A fluorose dentÃria à uma anomalia causada por ingestÃo excessiva de flÃor durante o perÃodo de formaÃÃo e desenvolvimento dos dentes, o que provoca o aparecimento de manchas brancas opacas no esmalte dentÃrio. Um estudo transversal de prevalÃncia de fluorose dentÃria e cÃrie foi realizado, em escolares na faixa etÃria de 10 a 14 anos, na comunidade rural de Rafael Arruda, municÃpio de Sobral no Estado do CearÃ, nordeste do Brasil. Nesta localidade, hà mais de dez anos, foi identificada a ocorrÃncia natural de altos teores de flÃor na Ãgua de consumo provavelmente devido a existÃncia de jazidas de fluorita no subsolo, contaminando os lenÃÃis freÃticos. O resultado da anÃlise da concentraÃÃo de flÃor na Ãgua das principais fontes revelou teores variando de 0,34 à 3,6 ppm, cerca de cinco vezes o teor considerado Ãtimo para o consumo humano, muitos dos quais ultrapassavam o limite recomendado que à de 1 ppm de flÃor. Foram submetidos ao exame clÃnico bucal 324 escolares, seguido de uma entrevista, buscando informaÃÃes relacionadas aos fatores que afetam a prevalÃncia e gravidade da fluorose dentÃria. Os Ãndices epidemiolÃgicos utilizados para fluorose dentÃria foram o Ãndice Dean e o Ãndice de Fluorose DentÃria da Comunidade, e para cÃrie o Ãndice CPO-D. Foi realizada uma anÃlise univariada entre a variÃvel dependente (F|uorose dentÃria) e as fatores predisponentes a esta, atravÃs do teste exato de Fischer. Entre as crianÃas examinadas 89,5% apresentaram algum grau de fluorose dentÃria, sendo 49,3% delas atingidas nas formas moderada e grave da intoxicaÃÃo, onde a forma mais prevalente foi a moderada (27,4%). NÃo houve estatisticamente diferenÃa significativa entre sexo e gravidade da fluorose. O Ãndice ComunitÃrio de Fluorose (CFI) encontrado foi de 2,3 correspondendo a um quadro grave, onde recomenda-se a desfluoretaÃÃo da Ãgua e caracteriza-se o problema como importante sob o ponto de vista da saÃde pÃblica. A prevalÃncia de cÃrie ocorreu em 88% da populaÃÃo, e o CPO-D mÃdio encontrado foi de 2,9, refletindo um padrÃo de severidade moderada segundo a OrganizaÃÃo Mundial da SaÃde. A evoluÃÃo dos componentes do CPO-D apresentou carÃter crescente com a idade e em relaÃÃo à necessidade de tratamento, a idade de 14 anos revelou uma experiÃncia presente de cÃrie da ordem de 30%. A fluorose dentÃria, constitui-se portanto, num problema de saÃde pÃblica para esta localidade que continua a consumir altos teores de flÃor na Ãgua, expondo-se diariamente ao risco de desenvolvimento de quadros de fluorose dentÃria, nos seus mais variados graus. A ingestÃo de altos teores de flÃor foi prejudicial causando fluorose dentÃria, mas nÃo encontramos benefÃcios adicionais na prevenÃÃo da cÃrie. Embora os resultados demonstrem uma prevalÃncia moderada de cÃrie, nÃo foi verificada associaÃÃo entre sua ausÃncia e a ocorrÃncia da fluorose.

O objetivo do estudo foi identificar fatores associados à fluorose dentária em Ribeirão Pires-SP, com água fluoretada desde 1985 e heterocontrole dos teores de flúor desde 1996. Foi realizada pesquisa epidemiológica tipo caso-controle com projeto aprovado pelo Comitê de Ética da FSP-USP. A população de estudo foi adolescentes de 12 a 15 anos de idade, identificados em 23 escolas de ensino fundamental por cirurgiã-dentista capacitada (k=0,79). Foram considerados casos 667 adolescentes com graus de fluorose 2, 3, 4 e 5 (Índice de Dean). A partir da região de residência dos casos, foram identificados 416 controles, de mesmo sexo e idade, com grau de fluorose 0, procurando-se garantir a mesma distribuição por região. Casos e controles (5 por cento ) foram examinados pela pesquisadora (k=0,90). Um formulário de entrevista foi construído, utilizando-se técnica de pesquisa exploratória, contendo dados relativos a variáveis demográficas, geográficas, escolaridade dos pais/responsáveis e relacionados à exposição a fontes de flúor em três ciclos (1o ano de vida, 1 a 3 anos e 4 a 6 anos de idade). A coleta dos dados foi feita por 55 entrevistadores cujo treinamento contemplou repetição de entrevistas e discussão de aspectos relevantes. Foram realizadas 509 entrevistas (319 casos e 190 controles). As respostas foram transcritas para digitação de forma dupla, com validação do banco de dados. A distribuição percentual do evento nos casos e controles nas categorias de exposição foi analisada utilizando-se o teste de Qui-quadrado de Pearson. Na análise univariada identificou-se as de maior associação para elaboração de modelos de regressão logística múltipla não condicional. A análise mostrou risco significativo para fluorose dentária nas seguintes situações de exposição: quando os adolescentes usaram dentifrício fluoretado nos 6 primeiros anos de vida (OR= 2,25; p=0,048) e eram responsáveis pela sua colocação no período de 4 a 6 anos de idade (OR=2,17; p=0,000), quando foi utilizada água fluoretada para preparo de alimentos nos 6 primeiros anos de vida (OR=2,90; p=0,026) e a interação entre maior escolaridade do pai e menor escolaridade da mãe (OR=2,15; p=0,024). Recomenda-se que os serviços de saúde considerem os resultados no planejamento das ações de educação em saúde reforçando o uso adequado de dentifrícios, além de manter a política de vigilância sanitária dirigida a múltiplas fontes de flúor / The purpose of this study was to identify factors associated with fluorosis in the city of Ribeirão Pires SP, which has fluoridated water since 1985, (with hetero-controls of fluoride levels since 1996). It was done an epidemiological case-control study which project was approved by the Ethics Committee of the FSP-USP. The study population consisted of 12 to 15 year old teenagers, identified by a trained dentist (k=0.79) in 23 high schools. 667 teenagers who showed fluorosis levels of 2, 3, 4 or 5 (Dean Index) were selected for this study. 416 children of the same age and sex and living in the same area were also identified as controls (fluorosis level = 0) in order to assure the same distribution by region. Cases and controls (5 per cent ) were examined (k=0.90) by the author. A questionnaire was elaborated, using the exploratory survey method, with data related to demographic, geographic, education level of parents/guardians, related to fluoride sources exposure in 3 different periods of life (first year, 1 to 3 years and 4 to 6 years of age). Data was collected by 55 interviewers whose training consisted of repeated interviews and case discussions. 509 interviews were made (319 cases and 190 controls) and the responses were transcribed and typed twice, with posterior validation of the database. Percentile distribution of the events of cases and controls of exposition categories were analyzed using Pearson Chi-Square test. In the univariable analysis, the variables with higher match were identified for posterior construction of models of non-conditional multiple logistic regression analyses. The analysis of regression showed significant risk for dental fluorosis in the following exposure situations: when the teenagers used fluoridated dentifrice during the first 6 years of life (OR=2.25; p=0.048) and they were responsible for its placement in a period of 4 to 6 years (OR=2.17; p=0.000), when it was used fluoridated water for food preparation during the 6 first years of life (OR=2.90; p=0.026) and in the relation of high educational level of the father and lower educational level of the mother (OR=2.15; p=0.024). It is recommended that the health services should consider these results in the planning of actions of health education activities in order to emphasize the importance of adequate use of dentifrices, and to maintain their sanitary control policies focused on multiple sources of fluoride

O objetivo do estudo foi identificar fatores associados à fluorose dentária em Ribeirão Pires-SP, com água fluoretada desde 1985 e heterocontrole dos teores de flúor desde 1996. Foi realizada pesquisa epidemiológica tipo caso-controle com projeto aprovado pelo Comitê de Ética da FSP-USP. A população de estudo foi adolescentes de 12 a 15 anos de idade, identificados em 23 escolas de ensino fundamental por cirurgiã-dentista capacitada (k=0,79). Foram considerados casos 667 adolescentes com graus de fluorose 2, 3, 4 e 5 (Índice de Dean). A partir da região de residência dos casos, foram identificados 416 controles, de mesmo sexo e idade, com grau de fluorose 0, procurando-se garantir a mesma distribuição por região. Casos e controles (5 por cento ) foram examinados pela pesquisadora (k=0,90). Um formulário de entrevista foi construído, utilizando-se técnica de pesquisa exploratória, contendo dados relativos a variáveis demográficas, geográficas, escolaridade dos pais/responsáveis e relacionados à exposição a fontes de flúor em três ciclos (1o ano de vida, 1 a 3 anos e 4 a 6 anos de idade). A coleta dos dados foi feita por 55 entrevistadores cujo treinamento contemplou repetição de entrevistas e discussão de aspectos relevantes. Foram realizadas 509 entrevistas (319 casos e 190 controles). As respostas foram transcritas para digitação de forma dupla, com validação do banco de dados. A distribuição percentual do evento nos casos e controles nas categorias de exposição foi analisada utilizando-se o teste de Qui-quadrado de Pearson. Na análise univariada identificou-se as de maior associação para elaboração de modelos de regressão logística múltipla não condicional. A análise mostrou risco significativo para fluorose dentária nas seguintes situações de exposição: quando os adolescentes usaram dentifrício fluoretado nos 6 primeiros anos de vida (OR= 2,25; p=0,048) e eram responsáveis pela sua colocação no período de 4 a 6 anos de idade (OR=2,17; p=0,000), quando foi utilizada água fluoretada para preparo de alimentos nos 6 primeiros anos de vida (OR=2,90; p=0,026) e a interação entre maior escolaridade do pai e menor escolaridade da mãe (OR=2,15; p=0,024). Recomenda-se que os serviços de saúde considerem os resultados no planejamento das ações de educação em saúde reforçando o uso adequado de dentifrícios, além de manter a política de vigilância sanitária dirigida a múltiplas fontes de flúor / The purpose of this study was to identify factors associated with fluorosis in the city of Ribeirão Pires SP, which has fluoridated water since 1985, (with hetero-controls of fluoride levels since 1996). It was done an epidemiological case-control study which project was approved by the Ethics Committee of the FSP-USP. The study population consisted of 12 to 15 year old teenagers, identified by a trained dentist (k=0.79) in 23 high schools. 667 teenagers who showed fluorosis levels of 2, 3, 4 or 5 (Dean Index) were selected for this study. 416 children of the same age and sex and living in the same area were also identified as controls (fluorosis level = 0) in order to assure the same distribution by region. Cases and controls (5 per cent ) were examined (k=0.90) by the author. A questionnaire was elaborated, using the exploratory survey method, with data related to demographic, geographic, education level of parents/guardians, related to fluoride sources exposure in 3 different periods of life (first year, 1 to 3 years and 4 to 6 years of age). Data was collected by 55 interviewers whose training consisted of repeated interviews and case discussions. 509 interviews were made (319 cases and 190 controls) and the responses were transcribed and typed twice, with posterior validation of the database. Percentile distribution of the events of cases and controls of exposition categories were analyzed using Pearson Chi-Square test. In the univariable analysis, the variables with higher match were identified for posterior construction of models of non-conditional multiple logistic regression analyses. The analysis of regression showed significant risk for dental fluorosis in the following exposure situations: when the teenagers used fluoridated dentifrice during the first 6 years of life (OR=2.25; p=0.048) and they were responsible for its placement in a period of 4 to 6 years (OR=2.17; p=0.000), when it was used fluoridated water for food preparation during the 6 first years of life (OR=2.90; p=0.026) and in the relation of high educational level of the father and lower educational level of the mother (OR=2.15; p=0.024). It is recommended that the health services should consider these results in the planning of actions of health education activities in order to emphasize the importance of adequate use of dentifrices, and to maintain their sanitary control policies focused on multiple sources of fluoride

Dental discoloration from fluorosis is a global public health problem. In Nigeria, 11.4% of the population is impacted by this disorder. Dental discoloration is caused by successive exposures to high fluoride concentrations during tooth development in utero and it is linked to the development of a variety of psychological and physiological problems, from dental aesthetics to a reduction in intelligence and skeletal changes. The purpose of this quantitative, cross-sectional study was to examine the cultural and environmental determinants of dental fluorosis in children in a rural community in Nigeria. A multilevel theoretical model was used to develop possible fluoride exposure pathways, such as good social services and dental care, as well as factors in the environment. The study was guided by 2 main research questions: What is the prevalence of fluorosis among Nigerian school-aged children? What is the severity of this fluorosis, and is it associated with the fluoride content of the soil, the water or the food? Data was collected by administering three surveys, on children aged 5 to15 years, their parent/guardian, and on community leaders. Chi-square and regression analysis tests were used to test for possible associations. The study findings showed a fluorosis prevalence rate of 86.6% in the 269 school children surveyed, with majority of these children between the ages of 8 to 13 years. The severity of children fluorosis was associated with the length of stay in the study area and the fluoride content in water, soil, and food. This study's possible impact on social change include raising awareness to the problem and the possible ways to resolve it, such as through, improved dental care services and a supportive social environment like flocculation of community water sources.

Orientador: Jaime Aparecido Cury / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-07-28T23:32:23Z (GMT). No. of bitstreams: 1 Peres_PauloEdelvarCorrea_D.pdf: 4915195 bytes, checksum: 619924c2c327c85d68fb00aed77138c1 (MD5) Previous issue date: 2001 / Resumo: Nas últimas décadas ocorreu um dec1ínio na prevalência de cárie na maioria dos países desenvolvidos e em desenvolvimento e um concomitante aumento na prevalência da fluorose dental. Assim o desenvolvimento de um dentiftício para crianças, com concentração reduzida de flúor poderia proporcionar maior segurança em relação a fluorose dental, desde que provasse ser tão eficiente quanto um dentiftício convencional. A avaliação in vitro demonstrou que a reatividade de uma formulação contendo 550 ppm F foi melhorada, aumentando a incorporação de flúor no esmalte dental bovino com desempenho similar a um dentiftício convencional com 1100 ppm F. Resultados preliminares sobre esta formulação, com o uso de placas palatinas, demonstraram sua eficácia em reduzir a desmineralização do esmalte. Entretanto não foi avaliada a relação dose/efeito, como também não foi utilizado como controle um dentiftício "Gold Standard" para demonstrar equivalência de efeito. Para avaliação do dentiftício foi realizado um estudo cruzado, duplo-cego, composto de 5 etapas, onde 15 voluntários adultos, usando prótese parcial removível, contendo 4 blocos de esmalte bovino, sendo 2 hígidos e 2 com lesão artificial subsuperficial de cárie. Os voluntários foram submetidos aos seguintes tratamentos com dentiftícios: 1= Não Fluoretado; 11= 275 ppm F; III=550 ppm F; IV= 1100 ppm F; V= Crest ("Gold Standard" ) 1100 ppm F. Os dentiftícios experimentaís são a base de sílica e foram formuladas com pH 5,5 para melhorar a reatividade do flúor (NaF) com o esmalte dental. Análises da dureza (Knoop) do esmalte superficial e seccionado longitudinalmente foram determinadas nos blocos. O esmalte também foi submetido a analises para avaliação do flúor incorporado. Os resultados demonstram que a formulação com 550 ppm F foi mais eficiente que os dentiftícios placebo e 275 ppm F (p<O,O5) e foi equivalente em efeito ao dentiftício "Gold Standard" (p>O,O5) em: 1) Reduzir a desmineralização do esmalte na superfície e na lesão de cárie; 2) Potencializar a remineralização do esmalte na superfície e na lesão de cárie; 3) Aumentar o flúor incorporado no esmalte hígido e com lesão de cárie. Os resultados sugerem que a formulação experimental com concentração reduzida de flúor pode ter a mesma eficácia do dentiftício convencional e poderia ser mais segura em relação a fluorose dental / Abstract: In the last decades there was a caries decline in most of the countries of the world, but at the same time the prevalence of dental fluorosis increased. Thus, the development of a dentifrice for children with low fluoride concentration would offer higher safety with regard to dental fluorosis, as long as it prove to be as efficient as a conventional one with 1000-1100 ppm F. The in vitro evaluation showed that the reactivity of a formulation containing 550 ppm F was improved, increasing the fluoride incorporation in dental enamel with action similar to a conventional dentifrice with 1100 ppm F. Preliminary results of this formulation, using palatal appliances, showed its efficiency on reducing enamel demineralization. Nevertheless, the dose/effect relationship was not evaluated, as well as a control such as a Gold Standard dentifrice was not used to demonstrate equivalence of effect. A 5 step double-blind crossover study was conducted with 15 adult volunteers wearing removable prosthesis, containing 4 bovine enamel blocks, 2 sound and 2 with subsuperficial caries lesions. The volunteers were submitted to the following treatments with dentifrices: 1= Non-fluoridated; II=275 ppm F; III=550 ppm F; IV= 1100 ppm F; V= Crest ("Gold Standard", 1100 ppm F). The dentifrices were silica-based and the formulations were modified (PH5,5) to improve the reactivity of fluoride (NaF) with dental enamel. Surface and cross sectional enamel microhardness (Knoop) were determined in the blocks. Enamel was also analyzed to evaluate fluoride uptake. The data showed that the formulation with 550 ppm F was more efficient than placebo and the one with 275 ppm F (p<0.05) and it was equivalent to the "gold standard"(p>0,05) in: 1) Reducing enamel demineralization on surface and in caries lesion; 2) Enhancing enamel remineralization on surface and in caries lesion; 3) Increasing fluoride in sound and carious enamel. The data suggest that the experimental formulation with lower fluoride concentration could have the same anticaries efficiency as the conventional and would be more safe with respect to dental fluorosis / Doutorado / Doutor em Biologia e Patologia Buco-Dental

Magister Scientiae Dentium - MSc(Dent) / Introduction: Dental fluorosis is a developmental disturbance of enamel that results from ingestion of high amounts of fluoride during tooth mineralization. Drinking water remains the main source of fluoride. Other sources of fluoride include infant formula, vegetables; canned fish as well as early, improper utilization of fluoridated toothpastes in children. Knowledge of risk factors in the causation of dental fluorosis may improve strategies to prevent dental fluorosis. Objective: To determine the prevalence of dental fluorosis among children aged 12-15 years old in Athi River sub-county, Machakos County, Kenya and assesses the level of knowledge on risk factors for dental fluorosis among their parents. Methodology: This was a descriptive study with an analytic component. A total of 281 children aged 12-15 years attending public primary schools within Athi River sub-county, Machakos County were included. A self-administered questionnaire was send to parents for socio-demographic characteristics and oral health practices. Children whose parents consented were examined and dental fluorosis scored according to the Thylstrup and Fejerskov index. Fourty randomly selected children were requested to bring water samples from their homes. Retail stores located in the area were visited for purchase of six different brands of bottled water. These samples were sent to a certified laboratory for fluoride analysis and reported in milligrams of fluoride per litre. Data analysis: Data was entered into SPSS version 20 and analysed for means, ANOVA of means and chi-square test of significance for categorical variables. All tests for significance were set at 95% confidence level (α≤0.05). Results: A total of 314 self-administered questionnaires were send to parents together with consent forms for their children‟s participation in the study. Two hundred and eighty six responded positively, giving a response rate of 91%. The overall prevalence of dental fluorosis among children aged 12-15 years was 93.4% with only 6.6% (n=19) recording a TFI score of 0. About one quarter 70(24.4%) of children had severe fluorosis with TFI scores of ≥5. The mean TFI score for all children was 3.09 (SD=2.0), with males recording a mean TF score of 3.01 (SD=2.11) and females a mean TF score of 3.16 (SD=1.88). Out of 44 water samples analysed, 29 (65.9%) had a fluoride content of less than 0.6mg/l, 5 (11.4%) had fluoride content of 0.7 - 1.5mg/l while 10 (22.7%) of samples had a fluoride content ≥1.5mg/l. The highest fluoride content recorded was 9.3mg/l, with another sample reflecting 8.9mgF/l. Three of the bottled water samples had a fluoride content of less than 0.6mg/l, while the other half of the bottled water reported 0.7 - 0.8mg/l fluoride. A majority (87.8%) of parents indicated that they had noticed children with brown staining of their permanent teeth in their community. About 80% of parents thought dental fluorosis was caused by salty water, while only 12.9% correctly identified water with high fluoride content as being responsible for the discolored teeth. Conclusion: Although about one in five water sources sampled had fluoride content of ≥1.5mg/l, the prevalence of dental fluorosis in this community was very high. Parental knowledge on the risk factors for dental fluorosis was low. Further research is necessary to identify the water distribution networks to provide sound evidence for engaging with the county authorities on provision of safe drinking water to the community.

Orientador: Célio Percinoto / Banca: Luiz Reynaldo de Figueiredo Walter / Banca: Aymar Pavarini / Banca: Maria Celeste Morita / Banca: Alberto Carlos Botazzo Delbem / Resumo: O objetivo do presente estudo foi identificar fatores associados à fluorose dentária, em uma localidade com níveis de concentração de flúor variando de 0,07 a 2,06 mgL/F. Das 727 crianças, de 6 a 10 anos de idade, matriculadas na rede de ensino público do município de Itambaracá, PR, no ano de 2001, examinaram-se 602 e, após computadas as perdas e as exclusões, 353 permaneceram como população de estudo. Os pais ou responsáveis responderam um formulário sobre a história médica e gestacional da criança, dieta láctea e fontes de exposição ao flúor no primeiro ano de vida. Os exames clínicos foram realizados nas próprias escolas, por dois cirurgiões dentistas previamente treinados e calibrados, sendo que um avaliou as opacidades difusas nos molares decíduos, através do Índice DDE e outro, a fluorose dentária na dentição permanente, pelo Índice de Dean. A análise bivariada mostrou haver relação entre a patologia e: os níveis de flúor no município, uso de dentifrício fluorado e a presença de doenças no primeiro ano de vida. Na análise multivariada foram considerados como fatores de risco: a presença de doenças e o uso de leite em pó diluído em água fluorada, no primeiro ano de vida, além do fator mais fortemente associado à fluorose, a presença de opacidades difusas nos molares decíduos (odds ratio = 22,97). A obtenção criteriosa de informações sobre a história médica e o padrão de consumo de leite, associados ao exame clínico dos molares decíduos, tão logo erupcionem, podem contribuir na identificação das crianças com maiores possibilidades de desenvolver a fluorose dentária, na dentição permanente. / Abstract: The aim of this study was to identify association factors of dental fluorosis in a community where the amount of fluoride in drinking water vary from 0,07 to 2,06ppmF. Among the 727 children aged 6 to 10 year-old regularly enrolled in public schools at Itambaracá-PR in 2001, 602 were examined, and after excluding criteria and loses were computed, 353 remained as study population. A questionnaire about gestational and medical histories, pattern of milk consumption and fluoride exposition in the first year of life was answered by the child's parents. Clinical examination was performed at the schools, by two previously trained and calibrated dentists. One evaluated enamel opacities in deciduous teeth through DDE index, and the other dental fluorosis in permanent teeth by Dean's index. Bivariate analysis displayed a relationship of dental fluorosis and place of residence according to the amount of fluoride in drinking water, use of fluorided dentifrice and systemic diseases in the first year of life. In multivariable analysis the observed risk factors were the use of powered milk reconstituted with fluorided water, and systemic diseases, both in the first year of life, and the most strongly associated one was the presence of diffused opacities in primary molars (odds ratio=22,97). To achieve standard information about medical history and pattern of milk consumption and a clinical examination of the deciduous molars as soon as they erupt can contribute in identifying children that have larger possibilities of developing dental fluorosis in permanent teeth. / Doutor

Magister Scientiae Dentium - MSc(Dent) / BACKGROUND: Fluorine is an abundant trace element in the Earth’s crust. The presence of fluorine in bedrocks is the primary source fluoride in ground water, though fluoride occurrence varies with the different rock types. High concentrations of fluoride ions are found in regions of volcanic activities. Volcanoes are the main persistent natural source of fluoride in ground water and in the atmosphere. The occurrence of high concentrations of fluoride in ground water has been reported worldwide. Dental fluorosis is a developmental disturbance of enamel that results from ingestion of high amounts of fluoride during tooth mineralization. Consumption of untreated fluoridated ground water remains the main cause of dental fluorosis in rural settlements. AIM: To establish the risk factors and knowledge of dental fluorosis in three communities of the Far North Region of Cameroon. METHODOLOGY: This study was descriptive and cross-sectional study with an analytic component and was conducted in three communities in Far North Region of Cameroon. The study population was a convenience sample irrespective of age, but who must have been living in the selected study sites for a minimum of 6 to 8 years. Structured questionnaires were administered to elicit socio-demographic characteristics, perceptions dental fluorosis and oral health practices. Oral examination was conducted to determine the extent of dental fluorosis that was scored according to the Thylstrup and Fejerskov index. Participants declared their water sources and water samples were obtained from these sources. Samples of commercial bottled mineral water was purchased from various local outlets. These samples were sent to a certified laboratory for fluoride analysis and are reported in milligrams of fluoride per litre.

A fluorose dentária é uma patologia que ocorre durante a formação dos dentes na presença de doses excessivas de fluoreto (F-). Os mecanismos pelos quais o F provoca a fluorose ainda são poucos conhecidos. A influência de fatores genéticos tem sido considerada na suscetibilidade/resistência do indivíduo em desenvolver a fluorose. Duas linhagens de camundongos (A/J e 129P3/J) com diferença na resistência ou suscetibilidade à fluorose dentária foram utilizadas para determinar se a suscetibilidade à fluorose pode ser explicada pela diferença no metabolismo e se há diferença no perfil protéico dos rins e urina destes animais. Para isso, um estudo metabólico foi conduzido com 18 camundongos A/J (suscetível) e 18 129P3 / J (resistente) após o desmame. Cada amostra foi dividida em 3 grupos, com diferentes concentrações de F- na água de beber (0, 10 e 50 ppm F). Uma vez que um estudo piloto revelou que os camundongos A/J ingeriam um maior volume de água quando comparado com o 129P3/J, a concentração de F- na água dada aos camundongos A/J foi ajustada semanalmente a fim de fornecer doses semelhantes de F- para ambas linhagens. Os animais foram mantidos em gaiolas metabólicas (n = 2/gaiola) por 7 semanas, com livre acesso à água e dieta de baixa ingestão de F- (0,95 ppm). A ingestão e excreção de F- foram calculadas, bem como os níveis de F- no plasma, no fêmur e no rim. O grau de fluorose dentária foi avaliado usando análise de fluorescência quantitativa (QLF) e exame clínico. Os perfis proteômicos renal e urinário foram examinados utilizando 2D-PAGE e coloração com azul de Coomassie.. Os dados do estudo metabólico foram testados para diferenças significativas pela ANOVA a 2 critérios (p <0,05). As imagens dos géis e as diferenças estatísticas (ANOVA, p<0,05) foram analisadas pelo programa Image Master Platinum 7.0. Os camundongos da linhagem A/J submetidos à alta concentração de fluoreto apresentaram um grau de fluorose significativamente maior quando comparado com a linhagem 129P3/J. A ingestão total de F- não diferiu significativamente entre as linhagens. A excreção total de F- foi significativamente maior para os camundongos A/J, devido à maior excreção urinária de F-. As duas linhagens não diferiram em relação à absorção F-, mas os animais 129P3/J retiveram significativamente maiores quantidades de F-, que foi consistente com níveis mais elevados de F- no fêmur, no entanto, os níveis de F- no plasma não diferiram significativamente entre as linhagens. Para os rins, a análise quantitativa de intensidade detectou, entre as linhagens A/J e 129P3/J, 122, 126 e 134 spots diferencialmente expressos nos grupos controle, e que receberam baixa e alta concentração de F-, respectivamente. Para a urina, 84 spots diferencialmente expressos foram observados para o grupo controle, 68 para o grupo que recebeu baixa concentração de F- e 66 para o grupo que recebeu alta concentração de F-. Os dados mostraram que há diferenças metabólicas e no perfil de expressão protéica renal e urinária intrínsecas a estas linhagens e que a exposição ao F- é capaz de alterar estes padrões. / Dental fluorosis occurs during tooth formation when excessive doses of fluoride (F) are ingested. The mechanisms that underlie the pathogenesis of dental fluorosis are not known so far. The influence of genetic factors has been considered in individual susceptibility/resistance to develop fluorosis. Two inbred mice strains (A/J and 129P3/J) have been reported to have different susceptibilities to dental fluorosis. They were used in the present study to determine if the susceptibility to dental fluorosis can be explained by alterations in F metabolism and to evaluate if there is difference in the profile of protein expression in kidney and urine of these animals. For this, a metabolic study was conducted with 18 A/J (susceptible) and 18 129P3/J (resistant) weanling mice. Each strain was divided into 3 groups, with differed according to the F concentration given in the drinking water (0, 10 and 50 ppm F). Since a pilot study showed that the A/J mice drank a higher volume of water when compared with the 129P3/J, the F concentration in the water given to the A/J mice was weekly adjusted in order to provide similar F intakes for both strains. The mice were housed in metabolic cages (n=2/cage) for 7 weeks, with free access to water and low-F diet (0.95 ppm). F intake and excretion were calculated, as well as plasma, femur and kidney F levels. The degree of dental fluorosis was assessed using QLF and clinical examination. Renal and urinary proteome profiles were examined using 2D-PAGE and coomassie brilliant blue staining. Data were tested for significant differences by 2-way repeated-measures ANOVA (p<0.05). The gels images and statistical differences (ANOVA, p <0.05) were analyzed by the Image Master Platinum 7.0 software. Significantly higher QLF scores were observed for the A/J mice submitted to 50 ppm F. The total F intake did not significantly differ between the strains. The total F excretion was significantly higher for the A/J mice, due to the higher urinary F excretion. The two strains did not differ in respect to F absorption, but the 129P3/J mice retained significantly higher amounts of F, which was consistent with their higher femur F levels. Plasma F levels, however, did not significantly differ between the strains. For kidney, quantitative intensity analysis detected, between strains A/J and 129P3/J, 122, 126 e 134 spots differentially expressed in the control group, in the group receiving low and high F concentrations, respectively. For urine, 84 spots differentially expressed were detected for control group, 68 for the group receiving low F concentration and 66 for the group receiving high F concentration. Data showed that intrinsic differences occur in the metabolism of F and profile of protein expression between these strains and that these profiles can be altered in the presence of F.

Apesar da grande utilização de alimentos industrializados à base de soja, não há relatos científicos conclusivos que demonstrem a possível influência do flúor contido nesses alimentos sobre a ocorrência de fluorose em dentes decíduos. São inúmeras as indicações desses alimentos, em especial nos casos de intolerância à lactose. Os objetivos deste estudo foram: 1) Identificar os alimentos industrializados à base de soja mais recomendados, por nutricionistas e médicos pediatras, para crianças; 2) Determinar as concentrações de flúor nesses alimentos; 3) Avaliar crianças com idade entre 4 a 6 anos quanto à prevalência de fluorose, na dentição decídua. Etapa 1. A amostra foi constituída por 20 médicos pediatras e 20 nutricionistas de Bauru-SP, que responderam um questionário dirigido, composto de questões objetivo-descritivas, sobre os alimentos à base de soja que eles mais indicam para crianças. Etapa 2. Foram relacionados os 10 alimentos mais citados, sendo analisadas as concentrações de flúor das amostras com eletrodo íon-específico (Orion 9409), após difusão facilitada por HMDS. Etapa 3. Foi realizado o levantamento epidemiológico de fluorose dentária em 6 escolas de Bauru-SP. Participaram 315 crianças com idade entre 4 e 6 anos, sendo identificadas neste grupo 26 crianças com intolerância à lactose. Os pais ou responsáveis responderam um questionário que abordou o perfil da criança e da família, permitindo identificar o uso ou não de alimentos à base de soja. Para verificar a prevalência e severidade de fluorose dentária foi utilizado o Índice de Dean. Os dados obtidos foram analisados estatisticamente por meio dos testes do qui-quadrado e de regressão logística multivariada. O conteúdo de flúor nos alimentos analisados variou de 0,03 a 0,50 µg F/mL. Observou-se diferença estatisticamente significativa nas concentrações de flúor de diferentes lotes do mesmo alimento em 6 marcas comerciais analisadas. A fluorose foi detectada em cerca de 10% das crianças, sendo que a severidade variou de muito leve a leve. Observou-se maior prevalência de fluorose em crianças de escola privada (p=0,030). A fluorose dentária em dentes decíduos esteve associada à intolerância à lactose, embora não tenha sido demonstrada significância estatística com o uso de alimentos industrializados à base de soja. / Despite of the great use of manufactured soy food, scientific reports are not conclusive about the possibility of dental fluorosis in primary dentition caused by fluoride contained in these kind of food. Soy-based food is indicated especially in cases of lactose intolerance. The aims of this study were: 1) to identify the most recommended manufactured soy food for children, by Pediatricians and Nutritionists; 2) to determine the fluoride concentrations in these soy food; 3) to evaluate the prevalence of dental fluorosis in the primary dentition of 4-6-year-old children. Stage 1. The sample was composed of 20 Pediatricians and 20 Nutritionists from Bauru-SP, who answered objective-descriptive questions, about the most indicated soy food for children. Stage 2. The top 10 products were analyzed with ion-specific electrode (Orion 9409), after HMDS facilitated-diffusion. Stage 3. A dental fluorosis survey was performed at six schools in Bauru-SP with three hundred and fifteen children from 4 to 6 years old. In this group 26 children with lactose intolerance were identified. Their parents answered a questionnaire related to the child and his/her familys profile which allowed identifying the use of soy food. Deans index was used to verify the prevalence and severity of dental fluorosis. Data were statistically analyzed by chi-square and multivariate logistic regression tests. Fluoride concentrations ranged between 0.03 and 0.50 µg F/mL. It was observed statistical significant difference in the fluoride concentrations among different lots of the same brand in 6 commercial analyzed. Dental fluorosis was detected in 10% of the children, with very mild and mild degrees. The prevalence of dental fluorosis was higher in private schools children (p=0.030). Dental fluorosis in primary dentition was associated with lactose intolerance, however, did not showed statistical significance with the use of manufactured soy food.