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Fluoridation of the public water supplies is recognized as among the top ten public health achievements of the twentieth century. However, the positive aspects of this measure depend on the maintenance of fluoride concentrations within adequate levels. Objective To report the results of seven years of external control of the fluoride (F) concentrations in the public water supply in Bauru, SP, Brazil in an attempt to verify, on the basis of risk/benefit balance, whether the levels are appropriate. Material and Methods From March 2004 to February 2011, 60 samples were collected every month from the 19 supply sectors of the city, totaling 4,641 samples. F concentrations in water samples were determined in duplicate, using an ion-specific electrode (Orion 9609) coupled to a potentiometer after buffering with TISAB II. After the analysis, the samples were classified according to the best risk-benefit adjustment. Results Means (±standard deviation) of F concentrations ranged between 0.73±0.06 and 0.81±0.10 mg/L for the different sectors during the seven years. The individual values ranged between 0.03 and 2.63 mg/L. The percentages of the samples considered “low risk” for dental fluorosis development and of “maximum benefit” for dental caries prevention (0.55-0.84 mg F/L) in the first, second, third, fourth, fifth, sixth, and seventh years of the study were 82.0, 58.5, 37.4, 61.0, 89.9, 77.3, and 72.4%, respectively, and 69.0% for the entire period. Conclusions Fluctuations of F levels were found in the public water supply in Bauru during the seven years of evaluation. These results suggest that external monitoring of water fluoridation by an independent assessor should be implemented in cities where there is adjusted fluoridation. This measure should be continued in order to verify that fluoride levels are suitable and, if not, to provide support for the appropriate adjustments.

Fluoridation of the public water supplies is recognized as among the top ten public health achievements of the twentieth century. However, the positive aspects of this measure depend on the maintenance of fluoride concentrations within adequate levels.ObjectiveTo report the results of seven years of external control of the fluoride (F) concentrations in the public water supply in Bauru, SP, Brazil in an attempt to verify, on the basis of risk/benefit balance, whether the levels are appropriate.Material and MethodsFrom March 2004 to February 2011, 60 samples were collected every month from the 19 supply sectors of the city, totaling 4,641 samples. F concentrations in water samples were determined in duplicate, using an ion-specific electrode (Orion 9609) coupled to a potentiometer after buffering with TISAB II. After the analysis, the samples were classified according to the best risk-benefit adjustment.ResultsMeans (±standard deviation) of F concentrations ranged between 0.73±0.06 and 0.81±0.10 mg/L for the different sectors during the seven years. The individual values ranged between 0.03 and 2.63 mg/L. The percentages of the samples considered “low risk” for dental fluorosis development and of “maximum benefit” for dental caries prevention (0.55-0.84 mg F/L) in the first, second, third, fourth, fifth, sixth, and seventh years of the study were 82.0, 58.5, 37.4, 61.0, 89.9, 77.3, and 72.4%, respectively, and 69.0% for the entire period.ConclusionsFluctuations of F levels were found in the public water supply in Bauru during the seven years of evaluation. These results suggest that external monitoring of water fluoridation by an independent assessor should be implemented in cities where there is adjusted fluoridation. This measure should be continued in order to verify that fluoride levels are suitable and, if not, to provide support for the appropriate adjustments.

This study evaluated the fluoride intake from dentifrices with different fluoride concentrations ([F]) by children aged 24-36 months, as well as the influence of the dentifrice flavor in the amount of fluoride ingested during toothbrushing. Thirty-three children were randomly divided into 3 groups, according to the [F] in the dentifrices: G-A (523 µgF/g), G-B (1,062 µgF/g) and G-C (1,373 µgF/g). Dentifrices A and B are marketed for children, while dentifrice C is a regular product. The amount of F ingested was indirectly obtained, subtracting the amount expelled and the amount left on the toothbrush from the amount initially loaded onto the brush. The results were analyzed by ANOVA, Tukey's test and linear regression analysis (p < 0.05). Children ingested around 60% of the dentifrice loaded onto the brush, but no significant differences were seen among the groups (p > 0.05). Mean daily fluoride intake from dentifrice for G-A, G-B and G-C was 0.022ª, 0.032ª and 0.061b mg F/kg body weight, respectively (p < 0.01). There was a strong positive correlation (r = 0.86, p < 0.0001) between the amount of dentifrice used and the amount of fluoride ingested during toothbrushing. The results indicate the need for instructing children's parents and care givers to use a small amount of dentifrice (< 0.3 g) to avoid excessive ingestion of fluoride. The use of low-[F] dentifrices by children younger than 6 years also seems to be a good alternative to minimize fluoride intake. Dentifrice flavor did not influence the percentage of fluoride intake.Avaliou-se a ingestão de flúor após uso de dentifrícios contendo diferentes concentrações de flúor ([F]) por crianças entre 24-36 meses de idade, além da influência do sabor do dentifrício na quantidade de flúor ingerida durante a escovação. Dividiram-se 33 crianças aleatoriamente em 3 grupos, de acordo com a [F] nos dentifrícios: G-A (523 µgF/g), G-B (1.062 µgF/g) e G-C (1.373 µgF/g). Os dentifrícios A e B são infantis, e o C, convencional. A quantidade de flúor ingerida foi indiretamente obtida subtraindo-se a quantidade de flúor expelida e a quantidade que restou na escova daquela inicialmente carregada na escova. Os resultados foram analisados por ANOVA, teste de Tukey e análise de regressão linear (p < 0,05). Aproximadamente 60% do dentifrício carregado na escova foi ingerido pelas crianças, embora sem diferenças significativas entre os grupos (p > 0,05). A ingestão média diária de flúor para G-A, G-B e G-C foi 0,022ª, 0,032ª e 0,061b mg F/kg de peso corporal, respectivamente (p < 0,01). Houve uma forte correlação positiva (r = 0,86, p < 0,0001) entre a quantidade de dentifrício utilizada e a quantidade de flúor ingerida durante a escovação. Os resultados indicam a necessidade de se instruir pais e cuidadores de crianças a utilizarem uma quantidade pequena de dentifrício (< 0,3 g) para se evitar ingestão excessiva de flúor. O uso de dentifrícios com [F] reduzida por crianças menores de 6 anos também se constitui numa boa alternativa para se minimizar a ingestão de flúor. O sabor do dentifrício não influenciou na porcentagem de ingestão deste íon.

The increasing consumption of juices, soft drinks and teas among children has increased significantly fluoride ingestion at the age range of risk for development of dental fluorosis. Objective: The purpose of this study was to evaluate fluoride concentrations in some brands of industrialized beverages consumed by children in the city of Bauru, SP, Brazil. Material and Methods: 98 brands of beverages were analyzed, divided into 3 lots, comprising 36, 32 and 30 brands, respectively, for the first, second and third lots. Fluoride concentrations were determined by HMDS-facilitated diffusion, using a fluoride ion-specific electrode (Orion 9409). Results: Fluoride concentrations ranged between 0.04 and 1.76 µg F/mL. It was observed a wide variation in fluoride concentrations among the different brands, as well as the different lots of the same brand. There was no information on fluoride concentrations on the labels of any product. Conclusions: Some of the products analyzed could contribute significantly to the total fluoride intake and, thus, be important risk factors for development of dental fluorosis, which indicates the need of controlling the production of these beverages with respect to fluoride concentration.

OBJECTIVE: To evaluate the prevalence of dental fluorosis in scholars aging 12 to 15 years old, residents in the city of Bauru, State of São Paulo, Brazil. METHODS: 1318 volunteers were enrolled in this study and examined in 18 public schools of the State of São Paulo. The examinations were performed in the schools' court by three dentists (with a Master's degree in Public Health), after toothbrushing supervised by another dentist. The teeth were dried with cotton pellets and examined under natural light by visual inspection, using an explorer as recommended by the WHO, a plane mirror and a tongue depressor. The Thylstrup-Fejerskov (TF) index was used for rating fluorosis. Intra and inter-examiner reproducibility was calculated and data were submitted to descriptive analysis. RESULTS: Approximately 36% of the children presented dental fluorosis, of which 28% was diagnosed as TF1 while the remaining received scores between TF2 and TF4. CONCLUSION: The prevalence of dental fluorosis in Bauru is within the expected range, based on previous studies. Although fluoride is an important resource for caries control, its use must be adequate to the needs of each specific population.

The aim of this study was to compare the dental caries prevalence, in the year 1998, in two cities of big population, one of them fluoridated, since 1975, the city of Bauru, and other, named Jaú, where the fluoridation was interrupted (1992). The two cities are located in the State of São Paulo, Brazil. The sample was composed by 189 children of 5 years old and 163 of 12 years old, both gender, distributed between Bauru and Jaú. The statistical analysis was made with use of the Student’s “t” test. The dental caries was registered with the use of the DMFT index and observed the percentage of children caries-free. No statistical differences were observed, considering the age and the cities. The outcomes showed that dmft of the 5 years old children in Bauru and Jaú were 1.06 1.32, respectively; and the DMFT of the 12 years old children were 2.92 and 3.45 respectively. The percentages of 5 years old caries free children in Bauru and Jaú were 54.84% and 55.21%, respectively. Considering the age of 12, the caries-free children were 21.34% in Bauru and 22.73% in Jaú. In the parameter evaluated the children living in Bauru, which has fluoridated water for more than 20 years, did not differ from the children from Jaú, which suffered interruption in the water fluoridation supply. Our results are differ from analysis performed during the decades of 70 and 80, when studies showed that the interruption in the fluoridation of drinking water was followed by an increase in the prevalence of dental decay. In conclusion, our data suggest that the interruption in water fluoridation at Jaú did not bring about a tendency towards caries increase. These results can be possibly explained by the use of fluoridated toothpaste, associated with the ingestion of other sources of fluoride and the presence of the “halo effect”. Our results indicate that the availability of other sources of fluoride must also be considered and taken into account in the planning of programs in public health dentistry.

OBJECTIVE: to analyze the fluoride concentration in the public water supply at the area supplied by the Water Treatment Station of Bauru and classify the samples as acceptable or unacceptable according to the fluoride concentration. MATERIAL AND METHODS: samples were collected from 30 areas at two periods, October 2002 and March 2003. The fluoride concentration in the samples was determined in duplicate, using an ion sensitive electrode (Orion 9609) connected to a potentiometer (Procyon, model 720). Samples with fluoride concentration ranging from 0.55 to 0.84 mg F/L were considered acceptable, and those whose concentration was outside this range as unacceptable. Data were analyzed by descriptive statistics. RESULTS: the fluoride concentration of the water samples varied between 0.31 and 2.01 mg F/L. Nearly 56% of the samples were classified as acceptable. CONCLUSION: the variations in fluoride concentration at the area supplied by the Water Treatment Station reinforce the need of constant monitoring for maintenance of adequate fluoride levels in the public water supply.OBJETIVO: Analisar a concentração de fluoreto da água de abastecimento público do setor abastecido pela Estação de Tratamento de Água de Bauru e classificar as amostras em aceitáveis ou inaceitáveis de acordo com a concentração de flúor. MATERIAL E MÉTODOS: Foram coletadas 238 amostras de 30 bairros em duas etapas, Outubro de 2002 e Março de 2003. A concentração de fluoreto presente nas amostras foi determinada em duplicata, utilizando-se o eletrodo íon sensível (Orion 9609), acoplado ao potenciômetro (Procyon, modelo 720). As amostras com concentração de flúor variando entre 0,55 e 0,84 mg F/L foram consideradas como aceitáveis e aquelas cuja concentração estava fora do intervalo, como inaceitáveis. Os dados foram analisados por meio de estatística descritiva. RESULTADOS: A concentração de fluoreto das amostras de água variou entre 0,31 e 2,01 mg F/L, sendo que cerca de 56% das amostras foram classificadas como aceitáveis. CONCLUSÃO: A variação na concentração de fluoreto do setor abastecido pela ETA reforça a importância de um monitoramento constante da fluoretação para a manutenção dos níveis adequados de fluoreto na água de abastecimento.

OBJECTIVES: The objectives of this study were to assess the fluoride concentration in the public water supply and the prevalence of dental fluorosis in schoolchildren between 7 and 15 years old, living in a peripheral district of the municipality of Bauru. MATERIAL AND METHODS: For this, fifty two water samples were collected on three different days of one week. These samples were analyzed for fluoride by means of the ion-sensitive electrode method (Orion 9609) coupled to a potentiometer (Procyon, model 720). In this method, 1.0 mL of TISAB II (Orion) was added to 1.0 mL of the sample. For the epidemiological survey of fluorosis, 52 schoolchildren of both genders, aged between 7 and 15 were assessed, with prior authorization from their caretakers. Only one person examined the children, after supervised toothbrushing and drying with cotton wool rolls. The TF index was used. RESULTS: The fluoride concentrations in the water samples ranged from 0.62 to 1.20 mg/L, with a mean of 0.9 mg/L. The prevalence of dental fluorosis was 33%, with severity ranging from TF1 to TF4 (Kappa of 0.73 and concordance of 83.33%). CONCLUSIONS: The results from the analysis of water samples indicated a fluoride concentration greater than recommended for Bauru. The fluorosis levels found were higher than expected for a peripheral district, in which water is one of the few sources of fluoride.OBJETIVOS: Avaliar a concentração de flúor na água de abastecimento público e a prevalência de fluorose dentária de escolares entre 7 e 15 anos de idade, residentes em um bairro da periferia de Bauru. MATÉRIAL E MÉTODOS: Foram coletadas 52 amostras de água durante três dias de uma semana e analisadas utilizando-se o eletrodo íon sensível (Orion 9609), acoplado a um potenciômetro (Procyon, modelo 720), com 1,0 mL da amostra à qual foi adicionado 1,0 mL de TISAB II (Orion). Para o levantamento epidemiológico de fluorose foram examinados 52 escolares entre 7 e 15 anos de idade, de ambos os gêneros, mediante a obtenção de autorização prévia dos responsáveis. Somente um examinador realizou os exames após escovação supervisionada e secagem dos dentes com rolos de algodão. O índice utilizado foi o TF, estabelecido a partir do grau máximo verificado em cada indivíduo. RESULTADOS: A concentração de flúor na água variou entre 0,62 e 1,15 mg/L, mantendo uma média de 0,9 mg/L. A prevalência de fluorose dentária verificada foi de 33%, com severidade variando entre TF1 e TF4 (Kappa=0,73 e concordância de 83,33%). CONCLUSÕES: Os resultados da análise das amostras de água indicam uma concentração média de flúor acima do recomendado para Bauru. O índice de fluorose dentária verificado foi maior que o esperado para um bairro da periferia, onde a água é uma das poucas fontes de ingestão de flúor.