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BACKGROUND: Polymorphisms in genes related to enamel formation and mineralization may increase the risk of developmental defects of enamel (DDE). AIM: To evaluate the existing literature on genetic polymorphisms associated with DDE. DESIGN: This systematic review was registered in the PROSPERO (CRD42018115270). The literature search was performed in PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and in the gray literature. Observational studies assessing the association between DDE and genetic polymorphism were included. The Newcastle-Ottawa Scale was used to assess the risk of bias. RESULTS: One thousand one hundred and forty-six articles were identified, and 28 met the inclusion criteria. Five studies presented a low risk of bias. Ninety-two genes related to enamel development, craniofacial patterning morphogenesis, immune response, and hormone transcription/reception were included. Molar-incisor hypomineralization (MIH) and/or hypomineralization of primary second molars (HPSM) were associated with 80 polymorphisms of genes responsible for enamel development, immune response, morphogenesis, and xenobiotic detoxication. A significant association was found between the different clinical manifestations of dental fluorosis (DF) with nine polymorphisms of genes responsible for enamel development, craniofacial development, hormonal transcription/reception, and oxidative stress. Hypoplasia was associated with polymorphisms located in intronic regions. CONCLUSION: MIH, HPSM, DF, and hypoplasia reported as having a complex etiology are significantly associated with genetic polymorphisms of several genes.

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Obtener una buena adhesión entre esmalte y bracket es un aspecto fundamental para el éxito del tratamiento en Ortodoncia. Algunos casos presentan desafíos en esta adhesión, especialmente cuando nos enfrentamos ante un esmalte con alteraciones como hipomineralizaciones, hipoplasias o fluorosis dental. Para sobreponer esta dificultad en la unión adhesiva se han propuesto diversas estrategias terapéuticas como es el uso de agentes desproteinizantes. El objetivo de esta revisión narrativa es describir el uso de hipoclorito de sodio como agente desproteinizante en dientes con alteraciones de esmalte para mejorar la adhesión en Ortodoncia. Se realizó una búsqueda bibliográfica en PubMed de los últimos 5 años. Se encontraron 116 artículos, de los cuales 23 cumplieron con los criterios requeridos y fueron seleccionados para la revisión. La desproteinización del esmalte con hipoclorito de sodio como paso previo al grabado ácido, es una estrategia útil en el proceso de cementación de aparatología de ortodoncia fija en dientes con alteraciones del esmalte. El uso de hipoclorito de sodio al 5,25 % es una alternativa de bajo co sto, no invasiva y eficiente para mejorar la fuerza de adhesión en pacientes con alteraciones del esmalte.

Obtaining good adhesion between enamel and bracket is a fundamental aspect for success in Orthodontics. Some cases present challenges in this adhesion, especially when we are faced with enamel with alterations such as hypomineralization, hypoplasia or dental fluorosis. To overcome this difficulty in adhesive bonding, various therapeutic strategies have been proposed, such as the use of deproteinizing agents. The objective of this study is to describe the use of sodium hypochlorite as a deproteinizing agent in teeth with enamel alterations to improve adhesion in Orthodontics. A bibliographic search was carried out in PubMed for articles within the last 5 years. In this study 116 articles were found, of which 23 met the required criteria and were selected for the review. Deproteinization of the enamel with sodium hypochlorite as a prior step to acid etching is an important stage in the cementation process of fixed appliances in orthodontics. The use of 5.25% sodium hypochlorite is a low-cost, non-invasive and efficient alternative to improve adhesion strength in patients with anomalies of tooth enamel.

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BACKGROUND: Dental fluorosis (DF) is caused by excessive exposure to fluoride during odontogenesis and leads to various changes in the development of tooth enamel. Some regions in Mexico are considered endemic fluorosis zones due to the high fluoride content in drinking water. The objective of this study was to perform a systematic review and meta-analysis to identify the association between the concentration of fluoride in drinking water and the severity of dental fluorosis in northern and western Mexico. METHODS: This protocol was registered in the PROSPERO database (ID: CRD42023401519). The search for information was carried out in the PubMed/Medline, Scopus, SpringerLink, and Google Scholar databases between January 2015 and October 2023. The overall relative risk was calculated using the inverse of variance approach with the random effects method. The RoB 2.0 tool was used to construct risk plots. RESULTS: Eleven articles were analyzed qualitatively, and most of the included studies presented at least one level of DF severity; six articles were analyzed quantitatively, dividing them into two regions. In North region it was observed a higher prevalence of severe TF cases, corresponding to ≥ TF 5 category (4.78) [3.55, 6.42]. In the West region, most of the included studies presented a higher prevalence of less severe cases, corresponding to ≤ TF 4, in comparison with the North region (0.01) [0.00, 0.52], interpreted as a protective effect. CONCLUSION: The concentrations of fluorides in drinking water are reportedly high in these regions and are directly related to the severity of dental fluorosis experienced by the inhabitants. In the Northern region exists a major concentration of fluoride in drinking water compared with the Western region as well as a prevalence of higher severity cases of dental fluorosis.

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La prevalencia de fluorosis dental presenta una gran variabilidad a nivel mundial. Es necesario su análisis como parte de la vigilancia epidemiológica. Objetivo: Conocer la literatura disponible sobre prevalencia de fluorosis dental a la edad de 12 años en relación con el método de fluoruración comunitario utilizado. Metodología: Dos investigadoras realizaron una revisión sistemática de la literatura sin límites temporales siguiendo las pautas PRISMA, utilizando las bases de datos Pubmed, Cochrane, Scopus, BVS y Google Schoolar en idioma inglés, español, portugués e italiano. Resultados: Fueron incluidos 19 artículos de diseño transversal, 16 pertenecientes a comunidades que utilizan agua fluorurada, uno que utiliza sal fluorurada y 2 que comparan resultados entre comunidades que utilizan agua o sal fluorurada. Conclusiones: existe gran variabilidad en los reportes de prevalencia de fluorosis dental. Independientemente del método de fluoruración comunitario utilizado las lesiones de fluorosis de severidad leve son las más prevalentes.

Os relatos sobre a prevalência de fluorose dentária aos 12 anos apresentam grande variabilidade, não havendo unificação quanto ao uso dos índices. Independentemente do meio comunitário de fluoretação e do índice utilizado, a fluorose dentária leve é ​​a mais prevalente. Objetivo: Conhecer a literatura disponível sobre prevalência de fluorose dentária aos 12 anos em relação ao método comunitário de fluoretação utilizado. Metodologia: Dois pesquisadores realizaram uma revisão sistemática da literatura sem limites de tempo seguindo as diretrizes PRISMA, utilizando as bases de dados Pubmed, Cochrane, Scopus, BVS e Google Schoolar em inglês, espanhol, português e italiano. Resultados: Foram incluídos 19 artigos transversais, sendo 16 pertencentes a comunidades que utilizam água fluoretada, un sal fluoretada e 2 que comparam resultados entre comunidades que utilizam água fluoretada ou salgada. Conclusões: Há grande variabilidade nos relatos de prevalência de fluorose dentária. Independentemente do método de fluoretação comunitária utilizado, as lesões de fluorose de gravidade leve são as mais prevalentes.

The prevalence of dental fluorosis presents great variability worldwide. Its analysis is necessary as part of epidemiological surveillance Objective: To know the available literature on the prevalence of dental fluorosis among 12 years-old in relation to the community fluoridation method used. Methodology: Two researchers carried out a systematic review of the literature without time limits following the PRISMA guidelines, using the Pubmed, Cochrane, Scopus, BVS and Google Schoolar databases in English, Spanish, Portuguese and Italian. Results: 19 cross-sectional articles were included, 16 belonging to communities that use fluoridated water, one that use fluoridated salt and 2 that compare results between communities that use fluoridated water or salt. Conclusions: there is great variability in the reports of prevalence of dental fluorosis. Regardless of the community fluoridation method used, fluorosis lesions of mild severity are the most prevalent.

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Introducción: La fluorosis dental es una patología endémica causada por la ingestión excesiva de fluoruros que pueden producir una alteración durante el desarrollo del esmalte, y es considerado un importante problema de salud pública porque afecta la salud bucal y sistémica de la población. Objetivo: Este estudio tuvo como idea principal determinar la frecuencia y los niveles de fluorosis dental en escolares de 12 a 15 años pertenecientes a dos instituciones educativas de Lima - Perú. Método: Se realizó un estudio descriptivo de tipo transversal, la muestra estuvo conformada por 252 estudiantes, entre 12 y 15 años de dos centros educativos de Lima. El muestreo fue por selección sistemática de elementos muestrales. La fluorosis dental se evalúo mediante el Índice de Dean. Para determinar la frecuencia y los niveles de fluorosis dental, se realizó un examen clínico bucal y se desarrolló un cuestionario validado previamente. Resultados: La frecuencia de fluorosis dental fue de 44,8% (n=113) afectando más a los varones en un 27,39% (n=69) y a los adolescentes de 13 años (15,1%). En relación con los niveles de fluorosis, predominó el tipo "muy leve" (34,9%). También se encontró una asociación entre la presencia y el nivel de fluorosis con el número de aplicaciones de flúor (p<0,05). Además, se dijo que el índice comunitario de fluorosis de Dean fue de 0,43. Conclusiones: En la población escolar evaluada, la frecuencia de fluorosis fue de 44,8% y el nivel predominante de fluorosis fue muy leve. Además, el índice comunitario fue de 0,43, el cual mostró un nivel límite de importancia para la salud pública. Por lo que se puede considerar que el número de aplicaciones tópicas de flúor recibido por la población sin una planificación adecuada se podría convertir en un factor de riesgo para causar fluorosis dental.

Introduction: Dental fluorosis is an endemic pathology caused by the excessive ingestion of fluorides that can produce an alteration during the development of the enamel and is considered an important public health problema because it affects the oral and systemic health of the population. Objective: The objective of this study was to determine the frequency and levels of dental fluorosis in school children between 12 and 15 years of age belonging to two educational institutions in Lima, Peru. Method: A descriptive cross-sectional study was carried out, the sample consisted of 252 students between 12 and 15 years of age from two educational centers in Lima. Sampling was by systematic selection of sample elements. Dental fluorosis was evaluated using the Dean Index. To determine the frequency and levels of dental fluorosis a clinical oral examination was carried out and a previously validated questionnaire was developed. Results: The frequency of dental fluorosis was 44.8% (n=113) affecting more males by 27.39% (n=69) and adolescents aged 13 years (15.1%). In relation to the levels of fluorosis, the "very mild" type predominated (34.9%). An association was also found between the presence and level of fluorosis with the number of fluoride applications (p<0.05). In addition, Dean's community fluorosis index was reported to be 0.43. Conclusions: In the school population evaluated, the frequency of fluorosis was 44.8% and the predominant level of fluorosis was very mild. In addition, the community index was 0.43, which indicated a borderline level of public health importance. Therefore, it can be considered that the number of topical fluoride applications received by the population without adequate planning could become a risk factor for causing dental fluorosis.

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A high number of citations can indicate the potential of any specific paper to influence other research and generate changes in clinical practice. Analyzing the most-cited papers in a certain scientific field may assist researchers to identify the influential papers as well their main characteristics. The present study aimed to analyze the 100 most-cited papers concerning dental fluorosis (DF) through a bibliometric review. A search was performed in the Web of Science Core Collection (WoS-CC) database in November 2021. The papers were displayed in descending order according to the number of citations in WoS-CC. Two independent researchers performed the selection. Scopus and Google Scholar were used to compare the number of citations with WoS-CC. The following data were extracted from the papers: title, authors, number and density of citations, institution, country, continent, year of publication, journal title, keywords, study design, and theme. Collaborative networks were generated using the VOSviewer software. The top 100 most-cited papers were published between 1974 and 2014 and were cited 6,717 times (ranging from 35 to 417). Community Dentistry and Oral Epidemiology (24%), Journal of Dental Research (21%), Journal of Public Health Dentistry (17%), and Caries Research (13%) published the most papers. Observational studies (60%) and literature reviews (19%) were the most common study designs. The main topics were epidemiology (44%) and fluoride intake (32%). The countries with the highest number of papers were the USA (44%), Canada (10%), and Brazil (9%). The University of Iowa (USA) had the most papers (12%). Levy SM was the author with the highest number of papers (12%). The 100 most-cited papers on DF were mainly observational studies focused on epidemiology and originated in North America. There were few interventional studies and systematic reviews among the most-cited papers concerning this topic.

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La fluorosis dental se caracteriza por una hipomineralización de la estructura dental causada por ingesta excesiva de flúor sistémico. En la dentición decidua, su diagnóstico precoz es importante, dado que será un predictor para la aparición de lesiones en la dentición permanente. El objetivo de esta revisión fue describir la evidencia científica sobre la fluorosis dental en dentición decidua reportando su etiología y factores relacionados, prevalencia, diagnóstico y tratamiento. Se realizaron búsquedas electrónicas en las bases de datos Pub-Med/Medline, EbscoHost y ScienceDirect (noviembre/2020), utilizando las palabras clave "dental fluorosis", "deciduous teeth", "primary tooth", "primary teeth". El desarrollo de fluorosis dental en dentición decidua se relacionó con la ingesta de múltiples fuentes de flúor principalmente, agua potable, alimentos de la dieta, fórmulas infantiles, suplementos y uso de dentífricos fluorados en dosis inadecuadas. Algunos factores prenatales, como vivir en terrenos montañosos o de gran altitud y habitar en lugares cercanos a minas de combustión de carbón, también fueron asociados. La prevalencia de fluorosis dental reportada en los estudios varió entre 6,2 y 96,6 %, dependiendo principalmente de la concentración de flúor en agua potable. Para el diagnóstico de la fluorosis dental en la dentición decidua se deben considerar características como la localización, aspecto, extensión y color de la lesión, realizando diagnóstico diferencial con otro tipo de defectos en esmalte y dentina. Así mismo, el tratamiento de las lesiones dependerá de la severidad del defecto y condiciones individuales del paciente.

Dental fluorosis is characterized by a hypomineralization of the tooth structure caused by excessive intake of systemic fluoride. In the deciduous dentition, its early diagnosis is important since it will be a predictor for the appearance of lesions in the permanent dentition. The objective of this review was to describe the scientific evidence on dental fluorosis in deciduous dentition, reporting its etiology and related factors, prevalence, diagnosis and treatment. Electronic searches were conducted PubMed / Medline, EbscoHost and ScienceDirect (November / 2020) databases, using the keywords "dental fluorosis", "deciduous teeth", "primary tooth", "primary teeth". The development of Dental fluorosis in deciduous dentition was related to the intake of multiple sources of fluoride mainly; drinking water, diet foods, infant formulas, supplements and the use of luoridated toothpastes in inadequate doses. Some prenatal factors such as living in mountainous or high altitude terrain and living in places near coal-burning mines were also associated. The prevalence of dental fluorosis in early childhood reported in the studies varied between 6.2% and 96.6%, depending mainly on the concentration of fluoride in drinking water. For the diagnosis of dental fluorosis in the deciduous dentition, characteristics such as the location, appearance, extension and color of the lesion must be considered, making a differential diagnosis with other types of enamel and dentin defects. Evenly, the treatment of lesions will depend on the severity defects and individual patient conditions.

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Dental fluorosis can cause changes in the enamel surface, conditioning its functionality and esthetics. The application of dental adhesives is a treatment option; however, their use on fluorotic teeth can result in limitations. The aim of this study was to compare the shear bond strength of two different adhesives, one with 10-MDP and one without 10-MDP, in different degrees of dental fluorosis.This is an in vitro study on dental enamel samples, a total of 180 samples with the inclusion criteria were treated, randomly divided into two groups of 90, according to the type of dental adhesive, where each group was again divided into three groups of 30 samples, representing different degrees of dental fluorosis according to the Thylstrup-Fejerskov index (Group I: TF1 and TF2; Group II: TF3; Group III: TF4). Normality tests, two-factor ANOVA, and post-hoc tests were used to determine differences between the groups, with a significance level of 95%. As results, a statistically significant difference was shown between the use of dental adhesive with 10-MDP and the three groups of dental fluorosis (p=0.011), in addition, a Tukey post-hoc test on the groups treated with 10-MDP adhesive revealed a statistically significant difference between group I versus group II, and group I versus group III, (p=<0.05). It is concluded that the use of adhesive systems with 10-MDP presents a better shear bond strength on enamel with dental fluorosis grades I and II in the Thylstrup-Fejerskov index.

La fluorosis dental puede ocasionar cambios en la superficie del esmalte, condicionando su funcionalidad y estética, la aplicación de adhesivos dentales es una opción de tratamiento, sin embargo, su uso en dientes fluoroticos puede resultar en limitaciones. El objetivo de este estudio consistió en comparar la fuerza de adhesión a la cizalladura de dos diferentes adhesivos, uno con 10-MDP y otro sin 10-MDP, en diferentes grados de fluorosis dental. Se trata de un estudio in vitro en muestras de esmalte dental, un total de 180 muestras con los criterios de inclusión fueron tratadas, aleatoriamente divididas en dos grupos de 90, de acuerdo al tipo de adhesivo dental, donde cada grupo fue dividido nuevamente en tres grupos de 30 muestras, representando diferentes grados de fluorosis dental según el índice de Thylstrup- Fejerskov (Grupo I: TF1 y TF2; Grupo II: TF3; Grupo III: TF4). Para determinar diferencias entre los grupos se utilizaron pruebas de normalidad, ANOVA de dos factores, y pruebas post-hoc, con un nivel de significancia de 95%. Como resultados, se mostró una diferencia estadísticamente significativa entre el uso de adhesivo dental con 10- MDP y los tres grupos de fluorosis dental (p=0.011), además, una prueba post hoc de Tukey sobre los grupos tratados con adhesivo 10-MDP revelaron una diferencia estadísticamente significativa entre el grupo I frente al grupo II, y el grupo I frente al grupo III, (p=<0.05) Se concluye que el uso de sistemas adhesivos con 10-MDP presentan una mejor resistencia de adhesión al cizallamiento en esmalte con grados de fluorosis dental I y II en el índice de Thylstrup-Fejerskov

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In recent decades, the increase in fluoride exposure has raised the numbers of dental fluorosis in fluoridated and non-fluoridated communities In Ecuador, but the last national epidemiological study on DF was conducted more than a decade ago. The objective of this cross-sectional descriptive study was to determine the prevalence, distribution and severity of dental fluorosis (DF) using the Dean index in 1606 schoolchildren aged 6 to 12 years from urban and rural environments in provinces that make up the Southern Region of Ecuador. Participants met the inclusion criteria which were age, locality, informed consent document and no legal impediment. The results are presented using percentage frequency measures and chi-square associations. The prevalence of dental fluorosis was 50.1% in the areas of Azuay, Cañar and Morona Santiago, with no significant differences (x2 = 5.83, p = 0.054). The types of DF found most frequently were very mild and mild in all provinces; a moderate degree was more prevalent in Cañar (17%). There was no significant association (p > 0.05) between sex and the presence of dental fluorosis and, with respect to severity, the most frequent degree was moderate at the age of 12 years. The prevalence of dental fluorosis in the area evaluated is high, especially in the light and very light degrees, with a tendency toward moderate levels. It is necessary to carry out studies on the factors that are predisposing to the development of this pathology in the population studied. This research is an update regarding this pathology in Ecuador, so it is concluded that it is necessary to continue developing studies based on the findings obtained, thus contributing to the public health of the country.

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The use of fluoride (F) in the prevention of dental caries is established. However, a high amount of F intake during tooth development can cause dental fluorosis The aim of this study was to analyze variations in F concentrations in chocolate bars (CB), chocolate cookies (CC), infant cereals (IC), and chocolate milk drinks (CD) to determine the daily intake of F from different sources by children at the age of risk for developing dental fluorosis. Distinct brands of CB, CC, IC, and CD were analyzed. Fluoride was separated by hexamethyldisiloxane-facilitated diffusion. Analysis was made in triplicate with an F ion-specific electrode. F ingestion (mg/kg body weight) was evaluated with the suggested consumption (0.05-0.07 mg/kg/day) for children aged 24 months (12 kg). The concentrations for all the analyzed products ranged from 0.025 to 1.827 µg/g F. The mean (range) F concentrations were CB= 0.210 ± 0.205 µg/g (0.073-0.698, n = 8), CC = 0.366 ± 0.416 µg/g (0.320-1.827, n = 9), IC = 0.422 ± 0.395 µg/g (0.073-1.061, n = 5), and CD = 0.169 ± 0.170 µg/mL (0.025-0.443, n = 12). The products that had the highest concentration in the categories CB, CC, IC, and CD, respectively, were Nescau-Ball (0.698 µg/g), Passatempo (1.827 µg/g), Milnutri (1.061 µg/g), and Toddynho (0.443 µg/mL). The consumption of only one unit of Toddynho (CD) is equivalent to more than 11% of the maximum suggested daily intake for a 24-month-old child (0.07 mg/kg body weight). When one product from each category is consumed together only once a day, this consumption is equivalent to approximately 24% of the suggested daily intake of fluoride for a 24-month-old child. The presence of high levels of fluoride in certain products suggests that they play a significant role in overall fluoride intake. It is crucial to closely monitor the fluoride content of food and drinks that are consumed by children who are at risk for dental fluorosis, and for product labels to clearly display the fluoride concentrations.

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The intake of high concentrations of fluoride, mainly through drinking water, diet and fluoridated dentifrices, produces fluorosis, which in its early stages is manifested as dental fluorosis (DF). To recognize exposure to fluoride in endemic areas and to evaluate the risk of developing health impairment, the WHO has established several biomarkers that are used to determine systemic fluorine (F-) exposure. Thus, the aim of this study was to conduct a systematic review and meta-analysis of the relationship between the severity of DF and fluoride biomarkers in endemic areas. The protocol of this study was previously registered as CRD42021244974. A digital search was carried out in PubMed/Medline, SpringerLink, Scopus, Cochrane and Google Scholar by employing the keywords "urine", "nails", "hair", "plasma", "saliva" and "dental fluorosis" for the original studies with content associated with F- for the biomarkers and DF. The mean difference was established as the effect measure for the meta-analysis. Seven studies fulfilled the eligibility criteria, among which five assessed urine and two employed nails as fluoride biomarkers. A positive significant difference was found between the biomarkers and the severity of DF (0.27, p < 0.001) and individually for each biomarker (urine: 0.14, p = 0.001; nails: 0.88, p < 0.05). The F- concentration in urine and nails is correlated with the severity of DF, with the most evident differences between healthy individuals and those with mild severity. Both biomarkers are adequate to assess this relationship in endemic areas of fluoride and DF.

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Objetivo: verificar o desenvolvimento da fluorose dentária e sua relação com os Determinantes Sociais da Saúde (DSS) através de uma revisão integrativa. Método: trata-se de uma revisão integrativa de estudos que abordam os aspectos dos DSS e sua relação com a fluorose dentária. A coleta de dados foi realizada entre o período de agosto de 2020 a abril de 2021. Resultados: dos estudos selecionados de língua portuguesa e inglesa observou-se que o Fluorose Dentária é um problema de saúde pública, de âmbito mundial. Conclusão: Assim, é oportuno pensar que a fluorose dentária pode ser influenciada pelo meio ao qual o indivíduo se insere, suas condições sociais, econômicas, psicológicas e comportamentais devem ser consideradas, conforme o olhar dos DSS.

Objective: to verify the development of dental fluorosis and its relationship with the Social Determinants of Health (SDH) through an integrative review. Method: this is an integrative review of studies that address aspects of DSS and its relationship with dental fluorosis. Data collection was carried out between August 2020 and April 2021. Results: from selected studies in Portuguese and English, it was observed that Dental Fluorosis is a public health problem, worldwide. Conclusion: Thus, it is opportune to think that dental fluorosis can be influenced by the environment in which the individual is inserted, their social, economic, psychological and behavioral conditions must be considered, according to the perspective of the DSS.

Objetivo: verificar el desarrollo de la fluorosis dental y su relación con los determinantes sociales de la salud (DE) a través de una revisión integradora. Método: se trata de una revisión integradora de estudios que abordan los aspectos de las SD y su relación con la fluorosis dental. Los datos fueron recolectados entre agosto de 2020 y abril de 2021. Resultados: a partir de los estudios seleccionados de portugués e inglés, se observó que la fluorosis dental es un problema de salud pública en todo el mundo. Conclusión: Por lo tanto, es oportuno pensar que la fluorosis dental puede estar influenciada por el entorno al que se incluye al individuo, se deben considerar sus condiciones sociales, económicas, psicológicas y de comportamiento, de acuerdo con la mirada del SSD.

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Abstract The purpose of this in vitro study was to test the hypothesis that fluoride treatment can prevent dental erosion on fluorotic enamel of different severities. It followed a 3×2 factorial design, considering a) fluorosis severity: sound (TF0, Thylstrup-Fejerskov Index), mild (TF1-2), moderate (TF3-4); and b) fluoride treatment: 0 (negative control) and 1150ppmF. Human molars with the three fluorosis severities (n=16, each) were selected and randomly assigned to the two fluoride treatments (n=8). Enamel blocks (4×4mm) were prepared from each tooth and subjected to a dental erosion cycling model, for 10 days. The daily cycling protocol consisted of erosive challenges (1% citric acid, pH 2.4), interspersed by periods of immersion in artificial saliva, and three 2-minute treatments with either 0 or 1150ppm F. The enamel volume loss (mm3) was calculated by subtracting values obtained by microtomography before and after cycling. Two-Way ANOVA showed no significant interaction between fluorosis severity and fluoride treatment (p=0.691), and no significant effect for either fluorosis severity (TF0 mean±standard-deviation: 13.5(10-2±0.42(10-2, TF1-2: 1.50(10-2±0.52(10-2, TF3-4: 1.24(10-2±0.52(10-2, p=0.416) or treatment (0ppmF: 1.49(10-2±0.53(10-2; 1150ppmF: 1.21(10-2±0.42(10-2; p=0.093), when evaluated independently. Considering the limitations of this in vitro study, the presence and severity of fluorosis in enamel do not appear to affect its susceptibility to dental erosion. Fluoride treatment was not effective in preventing the development of dental erosion in both sound and fluorotic enamel substrates under our experimental conditions.

Resumo Este estudo in vitro foi testou a hipótese de que o tratamento com flúor pode prevenir a erosão dentária no esmalte fluorótico de diferentes severidades. O objetivo deste estudo foi: investigar o efeito protetor dos fluoretos contra a erosão e abrasão simuladas no esmalte fluorótico. Seguiu um desenho fatorial 3×2, considerando a) severidade da fluorose em 3 níveis: hígido (TF0, Índice Thylstrup-Fejerskov), suave (TF1-2), moderada (TF3-4); b) tratamento com flúor: 0 (controle negativo) e 1150ppmF. Molares humanos com as três severidades de fluorose (n=16, cada) foram selecionados e distribuídos aleatoriamente para os dois tratamentos com flúor (n=8). Blocos de esmalte (4×4mm) foram preparados a partir de cada dente e submetidos a um modelo de ciclo de erosão dentária, por 10 dias. O protocolo de ciclagem diária consistiu em seis desafios erosivos de 5 minutos (1% de ácido cítrico, pH 2,4), intercalados por seis períodos de imersão em saliva artificial e três tratamentos de 2 minutos com 0 ou 1150ppmF. O volume do esmalte perdido foi calculado subtraindo o perfil superficial 3D obtido por microtomografia antes e depois da ciclagem. A ANOVA de dois fatores não mostrou interação significativa entre a severidade da fluorose e o tratamento com flúor (p = 0,691) e nenhum efeito significativo para a severidade da fluorose (TF0 média+/desvio padrão: 13,5(10-2±0,42(10-2, TF1-2: 1,50(10-2±0,52(10-2, TF3-4: 1,24(10-2±0,52(10-2, p=0,416) ou tratamento (0: 1,49(10-2±0,53(10-2; 1150ppmF: 1,21(10-2±0,42(10-2, p=0,093), quando avaliados independentemente. Considerando as limitações deste estudo in vitro, a presença e severidade da fluorose no esmalte não parece afetar sua suscetibilidade à erosão dentária. O tratamento com flúor não foi eficaz na prevenção do desenvolvimento da erosão dentária em esmalte hígido e fluorótico, sob as condições experimentais utilizadas.

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ABSTRACT Objective: The study aims to analyse the fluoride concentration in the water supply of the capital of each province of Mozambique, 2019 and compare with previous data 1978 and 2008. Methods: The water supply in cities of Mozambique were analysed in 1978, 2008 and 2019 and water from Tete's River in 1978 and 2019. The fluoride concentration of the water samples was determined in duplicate, using the ion-sensitive electrode (Orion 9609), coupled to a potentiometer (Procyon, model 720), adopting a significance level of 5%. Results: The average fluoride concentration found in the years 1978, 2008 and 2019 was 0.31, 0.33 and 0.14 mg F/L, respectively. The fluoride concentrations collected from household taps in 1978, 2008 and 2019 were: Cabo Delgado/Pemba (0.62, 0.28 and 0.07 mg F/L), Niassa/Lichinga (0.18, 0.98 and 0.07 mg F/L), Nampula/Nampula (0.18, 0.01 and 0.06 mg F/L), Zambézia/Quelimane (0.81, 0.37 and 0.15 mg F/L), Tete/Tete (1.00, 0.97 and 0 .46 mg F/L), Sofala/Beira (0.00, 0.01 and 0.10mg F/L), Manica/Chimoio (0.04, 0.01 and 0.07 mg F/L), Inhambane/Inhambane (0.00, 0.05 and 0.19 mg F/L), Gaza/Xai-Xai (0.01, 0.06 and 0.06 mg F/L) and Maputo (0.23, 0.36 and 0.23 mg F/L), respectively. In the waters of the Zambeze River was 5.5 mg F/L in 1978 and 0.12 mg F/L in 2019. There was no significant change between the fluoride concentrations in the water collected from the taps during the periods studied (p=0.83), however there was a significant difference in the water collected from the river (p<0.05). Conclusion: Tete' River showed a significant reduction in fluoride concentration, and in the piped water collected in all municipalities, the fluoride content was below optimum.

RESUMO Objetivo: O estudo visa analisar a concentração de flúor no abastecimento de água da capital de cada província de Moçambique, 2019 e comparar com dados anteriores de 1978 e 2008. Métodos: A água de abastecimento das cidades de Moçambique foi analisada em 1978, 2008 e 2019 e a água do Rio Tete em 1978 e 2019. A concentração de flúor das amostras de água foi determinada em duplicata, utilizando o eletrodo íon-sensível (Orion 9609), acoplado a um potenciômetro (Procyon, modelo 720), adotando-se nível de significância de 5%. Resultados: A concentração média de flúor encontrada nos anos de 1978, 2008 e 2019 foi de 0,31, 0,33 e 0,14 mg F/L, respectivamente. As concentrações de flúor recolhidas nas torneiras das casas em 1978, 2008 e 2019 foram: Cabo Delgado/Pemba (0,62, 0,28 e 0,07 mg F/L), Niassa/Lichinga (0,18, 0,98 e 0,07 mg F/L), Nampula/Nampula (0,18, 0,01 e 0,06 mg F/L), Zambézia /Quelimane (0,81, 0,37 e 0,15 mg F/L), Tete/Tete (1,00, 0,97 e 0,46 mg F/L), Sofala/Beira (0,00, 0,01 e 0,10 mg F/L), Manica/Chimoio (0,04, 0,01 e 0,07 mg F/L), Inhambane/Inhambane (0,00 , 0,05 e 0,19 mg F/L), Gaza/Xai-Xai (0,01, 0,06 e 0,06 mg F/L) e Maputo (0,23, 0,36 e 0,23 mg F/L), respectivamente. Nas águas do rio Zambeze foi de 5,5 mg F/L em 1978 e 0,12 mg F/L em 2019. Não houve alteração significativa entre as concentrações de flúor na água coletada das torneiras durante os períodos estudados (p=0,83), porém houve diferença significativa na água captada no Rio (p<0,05). Conclusão: O Rio Tete apresentou redução significativa na concentração de flúor, e na água das torneiras coletada em todas as cidades, o teor de flúor estava abaixo do ideal.

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Although fluoride (F) is required for the normal growth and development of several human organs and tissues, excessive exposure to it may be potentially toxic. Groundwater may present ranging levels of F; however, the appearance, taste, and smell are not altered. Thus, the present study aimed to evaluate dental fluorosis in children from a Brazilian slave-descendent community, as well as to assess F levels in the drinking water supplies available in that area. For that, 21 children aged from 6 to 14 years living in Rincão dos Martimianos were invited to participate. Thylstrup and Fejerskov index (a 0­9 scale) was used to assess dental fluorosis on permanent teeth. Furthermore, the F concentration of two water samples (from the artesian well and a tank) was determined by using a potentiometric method. All children presented dental fluorosis to some degree, ranging from score 2 to 9. About 81% of them had dental fluorosis scores equal to or over 5. Scores lower than 5 were observed only in children younger than 8 years; on the other hand, all children older than 8 years presented scores higher than 5. Moreover, artesian well water had an F concentration of 5 mg/L and tank water 0.8 mg/L. It is suggested that the F-rich groundwater supply was most probably responsible for dental fluorosis in that area. Brazilian slave-descendent communities, therefore, should receive constant attention from their local authorities in order to guarantee a proper water supply for consumption, as well as to provide public health education(AU)

Embora o flúor (F) seja necessário para o crescimento e desenvolvimento normal de vários órgãos e tecidos humanos, a exposição excessiva pode ser potencialmente tóxica. As águas subterrâneas podem apresentar níveis variados de F; no entanto, a aparência, o sabor e o cheiro não são alterados. Desta forma, o presente estudo teve como objetivo avaliar a fluorose dentária em crianças de uma comunidade brasileira descendente de escravos, bem como avaliar os níveis de F na água potável disponível nessa área. Para isso, 21 crianças de 6 a 14 anos residentes no Rincão dos Martimianos foram convidadas a participar da pesquisa. O índice de Thylstrup e Fejerskov (uma escala de 0 a 9) foi usado para avaliar a fluorose dentária em dentes permanentes. Além disso, a concentração de F de duas amostras de água (do poço artesiano e de um tanque) foi determinada pelo método potenciométrico. Todas as crianças apresentaram algum grau de fluorose dentária, variando de 2 a 9. Cerca de 81% delas apresentaram escores de fluorose dentária iguais ou superiores a 5. Escores inferiores a 5 foram observados apenas em crianças menores de 8 anos; por outro lado, todas as crianças maiores de 8 anos apresentaram escores superiores a 5. Além disso, a água do poço artesiano tinha concentração de F de 5 mg/L e a água do tanque 0,8 mg/L. Desta forma, acredita-se que a fonte de água subterrânea rica em F foi provavelmente responsável pela fluorose dentária na região avaliada. As comunidades quilombolas brasileiras, portanto, devem receber atenção constante de suas autoridades locais, a fim de garantir o abastecimento adequado de água para consumo, bem como proporcionar educação em saúde pública(AU)

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Genetic factors contribute to susceptibility and resistance to fluoride exposure. The aim of this systematic review was to identify alleles/genotypes of single nucleotide polymorphisms (SNPs) associated with dental fluorosis (DF) and to identify them as protective or risk factors. PubMed, ScienceDirect, Cochrane Library, Scopus and Web of Science were searched for articles; the last search was performed in August 2022. Human studies that analyzed the relationship between SNPs and DF published in English were included; systematic reviews and meta-analyses were excluded. Methodological quality was graded using the Joanna Briggs Institute checklist and risk of bias was assessed using the Cochrane Collaboration's tool. Eighteen articles were included, 44% of which showed high methodological quality and data from 5,625 participants aged 6 to 75 years were analyzed. The SNPs COL1A2, ESR2, DLX1, DLX2, AMBN, TUFT1, TFIP11, miRNA17, and SOD2 were considered risk factors, and ESR1, MMP20, and ENAM were considered protective factors. In conclusion, there are alleles and genotypes of different single nucleotide polymorphisms involved in increasing or decreasing the risk of developing dental fluorosis.

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OBJECTIVE: To assess the impact of caries, Molar Incisor Hypomineralization (MIH), and fluorosis on the Oral Health-Related Quality of Life (OHRQoL) of schoolchildren aged 8-10 years living in area with different fluoride levels in the drinking water. SUBJECT AND METHODS: The prevalence of caries and fluorosis were assessed among 663 Mexican schoolchildren using the International Caries Detection and Assessment System (ICDAS II) and the Thylstrup and Fejerskov Index (TFI), respectively. MIH was recorded using the European Academy of Pediatric Dentistry (EAPD) criteria and OHRQoL using the Child Perceptions Questionnaire (CPQ8-10). Poisson regression models were used in data analysis. RESULTS: Schoolchildren presenting two of the three conditions (cavitated lesions and TFI≥4, cavitated lesions and MIH or TFI≥4 and MIH) experienced worse quality of life than children who did not [RR=4.18; (95% CI 3.83, 4.56)]. Children with all three conditions had worse quality of life than children who did not [RR=5.64; (95% CI 5.13, 6.20)]. CONCLUSIONS: Fluorosis, MIH, and caries have a negative impact on the OHRQoL of schoolchildren living in area with a high concentration of fluoride in their drinking water.

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RESUMEN En los últimos años se ha desarrollado un nuevo enfoque más conservador para detener y controlar las lesiones cariosas iniciales, usando la técnica con resinas infiltrativas, desarrollada con la finalidad de aportar a los tratamientos no invasivos siendo utilizadas como método para el diagnóstico de lesiones cariosas no cavitadas; aunque, actualmente su uso se ha expandido para tratar otro tipo de lesiones que afectan al esmalte como la fluorosis dental. Para este artículo de revisión fueron seleccionados artículos originales, investigaciones in vitro, in vivo, reportes de casos, revisiones sistemáticas y de literatura; llevándose a cabo la búsqueda en 6 bases de datos: PubMed, Google Académico, ScienceDirect, Wiley, EBSCO, Springer, de las cuales se obtuvo información acerca de la eficacia, beneficios, aplicaciones clínicas y, técnica de aplicación de las resinas infiltrativas.

ABSTRACT In recent years, a new standard of resins called infiltrative resins has been generated, which were developed with the aim of contributing to non-invasive treatments, being used as a treatment for the diagnosis of non-cavitated carious lesions; although, currently its use has expanded to treat other types of lesions that affect the enamel such as dental fluorosis. For this review article, original articles, in vitro and in vivo research, case reports, systematic and literature reviews were selected; carrying out the search in 6 databases: PubMed, Google Scholar, ScienceDirect, Wiley, EBSCO and Springer, from which information was obtained about the efficacy, benefits, clinical applications and application technique of the infiltrative resins.

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Resumen Introducción: Diversos estudios han demostrado que los padres aún no cuentan con el conocimiento suficiente sobre el uso de pastas dentales que deben consumir sus hijos. Muchos de ellos desconocen desde que edad se debe empezar con el uso de pastas dentales, la cantidad exacta que se debe colocar en el cepillo y sobre todo con qué frecuencia se deben cepillar. Objetivo: Asociar el nivel de conocimiento de los padres sobre el uso de pastas dentales con las características asociadas a la ingesta estimada de fluoruro en niños entre los 6 meses a 8 años de Lima Metropolitana y Callao. Materiales y métodos: Estudio de tipo observacional, descriptivo y transversal. Se realizó el cuestionario a 264 padres de familia residentes en Lima Metropolitana y Callao durante los meses de julio a septiembre del 2020. Se calcularon las frecuencias absolutas y relativas. Para el análisis bivariado, se utilizó la prueba de Chi cuadrado de El nivel de significancia estadística fue de 0.05. Resultados: Se observa que el 52.94% de los padres, así como el 60.41% de las madres presentan un nivel medio de conocimiento sobre el uso de pastas dentales con flúor. Además, se obtuvo que el 56.25% de los padres que afirmaron que sus hijos no se enjuagan con agua después del cepillado presentan un nivel alto de conocimiento sobre el uso de pastas dentales con flúor. Conclusión: Se obtuvo que el 57.58% de los padres tenían un nivel medio de conocimiento sobre el uso de pastas dentales con flúor. Se encontró asociación entre el nivel de conocimiento sobre el uso de pastas dentales con flúor y las características asociadas a la ingesta estimada de fluoruro.

Abstract Introduction: Various studies have shown that parents still do not have sufficient knowledge about the use of toothpastes that their children should consume. Many of them do not know from what age to start using toothpastes, the exact amount to be placed on the brush and especially how often they should be brushed. Aim: To associate the level of knowledge of parents about the use of toothpastes with the characteristics associated with the estimated intake of fluoride in children between 6 months to 8 years of Metropolitan Lima and Callao. Materials and methods: An observational, descriptive, and crosssectional study. The questionnaire was carried out on 264 parents residing in Metropolitan Lima and Callao during the months of July to September 2020. The absolute and relative frequencies were calculated. For the bivariate analysis, the Chi-square test of the level of statistical significance was used was 0.05. Results: It is observed that 52.94% of the fathers, as well as 60.41% of the mothers present a medium level of knowledge about the use of fluoride toothpastes. In addition, it was found that 56.25% of parents who stated that their children do not rinse with water after brushing have a high level of knowledge about the use of fluoride toothpastes. Conclusion: It was found that the 57.58% of parents had a median level of knowledge about the use of fluoride toothpastes. An association was found between the level of knowledge about the use of fluoride toothpastes and the characteristics associated with the estimated fluoride intake.

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