Introdução: No ano de 2013, o Conselho Regional de Odontologia de São Paulo examinou os teores de fluoreto na água de abastecimento público de 105 municípios do estado de São Paulo. Os resultados apontaram que 25,7% dos municípios apresentava teores abaixo dos recomendados, sendo que em nove (8,5%), as amostras apresentavam valores próximos de zero, contrastando com o êxito desta política no estado de São Paulo, que à época exibia uma cobertura de aproximadamente 90% da população. Objetivos: (a) identificar como as características político-administrativas do Estado brasileiro, influenciam a implementação de políticas públicas no nível local; (b) situar o ente municipal na trajetória da política de fluoretação da água de abastecimento público no estado de São Paulo, tendo em vista o percurso histórico das políticas de saneamento; (c) compreender como atuam os operadores de linha de frente da política de fluoretação da água de abastecimento público em pequenos municípios de uma região do estado de São Paulo. Método: a investigação foi realizada em três etapas. A primeira foi desenvolvida por meio de uma pesquisa bibliográfica, na qual aspectos teóricos relativos à trajetória do Estado federal brasileiro, como a autonomia dos governos municipais e as relações dos entes federativos entre si, foram cotejados com as reflexões provenientes dos estudos do poder local e das políticas públicas no país, recuperando-se elementos essenciais para a compreensão do sistema federalista implantado no Brasil. Na segunda etapa foi analisada a história do saneamento no Brasil a fim de situar a política de fluoretação da água de abastecimento neste contexto, buscando compreender como o modelo adotado para a configuração do saneamento refletiu na implementação da referida política. Na terceira etapa foi realizada uma pesquisa empírica em dois pares de municípios paulistas com menos de 25 mil habitantes, pertencentes à região de São José de Rio Preto, SP, que participaram do estudo mencionado. Cada par continha um município cujos teores de fluoreto se encontravam conforme o recomendado e outro no qual estes teores se situavam abaixo do previsto. Foram realizadas entrevistas em profundidade com 11 profissionais envolvidos com a implementação da política, sendo três cirurgiões-dentistas, um auxiliar de saúde bucal, três técnicos responsáveis pela operação dos sistemas de abastecimento de água, um agente administrativo que atuava como coordenador de saúde bucal; duas enfermeiras articuladoras da atenção básica e um membro do departamento regional de vigilância sanitária. Os dados coletados foram complementados por meio da interpretação das observações registradas em diário de campo. Resultados: A literatura aponta que o desenho político do Estado brasileiro, marcado pela equiparação de poder entre os três entes federados pode dificultar a implementação de políticas que requeiram a atuação cooperativa entre as esferas federal, estadual e municipal. A autonomia legal das subunidades nacionais implica na estruturação de uma série de arranjos de poder que não devem ser desprezados quando se almeja a implantação de certa política pública. No caso da política de saneamento, na qual se insere a fluoretação da água de abastecimento público, observa-se uma trajetória histórica que contribuiu para a instauração de um cenário constituído por grandes companhias estaduais de abastecimento e pela implantação de complexos sistemas municipais em cidades de grande porte. Aos municípios pequenos restou a adoção de sistemas simplificados que perduram até hoje. Junto ao campo de pesquisa foi possível observar que a atuação dos atores envolvidos no processo de implementação tem importante influência sobre o desenho final da política uma vez que, por desfrutarem de certa autonomia em relação às suas ações, a operacionalizam também a partir de suas referências. Além disso, tendo em vista a precariedade das administrações públicas municipais, as características das burocracias locais também devem ser consideradas, tanto os aspectos técnicos e profissionais, quanto os valores, interesses e motivações que permeiam o poder discricionário dos atores. Considerações finais: A implementação de políticas públicas no âmbito municipal, em especial daquelas que requerem a co-participação das esferas estadual e federal, como é o caso da política de fluoretação da água, é condicionada entre outros aspectos, pela tradição das práticas políticas observadas no Brasil ao longo de sua história, pelas relações de interdependência entre os entes integrantes da federação, pela forma como se desenvolveu a política de saneamento no país e pela atuação dos atores em nível local. / Introduction: In the year of 2013, the São Paulo State Council of Dentistry examined the fluoride level of the public supply water in 105 municipalities in the state of São Paulo. The results pointed out that 25,7% had suboptimal levels and that the samples had levels close to zero in nine (8.5%) of the towns, differentiating them from the policy\'s success in the rest of the state of São Paulo, in which population coverage reached approximately 90% in that time. Objectives: (a) to identify how the political and administrative characteristics of the Brazilian state influence in the implementation of public policies at local level; (b) to situate the municipal entity in the history of the water fluoridation policy in the state of São Paulo, considering the historical journey of the sanitation\'s policies; (c) to understand how streetlevel operators act concerning fluoridation policy in a region of the state of São Paulo. Methods: the research had three stages. The first one was developed through a bibliographic research, which summarized the theoretical aspects of the Brazilian federative state\'s trajectory. The municipal governments\' autonomies and the relations between the federative entities were compared with the reflections from the studies about the local power and the public policies in the country, recovering essential elements for the understanding of the federalist system implemented in Brazil. In the second stage, the history of Brazilian sanitation system was analyzed with the objective of situating the fluoridation policy of water public supply in this context, also with the aim of understanding how the adopted model in the sanitation system influenced the policy implementation. During the third stage, an empirical research was undertaken in two pairs of towns selected from the mentioned study. They had less than 25 thousand inhabitants and belonged to the region of São José do Rio Preto. Each pair had a town in which the fluoride level was considered optimal and another in which the level was considered low. In-depth interviews were undertaken with 11 professionals involved with the policy implementation, three dental surgeons, one dental assistant, three technicians responsible for the operation of the water supply system, one administrative agent who conducted the oral health policy, two primary healthcare policy facilitators nurses and one member of the regional department of the Sanitary Surveillance participated. The data collected were complemented through interpretation provided by observations registered in the field diary. Results: The literature points out that the political framework of the Brazilian state, characterized by the power levelling among the three federative entities, can hamper the implementation of policies that require the cooperative action among the federal, state and municipal levels. The legal autonomy of the national subunits imply building of several power arrangements that should not be neglected when the implementation of a certain public policy is aimed. In the case of sanitation policy, in which the fluoridation policy of water public supply is encompassed, it was observed the institution of a legal mark that have privileged the implantation of big state sanitation utilities and also complex municipal systems in larger cities. Smaller towns were left to the adoption of simplified systems that remain until today. Together with the research field, we verified that the action of the workers involved in the process of policy implementation has important influence on the final shape of the policy. As they have a certain autonomy regarding their actions, they operationalize it also based on their own references and discretionary power. In addition, considering the fragility of municipal public administration, the characteristics of local bureaucracies should also be considered, including the technical and professional aspects, values, interests and motivations that intersect the discretionary power of the policy actors. Final considerations: The implementation of public policies at the municipal level, especially those that require the co-participation of the state and federal spheres, such as the water fluoridation policy, is conditioned, among other aspects, by the tradition of political practices observed in Brazil throughout its history, the relations of interdependence between the entities that are part of the federation, the way in which the sanitation policy was developed in the country and the actions of the actors at the local level.

Oral health impacts general health and well-being throughout the lifespan. Recent trends in the United States towards cessation of community water fluoridation (CWF) may increase disparities in oral health. The purpose of this quantitative retrospective cohort study was to analyze Medicaid dental claims records for caries related procedures among 0 to18-year-old patients during an optimal CWF year 2003 (n = 854) and compare them to claims records from 2012 (n = 1,053), 5 years after CWF was ceased. The theoretical framework of this study was the diffusion of innovations theory. Statistically significant results included higher mean number of caries related procedures among 0 to18 year and < 7-year aged patients in the suboptimal CWF group (2.57 vs. 2.43, p < 0.001; 2.68 vs. 2.01, p = 0.004, respectively). Mean caries related treatment costs per patient was also higher in the 0 to18 year and < 7-year suboptimal CWF groups compared to the optimal CWF group (583.70 vs 344.34 $, p < 0.0001; 692.87 vs. 350.13 $, p < 0.0001, respectively). Binary logistic regression analysis results indicated a protective effect from optimal CWF for the 0 to18 and < 7 year age groups ([OR] 0.75, 95% CI [0.62, 0.90], p = 0.002); OR = 0.70, 95% CI [0.52, 0.95], p = 0.02, respectively). The results confirm optimal CWF exposure prevents dental decay, expand the evidence base of caries epidemiology under CWF cessation, and indicate patients without early childhood CWF exposure experience more dental caries procedures and treatment costs. These findings may create opportunities for social change by supplying evidence that can be used to improve equity oriented oral health public policies that protect population health.

Includes bibliographical references (leaves 232-247). Obtained information on dental caries and fluorosis among a representative sample of Vietnamese children. Also collected information on factors likely to influence caries experience and dental fluorosis and undertook statistical analyses to examine the relationship between fluoride in drinking water, dental caries and dental fluorosis

This study aimed to (1) review the reported levels of fluoride in drinking waters, food stuffs and other environmental media around the world, and the current magnitude of prevalence of fluorosis observed in human being and animals, with special reference to India and (2) critically evaluate the strategy adopted for prevention and control of the fluorosis problem in India by conducting questionnaire surveys with professionals from 11 endemic districts, and high school students of two schools located at an endemic area with high fluorosis incidences. Through a comprehensive literature review, it was able to identify 18 endemic states in India with high fluoride levels in their drinking waters while having various degrees of fluorosis problems. These states were further classified into three categories, namely high (>10 mg/L fluoride in drinking waters), moderate (5-9.9 mg/L) and low (1-4.9 mg/L) endemic regions. There were five, nine and four states falling into the high, moderate and low endemic categories, respectively. High fluoride concentrations were observed in the soil near industrial sites, foodstuffs and beverages, and tea leaves. Also, adverse effects of fluoride on terrestrial and aquatic plants, terrestrial vertebrates and invertebrates, and aquatic vertebrates and invertebrates, were observed and demonstrated in laboratory conditions. The questionnaire survey with Indian professionals in 11 fluoride endemic districts found that although all districts had received funds for combating fluorosis problems, there had been delays in executing the associated health promotion, monitoring and treatment programmes in some districts and the utilisation of the fund for the programmes was quite slow. Staff appointment, staff training, medical treatment provision, education and awareness activities, referral hospital facility provision, vehicle facility, monthly reporting, clinical survey and water and urine samples testing, timely monitoring and supervision, and involvement of various medical staff, were found to be inadequate in most districts. In the questionnaire survey conducted at the two high schools, one of the schools (school A) was supplied with alternate source of filtered water (i.e., with normal fluoride concentration) and the second school (school B) was one, which had non-defluoridated ground water supply for drinking (i.e., with high fluoride concentration). This survey found that the awareness about signs of fluorosis, field visit of health worker, cause and preventability of fluorosis, and perception of spread of fluorosis, was comparatively better amongst students of school A than that of school B. Both the schools’ students had positive attitude towards cooperation, prevention and control efforts being made for fluorosis. / published_or_final_version / Environmental Management / Master / Master of Science in Environmental Management

<p>The purpose of this study was to investigate grade 12 students conceptual understanding of chemical reaction using fluoridation of public water supply as a practical example of chemical reaction. The study also attempted to find out the effectiveness of concept mapping in facilitation the students understanding of chemical reaction, particularly redox reactions.</p>

Bibliography: leaves 268-281. / xviii, 281 leaves : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--Adelaide University, Dept. of Public Health, 2001

Thesis (D.P.H.)--University of Michigan, 1994.

Thesis (D.P.H.)--University of Michigan.

Thesis (D.P.H.)--University of Michigan.

Akademisk avhandling--Karolinska institutet. Stockholm. / Extra t.p., with thesis statement, inserted. Bibliography: p. 35-36.