RESUMO
UNLABELLED: In 1987, Costa Rica implemented a national salt fluoridation programme using sodium fluoride (225-275 mg F/kg). OBJECTIVE: To evaluate the prevalence and severity of enamel fluorosis (EF) in Costa Rican schoolchildren as part of the biological monitoring of the salt fluoridation programme. BASIC RESEARCH DESIGN: In 1999, eight calibrated examiners (interexaminer Kappa = 0.73) recorded EF in the maxillary anterior teeth and first bicuspids (FDI's teeth 14 to 24) using Dean's Index and artificial light without drying. The multistrata probability sample included 12 and 15-year-old schoolchildren (n = 2,499), representing seven regions of the country. Data were analyzed in SAS and SUDAAN to account for sampling design. SETTING: Costa Rican schoolchildren. The 12-year-old cohort was born when salt fluoridation started. PARTICIPANTS: 3,758 children in selected age groups. MAIN OUTCOME MEASURES: Dean's index was calculated for cuspid to cuspid (teeth 13 to 23) and premolar to premolar (teeth 14 to 24). RESULTS: Prevalence of EF (very mild or higher) at age 12 years was 17% for teeth 13 to 23 and 32% when teeth 14 and 24 were included. At age 15 years, the prevalence was 12% for teeth 13 to 23 and 25% when teeth 14 and 24 were included. Large regional differences were observed: from 10% to 76% among 12-year-old children and from 6% to 50% among 15-year-old children. CONCLUSIONS: In the aggregate, EF prevalence is within the range expected for a salt fluoridation programme, but regions with higher severity need further investigation on additional sources of fluoride including environmental sources. Prevalence figures were higher in the cohort born at time of fluoridation.
Assuntos
Fluorose Dentária/epidemiologia , Adolescente , Fatores Etários , Dente Pré-Molar/patologia , Cariostáticos/administração & dosagem , Criança , Estudos de Coortes , Costa Rica/epidemiologia , Dente Canino/patologia , Inquéritos de Saúde Bucal , Feminino , Fluoretos/administração & dosagem , Humanos , Incisivo/patologia , Masculino , Prevalência , Cloreto de Sódio na Dieta/administração & dosagemRESUMO
Data on the prevalence and severity of dental caries collected by country members of the Pan American Health Organisation (PAHO) were summarised to analyse current status and trends since the 1970s. The mean number of decayed, missing, and filled teeth (DMF-T) among 12-year-old children and the relative contribution of each DMF-T component were collected from official reports and publications in the scientific literature. Overall, a secular trend toward lower caries prevalence was observed in most countries, more notably among those with large prevention programmes using fluorides. Many countries have reached the World Health Organization (WHO) year 2000 goal of a mean DMF-T of < or = 3 but others are still far from reaching that goal. Few countries have reached the status of having large proportions of disease prevalence localised in a small percentage of the population, a pattern observed as prevalence decreases. Since 1994, PAHO's Regional Oral Health Program has developed two strategies to address these issues: the introduction and reinforcement of national preventive programmes using fluorides and the introduction of the atraumatic restorative treatment (ART).