Cruz Mariângela Guanaes Bortolo da, Narvai Paulo Capel
Universidade de São Paulo. Faculdade de Saúde Pública. São Paulo, SP, Brasil.
Universidade de São Paulo. Faculdade de Saúde Pública. Departamento de Política, Gestão e Saúde. São Paulo, SP, Brasil.
Rev Saude Publica. 2018 Apr 9;52:28. doi: 10.11606/S1518-8787.2018052016330.
To analyze the association between exposure to fluoridated water and dental caries in a context of widespread use of fluoride toothpaste in Brazil, in a scenario of low prevalence of the disease.
This is a cross-sectional observational study, of the census type, in the form of a double population-based epidemiological survey carried out in two municipalities of the state of São Paulo in 2014. The sample consisted of adolescents aged 11 and 12 years, exposed (n = 184) or not exposed (n = 128) to fluoridated water for at least five years. The populations studied lived in communities of the same geographic region and had small demographic size and similar socioeconomic classification, differing only in the exposure (Silveiras) or not exposure (São José do Barreiro) to fluoridated water. The experience, magnitude, and degree of polarization of dental caries in these populations were analyzed using the DMFT and SiC indexes, and the association was tested using Pearson's chi-square statistics and prevalence ratio between those not exposed and those exposed to fluoridated water.
Although caries experience (DMFT ≥ 1) was not associated with exposure to fluoridated water (chi-square = 1.78; p = 0.18; α = 5%), a significant difference was observed in the magnitude with which the disease reached the population: the means of DMFT were 1.76 in those exposed and 2.60 in those not exposed and the means of SiC were 4.04 and 6.16, respectively. The degree of polarization, indicated by the percentage of subjects with DMFT = 0, was different, being it higher (41.8%) in subjects exposed and lower (34.3%) in subjects not exposed. The prevalence ratio between those not exposed and those exposed was 1.13, indicating little expressiveness in prevalence difference.
Exposure to fluoridated water implied lower mean values for the DMFT and SiC indexes, even in the presence of the concomitant exposure to fluoridated toothpaste, in a scenario of low prevalence of the disease, and with a similar pattern of caries distribution in the populations analyzed.
在巴西广泛使用含氟牙膏且该疾病患病率较低的情况下，分析饮用含氟水与龋齿之间的关联。
这是一项普查类型的横断面观察性研究，采用基于人群的双重流行病学调查形式，于2014年在圣保罗州的两个城市开展。样本由11岁和12岁的青少年组成，其中至少五年饮用含氟水的有184人（暴露组），未饮用含氟水的有128人（非暴露组）。所研究的人群生活在同一地理区域的社区，人口规模小且社会经济分类相似，仅在是否饮用含氟水方面存在差异（西尔韦拉斯饮用含氟水，圣若泽杜巴雷鲁未饮用含氟水）。使用DMFT和SiC指数分析这些人群中龋齿的患病情况、严重程度和两极分化程度，并使用Pearson卡方统计量以及非暴露组与暴露组之间的患病率比来检验关联性。
尽管龋齿患病情况（DMFT≥1）与饮用含氟水无关（卡方 = 1.78；p = 0.18；α = 5%），但在疾病累及人群的严重程度方面观察到显著差异：暴露组的DMFT均值为1.76，非暴露组为2.60，SiC均值分别为4.04和6.16。由DMFT = 0的受试者百分比表示的两极分化程度不同，暴露组较高（41.8%），非暴露组较低（34.3%）。非暴露组与暴露组之间的患病率比为1.13，表明患病率差异的表达性较小。
在疾病患病率较低且所分析人群龋齿分布模式相似的情况下，即使同时使用含氟牙膏，饮用含氟水仍意味着DMFT和SiC指数的均值较低。
