Neste estudo foi avaliado o efeito de uma formulação de dentifrício líquido com pH acidulado e baixa concentração de flúor (F) na prevenção de novas lesões cariosas e na incorporação de F no biofilme dentário e nas unhas. Foram selecionadas 1.402 crianças com idade inicial de 4 anos e experiência de cárie, as quais foram divididas em 4 grupos que diferiram em relação ao dentifrício utilizado por 20 meses: G1dentifrício líquido (1100 ppmF, NaF, pH 4,5, n=345), G2 - dentifrício líquido (1100ppmF, NaF, pH 7,0, n=343), G3 - dentifrício líquido (550 ppmF, NaF, pH 45, n=354), G4 pasta comercial Sorriso Fresh (controle -1100 ppmF, NaF, pH 7,0, n=360. A pasta comercial e os dentifrícios experimentais foram dispensados na escova usando as técnicas transversal e da gota , respectivamente. A progressão de cárie (ceo-s) foi avaliada no início do estudo e após 12 e 20 meses de uso contínuo dos dentifrícios. Uma subamostra de cada grupo participou na segunda etapa do estudo, conduzida 15 meses após o início da primeira etapa. Após as unhas das mãos e dos pés terem sido deixadas crescer por 14 dias, foram coletadas unhas das mãos e dos pés em duas ocasiões separadas (n=15 para cada grupo). Amostras de biofilme dentário foram coletadas 1 h após a última utilização dos respectivos dentifrícios (n=21 por grupo). Biofilme e unhas foram analisados para o F com eletrodo, após difusão facilitada por HMDS. Os dados de ceo-s foram analisados pelo teste Kruskal-Wallis (p <0,05). Os dados do biofilme foram analisados por ANOVA e teste de Tukey, ao passo que os dados das unhas foram analisados por ANOVA a dois critérios de medidas repetidas e teste de Bonferroni (p <0,05). Após 20 meses, 1053 escolares (G1=271, G2=262, G3=250 e G4=270) completaram o estudo. As médias (±DP) do ceo-s no baseline e após 20 meses, e do respectivo incremento para cada grupo foram, respectivamente: G1) 5,07±5,11, 7,13±6,53 e 30,8%; G2) 4,80±5,00, 6,88±6,78 e 31,9%; G3) 5,24±5,37, 7,29±7,27 e 30,5%; G4) 5,05±4,89, 7,13±6,35 e 31,1%. Não houve diferença significativa entre os grupos para nenhuma dessas variáveis. A média (±EP, unidade mmol / Kg de peso seco) das concentrações de F no biofilme foram 3,091±0,984a, 1,667±0,410a, 1,448±0,303a e 0,405±0,103b para G1, G2, G3 e G4, respectivamente. As [F]s nas unhas das mãos foram significativamente mais elevadas quando comparadas às dos pés. As mais altas concentrações de F foram encontradas para a pasta comercial, diferindo significativamente dos dentifrícios líquidos. As menores [F]s foram encontradas para o dentifrício de 550 ppm F, diferindo significativamente dos demais dentifrícios. Os dentifrícios líquidos de 1100 ppm F levaram a [F]s intermediárias nas unhas e não diferiram significativamente um do outro. Os resultados sugerem que o dentifrício de baixa concentração de F (550 ppm) e pH acidulado tem a mesma eficácia anti-cáries que os dentifrícios convencionais (1100 ppm F). A redução do pH do dentifrício aumenta a incorporação de F no biofilme sem afetar a concentração de F nas unhas. Portanto, o uso do dentifrício de baixa concentração de F e pH acidulado parece ser uma boa alternativa para prevenir cárie dentária e reduzir a ingestão de F a partir do dentifrício em crianças pequenas. / The purpose of this study was to evaluate the efficacy of a liquid dentifrice with reduced pH and low fluoride concentration for the prevention of new carious lesions and fluoride uptake in dental biofilm and nails. One thousand four hundred and two 4-year-old schoolchildren with caries experience were randomly allocated to 4 groups, differing according to the dentifrice used for 20 months: G1liquid dentifrice (1,100 ppmF, NaF, pH 4.5, n=345), G2-liquid dentifrice (1,100 ppmF, NaF, pH 7.0, n=343), G3-liquid dentifrice (550 ppmF, NaF, pH 4.5, n=354), G4-commercial toothpaste (control-1,100 ppmF,NaF, pH 7.0, n=360). The liquid dentifrices and toothpaste were applied to the toothbrush using the drop and transverse techniques, respectively. Caries progression (dmfs) was evaluated at baseline and after 12 and 20 months of continuous use of the dentifrices. A subsample of each group participated in the second section. Fingernails and toenails were clipped in two separate occasions, after being allowed to grow for 14 days (n=15 for each group). Plaque samples were collected 1 hr after the last use of the respective dentifrices (n=21 for each group). Plaque and nails [F]s were analyzed with the electrode, after HMDS-facilitated diffusion. dmfs data were analyzed by Kruskal-Wallis test (p<0,05).Plaque data were tested by ANOVA and Tukey\'s test, while nails data were analyzed by two-way repeated-measures ANOVA and Bonferroni\'s test (p<0.05). Results: 1,053 children were examined after 20 months (271, 262, 250 and 270 children for G1, G2, G3 and G4, respectively). Mean dmfs(±SD) at baseline, after 20 months and % increment were, respectively: G1) 5.07±5.11, 7.13±6.53 and 30.8%; G2) 4.80±5.00, 6.88±6.78 and 31.9%; G3) 5.24±5.37, 7.29±7.27 and 30.5%; G4) 5.05±4.89, 7.13±6.35 and 31.1%. No significant differences were found among the groups for all the variables tested. Mean (±se, unit mmol/Kg dry weight) plaque [F]s were 3.091±0.984a, 1.667±0.410a, 1.448±0.303a 0.405±0.103b for G1, G2, G3 and G4, respectively. Fingernails [F]s were significantly higher when compared to toenails. The highest [F]s were found for that significantly differed from the experimental liquid dentifrices, except for A (toenails only). The lowest [F]s were found for C, which significantly differed from all the other dentifrices. The experimental 1,100 ppm F dentifrices led to intermediary [F]s in nails and did not significantly differ from each other. Conclusions: The results suggest that the low-fluoride (550 ppm F) acidic dentifrice has the same anticaries effectiveness as the conventional 1,100 ppm F dentifrices. The reduction of the dentifrice pH increases the F uptake in dental plaque and does not affect nails [F]s. Thus, the use of low-fluoride acidic dentifrices seems to be a good alternative to prevent dental caries and reduce the F intake from dentifrice in small children.

Orientador: Bernardino Ribeiro de Figueiredo / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Geociencias / Made available in DSpace on 2018-08-11T21:52:30Z (GMT). No. of bitstreams: 1 Komati_SergioHideki_M.pdf: 2629006 bytes, checksum: 2810d03559d246f7e6cf98ebb9a6ef8c (MD5) Previous issue date: 2008 / Resumo: O conteúdo do presente trabalho encontra-se distribuído em dois capítulos na forma de artigos científicos constituindo duas partes distintas. Na primeira parte constam os resultados obtidos em levantamento da informação disponível sobre fluorose dentária e ocorrência de flúor em água subterrânea no Estado de São Paulo. Consistiu de um estudo descritivo simples, com fontes de dados documentais e resultantes de busca nos portais da Biblioteca Virtual de Saúde-BIREME, banco de teses e portal de periódicos da CAPES e Google, utilizando-se como descritores: flúor, fluorose, água subterrânea e São Paulo, os quais foram cruzados para obtenção de resultados. Utilizou-se também dados do Ministério da Saúde-Brasil, Companhia de Tecnologia de Saneamento Ambiental (CETESB), Agência Nacional das Águas (ANA) e do Departamento de Água e Esgoto do Estado de São Paulo (DAEE). Foram identificados os municípios onde se localizam poços com teores elevados de fluoreto bem como os municípios onde foram relatados casos de fluorose dentária moderada e severa como, por exemplo, Amparo, Bebedouro, Campinas, Itapirapuã Paulista, entre outros. As ocorrências de poços com excesso de fluoreto, com concentrações capazes de acarretar fluorose dentária e óssea, e municípios que apresentaram casos de fluorose dental moderada e severa, distribuem-se por todo território paulista sobre seus principais aqüíferos. Em geral, observou-se que os municípios que não utilizam fluoretação da água de abastecimento não apresentam casos de fluorose, com exceção de Itapirapuã Paulista, localizado em região próxima a ocorrências e jazidas de fluorita. A segunda parte deste estudo consistiu de uma avaliação da qualidade das águas com respeito ao flúor que serviu de base para discutir as informações sobre a prevalência de fluorose em Amparo (SP). Realizaram-se três campanhas para coleta de águas superficiais, subterrâneas e tratada, e duas de fontes naturais e água engarrafada. Em cada ponto foram tomados os parâmetros físicoquímicos in situ e coletadas alíquotas de água filtrada para análise em cromatógrafo de íons. Constatou-se que as águas superficiais apresentaram concentrações de flúor variando entre 0,09 e 0,14 mg L-1. A água tratada apresentou, em 29,4% das amostras, concentração de flúor dentro do intervalo considerado ótimo para o Estado de São Paulo (0,6 a 0,8 mg L-1), variando entre 0,48 e 1,4 mg L-1. Os poços, fontes naturais e água engarrafada apresentaram baixas concentrações de fluoreto em 100% das amostras, no intervalo de <0,01 a 0,58 mg L-1. As informações disponíveis sobre a prevalência de fluorose dental em Amparo revelam que em escolares de 12 anos de idade obteve-se em 2002 um índice de 7,4% evoluindo em 2004 para 34% principalmente dos graus muito leve e leve. Verificou-se, não obstante, que parte da população do município de Amparo está sujeita ao consumo de água subfluoretada (poços, fontes e água engarrafada) e parte está ocasionalmente exposta ao consumo de água com excesso de flúor (água tratada). Embora a prevalência de fluorose tenha aumentado em Amparo nos últimos anos, constata-se também que parte da população está sem o efeito protetor da fluoretação contra a cárie dentária ensejando monitoramento periódico da qualidade das águas e um maior controle por parte da vigilância sanitária. / Abstract: This work presents two parts in the form of scientific articles. In the first part are the results obtained from the available information on dental fluorosis and on the occurrence of fluorine in groundwater in the State of Sao Paulo, Brazil. This part consisted of a simple descriptive study using documentary data such as technical reports and data bases available at the Virtual Library of Health-BIREME, theses and journals at CAPES web site and Google, using descriptors such as fluorine, fluorosis, groundwater and São Paulo. In addition, some information from the Ministry of Health-Brazil, the Technology Environmental Sanitation Company (CETESB), National Water Agency (ANA) and the Department of Water and Sewerage of the State of Sao Paulo (DAEE) were used. Based on the collected information two groups of municipalities were identified: (i) municipalities where groundwater was found to contain high levels of fluoride e.g. Amparo, Araçatuba, Campinas, Sorocaba among others and, (ii) municipalities where moderate and severe fluorosis were indicated e.g. Amparo, Bebedouro, Campinas, Itapirapuã Paulista among others. Examples of wells with excess of fluoride in water, which can lead to dental and skeletal fluorosis and, municipalities with cases of moderate and severe dental fluorosis, are spread throughout Sao Paulo State on its major aquifers. In general, it was observed that municipalities where fluoride addition to drink water is not used cases of dental fluorosis are not found, except for Itapirapuã Paulista that is located near the region hosting occurrences and ore deposits of fluorite. The second part of this study consisted of water quality assessment with respect to fluoride in the Amparo Municipality, Brazil, aimed to highlight and to discuss the information on the prevalence of fluorosis in that area. Three sampling campaigns for collection of surface water, groundwater and treated water, and two campaigns for collection of natural springs and bottled water were carried out. At each point the physical and chemical water quality parameters were measured in the field and, aliquots of filtered water for chemical analysis in ionic chromatography were collected. It was found that fluoride concentrations in surface water ranged from 0.09 and to 0.14 mg L-1. About 29 % of the samples of treated water showed fluoride concentrations in the range considered optimal for the state of Sao Paulo (0.6 to 0.8 mg L-1), between 0.48 and 1.4 mg L-1. Groundwater, spring water and bottled water showed low concentrations of fluoride in 100% of the samples ranging from <0.01 to 0.58 mg L-1. The available information on the prevalence of dental fluorosis in Amparo shows that among 12 years old schoolchildren dental fluorosis increased from 7.4 % in 2002 to 34 % in 2004 mainly in the very light and mild levels. The present study, however, indicates that part of the population of the Amparo municipality is subject to consumption of low fluoride water from wells, fountains and bottled water and, part of population is occasionally exposed to consumption of water with excess of fluoride (treated water). Although the prevalence of fluorosis in Amparo has increased in recent years, it was also noted that part of the population remains without the fluoride protection effect against dental caries which leads to the conclusion that regular monitoring of water quality and an active sanitary surveillance are necessary. / Mestrado / Geologia e Recursos Naturais / Mestre em Geociências

O conhecimento da situação de saúde bucal de diferentes grupos populacionais, por meio de levantamentos epidemiológicos, é fundamental para o planejamento e desenvolvimento de ações em saúde adequadas às necessidades e aos riscos específicos de cada grupo, bem como possibilita monitorar os agravos e avaliar as estratégias implementadas ao longo do tempo. Este estudo buscou delinear o perfil epidemiológico de crianças de 12 anos de idade matriculadas nas escolas do município de Rio Grande da Serra, Estado de São Paulo, quanto à prevalência da fluorose dentária e a prevalência e necessidade de tratamento para cárie dentária. Buscou ainda, caracterizar a população, verificando as associações existentes entre as condições de estudo e as variáveis: socioeconômicas, demográficas, de acesso aos serviços odontológicos, percepção em saúde bucal e hábitos de higiene bucal. A amostra foi composta por 393 escolares. Apenas uma cirurgiã-dentista, previamente calibrada (Kappa=0,84), realizou todos os exames clínicos utilizando a metodologia recomendada pela Organização Mundial da Saúde (4a edição). A prevalência da cárie dentária aos 12 anos de idade foi de 55,7% e o índice CPOD médio encontrado foi de 1,5. O maior percentual encontrado quanto à necessidade de tratamento em relação cárie dentária foi para restauração de uma superfície em 30,6% dos avaliados, seguido por restauração de duas ou mais faces em 14,8%. A prevalência da fluorose dentária aos 12 anos de idade, segundo índice Dean, foi de 57%, praticamente restrita aos graus muito leve (48,3%) e leve (8,4%). Encontrou-se associação estatisticamente significante entre fluorose dentária e: número de cômodos na casa; ingestão de dentifrício e tamanho da escova de dente. Também se revelou estatisticamente significante a associação entre cárie dentária e: número de pessoas na casa; visita ao cirurgião-dentista e freqüência de escovação. Os resultados encontrados indicam a necessidade de implementação de medidas de atenção à saúde bucal, em especial aquelas voltadas à educação em saúde, ao controle dos fluoretos e ao monitoramento da fluorose dentária. / Knowledge of oral health conditions of different population groups, through epidemiological surveys, is essential for planning and developing actions on health appropriated for the needs and specific risks of each group, as well as it enables the monitoring of damages and the evaluation of implemented strategies over time.This study aimed at delineating the epidemiological profile of 12-year-old children who were enrolled in schools of the Municipality of Rio Grande da Serra, in the State of São Paulo, regarding the prevalence of dental fluorosis, as well as the prevalence and need of treatment for dental caries. The study has also sought to characterize the population, checking the associations between the study conditions and variables: socioeconomic, demographic, access to dental services, perception of oral health and oral hygiene habits. The sample consisted of 393 students. Only one dental surgeon, previously calibrated (Kappa = 0.84), performed all clinical examinations using the methodology recommended by the World Health Organization (4th edition). Regarding the need for treatment of dental caries, the highest percentage found was for the restoration of a surface in 30.6% of the assessed, followed by the restoration of two or more faces in 14.8% of them. The prevalence of dental fluorosis amongst 12-year-old children, according to Dean index, was 57%, largely confined to very mild (48.3%) and mild degrees (8.4%). It was found a statistically significant association between dental fluorosis and: the number of rooms inside the house; the ingestion of toothpaste; the toothbrush size. It has also revealed a statistically significant association between dental caries and: the number of people in the house; visit to the dentist; and brushing frequency. The findings denote the need for the implementation of oral health care measures, in particular those focused on health education, control of fluorides, and monitoring of dental fluorosis.

A cárie dentária é um dos maiores problemas de saúde pública dentro das patologias bucais ao nível mundial. Este estudo objetivou avaliar a prevalência de cárie e de fluorose dentária em adolescentes das regiões urbana e suburbana do município de Maputo e identificar a sua associação com placa bacteriana, estado nutricional, frequência do consumo de açúcar e concentração de flúor na água de abastecimento. A amostragem das escolas foi feita por conglomerados, composta por cinco escolas públicas urbanas e cinco suburbanas, tendo com unidades amostrais 601 adolescentes com 12 anos de idade, selecionados aleatoriamente. Os exames foram realizados por um examinador calibrado, sob condições padronizadas, usando índice CPOD, índice de fluorose, PHP e IMC. Foi aplicado um questionário para registrar o consumo de açúcar e foi realizada a análise da água de abastecimento. A análise bivariada foi utilizada para verificar diferenças de CPOD, fluorose, placa bacteriana, estado nutricional, frequência do consumo do açúcar e concentração de flúor na água de abastecimento público entre as regiões urbanas e suburbanas. A Correlação de Pearson foi aplicada para verificar associação entre CPOD e PHP. O nível de significância adotado foi de 5%. O CPOD encontrado foi 0,99 (± 1,65). As crianças em escolas urbanas apresentaram menor prevalência de cárie dentária (CPOD = 0,84 ± 1,49) em relação às crianças em escolas suburbanas (CPOD = 1,14 ± 1.80) (p = 0,03). Apenas 8,15% apresentaram graus de fluorose entre muito leve a moderada. A maioria das crianças apresentaram higiene bucal deficiente. Os casos de desnutrição foram mais encontrados nas escolas suburbanas (n = 109; 36,22%) do que nas escolas urbanas (n = 66; 22,00%), (p <0,00). A frequência de consumo do açúcar foi maior entre os escolares urbanos em comparação com suburbanos (p <0,00). O nível de flúor na água de consumo nas escolas urbanas foi de 0,4 ppm F, superior ao nível de flúor nas escolas suburbanas, que foi de 0,2 ppm F. Os resultados demosntraram que a cárie dentária não deve ser considerada um grande problema de saúde pública em Maputo. As áreas urbanas e suburbanas apresentaram distribuição desigual na prevalência de cárie, estado nutricional e nível de flúor na água de abastecimento, evidenciando a necessidade de intervenção no grupo de maior de risco. / Dental caries is the one of the largest public health problem in oral health worldwide. This study aimed to evaluate the prevalence of dental caries and dental fluorosis in children from urban and suburban area of the Maputos city and identify its association with dental plaque, nutritional status, frequency of consumption of sugar and the concentration of fluoride in the water supply. Sampling of schools was made by conglomerates, composed by five urban public schools and five suburban, with 601 adolescents 12 years of age, selected randomly. Clinical examinations were performed under standardized conditions by a calibrated examiner using DMFT index, index of fluorosis, PHP, BMI. It was applied a questionnaire about consumption of sugar and was made analysis of water supply. Bivariate analysis was used to verify differences in DMFT, fluorosis, dental plaque, nutritional status, frequency of consumption of sugar and concentration of fluoride in the public water supply between the urban and suburban areas. The Pearson\'s correlation was applied to verify correlation between DMFT and PHP. The level of significance was set at 5%. The mean DMFT was 0.99 (± 1.65). Children in urban schools had lower prevalence of dental caries (DMFT = 0.84 ± 1.49) in comparison with children in suburban schools with high prevalence (DMFT = 1.14 ± 1.80) (p = 0.03). Only 8.15% had very mild to moderate fluorosis score. Most of children presented poor oral hygiene. Cases of malnutrition were found in most suburban schools (n = 109; 36.22%) than in urban schools (n = 66; 22.00%) (p=0.03). The frequency of sugar consumption was higher among urban children compared to suburban schools (p <0.00). The level of fluoride in water consumption in urban schools was 0.4 ppm F, above the level of fluoride in suburban schools, which was 0.2 ppm F. The results showed that dental caries should not be considered a public health problem in Maputo. The urban and suburban areas presented inequity distribution in the prevalence of dental caries, nutritional status and level of fluoride in water supply, highlighting the need for intervention in the highest risk.

The primary prevention of dental caries includes the regular reduction of dental plaque, the adequate nutrition with reduced frequency of sugar intake and the application of topical and/or alimentary fluorides. The caries-protective effect of fluorides is based on the stabilization of demineralization/remineralization processes in the surface of teeth. The alimentary fluoride intake involves its nutritional sources, fluoride supplements when administered and unintentionally swallowed fluoride toothpastes. The fluoride intake, besides its verifiable and significant contribution to the control of cariogenic conditions in the oral cavity, brings some risk in the period of permanent teeth development. That is why the fluoride intake in childhood ought to be well set up and controlled for achieving the maximum benefit in caries reduction and for minimizing the risk for the enamel development. The assessment on fluoride content in its most significant nutritional sources and the model estimates of fluoride intake in preschool children have been conducted with the aim at contributing the solution of the benefit/risk strategy of fluoride caries prevention. The fluoride content was estimated in bottled waters for preschool children, in instant milk formulas, in herbal teas for children and in instant products of...

Bakgrund: Mineraliseringsstörning på tänder kan antingen vara genetiska eller orsakas av interna och/eller externa faktorer. De olika faktorerna orsakar antingen en lokal eller en generell mineraliseringsstörning på emalj. En av faktorerna är en kemikalisk i form av fluor. Fluoridhalter i vatten som är mellan 1,5 – 3,0 mg/l kan orsaka dental fluoros, vilket gör tänderna ömtåliga och mycket sköra. Det har upptäckts höga fluorhalter, i dricksvatten, även långt över det av WHO rekommenderade, 1,0 mg/l, i flera olika länder, däribland Sydafrika. Syfte: Att studera samband mellan fluoridkoncentration i dricksvatten och dental fluoros i Sydafrika hos barn. Frågeställning: Hur påverkar höga respektive låga fluoridkoncentrationer förekomsten av dental fluoros i Sydafrika? Metod: Databaserna DOSS, MEDLINE samt CINHAL användes för att utföra litteraturstudien. Totalt inkluderades 10 artiklar som sedan kvalitetsgranskades inspirerade Forsberg &amp; Wengström kvalitetsgranskningsmall. Resultat: Barn som bodde i ett lågt fluoridområde med 0,19 mg/l, där var det 49% som hade dental fluoros och 38% hade ingen dental fluoros. På områden med hög fluoridhalt upp till 3,00 mg/l var det 96% av barnen som hade dental fluoros, varav 30% hade grad 5 vilket är svår dental fluoros. Slutsats: Ju högre fluoridkoncentrationer i dricksvatten desto större antal fall av dental fluoros / Background: Teeth mineralization disorder can either be genetic or caused by internal and/or external factors. The various factors cause either a local or a general enamel mineralization disorder. One of the factors is a chemical in the form of fluoride. Fluoride levels in water between 1.5 - 3.0 mg/l can cause dental fluorosis, making teeth delicate and very brittle. High fluorine levels have been detected in drinking water, even well above the WHO recommended 1.0 mg/l, in several different countries, including South Africa. Aim: To study the relationship between fluoride concentration in drinking water and dental fluorosis in South Africa in children. Question: How do high respective low fluoride concentrations affect the incidence of dental fluorosis in South Africa? Method: The DOSS, MEDLINE and CINHAL databases were used to carry out the literature study. A total of 10 articles were included, which were then quality checked inspired by Forsberg &amp; Wengström's quality review template. Results: Children living in a low fluoride range of 0.19 mg/l, where 49% had dental fluorosis and 38% had no dental fluorosis. In areas with high fluoride concentrations up to, 3.00 mg/l, 96% of children had dental fluorosis, of which 30% had grade 5 which is severe dental fluorosis. Conclusion: The higher the fluoride concentrations, the greater the number of dental fluorosis cases.

Magister Chirurgiae Dentium - MChD / Purpose: To assess the oral health status of 4-15-year-old schoolchildren in the Western Region of the Eastern Cape Province, by determining the prevalence of dental caries, periodontal disease, dental fluorosis, malocclusion and oral mucosal lesions and to create baseline data for planning oral health services in this region. Materials and Methods: The prevalent analytic survey was undertaken on 822 schoolchildren between the ages of 4-15 years in 27 different schools. The sample size selected for this region by the Department of Statistics, University of Pretoria, for the National Oral Health Survey of 1999/2000 was used. The data on 209, 210, 209 and 194 scholars in the 4-5, 6, 12 and 15-year-old age groups respectively were collected. The World Health Organization's (1997) criteria were used to determine the prevalence of caries, periodontal treatment needs, the dental fluorosis, malocclusion and prevalence of oral mucosal lesions. Six calibrated and trained examiners recorded the data on a survey form. The WHO survey forms were used for data collection. The data were analysed and processed by the author on Microsoft Excel 2000. Results: The sample size consisted of 1.35 % Asian, 51.89 % Black, 26.07 % Coloured and 20.06 % White scholars. Nearly equal amounts of males (48.3 %) and females (51.7%) were examined. The dental caries prevalence in the primary dentition of 4-5-year-olds with an average age of 4.43 years was 40.67%, with a mean dmft of 3,56. The dental caries prevalence in the permanent dentition of6-, 12- and 15-year-oldage groups was 67.62%, 46.05% and 67.92% respectively. The mean DMFT for 6-, 12- and 15 year olds were 0.05, 1.19 and 2.02 respectively. Gender differences and differences in prevalence of dental caries between the populations groups were recorded. The Coloured children experienced the highest dental caries prevalence. In the 4-5- and 15-year-old groups the males were affected more than the females by dental caries. Prevalent differences were recorded between rural and urban areas in the same population group. The prevalence of periodontal disease in 373, 12-15-year-olds was 79.09%. Only 4.02 % were in need of dental hygiene instructions and polishing. Dental education, dental hygiene instructions, dental scaling and polishing were needed by 75.07% of the children. Dental fluorosis prevalence in 450, 6-15-year-olds was 13.03%. Dental fluorosis did not affect 86.97% of the scholars; 10.63% had mild fluorosis and 2.05% was severely affected. The mean fluoride concentration in the drinking water in this region were 1.07 mgIL, ranging between 0.3-3 mgIL. Definite malocclusion was recorded in only 0.48% of the 12-year-old group, whom needed elective treatment. In the 12-year-olds, 99.52% needed no or slight treatment for no or minor malocclusions. The majority of children had no oral mucosal lesions (91.55%). The prevalence of oral mucosal lesions was 8.5% in this survey. The most frequent conditions were traumatic lesions (1.96%), dento-alveolar abscess (1.22%) and herpes labialis (1.22%). The intra-examiner reliability for caries, dental fluorosis, periodontal treatment needs and prevalence of malocclusions was 97.66%, 100%, 88.89% and 86.67% respectively. The inter-examiner reliability was 98.75%, 98.34%, 100%, 100% and 100% respectively for the five examiners. Conclusion: This survey indicated a higher prevalence of dental caries in the primary dentition (63.48%), than the permanent dentition (41.3%). The mean dmft was 3.65 and the DMFT 1.2, which indicated a low mean caries experience for these children. The WHO goal for the year 2000 for the 6-year-olds of 50% being caries free has not reached for only 32.56% were caries free. The mean DMFT of 1.2 for 12-year-olds in this survey is below the WHO goal of a mean DMFT of 1.5 or less. The lack of available preventative service provision, were ) indicated by the low percentage of fissure sealants (2.8%). The need for dental treatment was highlighted by the need mostly for one-surface restorations. Preventative treatment, two-surface fillings and extractions were also needed. Periodontal disease was a major public oral health concern for this region for a prevalence of 79.09% was recorded for the 12-15-year-olds. The majority of the children affected by periodontal disease (75.07%) were in need of professional cleaning and calculus removal. The prevalence of dental fluorosis was 8.2%, 19.87% and 13.05% for 6-, 12- and IS-year age groups respectively. The prevalence of malocclusion was 0.48% for the 12-year-old group. The prevalence of oral mucosa lesions was 8.5% for 4-15-year-old schoolchildren. Therefore, the conclusion can be made that dental fluorosis; malocclusions and oral mucosal lesions were no public concern in this region. The major public oral health concerns were dental caries in the primary dentition and periodontal disease in all age groups. Recommendations: Dental services in this region should be directed towards prevention of dental caries in the primary dentition and periodontal disease in all age groups. The focus of dental services should be primarily on preventative programs and treatments. The public dental treatments needs indicated in this survey, namely scaling and polishing, restorations and extractions, consists of the primary health care package delivery. Currently, no evaluation tool exists to monitor the efficiency of oral health programs, no baseline data for the Province exists. Therefore, the urgent need for dental research and oral health service planning and delivery are recommended.

Fluoride in drinking water can lead to a crippling disease called fluorosis. As there is no cure for fluorosis, prevention is the only means of controlling the disease and research into fluoride remediation is critical. This work begins by providing a new approach to assessing fluoride remediation strategies using a combination of groundwater chemistry, saturation indices, and multivariate statistics based on the results of a large groundwater survey performed in a fluoride-contaminated region of India. From the Indian groundwater study, it was noted that one technique recommended for defluoridation involved using hydrous ferric oxide (HFO) as a solid phase sorbent for fluoride. This prompted investigation of bacteriogenic iron oxides (BIOS), a biogenic form of HFO, as a means of approaching bioremediation of fluoride. Batch sorption experiments at ionic strengths ranging from 0.001 to 0.1 M KNO3 and time course kinetic studies with BIOS and synthetic HFO were conducted to ascertain total sorption capacities (ST), sorption constants (Ks), and orders of reaction (n), as well as forward (kf) and reverse (kr) rate constants. Microcosm titration experiments were also conducted with BIOS and HFO in natural spring water from a groundwater discharge zone to evaluate fluoride sorption under field conditions. This thesis contributes significant, new information regarding the interaction between fluoride and BIOS, advancing knowledge of fluoride remediation and covering new ground in the uncharted field of fluoride bioremediation.

Introdução - A quantidade de flúor ingerida, proveniente de todas as fontes, durante o período crítico de formação dos dentes, é o principal fator de risco para a fluorose dentária. Dentre estas fontes estão a água fluoretada, o dentifrício fluoretado e os alimentos, bebidas, fórmulas e suplementos infantis. Considerando-se que a fluorose dentária tem aumentado em todas as regiões é importante avaliar, além da água e do dentifrício, também a contribuição diária do consumo alimentar das crianças e a concentração de flúor nesses itens alimentares para a ingestão de flúor. Objetivo - Descrever o consumo alimentar de crianças de 2 a 6 anos, com relação ao flúor. Métodos - Foram avaliadas 379 crianças, de 2 a 6 anos, faixa etária de risco para fluorose, residentes em Bauru - São Paulo, município com fluoretação artificial da água de abastecimento público. A amostragem foi estratificada por setor, baseando-se no Plano Diretor do Município. O consumo alimentar foi avaliado pelo Questionário de Freqüência Alimentar Semiquantitativo, aplicado aos pais ou responsáveis, e a concentração de flúor nos itens alimentares a partir de análises laboratoriais. As crianças foram classificadas quanto à ingestão diária de f1úor de acordo com a Dietary Reference Intakes. Resultados - Dentre os 70 itens alimentares, o arroz, a água de abastecimento público e o leite foram os mais consumidos; o chá preto, o leite em pó de soja diluído com água de abastecimento público e o biscoito Danyt\'s® apresentaram maior concentração de flúor; a água de abastecimento público, o refrigerante Coca-Cola® e a batata frita representaram maior contribuição diária para ingestão de flúor. Os itens alimentares mais consumidos apresentaram, em média (±DP), concentração de flúor (0,015 ± 0,028 mgF/porção) significantemente menor (p = 0,03) que os menos consumidos (0,107 ± 0,162 mgF/porção). Os itens alimentares com maior concentração de flúor contribuíram significantemente (p < 0,001) para a ingestão do halogênio (0,018 ± 0,037 mgF/dia). A média da ingestão de flúor por meio dos alimentos sólidos e líquidos, da água e da escovação foi de 0,017 ± 0,016; 0,011 ± 0,004 e 0,036 ± 0,028 mgF/kg peso/dia, respectivamente, totalizando 0,064 ± 0,035 mgF/kg peso/dia. Das 379 crianças, 31,2% apresentaram risco de fluorose. O dentifrício e os itens alimentares (sólidos, água e outros líquidos) contribuíram com 57% e 43%, respectivamente, para a ingestão de flúor. Conclusão - O dentifrício foi a principal fonte para a ingestão de f1úor pelas crianças, porém, a concentração desse halogênio nos itens alimentares contribuiu significantemente para a ingestão, representando risco para f1uorose dentária. / The quantity of fluoride ingested, deriving from all sources, during the critical period of formation of the teeth, is the main factor of risk for the dental fluorosis. Among this sources, we have the fluoridated water, the fluoridated dentifrice and the food, drinks, chemical formula and the infant supplements. Taking into consideration that the dental fluorosis has increased in all regions, it is important to evaluate it, besides the water and the dentifrice, the daily contribution of children\'s food consumption and the concentration of fluoride in these food items for the ingestion of fluoride. Objective - Describe the food consumption of children from 2 to 6 years old, relationg to fluoride. Methods - 379 children were evaluated at risking ages for fluorosis, residents in Bauru - São Paulo, district with artificial f1uoridation. The sampling was stratified by sector, based on the Director\'s Plan of the District. The food intake was evaluated by the Food Frequency Semiquantitative Questionnaire, applied on parents or responsable one, and the concentration of fluoride on the food items from analyses in laboraties. The children were classified based on theis daily ingestion of fluoride according to the Dietary Reference Intakes. Results - Among the 70 food items, rice, public water supply and the milk were the most consumed ones; the black tea, the soybean powdered milk diluted in public water and the biscuit Danyt\'s® presented the gratest daily contribution for the ingestion of fluoride. The most consumed food items present, in average (± DP), concentration of fluoride (0,015 ± 0,028 mg F / portion), significantly lower (p = 0,03) that the less consumed (0,107 ± 0,162 mgF/portion). The food items with the greatest concentration of fluoride contributed significantly (p < 0,001) for the ingestion of the mineral (0,018 ± 0,037 mgF/day). The average amount of fluoride ingestion taken from the solid food and the liquid ones (except water) coming from the water and the teeth brushing was 0,017 ± 0,016; 0,011 ± 0,004 and 0,036 ± 0,028 mgF/kg weight/day, respectively, totalizing 0,064 ± 0,035 mgF/kg weight/dia. 31,2% of the 379 children presented risk of fluorosis. The dentifrice and the food items (solid, water and other liquids) contributed with 57% and 43%, respectively, for the ingestion of fluoride. Conclusion - The dentifrice was the main source for the ingestion of fluoride, by the children, however, the concentration of this mineral in food items contributed significantly for the ingestion by the children, representing risk for dental fluorosis.

Introdução - A quantidade de flúor ingerida, proveniente de todas as fontes, durante o período crítico de formação dos dentes, é o principal fator de risco para a fluorose dentária. Dentre estas fontes estão a água fluoretada, o dentifrício fluoretado e os alimentos, bebidas, fórmulas e suplementos infantis. Considerando-se que a fluorose dentária tem aumentado em todas as regiões é importante avaliar, além da água e do dentifrício, também a contribuição diária do consumo alimentar das crianças e a concentração de flúor nesses itens alimentares para a ingestão de flúor. Objetivo - Descrever o consumo alimentar de crianças de 2 a 6 anos, com relação ao flúor. Métodos - Foram avaliadas 379 crianças, de 2 a 6 anos, faixa etária de risco para fluorose, residentes em Bauru - São Paulo, município com fluoretação artificial da água de abastecimento público. A amostragem foi estratificada por setor, baseando-se no Plano Diretor do Município. O consumo alimentar foi avaliado pelo Questionário de Freqüência Alimentar Semiquantitativo, aplicado aos pais ou responsáveis, e a concentração de flúor nos itens alimentares a partir de análises laboratoriais. As crianças foram classificadas quanto à ingestão diária de f1úor de acordo com a Dietary Reference Intakes. Resultados - Dentre os 70 itens alimentares, o arroz, a água de abastecimento público e o leite foram os mais consumidos; o chá preto, o leite em pó de soja diluído com água de abastecimento público e o biscoito Danyt\'s® apresentaram maior concentração de flúor; a água de abastecimento público, o refrigerante Coca-Cola® e a batata frita representaram maior contribuição diária para ingestão de flúor. Os itens alimentares mais consumidos apresentaram, em média (±DP), concentração de flúor (0,015 ± 0,028 mgF/porção) significantemente menor (p = 0,03) que os menos consumidos (0,107 ± 0,162 mgF/porção). Os itens alimentares com maior concentração de flúor contribuíram significantemente (p < 0,001) para a ingestão do halogênio (0,018 ± 0,037 mgF/dia). A média da ingestão de flúor por meio dos alimentos sólidos e líquidos, da água e da escovação foi de 0,017 ± 0,016; 0,011 ± 0,004 e 0,036 ± 0,028 mgF/kg peso/dia, respectivamente, totalizando 0,064 ± 0,035 mgF/kg peso/dia. Das 379 crianças, 31,2% apresentaram risco de fluorose. O dentifrício e os itens alimentares (sólidos, água e outros líquidos) contribuíram com 57% e 43%, respectivamente, para a ingestão de flúor. Conclusão - O dentifrício foi a principal fonte para a ingestão de f1úor pelas crianças, porém, a concentração desse halogênio nos itens alimentares contribuiu significantemente para a ingestão, representando risco para f1uorose dentária. / The quantity of fluoride ingested, deriving from all sources, during the critical period of formation of the teeth, is the main factor of risk for the dental fluorosis. Among this sources, we have the fluoridated water, the fluoridated dentifrice and the food, drinks, chemical formula and the infant supplements. Taking into consideration that the dental fluorosis has increased in all regions, it is important to evaluate it, besides the water and the dentifrice, the daily contribution of children\'s food consumption and the concentration of fluoride in these food items for the ingestion of fluoride. Objective - Describe the food consumption of children from 2 to 6 years old, relationg to fluoride. Methods - 379 children were evaluated at risking ages for fluorosis, residents in Bauru - São Paulo, district with artificial f1uoridation. The sampling was stratified by sector, based on the Director\'s Plan of the District. The food intake was evaluated by the Food Frequency Semiquantitative Questionnaire, applied on parents or responsable one, and the concentration of fluoride on the food items from analyses in laboraties. The children were classified based on theis daily ingestion of fluoride according to the Dietary Reference Intakes. Results - Among the 70 food items, rice, public water supply and the milk were the most consumed ones; the black tea, the soybean powdered milk diluted in public water and the biscuit Danyt\'s® presented the gratest daily contribution for the ingestion of fluoride. The most consumed food items present, in average (± DP), concentration of fluoride (0,015 ± 0,028 mg F / portion), significantly lower (p = 0,03) that the less consumed (0,107 ± 0,162 mgF/portion). The food items with the greatest concentration of fluoride contributed significantly (p < 0,001) for the ingestion of the mineral (0,018 ± 0,037 mgF/day). The average amount of fluoride ingestion taken from the solid food and the liquid ones (except water) coming from the water and the teeth brushing was 0,017 ± 0,016; 0,011 ± 0,004 and 0,036 ± 0,028 mgF/kg weight/day, respectively, totalizing 0,064 ± 0,035 mgF/kg weight/dia. 31,2% of the 379 children presented risk of fluorosis. The dentifrice and the food items (solid, water and other liquids) contributed with 57% and 43%, respectively, for the ingestion of fluoride. Conclusion - The dentifrice was the main source for the ingestion of fluoride, by the children, however, the concentration of this mineral in food items contributed significantly for the ingestion by the children, representing risk for dental fluorosis.