Nascimento HA, Ferreira JM, Granville-Garcia AF, Costa EM, Cavalcante AL, Sampaio FC. Estimation of toothpaste fluoride intake in preschool children. Braz Dent J. 2013;24(2). pii: S0103-64402013000200142. doi: 10.1590/0103-6440201302087.
The objective of this study was to estimate the intake of toothpaste fluoride used by children aged 2 to 6 years (n=87) treated at a hospital of a medium-sized city (Campina Grande, PB) in the Northeastern region of Brazil. Data regarding sociodemographic characteristics of families and children’s toothbrushing were collected from questionnaire-based interviews with parents/guardians, and the amount of fluoride used during toothbrushing was estimated using a precision scale for assessment of the risk of dental fluorosis, considering a cutoff value of 0.07 mgF/kg body weight/day. Fluoride content in the toothpastes was analyzed using a specific fluoride electrode. Data were analyzed using descriptive and inferential statistics using the chi-square and Fisher’s exact tests (α=0.05). Considering the use of the derice, the risk of fluorosis in the children was 19.5%. There was significant association (p<0.05) between the risk of fluorosis, brushing frequency, type of derice and who performed the child’s oral hygiene. It was concluded that a high percentage of children in the studied sample used toothpaste inappropriately and were at risk of developing dental fluorosis.
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In this study samples were taken and tested for fluoride in Brazilian cities. The results of these analyses are presented, and then the statement is made:
“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.”
No evidence is provided that the above statement is true in the population served. The conclusion is imposed on the data by the authors.
Moimaz SA, Saliba NA, Saliba O, Sumida DH, Souza NP, Chiba FY, Garbin CA. Water fluoridation in 40 Brazilian cities: 7 year analysis. J Appl Oral Sci. 2013;21(1):13-9.
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.
The contractor shall continue the Literature Search to survey peer-reviewed literature to identify existing and relevant environmental justice issues impacting relevant communities in Brazil and complete the literature search.
Title: R–Brazil Environmental Justice Workshop and Pilot Project Sol. #: RFQ-DC-12-00064
Agency: Environmental Protection Agency Office: Office of Acquisition Management Location: EPA/Headquarters Posted On: Jul 27, 2012 2:50 pm Base Type: Presolicitation Link: https://www.fbo.gov/spg/EPA/OAM/HQ/RFQ-DC-12-00064/listing.html
This study in Brazil attempts to show the benefits of water fluoridation by comparing the results of dental caries prevalence in children in 2 different groups separated by 21 years. Factors other than fluoridation that would confound the results over such a long period of time (e.g., brushing, dentifrice availability, etc)…..regardless of what the statistics imply.
Hashizume, LM, Mathias, TC, Cibils, DM, and M. Maltz. Effect of the widespread use of fluorides on the occurrence of hidden caries in children. International Journal of Paediatric Dentistry 2012 Feb 20. doi: 10.1111/j.1365-263X.2012.01231.x.
Background. It has been suggested that the widespread use of fluorides could interfere in the prevalence of clinically undetected occlusal dentine caries. Aim. The objective of this study was to determine the role of public water fluoridation and fluoride dentifrice on the prevalence of hidden caries in 8-10-year-old children.
Design. Clinical and radiographic data on schoolchildren collected in an epidemiologic study in Porto Alegre, Brazil, at two moments, 1975 (n=228) and 1996 (n=213), were analysed. Only the first permanent molars were studied. Only children of the 1996 examinations had benefited from fluoridated water soon after birth and had regular access to fluoride dentifrices. The criterion applied for hidden caries, when data from 1975 to 1996 were compared, was clinical sound surfaces that presented a radiolucent zone in the dentine.
Results. The prevalence of clinically sound surfaces and percentage of hidden caries was 0.51 and 26.4% in 1975 and 2.67 and 12.9% in 1996, respectively. The prevalence of hidden caries differed statistically between the two periods (P<0.05).
Conclusions. The results do indicate that the widespread use of fluoride via public water supply and dentifrices decreases the prevalence of hidden caries.
In this study, a portion of the water systems exceeded the recommended level, and some were below. Even with the best control methods, a portion of the population served will be over exposed and some will be under exposed. So is there an overall population net benefit?
Moimaz SA, Saliba O, Chiba FY, Saliba NA. External control of the public water supply in 29 Brazilian cities. Braz Oral Res. 2012 Feb;26(1):12-8.
The fluoridation of public water supplies is considered the most efficient public health measure for dental caries prevention. However, fluoride levels in the public water supply must be kept constant and adequate for the population to gain preventive benefit. The aim of this study was to analyze fluoride levels in the public water supply of 29 Brazilian municipalities during a 48-month period from November 2004 to October 2008. Three collection sites were defined for each source of municipal public water supply. Water samples were collected monthly and analyzed at the Research Laboratory of the Nucleus for Public Health (NEPESCO), Public Health Postgraduate Program, Araçatuba Dental School (UNESP). Of the 6862 samples analyzed, the fluoride levels of 53.5% (n = 3671) were within the recommended parameters, those of 30.4% (n = 2084) were below these parameters, and those of 16.1% (n = 1107) were above recommended values. Samples from the same collection site showed temporal variability in fluoride levels. Variation was also observed among samples from collection sites with different sources within the same municipality. Although 53.5% of the samples contained the recommended fluoride levels, these findings reinforce the importance of monitoring to minimize the risk of dental fluorosis and to achieve the maximum benefit in the prevention of dental caries.
The relative benefits of dentifrices versus water fluoridation are not distinguished in this Brazilian study.
Hashizume LN, Mathias TC, Cibils DM, Maltz M. Effect of the widespread use of fluorides on the occurrence of hidden caries in children. Int J Paediatr Dent. 2012 Feb 20. doi: 10.1111/j.1365-263X.2012.01231.x.
Background: It has been suggested that the widespread use of fluorides could interfere in the prevalence of clinically undetected occlusal dentine caries. Aim. The objective of this study was to determine the role of public water fluoridation and fluoride dentifrice on the prevalence of hidden caries in 8-10-year-old children.
Design: Clinical and radiographic data on schoolchildren collected in an epidemiologic study in Porto Alegre, Brazil, at two moments, 1975 (n=228) and 1996 (n=213), were analysed. Only the first permanent molars were studied. Only children of the 1996 examinations had benefited from fluoridated water soon after birth and had regular access to fluoride dentifrices. The criterion applied for hidden caries, when data from 1975 to 1996 were compared, was clinical sound surfaces that presented a radiolucent zone in the dentine.
Results: The prevalence of clinically sound surfaces and percentage of hidden caries was 0.51 and 26.4% in 1975 and 2.67 and 12.9% in 1996, respectively. The prevalence of hidden caries differed statistically between the two periods (P<0.05).
Conclusions: The results do indicate that the widespread use of fluoride via public water supply and dentifrices decreases the prevalence of hidden caries.
Frazao, P., M.A. Peres, and J.A. Cury. Drinking water quality and fluoride concentration. Rev Saude Publica. 2011 Oct;45(5):964-73. Epub 2011 Jul 22.
This paper aimed to analyze the fluoride concentration in drinking water, taking into account the balance between the benefits and risks to health, in order to produce scientific backing for the updating of the Brazilian legislation. Systematic reviews studies, official documents and meteorological data were examined. The temperatures in Brazilian state capitals indicate that fluoride levels should be between 0.6 and 0.9 mg F/l in order to prevent dental caries. Natural fluoride concentration of 1.5 mg F/l is tolerated for consumption in Brazil if there is no technology with an acceptable cost-benefit ratio for adjusting/removing the excess. Daily intake of water with a fluoride concentration > 0.9 mg F/l presents a risk to the dentition among children under the age of eight years, and consumers should be explicitly informed of this risk. In view of the expansion of the Brazilian water fluoridation program to regions with a typically tropical climate, Ordinance 635/75 relating to fluoride added to the public water supply should be revised.
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Biochemistry and Cariology – Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil.
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In spite of decades of research on fluoride and the recognition of its role as the cornerstone of dental caries reduction in the last fifty years, questions still arise on its use at community, self-applied and professional application levels. Which method of fluoride delivery should be used? How and when should it be used? How can its benefits be maximized and still reduce the risks associated with its use? These are only some of the challenging questions facing us daily. The aim of this paper is to present scientific background to understand the importance of each method of fluoride use considering the current caries epidemiological scenario, and to discuss how individual or combined methods can be used based on the best evidence available.
This is an interesting review article that discusses adding iron to drinking water to prevent childhood anemia in different situations, including preschool children in a day care center, low socioeconomic families in Brazil, and implementation at the community level. In the United States, the US Environmental Protection Agency (USEPA) is specifically prohibited from requiring public water system to add substances to achieve health benefits.
Dutra-de-Oliveira, J.E., J.S. Marchini, J. Lamounier, and C.A. Almeida. Iron-Fortified Drinking Water Studies for the Prevention of Children’s Anemia in Developing Countries. Anemia. 2011;2011:815194. Epub 2011 Aug 4.
Department of Internal Medicine, Ribeirão Preto School of Medicine, University of São Paulo, Av Bandeirantes 3900, 14049-900 Ribeirao Preto, SP, Brazil.
Abstract is below. Click here for the full study (open source).
Abstract (National Library of Medicine)
Anemia and iron deficiency should receive special attention considering their high prevalence and serious consequences. For prevention, globally it is recommended to increase dietary iron intake, iron fortification of industrialized foods, and medical iron supplementation. Food fortification for the prevention of iron deficiency in developing countries should consider carriers locally available and consumed daily, requiring limited infrastructure and technology. Drinking water is the iron carrier we have been working for years for the prevention of iron deficiency and anemia in small children in Brazil. It was shown that studies with iron-fortified drinking water were proved to be effective on children’s anemia prevention. Water is found everywhere, consumed daily by everyone may be easily fortified with simple technology, is low priced and was effective on the prevention of children’s anemia. Fortification of drinking water with iron was locally implemented with the direct participation of the government and community. Government authorities, health personnel and population were part of the project and responsible for its community implementation. The mayor/municipality permitted and supported the proposal to supply it to children at their day-care centers. To keep the children drinking water iron fortified supply an officially authorized legislation was also approved.