Reflexões metodológicas sobre prevalência da fluorose dentária nos inquéritos de saúde bucal Methodological discussion about prevalence of the dental fluorosis on dental health surveys

OBJECTIVE To analyze the limitations of studying dental fluorosis in cross-sectional studies. METHODS Data from the Oral Health of the Brazilian Population (SBBrasil 2003) and the Brazilian Oral Health Survey (SBBrasil 2010) were used. Epidemiological trends for fluorosis in 12-year-old Brazilians, aspects of the reliability of the data as well as the accuracy of the estimates are assessed for these two studies. The distribution of prevalence of fluorosis was carried out according to the domains of the study (state capitals and regions) and the year in which the study took place. The confidence intervals (95%CI) were also shown for simple prevalence (without taking into account level of severity). RESULTS The prevalence of dental fluorosis showed considerable variation, between 0% and 61% in 2003 and 0% and 59% in 2010. Inconsistencies were observed in the data in individual terms (for year and for domain) and in the behavior of the trend. Considering the expected prevalence and the data available in the two studies, the minimum sample size should be 1,500 individuals in order to obtain 3.4% and 6.6% confidence intervals, considering the minimum coefficient of variation to be 15%. Given the subjectivity in its classification, examinations for dental fluorosis may show more variation than those for other oral health conditions. The power to establish differences between the domains of the study with the sample of the SBBrasil 2010 is quite limited. CONCLUSIONS Based on the 2003 and 2010 studies, it was not possible to analyze patterns of dental fluorosis in Brazil; these data are merely exploratory indicators of the prevalence of dental fluorosis. It was impossible to make comparisons due to different analysis models being used in the two surveys. Investigating dental fluorosis in population-based surveys is not even an economically viable technique, using localized epidemiological studies with a sampling plan would be more suitable [corrected].

[1]  S. Levy,et al.  Examiner reliability of fluorosis scoring: a comparison of photographic and clinical examination findings. , 2012, Journal of public health dentistry.

[2]  P. DenBesten,et al.  Chronic fluoride toxicity: dental fluorosis. , 2011, Monographs in oral science.

[3]  Zsófia Osváth,et al.  DOI: 10 , 2011 .

[4]  B. Dye,et al.  Prevalence and severity of dental fluorosis in the United States, 1999-2004. , 2010, NCHS data brief.

[5]  W. Thomson,et al.  An epidemiological comparison of Dean's index and the Developmental Defects of Enamel (DDE) index. , 2010, Journal of public health dentistry.

[6]  Ricardo Wathson Feitosa de Carvalho,et al.  Estudo da prevalência de fluorose dentária em Aracaju , 2010 .

[7]  Roberta Pereira NiquiniI,et al.  Rev Saúde Pública , 2010 .

[8]  C. Yeung,et al.  A systematic review of the efficacy and safety of fluoridation , 2008, Evidence-Based Dentistry.

[9]  G. Stookey,et al.  Development of a standardisation device for photographic assessment of dental fluorosis in field studies. , 2008, Oral health & preventive dentistry.

[10]  M. Lennon,et al.  The effective use of fluorides in public health. , 2005, Bulletin of the World Health Organization.

[11]  H. Whelton,et al.  A review of fluorosis in the European Union: prevalence, risk factors and aesthetic issues. , 2004, Community dentistry and oral epidemiology.

[12]  P. Frazão,et al.  [Dental fluorosis: comparison of two prevalence studies]. , 2004, Cadernos de saude publica.

[13]  M. L. R. Sousa,et al.  A saúde bucal de escolares residentes em locais com ou sem fluoretação nas águas de abastecimento público na região de Sorocaba, São Paulo, Brasil , 2003 .

[14]  O. Fejerskov,et al.  Dental fluorosis: chemistry and biology. , 2002, Critical reviews in oral biology and medicine : an official publication of the American Association of Oral Biologists.

[15]  P. C. Narvai,et al.  A fluorose dentária no Brasil: uma revisão crítica , 2002 .

[16]  Franklin Delano Soares Forte,et al.  Fluorose dentária em crianças de Princesa Isabel, Paraíba , 2001 .

[17]  Holloway Pj.  Systematic review of public water fluoridation. , 2000 .

[18]  P. Holloway.  Systematic review of public water fluoridation. , 2000, Community dental health.

[19]  A. Pereira,et al.  Analysis of three dental fluorosis indexes used in epidemiologic trials. , 1999, Brazilian dental journal.

[20]  D. Pendrys.  Analytical studies of enamel fluorosis: methodological considerations. , 1999, Epidemiologic reviews.

[21]  M. A. van 't Hof,et al.  Comparison of two indices of dental fluorosis in low, moderate and high fluorosis Tanzanian populations. , 1994, Community dentistry and oral epidemiology.

[22]  R. Ellwood,et al.  A comparison of information recorded using the Thylstrup Fejerskov index, Tooth Surface Index of Fluorosis and Developmental Defects of Enamel index. , 1994, International dental journal.

[23]  D. Pendrys.  The fluorosis risk index: a method for investigating risk factors. , 1990, Journal of public health dentistry.

[24]  A. Kingman,et al.  A new method for assessing the prevalence of dental fluorosis--the Tooth Surface Index of Fluorosis. , 1984, Journal of the American Dental Association.

[25]  A. Thylstrup,et al.  Clinical appearance of dental fluorosis in permanent teeth in relation to histologic changes. , 1978, Community dentistry and oral epidemiology.

[26]  N. Long.  WATER FLUORIDATION , 1970, The Medical journal of Australia.

[27]  H. T. Dean.  The investigation of physiological effects by the epidemiological method , 1942 .