Argentina* |
Durán et al., 201714
|
Water |
1975 - Law proposing fluoridation or de-fluoridation of drinking water to achieve optimal fluoride concentration passed. |
Samples of water (2008 - 2012) were collected from 190 localities in 17 departments in the province of Tucumán, Argentina. |
The results showed that 1% of the population consumed water with optimal fluoride concentration (0.7–1.0 ppm F), 94% consumed water with fluoride concentrations below the recommended limits, and 5% were exposed to fluoride concentrations above the optimal limit |
Brazil |
Roncalli et al., 201915
|
1974 - Brazilian legislation on fluoridation of water supply passed. |
Data on the fluoridation process and the concentration of fluoride in the public water supply in all 614 municipalities of Brazil (>50,000 inhabitants representing 65% of the Brazilian population) evaluated in 2012. |
The proportions of municipalities without access to fluoridated water were as follows: North (88.9%), North-east (52.3%), Mid-west (22.9%), South-east (10.8%), and South (2%). The remaining proportions represented municipalities that had access to water fluoridation in whole or in part. |
The sanitation strategies adopted in larger cities serve as a basis for smaller demographic municipalities in the same regions by the influence they have. |
Cuba |
Künzel and Fischer, 200016
|
1973 - Water fluoridation program was implemented. Pilot fluoridation plant was installed in the rural community of La Salud, Province of Habana. |
1990 - Cuba stopped the import of fluoride due to economic problems. |
Chile |
Yévenes et al., 201917
|
Water and milk |
Water fluoridation was first implemented in some cities in 1953, and was then expanded to other cities in the country by 1984. |
In rural areas with no access to tap water, fluoride was provided though a Fluoridated School Feeding Program using milk. |
Currently, 83 % of the urban population, representing 72% of the total population of Chile, has access to fluoridated drinking water. |
Brazil |
Cury et al., 200418
|
Water, dentifrices, APF, and mouth-rinses |
1953 - Water fluoridation introduced; 1975 - federal law advising water fluoridation in all cities having water treatment systems passed. |
1989 - The most popular commercially available Brazilian dentifrice was fluoridated. |
1990s - Spread of preventive programs (tooth-brushing at schools with fluoride dentifrices, weekly fluoride rinsing, and APF application). |
1990s - 90% of commercially available dentifrices fluoridated. |
Water fluoridation, expansion of preventive programs at schools, and the widespread use of fluoride dentifrices are consistently linked to the decline in caries incidence observed in Brazil (1986–2003). |
Haiti |
Bedos and Brodeur, 200019
|
Water and sealant |
Although caries prevention methods such as the application of occlusal sealants and the use of fluoridated water have been mentioned as desirable, the associated costs make implementation difficult for a developing country. |
Belize, Bolivia, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, Mexico, Peru, Uruguay, and Venezuela |
Marthaler, 201320
|
Salt |
Salt fluoridation programs - Colombia, Costa Rica, Mexico, and Uruguay have over 20 years of documented use of fluoridated salt provided to 160 million people. Belize, Bolivia, Cuba, Dominican Republic, Ecuador, Peru, Venezuela have also implemented salt fluoridation programs. |
Mexico |
Betancourt-Lineares et al., 201321
|
1988 - National Salt Fluoridation Program (PNFS) implemented in Mexico. |
Five states excluded due to the presence of natural fluoride in higher than optimal concentration in the water. |
Partially incorporated in eleven states due to the presence of natural fluoride in concentrations > 0.7 ppm in the water supply of some municipalities. |
Concerns about dental fluorosis. |
García-Pérez et al., 201322
|
Two rural towns in Mexico with natural fluoride concentrations of 0.7 to 1.5 ppm in the water also receive fluoridated salt. Higher fluorosis levels were observed in the town with higher concentration of fluoride in water (1.0 ppm). A difference in the prevalence of caries among children living in the two towns was observed. |
Venezuela |
Montero et al., 200723
|
Salt |
1995 - Salt fluoridation program implemented. |
The main sources of fluoride exposure: dentifrices (1100 mgF/L), salt (60–90 mgF/L), and naturally fluoridated water with concentrations ranging from 0.13 to 2.32 mgF/L. Two types of salts available: a) fluoridated, to be consumed in areas with concentrations of fluoride < 0.5 mg/L in drinking water, and b) non-fluoridated, to be distributed in areas with high prevalence of dental fluorosis. The consumption of fluoridated salt in areas with high rates of dental fluorosis only increased the risk further. |
Nicaragua |
Walsh and Cury, 201824
|
2007 - Law mandating fluoridation of salt (concentration range: 200–225 mg/kg) for human consumption passed in Nicaragua. |
Fluoride concentration in 11 brands of salt sold in Managua, Nicaragua evaluated. |
Of these, only two brands presented optimal fluoride concentration, as required by the legislation. Among the other brands, 2 were not fluoridated and five had fluoride concentrations below the mandated range. |
Surveillance systems for the salt fluoridation program should be improved. |
Peru |
Cury et al., 201825
|
Peruvian legislation states that salt for human consumption should be fluoridated (concentration range: 200–250 mg F/kg). |
Fluoride concentration in four brands of salt commercially available in Lima, Peru were evaluated. |
The fluoride concentrations were not homogeneous in any of the salt samples (ranging from 72.0 to 1449.7 mg F/kg). |
The manufacturing and sanitary surveillance of fluoride salt in Peru should be improved. |
Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay, and Venezuela |
Gillespie and Baez, 200526
|
Salt and water |
1964 - 1972 - Colombia Trial for use of fluoridated salt - The clinical results showed changes in dental caries prevalence, and the efficacy of fluoridated salt was comparable to that of water fluoridation. |
1972 - 1986 - Discussion to implement salt fluoridation in Latin American and Caribbean countries. Colombia was committed to fluoridated salt. Brazil, Chile, and Argentina were interested in expanding water fluoridation. |
1986 - 1992 - Costa Rica, Uruguay, Peru, and Mexico (areas with low fluoride) implemented fluoridated salt programs. Since Nicaragua and El Salvador already had natural fluoride in their water supply, the need for additional fluoride sources had to be evaluated. |
1992 - 2004 - Honduras, Guatemala, Paraguay, and Nicaragua implemented fluoridated salt programs. Argentina commenced production of fluoridated salt. Venezuela, Bolivia, Cuba, Dominican Republic, and Ecuador began initiating programs. Most countries in Latin America, with the exceptions of Brazil, Chile, and Panama, had implemented use of fluoridated salt. |
Brazil, and Uruguay |
Fabruccin et al., 201627
|
Two population-based oral health surveys of 12-year-old school children exposed to a) artificially fluoridated water in Porto Alegre, South Brazil, and b) artificially fluoridated salt in Montevideo, Uruguay. |
“Salt fluoridation is recommended by the WHO as an alternative method when water fluoridation might be unavailable for technical, financial, or sociocultural reasons.” |
Furthermore, the salt fluoridation program in Uruguay is limited to salt for domestic use only, with no coverage of public and private canteens, restaurants, and bakeries as recommended by the WHO. |
In Porto Alegre, most of the water for human consumption, available through the public water supply system or as commercially available bottles, is fluoridated. |
Cuba |
García Melián et al., 200228
|
2001 - Cuba implemented a salt fluoridation program. However, areas with natural fluoride present in the water supply do not receive fluoridated salt and are also monitored to ensure optimal levels of fluoride concentration for caries control. |
Colombia |
Agudelo-Suárez et al., 201329
|
Salt, water, and milk |
The use of fluoride as a public health strategy may be hindered by the prevalence and severity of dental fluorosis. This is further complicated by a general lack of knowledge regarding dental fluorosis (even by health professionals) and the absence of monitoring to ensure appropriate fluoride use. |
This is a common concern in most Latin American countries with salt and water fluoridation programs; however, the occurrence of high concentrations of fluoride in the water in some regions may result in dental fluorosis, as seen in some parts of Mexico. |
From a public health perspective, policies and strategies should attempt to eliminate or reduce simultaneous sources of systemic fluoridation (water, salt, or other supplements). |
Peru |
Vallejos-Ragas and Tineo-Tueros, 201530
|
Salt, mouth-rinse, APF, milk, and dentifrices |
1964 - 2% sodium fluoride solution applied on the tooth surfaces. Four applications at different time points in the child’s life (3, 7, 10, and 13-years-old). |
1984 - Salt fluoridation program implemented. |
1985 to 2008 - 0.2% sodium fluoride mouth-rinse administered to children in public schools. |
1995 to 2000 - 1.23% acidulated phosphate fluoride (APF) gels used to complement the mouth-rinse program. |
1999 - 2004 - Milk fluoridation program |
2001 - Regulations regarding the addition of fluoride to dentifrices and mouth-rinses published. |
Brazil |
Conde et al., 200331
|
Dentifrice |
Five dentifrices most commonly used in Brazil were evaluated (1000 to 1500 ppm F). |
All of the dentifrices were manufactured in Brazil. |
MFP was present in 100% of the samples analyzed. |
All dentifrices contained a total soluble fluoride (TSF) concentration greater than 1000 ppm F to provide an anti-caries effect. |
Chile |
Fernández et al., 201732
|
Thirty dentifrices commercially available in the three main chain drugstores in Chile were evaluated. |
Eighteen dentifrices targeting the general public (1100 to 1450 ppm F) contained 78% NaF, 17% MFP, and 5% NaF/MFP. |
Twelve dentifrices targeting children (422 to 1100 ppm F) contained 58% NaF and 42% MFP. |
Among dentifrices targeting children, only 25% contained > 1000 ppm F. A total of 42% of dentifrices had low fluoride concentrations (422 to 475 ppm F) with MFP and CaCO3 as abrasives, thus lowering the TSF further. |
Two dentifrices contained NaF with CaCO3 as abrasive (incompatible, decrease soluble fluoride). |
Peru |
Chavez et al., 201933
|
Twenty-three dentifrices, of which four did not have fluoride and 19 had fluoride in concentrations ranging from 452 to 1450 ppm F, targeting children were evaluated (Lima, Peru). |
All of the dentifrices were manufactured in Ecuador, Peru, USA, China, Mexico, Brazil, and Spain. |
NaF was present in 70% of the samples analyzed and MFP was present in 30%. |
Most dentifrices exhibited total fluoride (TF) concentration equal to that mentioned on the label. However, one dentifrice exhibited a concentration of 515.1 ppm F, despite advertising 1450 ppm on the packaging. |
The majority of children’s dentifrices were fluoridated, although only 53% contained a TSF concentration greater than 1000 ppm F (necessary for anti-caries effect). |
Uruguay |
Loureiro et al., 201734
|
Six commercial brands of children’s dentifrices available in Uruguay were tested (500 to 1100 ppm F). The dentifrices were manufactured in Uruguay, Mexico, and Brazil. NaF was present in 83% of the samples analyzed and MFP was present in 17%. Two dentifrices contained NaF with CaCO3 as abrasive (incompatible, > 50% fluoride insoluble). One dentifrice was formulated with MFP and CaCO3 as abrasive (compatible). Three dentifrices contained NaF and Silica, resulting in TSF concentration similar to TF. Only 33% contained a TSF concentration greater than 1000 ppm F (necessary for anti-caries effect). |
Brazil |
Iwakura and Morita, 200435
|
Mouth-rinse |
1970s - The role of fluoride mouth-rinse programs in caries control strategies was re-evaluated. |
In Brazil, the application of 0.2% sodium fluoride mouth-rinse has been one of the most commonly used methods of preventing caries after the fluoridation of public water supply. |
In Londrina (water fluoridation started in 1972), Paraná State, the weekly fluoride mouth-rinse program (which completed 20 years in 2001) targeted 248,872 school children aged 6 to 12 years. |
2001 - The results showed that the fluoride mouth-rinse program (twice/week using 0.2% sodium fluoride mouth-rinse) was not associated with a lower prevalence of caries, both in public and private schools. |
Brazil |
Arruda et al., 201236
|
Varnish |
A great heterogeneity in the distribution of dental caries was observed, further complicated by inequalities in access to fluoride, particularly in rural communities. Fluoride varnish (5% NaF) application was evaluated. |
Chile |
Palacio et al., 201937
|
A decision analytic model (DAM)-based cost-effectiveness analysis aimed to evaluate the costs and effects (in terms of caries prevalence) of a Chilean fluoride varnish program. Cost was found to be a limitation. |
Dominican Republic |
Abreu-Placeres et al., 201938
|
A randomized clinical trial (including 180 children aged 6 to 7 years and considered to be at high risk of developing caries) evaluated the effectiveness of fluoride varnish (FV) application in the prevention of carious lesions on erupting first permanent molars. Groups evaluated: (i) control, (ii) FV applied every 3 months, and (iii) FV applied every 6 months. |
FV application every 3 months reduced the risk of developing caries lesions to a greater extent than FV application every 6 months and the control group. |
El Salvador |
Dabiri et al., 201639
|
A rural community-based program (Asociación Salvadoreñna Pro-Salud Rural - ASAPROSAR) evaluated the use of fluoride varnish application as a preventive measure for dental caries. |