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Doctoral Thesis
DOI
10.11606/T.6.2005.tde-22092011-145657
Document
Author
Full name
Tania Izabel Bighetti Forni
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2005
Supervisor
Committee
Frazão, Paulo (President)
Cury, Jaime Aparecido
Fernandez, Roberto Augusto Castellanos
Narvai, Paulo Capel
Sousa, Maria da Luz Rosario de
Title in Portuguese
Fatores associados à fluorose dentária em área com água fluoretada
Keywords in Portuguese
Epidemiologia
Flúor
Fluorose Dentária
Risco
Abstract in Portuguese
O objetivo do estudo foi identificar fatores associados à fluorose dentária em Ribeirão Pires-SP, com água fluoretada desde 1985 e heterocontrole dos teores de flúor desde 1996. Foi realizada pesquisa epidemiológica tipo caso-controle com projeto aprovado pelo Comitê de Ética da FSP-USP. A população de estudo foi adolescentes de 12 a 15 anos de idade, identificados em 23 escolas de ensino fundamental por cirurgiã-dentista capacitada (k=0,79). Foram considerados casos 667 adolescentes com graus de fluorose 2, 3, 4 e 5 (Índice de Dean). A partir da região de residência dos casos, foram identificados 416 controles, de mesmo sexo e idade, com grau de fluorose 0, procurando-se garantir a mesma distribuição por região. Casos e controles (5 por cento ) foram examinados pela pesquisadora (k=0,90). Um formulário de entrevista foi construído, utilizando-se técnica de pesquisa exploratória, contendo dados relativos a variáveis demográficas, geográficas, escolaridade dos pais/responsáveis e relacionados à exposição a fontes de flúor em três ciclos (1o ano de vida, 1 a 3 anos e 4 a 6 anos de idade). A coleta dos dados foi feita por 55 entrevistadores cujo treinamento contemplou repetição de entrevistas e discussão de aspectos relevantes. Foram realizadas 509 entrevistas (319 casos e 190 controles). As respostas foram transcritas para digitação de forma dupla, com validação do banco de dados. A distribuição percentual do evento nos casos e controles nas categorias de exposição foi analisada utilizando-se o teste de Qui-quadrado de Pearson. Na análise univariada identificou-se as de maior associação para elaboração de modelos de regressão logística múltipla não condicional. A análise mostrou risco significativo para fluorose dentária nas seguintes situações de exposição: quando os adolescentes usaram dentifrício fluoretado nos 6 primeiros anos de vida (OR= 2,25; p=0,048) e eram responsáveis pela sua colocação no período de 4 a 6 anos de idade (OR=2,17; p=0,000), quando foi utilizada água fluoretada para preparo de alimentos nos 6 primeiros anos de vida (OR=2,90; p=0,026) e a interação entre maior escolaridade do pai e menor escolaridade da mãe (OR=2,15; p=0,024). Recomenda-se que os serviços de saúde considerem os resultados no planejamento das ações de educação em saúde reforçando o uso adequado de dentifrícios, além de manter a política de vigilância sanitária dirigida a múltiplas fontes de flúor
Title in English
Factors associated with dental fluorosis in a water fluoridated area
Keywords in English
Dental fluorosis
Epidemiology
Fluoride
Risk
Abstract in English
The purpose of this study was to identify factors associated with fluorosis in the city of Ribeirão Pires SP, which has fluoridated water since 1985, (with hetero-controls of fluoride levels since 1996). It was done an epidemiological case-control study which project was approved by the Ethics Committee of the FSP-USP. The study population consisted of 12 to 15 year old teenagers, identified by a trained dentist (k=0.79) in 23 high schools. 667 teenagers who showed fluorosis levels of 2, 3, 4 or 5 (Dean Index) were selected for this study. 416 children of the same age and sex and living in the same area were also identified as controls (fluorosis level = 0) in order to assure the same distribution by region. Cases and controls (5 per cent ) were examined (k=0.90) by the author. A questionnaire was elaborated, using the exploratory survey method, with data related to demographic, geographic, education level of parents/guardians, related to fluoride sources exposure in 3 different periods of life (first year, 1 to 3 years and 4 to 6 years of age). Data was collected by 55 interviewers whose training consisted of repeated interviews and case discussions. 509 interviews were made (319 cases and 190 controls) and the responses were transcribed and typed twice, with posterior validation of the database. Percentile distribution of the events of cases and controls of exposition categories were analyzed using Pearson Chi-Square test. In the univariable analysis, the variables with higher match were identified for posterior construction of models of non-conditional multiple logistic regression analyses. The analysis of regression showed significant risk for dental fluorosis in the following exposure situations: when the teenagers used fluoridated dentifrice during the first 6 years of life (OR=2.25; p=0.048) and they were responsible for its placement in a period of 4 to 6 years (OR=2.17; p=0.000), when it was used fluoridated water for food preparation during the 6 first years of life (OR=2.90; p=0.026) and in the relation of high educational level of the father and lower educational level of the mother (OR=2.15; p=0.024). It is recommended that the health services should consider these results in the planning of actions of health education activities in order to emphasize the importance of adequate use of dentifrices, and to maintain their sanitary control policies focused on multiple sources of fluoride
 
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Publishing Date
2011-11-04
 
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