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

Orientador : Antonio Carlos Pereira / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-09T14:09:31Z (GMT). No. of bitstreams: 1 Guerra_LucianeMiranda_D.pdf: 741743 bytes, checksum: 579d9e97d3abe140fabc2d7c22d93f5a (MD5) Previous issue date: 2007 / Resumo: Em meio à discussão sobre a eficiência da fluoretação das águas de abastecimento público, concomitante com o momento histórico de amplos investimentos federais na implantação de novos sistemas públicos de fluoretação das águas, há um cenário propício para se discutir a quem e como tal método se faz importante como estratégia de prevenção de cárie em comunidades. O presente estudo buscou estudar as prevalências de cárie e fluorose em duas cidades; uma com fluoretação das águas de abastecimento e outra sem tal fluoretação; além de verificar a interferência das variáveis sócio-econômicas em relação aos problemas estudados. Para tanto, foram selecionados dois municípios do Estado de São Paulo, Brasil, sendo que um deles, Piracicaba, possui fluoretação das águas de abastecimento público desde 1971 e, o outro, Holambra, nunca fluoretou suas águas de abastecimento. Para o município de Piracicaba, a seleção das escolas foi feita por amostragem probabilística por conglomerados, sendo selecionadas, de forma proporcional, 24 escolas públicas e privadas no município. No município de Holambra foram avaliadas todas as escolas existentes no município, totalizando seis. A amostra foi constituída por 1121 escolares de 12 anos oriundos de escolas públicas e privadas dos municípios de Piracicaba (n=1002) e Holambra (n=119). Todos os escolares foram examinados sob luz natural, utilizando-se espelho bucal plano, sonda IPC (ball point), e escovação prévia, seguindo as orientações da Organização Mundial da Saúde. Os exames, nos dois municípios, foram realizados por examinador calibrado (Kappa >0,91 para cárie e Kappa=0,89 para fluorose). Foram calculados os índices CPOD para toda a amostra e o índice SiC (média CPOD para o terço da amostra representado pelos indivíduos que possuem os mais altos níveis de cárie). Foi realizada análise univariada para se testar a associação entre as variáveis independentes (socioeconômicas, comportamentais e demográficas) e as variáveis dependentes (CPOD e fluorose) ao nível de significância de 5%, utilizando-se o teste qui quadrado. A análise de Regressão Logística demonstrou as variáveis consideradas como indicadores de risco. Foram estimados os ODDS Ratio e seus intervalos de confiança de 95%. Os resultados demonstraram, entre outras coisas, que: crianças que apresentaram atividade de cárie tiveram, respectivamente para Piracicaba e Holambra, 3,1 e 3,53 vezes mais chance de apresentarem alta experiência de cárie quando comparado com o grupo sem atividade da doença; que o grau de escolaridade do pai da criança foi estatisticamente associado, à fluorose e à cárie no município de Piracicaba. Concluiu-se que a fluoretação das águas de abastecimento público é uma estratégia que diminui a prevalência de cárie, tanto em relação ao CPOD apresentado pelo total da população quanto para o grupo de polarização; que a prevalência de Fluorose Dentária foi maior no município que possui fluoretação das águas de abastecimento. E, finalmente, que algumas variáveis socioeconômicas e demográficas podem interferir no perfil de distribuição da doença cárie / Abstract: In the midst of the discussion about the efficiency of public fluoridation water supply and as the federal government is making massive investments in new public systems for water supply fluoridation, there is an appropriate scenario to discuss to whom and to what extent such method is important how such this method is important in prevention of caries. This work sought to study the prevalence of caries and fluorosis in two cities - one of which with public water supply fluoridation and the other one without it. Besides that we sought to look into the interference of socio-economic variables in relation to the problems being studied. In order to carry out the study, two cities located in the State of São Paulo, Brazil, namely Piracicaba, in which the public water supply has been fluorided since 1971 and , the other one, Holambra, which has never fluorided its water supply. For the city of Piracicaba, the schools were chosen by probability sampling clustering, when 24 public and private schools were selected proportionally. On the other hand, in the city of Holambra all of the 6 schools were selected. As it is, the sample was made up of a total of 1121 12 years old school children both from the public and the private school system located in Piracicaba (n=1002) and Holambra (n= 119). All of the subjects were examined in daylight, by means of dental mirror, CPI probe (ball point), and previous tooth brushing, in accordance with the World Health Organization guidelines. The exams in both cities were conducted by previously calibrated examiner (Kappa >0,91 for tooth decay and Kappa=0,89 for fluorosis). DMFT index were calculated for the whole sample and the SiC index (average for the third of the sample represented by those subjects with the highest levels of cavities). Univariated analyses was conducted so as to test the association among the independent variables (socioeconomic, behavioral and demographic) upon the dependent variables (DMFT and fluorosis) with a significance level of 5%, by using the chi-square test. The multiple logistic regression analysis showed the variables considered as risk indicators. The ODDS ratio were estimated and their tolerance level of 95%. The results showed, among other things, that: children who presented caries activity are, respectively for Piracicaba and Holambra, 3.1 and 3.53 times more likely to develop high levels of caries as compared to those who have not developed the condition; the education level of the child¿s parent was statistically associated with fluorosis and caries in the city of Piracicaba. We can conclude, therefore, that public water supply fluoridation is a strategy which reduces caries, not only in relation to DMFT shown by the total population, but also to the polarization group; that the prevalence of dental fluorosis was higher in Holambra, where community water is fluorided; and, finally, that some socioeconomic and demographic variables may interfere with the distribution profile of caries / Doutorado / Saude Coletiva / Doutor em Odontologia

A fluoretação da água de abastecimento público tem-se mostrado como uma das medidas de saúde pública de maior alcance social, atingindo todas as idades, todas as classes sociais indistintamente e com a melhor relação custo-benefício. O objetivo deste trabalho foi o de verificar os teores de flúor da água de abastecimento público do município de Cananéia-SP, no período de um ano (2010-2011). Estabeleceu-se um protocolo de coletas mensais de amostras de água. As amostras foram coletadas em nove setores da zona urbana abrangendo três bairros e três setores da zona rural. A análise das amostras foi realizada em duplicata para cada amostra, utilizando-se o método do eletrodo específico para o íon flúor combinado (Orion 96-09) acoplado ao potenciômetro analisador de íons (EA-940), onde acusa a diferença de potencial entre as soluções de dentro do eletrodo e a solução que está sendo analisada. Foram realizadas 90 coletas de amostras de água, da zona urbana e zona rural. Nas 62 amostras da zona urbana identificou-se em 69,4% (43) a concentração de fluoretos estava em níveis aceitáveis (0,60 a 0,80 mgF/L), das 19 amostras consideradas inaceitáveis 17,0% (10) estavam com os teores acima do máximo permitido (> 0,80 mgF/L) e 15,2% (9), abaixo do recomendado (< 0,60 mgF/L). A zona rural considerando-se somente regiões onde o consumo de água tratada, das 14 amostras coletadas 57,1% (8) apresentou teores aceitáveis, 35,7% (5) apresentou resultados dos teores abaixo do estabelecido e 7,2% (1), o teor ficou acima. Na zona rural parte da população consome água proveniente da cachoeira sem tratamento e os teores de flúor presente nestas águas são inferiores a 0,05 mgF/L; como ficou demonstrado no resultado das análises das 14 amostras coletadas. Tendo em vista os resultados encontrados faz-se necessário o controle contínuo dos teores de flúor presente nestas águas garantindo assim a qualidade da água fornecida para a população com teores adequados de flúor, visando à prevenção da cárie dentária de maneira efetiva sem riscos de fluorose dentária. / Fluoridation of public water supplies has been shown as one of public health measures for greater social impact, reaching all ages, all social classes indiscriminately and with the best cost-effective relation. The objective of this study was to determine the levels of fluoride in public water supplies in the city Cananéia (State of Sao Paulo, Brazil) in one year (2010-2011). A protocol for collecting monthly water samples was established. Samples were collected in nine sectors of the urban area covering three districts and three rural sectors. Sample analysis was performed in duplicate for each sample, using the method of ion-selective electrode for combined fluoride (Orion 96-09) linked to a potentiometer ion analyzer (EA-940), which accuses the potential difference between solutions within the electrode and the solution being analyzed. Ninety (90) samples of water were collected from urban and rural areas. From 62 samples of the urban area, the concentration of fluoride at acceptable levels (0.60 to 0.80 mgF / L), was identified in 69.4% (43) ; from 19 samples at level considered unacceptable, 17.0% (10) presented levels above the maximum allowed (> 0.80 mgF / L) and 15.2% (9) present levels at a level lower than recommended (< 0.60 mgF / L). In the rural zone and only considering regions where treated water was consumed, from 14 samples collected, eight (8) 57.1% had acceptable levels, five (5) 35.7% had results below the levels established and one (1) 7.2 % was above the content. In rural areas most people get water without treatment and that this region of the 14 samples collected values of fluoride were found below 0.05 mgF / L. Given the findings it is necessary to keep continuous control of adequate fluoride levels in order to ensure the quality of water supplied to the population aiming the prevention of dental caries in an effective manner without risk of dental fluorosis.

Water fluoridation has been confirmed by three recent reviews as one of the most cost-effective and safe primary preventive measure against dental caries. Despite this evidence no artificially fluoridated water scheme exists in South Africa. The economic impact of water fluoridation in times of a reduction in dental caries should be weighed against its benefits. A minimum package of oral care has been proposed for implementation in the public oral health services. Irrespective of the implementation of water fluoridation and/or a minimum package or oral care, it will impact on the required oral health human resources. The aim of this study was to investigate the economic viability of the implementation of water fluoridation and the delivery of the minimum package of oral care and the impact this will have on human resources planning for oral health in South Africa. Computerised simulation models were developed for this study. Per capita cost, cost-effectiveness and cost-benefit of the implementation of water fluoridation was calculated for seventeen major metropolitan cities, towns and water boards in South Africa. Treatment need data was converted to a per capita cost to express the delivery of the minimum package of oral care as a monetary value. The World Health Organization/Fédération Dentaire Internationale and a “Service Targets Method” model were used to calculate the oral health human resources required to deliver the minimum package of oral care. The average per capita cost of water fluoridation for the total population is R2.08. At an anticipated 30% caries reduction achieved with water fluoridation, average cost-effectiveness is R33.16 and cost-benefit was calculated as 0.18. Cost-benefit equals or exceeds 0.8 for only three municipalities or water boards at an anticipated 10% caries reduction as a result of the implementation of water fluoridation. The average per capita cost to provide the minimum package of oral care is R245.95 without the impact of water fluoridation and R186.03 at an anticipated 30% caries reduction due to water fluoridation. Oral hygienists represent more than 50%, dental therapists between 30 to 40% and dentists less than 10% of the total oral health human resources required to deliver the minimum package of oral care. At an anticipated caries reduction of 30% due to the introduction of water fluoridation, the number of dentists required decrease by 29%, dental therapists between 27.5 and 29.8% and oral hygienists between 2.1 and 10.5%. This converts to a saving in salaries of R14,8 million per year.</p It is recommended that water fluoridation remains a viable option for South Africa, even if only a 10% caries reduction as a result of its introduction is achieved. All provinces should actively pursue the introduction of the minimum package of oral care with appropriate modes of delivery by creating a number of posts as well as incentives to attract especially oral hygienists and dental therapists to the public service. The impact of the introduction of water fluoridation on human resources should always be considered in planning the number of oral health professionals to be trained. / Thesis (PhD)--University of Pretoria, 2009. / Community Dentistry / unrestricted

Introdução - A política de fluoretação das águas de abastecimento público requer aplicação contínua desta medida em níveis adequados de flúor. O controle operacional é realizado pelas empresas de saneamento ao adicionar flúor às águas, cuja medida deve ser complementada pela ação dos sistemas de vigilância segundo o princípio do heterocontrole. Sistemas de vigilância lidam com informações de interesse público, nos marcos legais desenvolvidos pelos Estados. No mundo contemporâneo, tais marcos implicam contemplar o direito de acesso à informação. Objetivo - Descrever o sistema de vigilância da fluoretação da água no município de São Paulo, no período 1990-2011. Método - Pesquisa baseada em dados secundários disponibilizados pela Secretaria Municipal de Saúde de São Paulo, no período 1990-2011. Os teores de fluoreto nas amostras foram classificados segundo as dimensões de risco e benefício para fluorose e cárie dentária, avaliados concomitantemente. Adicionalmente, realizou-se revisão bibliográfica do marco legal brasileiro que trata da Lei de Acesso à Informação (LAI), tendo em vista que dados produzidos pelos sistemas de vigilância em saúde são de interesse público. Resultados - Foram analisadas 19.071 amostras. A média anual de registros identificados no período de pontos fixos atingiu 647 amostras, correspondendo a um valor acima do necessário para a cobertura total do sistema (n=180). A média anual de registros foi ainda maior para o período de pontos variáveis, com 1.340 amostras. A média geral dos teores de flúor foi de 0,66 mg/l. Com relação à prevenção da cárie, 44 por cento das amostras representam benefício moderado e 54 por cento benefício máximo. Quanto à fluorose dentária, 99 por cento das amostras representam risco mínimo. Com relação à LAI, o período histórico contemporâneo se apresenta, no Brasil, como um cenário de possibilidades e desafios aos avanços dos modelos de vigilância em saúde, incluindo a qualidade da água, com potencial para ampliar as possibilidades de controle sobre as políticas públicas. Conclusão: O benefício preventivo quanto à cárie não foi aproveitado em seu potencial pleno. O risco para fluorose dentária foi baixo. O número de amostras anuais coletadas apresentou tendência de aumento no período estudado, registrando-se variações que se situaram, contudo, sempre acima do limite inferior capaz de assegurar a cobertura total do sistema. Tendo em vista as disposições da LAI, dados e informações produzidos pelos sistemas de vigilância da qualidade da água são de interesse público e, portanto, devem estar disponíveis integralmente / Introduction - The policy of community water fluoridation requires continuous application of this measure by the adequate use of fluoride levels. Operational control is carried out by drinking-water suppliers to add fluoride to the water, which measure must be complemented by action of surveillance systems on the principle of external control. Surveillance systems deal with information of public interest, within the legal frameworks developed by the States. In the contemporary world, such landmarks contemplate the right of access to information. Objective - To describe the surveillance system of drinking-water fluoridation in the city of Sao Paulo, in the period 1990-2011. Method - Research based on secondary data provided by the Municipal Health Secretary of Sao Paulo, in the period 1990-2011. Fluoride levels in the samples were classified according to the dimensions of risk and benefit related to fluorosis and dental caries, concurrently assessed. Additionally, it was carried out a literature review of the Brazilian legal framework that deals with the Law on Access to Information (LAI), considering that data produced by health surveillance systems are of public interest. Results - It was analyzed 19,071 samples. The average annual records identified between fixed points period reached 647 samples, corresponding to a value higher than necessary to cover the entire system (n = 180). The average of the variable annual record points was even greater for the period, with 1,340 samples. The overall average fluoride concentration was 0.66 mg/l. With respect to the prevention of caries, 44 per cent of the samples represent moderate benefit and 54 per cent maximum benefit. As for dental fluorosis, 99 per cent of the samples represented minimal risk. With respect to LAI, the contemporary historical period presented in Brazil, as a scenario for possibilities and challenges to the improvement of health surveillance models, including water quality, with the potential to expand the possibilities of control over public policies. Conclusion: The preventive benefit concerning dental caries has not been tapped into its full potential. The risk for dental fluorosis was low. The annual number of collected samples showed a tendency to increase during the study period, registering variations which remained, however, always above the lower limit to ensure full coverage of the system. In view of the provisions of LAI, data and information produced by drinking-water surveillance systems are of public interest and therefore should be integrally available

Introdução - A política de fluoretação das águas de abastecimento público requer aplicação contínua desta medida em níveis adequados de flúor. O controle operacional é realizado pelas empresas de saneamento ao adicionar flúor às águas, cuja medida deve ser complementada pela ação dos sistemas de vigilância segundo o princípio do heterocontrole. Sistemas de vigilância lidam com informações de interesse público, nos marcos legais desenvolvidos pelos Estados. No mundo contemporâneo, tais marcos implicam contemplar o direito de acesso à informação. Objetivo - Descrever o sistema de vigilância da fluoretação da água no município de São Paulo, no período 1990-2011. Método - Pesquisa baseada em dados secundários disponibilizados pela Secretaria Municipal de Saúde de São Paulo, no período 1990-2011. Os teores de fluoreto nas amostras foram classificados segundo as dimensões de risco e benefício para fluorose e cárie dentária, avaliados concomitantemente. Adicionalmente, realizou-se revisão bibliográfica do marco legal brasileiro que trata da Lei de Acesso à Informação (LAI), tendo em vista que dados produzidos pelos sistemas de vigilância em saúde são de interesse público. Resultados - Foram analisadas 19.071 amostras. A média anual de registros identificados no período de pontos fixos atingiu 647 amostras, correspondendo a um valor acima do necessário para a cobertura total do sistema (n=180). A média anual de registros foi ainda maior para o período de pontos variáveis, com 1.340 amostras. A média geral dos teores de flúor foi de 0,66 mg/l. Com relação à prevenção da cárie, 44 por cento das amostras representam benefício moderado e 54 por cento benefício máximo. Quanto à fluorose dentária, 99 por cento das amostras representam risco mínimo. Com relação à LAI, o período histórico contemporâneo se apresenta, no Brasil, como um cenário de possibilidades e desafios aos avanços dos modelos de vigilância em saúde, incluindo a qualidade da água, com potencial para ampliar as possibilidades de controle sobre as políticas públicas. Conclusão: O benefício preventivo quanto à cárie não foi aproveitado em seu potencial pleno. O risco para fluorose dentária foi baixo. O número de amostras anuais coletadas apresentou tendência de aumento no período estudado, registrando-se variações que se situaram, contudo, sempre acima do limite inferior capaz de assegurar a cobertura total do sistema. Tendo em vista as disposições da LAI, dados e informações produzidos pelos sistemas de vigilância da qualidade da água são de interesse público e, portanto, devem estar disponíveis integralmente / Introduction - The policy of community water fluoridation requires continuous application of this measure by the adequate use of fluoride levels. Operational control is carried out by drinking-water suppliers to add fluoride to the water, which measure must be complemented by action of surveillance systems on the principle of external control. Surveillance systems deal with information of public interest, within the legal frameworks developed by the States. In the contemporary world, such landmarks contemplate the right of access to information. Objective - To describe the surveillance system of drinking-water fluoridation in the city of Sao Paulo, in the period 1990-2011. Method - Research based on secondary data provided by the Municipal Health Secretary of Sao Paulo, in the period 1990-2011. Fluoride levels in the samples were classified according to the dimensions of risk and benefit related to fluorosis and dental caries, concurrently assessed. Additionally, it was carried out a literature review of the Brazilian legal framework that deals with the Law on Access to Information (LAI), considering that data produced by health surveillance systems are of public interest. Results - It was analyzed 19,071 samples. The average annual records identified between fixed points period reached 647 samples, corresponding to a value higher than necessary to cover the entire system (n = 180). The average of the variable annual record points was even greater for the period, with 1,340 samples. The overall average fluoride concentration was 0.66 mg/l. With respect to the prevention of caries, 44 per cent of the samples represent moderate benefit and 54 per cent maximum benefit. As for dental fluorosis, 99 per cent of the samples represented minimal risk. With respect to LAI, the contemporary historical period presented in Brazil, as a scenario for possibilities and challenges to the improvement of health surveillance models, including water quality, with the potential to expand the possibilities of control over public policies. Conclusion: The preventive benefit concerning dental caries has not been tapped into its full potential. The risk for dental fluorosis was low. The annual number of collected samples showed a tendency to increase during the study period, registering variations which remained, however, always above the lower limit to ensure full coverage of the system. In view of the provisions of LAI, data and information produced by drinking-water surveillance systems are of public interest and therefore should be integrally available

This study investigated the effect of geographic location on Severe Early Childhood Caries (S-ECC) in Native American Children three years of age from a Norther Plains Tribal Community. Geographic location of study participants was ascertained by postal district and categorized into geographic regions as well as dental clinic accessibility, defined as dental services present or absent in that district. The association of location category and dental caries (dmfs) was evaluated cross-sectionally at 36 months of age. Descriptive statistics demonstrated differences in dental caries distribution by geographic region and accessibility category. Bivariate analysis of disease by location showed a significant difference in dmfs between 4 geographic regions (p=0.0159) but not between accessibility categories (p=0.0687). Multivariable regression modeling for geographic region demonstrated the unique effect of geographic region on dental caries experience as well as five other key risk factors. Incident Rate Ratios (IRR) were computed for each of the risk factors, including number of erupted teeth (IRR=1.89, p=0.0147), fluoride exposure from tap water (IRR=1.70, p=0.0173), annual family income (IRR=1.58, p=0.0392), maternal DMFS (IRR=1.02, p=0.0040), and Mean Adequacy Ratio (IRR=1.05, p=0.1042). This study demonstrated statistically significant variation in cumulative dental caries experience of Native American children aged 36 months among geographic regions and identified the specific unites of association through multivariate modeling. These findings can be used for local dental caries prevention programs and contribute to a broader understanding of S-ECC among very young Native American children.