba O, Marques LB, Garbin CAS, Saliba NA. Dental fluorosis and its influence on children's life. Braz Oral Res 2015; 29:S1806-83242015000100214. [PMID: 25590503 DOI: 10.1590/1807-3107bor-2015.vol29.0014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 09/01/2014] [Indexed: 11/21/2022] Open
Abstract
This study verified the prevalence of dental fluorosis in 12-year-old children and its association with different fluoride levels in the public water supply, and evaluated the level of perception of dental fluorosis by the studied children. To assess fluorosis prevalence, clinical examinations were performed and a structured instrument was used to evaluate the self-perception of fluorosis. The water supply source in the children's area of residence since birth was used as the study criterion. In total, 496 children were included in the study. Fluorosis was diagnosed in 292 (58.9%) children; from these, 220 (44.4%) children were diagnosed with very mild fluorosis, 59 (11.9%) with mild fluorosis, 12 (2.4%) with moderate fluorosis, and 1 (0.2%) child with severe fluorosis. A significant association (p = 0.0004) was observed between the presence of fluorosis and areas with excessive fluoride in the water supply. Among the 292 children that showed fluorosis, 40% perceived the presence of spots in their teeth. The prevalence of fluorosis was slightly high, and the mildest levels were the most frequently observed. Although most of the children showed fluorosis to various degrees, the majority did not perceive these spots, suggesting that this alteration did not affect their quality of life.
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Affiliation(s)
- Suzely Adas Saliba Moimaz
- Department of Social and Pediatric Dentistry, Araçatuba Dental School, Universidade Estadual Paulista, Araçatuba, SP, Brazil
| | - Orlando Saliba
- Department of Social and Pediatric Dentistry, Araçatuba Dental School, Universidade Estadual Paulista, Araçatuba, SP, Brazil
| | - Lívia Bino Marques
- Department of Social and Pediatric Dentistry, Araçatuba Dental School, Universidade Estadual Paulista, Araçatuba, SP, Brazil
| | - Cléa Adas Saliba Garbin
- Department of Social and Pediatric Dentistry, Araçatuba Dental School, Universidade Estadual Paulista, Araçatuba, SP, Brazil
| | - Nemre Adas Saliba
- Department of Social and Pediatric Dentistry, Araçatuba Dental School, Universidade Estadual Paulista, Araçatuba, SP, Brazil
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Moimaz SAS, Saliba NA, Saliba O, Sumida DH, Souza NPD, Chiba FY, Garbin CAS. Water fluoridation in 40 Brazilian cities: 7 year analysis. J Appl Oral Sci 2013; 21:13-9. [PMID: 23559106 PMCID: PMC3881812 DOI: 10.1590/1678-7757201302280] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 11/30/2012] [Indexed: 11/22/2022] Open
Abstract
Objectives: Fluoride levels in the public water supplies of 40 Brazilian cities were analyzed and
classified on the basis of risk/benefit balance. Material and Methods: Samples were collected monthly over a seven-year period from three sites for each water
supply source. The samples were analyzed in duplicate in the laboratory of the Center
for Research in Public Health - UNESP using an ion analyzer coupled to a
fluoride-specific electrode. Results: A total of 19,533 samples were analyzed, of which 18,847 were artificially fluoridated
and 686 were not artificially fluoridated. In samples from cities performing water
fluoridation, 51.57% (n=9,720) had fluoride levels in the range of 0.55 to 0.84 mg F/L;
30.53% (n=5,754) were below 0.55 mg F/L and 17.90% (n=3,373) were above 0.84 mg F/L
(maximum concentration=6.96 mg F/L). Most of the cities performing fluoridation that had
a majority of samples with fluoride levels above the recommended parameter had deep
wells and more than one source of water supply. There was some variability in the
fluoride levels of samples from the same site and between collection sites in the same
city. Conclusions: The majority of samples from cities performing fluoridation had fluoride levels within
the range that provides the best combination of risks and benefits, minimizing the risk
of dental fluorosis while preventing dental caries. The conduction of studies about
water distribution systems is suggested in cities with high natural fluoride
concentrations in order to optimize the use of natural fluoride for fluoridation costs
and avoid the risk of dental fluorosis.
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Affiliation(s)
- Suzely Adas Saliba Moimaz
- Preventive and Social Dentistry Post-Graduation Program, Univ. Estadual Paulista - UNESP, Araçatuba, SP, Brazil.
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Moimaz SAS, Saliba O, Chiba FY, Sumida DH, Garbin CAS, Saliba NA. Fluoride concentration in public water supply: 72 months of analysis. Braz Dent J 2012. [DOI: 10.1590/s0103-64402012000400024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Known as one of the ten most important advances on Public Health in the 20th century, fluoridation of public water supply is a measure of wide population coverage, which is effective on caries control. The city of Araçatuba, in the Northwest region of the São Paulo state, Brazil, started public water supply fluoridation in 1972 and, based on the average annual highest temperature, has kept the fluoride concentration between 0.6 to 0.8 mgF/L. The purpose of this study was to analyze monthly the fluoride concentration in public water supply in the city of Araçatuba during 72 months. Water samples were collected monthly on weekdays, directly from the water distribution network, on pre-established locations and analyzed in duplicate between November 2004 and October 2010 at the Research Laboratory of the Nucleus for Public Health (NEPESCO) of the Public Health Graduate Program from Araçatuba Dental School/UNESP, Brazil, using an fluoride-specific electrode connected to an ion analyzer. From the total of samples (n=591), 67.2% (n=397) presented fluoride concentration between 0.6 and 0.8 mgF/L; 20.6% (n=122) below 0.6 mgF/L; 11.5% (n=68) between 0.8 and 1.2 mgF/L and 0.7% (n=4) above 1.2 mgF/L. Most samples showed fluoride levels within the recommended parameters. Minimal variation was observed among the analyzed collection locations, showing that the city has been able to control the fluoride levels in the public water supply and reinforcing the importance of surveillance and constant monitoring to assure the quality of the water delivered to the population.
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