Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2018 Apr 9:52:28.
doi: 10.11606/S1518-8787.2018052016330.

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

[Article in English, Portuguese]
Mariângela Guanaes Bortolo da Cruz  1 , Paulo Capel Narvai  2
Affiliations
Observational Study

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

[Article in English, Portuguese]
Mariângela Guanaes Bortolo da Cruz et al. Rev Saude Publica. .

Abstract
in English, Portuguese

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.

OBJETIVO: Analisar a associação entre a exposição à água fluoretada e cárie dentária, em contexto de uso generalizado de creme dental fluoretado no Brasil, em cenário de baixa prevalência da doença.

MÉTODOS: Realizado estudo observacional transversal, de tipo censitário, na modalidade de duplo inquérito epidemiológico populacional, em dois municípios paulistas em 2014. Participaram adolescentes de 11 e 12 anos, imersos na sua condição de exposição (n = 184) ou não exposição (n = 128) à água fluoretada, há pelo menos cinco anos. As populações avaliadas residiam em comunidades da mesma região geográfica, de pequeno porte demográfico e com classificação socioeconômica similar, diferenciando-se apenas pela condição de exposição à água fluoretada (Silveiras) e de não exposição (São José do Barreiro). A experiência, a magnitude e o grau de polarização da cárie dentária nessas populações foram analisadas por meio dos índices CPOD e SiC e a associação foi testada empregando-se as estatísticas qui-quadrado de Pearson e razão de prevalência entre não expostos e expostos à água fluoretada.

RESULTADOS: Embora a experiência de cárie (CPOD ≥ 1) não tenha se associado com a exposição à água fluoretada (qui-quadrado = 1,78; p = 0,18; α = 5%), observou-se expressiva diferença na magnitude com que a doença atingiu a população: as médias CPOD foram de 1,76 em expostos e 2,60 em não expostos e as médias SiC foram de 4,04 e 6,16, respectivamente. O grau da polarização, indicado pela porcentagem de indivíduos com CPOD = 0, foi diferente, maior (41,8%) em expostos e menor (34,3%) em não expostos. A razão de prevalência entre não expostos e expostos foi de 1,13, indicando pouca expressividade na diferença das prevalências.

CONCLUSÕES: A exposição à água fluoretada implicou menores valores médios dos índices CPOD e SiC, ainda que em presença de exposição concomitante a dentifrício fluoretado, em cenário de baixa prevalência da doença e padrão similar de distribuição de cárie nas populações analisadas.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: The authors declare no conflict of interest.

Figures

Figure 1
Figure 1. Box Plot of the distribution of the values of the DMFT index, in schoolchildren aged 11 and 12 years, according to exposure to fluoridated water. Silveiras (with fluoridation) and São José do Barreiro (without fluoridation), State of São Paulo, Brazil, 2014.
Figure 2
Figure 2. Percentage distribution of the values of the DMFT index, in schoolchildren aged 11 and 12 years, according to exposure to fluoridated water. Silveiras (with fluoridation) and São José do Barreiro (without fluoridation), state of São Paulo, Brazil, 2014.
Figure 3
Figure 3. Lorenz curves for the load distributions of dental caries in schoolchildren aged 11 and 12 years, according to exposure to fluoridated water. Silveiras (exposed) and São José do Barreiro (not exposed), State of São Paulo, Brazil, 2014.
See this image and copyright information in PMC

References

    1. Alves RX, Fernandes GF, Razzolini MTP, Frazão P, Marques RAA, Narvai PC. Evolução do acesso à água fluoretada no Estado de São Paulo, Brasil: dos anos 1950 à primeira década do século XXI. Cad Saude Publica. 2012;28(Supl):s69–s80. https://doi.org/10.1590/S0102-311X2012001300008. - DOI - PubMed
    1. Antunes JLF, Narvai PC, Nugent ZJ. Measuring inequalities in the distribution of dental caries. Community Dent Oral Epidemiol. 2004;32(1):41–48. https://doi.org/10.1111/j.1600-0528.2004.00125.x. - DOI - PubMed
    1. Antunes JLF, Narvai PC. Políticas de saúde bucal no Brasil e seu impacto sobre as desigualdades em saúde. Rev Saude Publica. 2010;44(2):360–365. https://doi.org/10.1590/S0034-89102010005000002. - DOI - PubMed
    1. Barbosa AS, Boery RNSO, Boery EN, Gomes DL, Filho, Sena ELS, Oliveira AAS. A Resolução 196/96 e o sistema brasileiro de revisão ética de pesquisas envolvendo seres humanos. [cited 2017 Nov 3];Rev Bioetica. 2011 19(2):523–542. http://revistabioetica.cfm.org.br/index.php/revista_bioetica/article/vie....
    1. Barata RCB. O desafio das doenças emergentes e a revalorização da epidemiologia descritiva. Rev Saude Publica. 1997;31(5):531–537. https://doi.org/10.1590/S0034-89101997000600015. - DOI - PubMed

Publication types