Health surveillance: public water supply fluoridation in 40 municipalities of São Paulo, Brazil

Moimaz, Suzely Adas Saliba; Santos, Luis Felipe Pupim dos; Saliba, Tânia Adas; Saliba, Nemre Adas; Saliba, Orlando

doi:10.1590/1413-81232020257.03972018

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Brasil

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ARTICLE • Ciênc. saúde coletiva 25 (7) • July 2020 • https://doi.org/10.1590/1413-81232020257.03972018 copy

Health surveillance: public water supply fluoridation in 40 municipalities of São Paulo, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Since fluoridation of water is an established public health measure for the prevention of dental caries and considering that monitoring of the method is crucial to its success, this study aimed to analyze the results of the analysis of the fluorine content of public water supply of 40 municipalities in the state of São Paulo, from November 2004 to December 2016. Samples were analyzed monthly using the potentiometric method. Of the 32,488 samples, 50.94% contained fluoride levels within the recommended range. In 2004, it was verified that 21 cities (52.50%) had mean levels within the recommended parameter, increasing to 32 cities (80.00%) in 2016. It was observed that 15 municipalities that initially had levels of fluoride below 0.55 mgF/L in their water supply adjusted to adequate levels during the project. In the first year of the study, 47.76% of the samples had values in the recommended range, which increased to 58.22% in 2016. Most of the municipalities adjusted the levels of fluoride in their waters over the years, evidencing the performance of heterocontrol programs as important strategies that assist in the monitoring of the method and have significant participation in the control of the water quality supplied to the population.

Key words
Fluoridation; Public health; Oral health; Water supply

Fluoride content in water (in ppm or mg f/l)	Benefit (caries prevention)	Risk (production of dental fluorosis)
0.00 to 0.44	Negligible	Negligible
0.45 to 0.54	Minimum	Low
0.55 to 0.84 (*)	Maximum	Low
0.85 to 1.14	Maximum	Moderate
1.15 to 1.44	Questionable	High
1.45 or more	Harmful	Very High

mgF/L	n	%
<0.55	7,945	24.46
from 0.55 to 0.84	16,548	50.94
from 0.85 to 1.14	6,536	20.12
>1.14	1,459	4.48
Total	32488	100.00

	2004		2005		2006		2007		2008		2009		2010		2011		2012		2013		2014		2015		2016
Municipality	mean	sd	mean	sd	mean	sd	mean	sd	mean	sd	mean	sd	mean	sd	mean	sd	mean	sd	mean	sd	mean	sd	mean	sd	mean	sd
Alto Alegre	0.54	0.14	0.67	0.08	0.66	0.06	0.61	0.07	0.64	0.06	0.66	0.07	0.60	0.10	0.64	0.11	0.65	0.06	0.64	0.11	0.77	0.17	0.78	0.08	0.79	0.15
Andradina	0.74	0.16	0.77	0.22	0.65	0.47	0.59	0.41	0.55	0.38	0.51	0.36	0.59	0.46	0.75	0.38	0.83	0.27	0.70	0.22	0.81	0.34	0.76	0.17	0.76	0.12
Araçatuba	0.64	0.14	0.53	0.14	0.66	0.10	0.79	0.10	0.76	0.13	0.77	0.14	0.73	0.14	0.81	0.09	0.72	0.21	0.74	0.15	0.71	0.08	0.65	0.08	0.75	0.09
Auriflama	0.61	0.13	0.42	0.32	0.58	0.14	0.70	0.03	0.65	0.05	0.67	0.03	0.67	0.02	0.68	0.02	0.72	0.06	0.78	0.09	0.80	0.14	0.69	0.13	0.74	0.15
Avanhandava	0.89	0.17	0.66	0.22	0.48	0.01	1.60	0.10	0.76	0.09	0.65	0.11	0.49	0.30	0.66	0.21	0.81	0.36	0.76	0.16	0.69	0.27	0.77	0.08	0.88	0.20
Barbosa	0.39	0.20	0.60	0.30	0.75	0.24	0.74	0.10	0.75	0.17	0.84	0.14	0.70	0.16	0.60	0.10	0.69	0.10	0.73	0.15	0.84	0.22	0.73	0.18	0.87	0.22
Bento de Abreu	0.53	0.17	0.60	0.10	0.65	0.13	0.66	0.18	0.57	0.08	0.57	0.12	0.72	0.13	0.76	0.08	0.77	0.25	0.74	0.11	0.83	0.27	0.80	0.54	0.79	0.24
Bilac	0.12	0.07	0.60	0.33	0.76	0.43	^* * no water samples were sent in any month of the year.	^* * no water samples were sent in any month of the year.	^* * no water samples were sent in any month of the year.	^* * no water samples were sent in any month of the year.	^* * no water samples were sent in any month of the year.	^* * no water samples were sent in any month of the year.	^* * no water samples were sent in any month of the year.	^* * no water samples were sent in any month of the year.	0.34	0.21	0.44	0.27	0.78	0.33	0.71	0.39	0.71	0.37	^* * no water samples were sent in any month of the year.	^* * no water samples were sent in any month of the year.
Birigui	0.21	0.20	0.62	0.29	0.69	0.31	0.64	0.34	0.76	0.33	0.81	0.28	0.82	0.27	0.88	0.35	0.93	0.33	0.79	0.31	0.87	0.31	0.80	0.22	0.80	0.23
Braúna	0.06	0.01	0.05	0.02	0.07	0.02	0.57	0.26	0.69	0.20	0.73	0.26	0.71	0.36	0.83	0.21	0.76	0.21	0.84	0.20	0.88	0.22	0.79	0.17	0.82	0.20
Brejo Alegre	0.54	0.06	0.59	0.09	0.65	0.14	0.71	0.05	0.69	0.13	0.62	0.09	0.63	0.05	0.79	0.04	0.75	0.03	0.69	0.18	0.73	0.14	0.67	0.05	0.70	0.12
Buritama	0.10	0.01	0.08	0.04	0.54	0.36	0.48	0.31	0.33	0.29	0.57	0.29	0.58	0.26	0.65	0.29	0.76	0.21	0.71	0.22	0.88	0.31	0.81	0.42	0.77	0.11
Castilho	0.47	0.17	0.62	0.20	0.73	0.28	0.69	0.13	0.78	0.17	0.71	0.16	0.64	0.20	0.68	0.23	0.63	0.24	0.73	0.20	0.79	0.33	0.80	0.30	0.74	0.18
Clementina	0.10	0.02	0.07	0.03	0.10	0.11	0.28	0.34	0.47	0.40	0.32	0.25	0.67	0.24	0.75	0.15	0.89	0.16	0.87	0.15	0.85	0.12	0.72	0.16	0.82	0.20
Coroados	0.76	0.01	0.71	0.06	0.70	0.10	0.67	0.08	0.73	0.07	0.62	0.05	0.59	0.04	0.64	0.07	0.64	0.06	0.83	0.14	0.85	0.20	0.70	0.12	0.77	0.11
Gabriel Monteiro	0.76	0.02	0.67	0.08	0.69	0.06	0.71	0.05	0.72	0.09	0.71	0.06	0.66	0.24	0.75	0.27	0.72	0.15	0.86	0.11	0.64	0.19	0.87	0.25	0.84	0.24
Glicério	0.41	0.12	0.33	0.18	0.42	0.19	0.39	0.19	0.40	0.19	0.43	0.25	0.69	0.17	0.75	0.30	0.92	0.37	0.73	0.24	0.82	0.12	0.66	0.12	0.67	0.11
Guaraçai	0.57	0.13	0.47	0.19	0.42	0.35	0.47	0.33	0.48	0.22	0.69	0.11	0.78	0.13	0.85	0.17	0.89	0.19	0.79	0.16	0.81	0.15	0.70	0.14	0.79	0.13
Guararapes	0.60	0.01	0.61	0.06	0.65	0.13	0.72	0.15	0.79	0.10	0.73	0.18	0.68	0.09	0.74	0.10	0.79	0.12	0.85	0.16	0.87	0.12	0.74	0.03	0.81	0.15
Guzolândia	0.71	0.01	0.67	0.05	0.75	0.07	0.73	0.08	0.63	0.14	0.65	0.07	0.62	0.09	0.75	0.07	0.71	0.12	0.66	0.24	0.86	0.11	0.73	0.07	0.82	0.15
Ilha Solteira	0.63	0.08	0.66	0.07	0.61	0.18	0.63	0.06	0.55	0.18	0.61	0.06	0.59	0.13	0.67	0.06	0.65	0.08	0.67	0.09	0.77	0.18	0.77	0.15	0.81	0.11
Itapura	0.08	0.01	0.39	0.24	0.18	0.25	0.67	0.34	0.45	0.27	0.30	0.22	0.59	0.42	0.61	0.36	0.88	0.34	0.92	0.33	0.74	0.43	0.75	0.41	0.82	0.33
Lavínia	0.12	0.10	0.30	0.25	0.47	0.32	0.67	0.31	0.70	0.33	0.69	0.30	0.68	0.33	0.66	0.32	0.58	0.36	0.38	0.21	0.59	0.68	0.53	0.35	0.47	0.25
Lourdes	0.54	0.05	0.56	0.08	0.65	0.08	0.67	0.05	0.66	0.06	0.70	0.07	0.62	0.07	0.64	0.11	0.77	0.19	0.81	0.13	0.89	0.34	0.71	0.08	0.74	0.20
Luiziânia	0.55	0.12	0.63	0.14	0.56	0.20	0.66	0.02	0.66	0.03	0.66	0.02	0.66	0.02	0.70	0.03	0.72	0.05	0.81	0.10	0.77	0.18	0.75	0.23	0.73	0.10
Mirandópolis	0.48	0.12	0.69	0.17	0.73	0.26	0.68	0.28	0.77	0.39	0.62	0.23	0.57	0.15	0.49	0.22	0.95	0.25	0.80	0.21	0.80	0.21	0.70	0.12	0.79	0.19
Murutinga do Sul	0.62	0.18	0.37	0.12	0.49	0.19	0.49	0.20	0.33	0.11	0.35	0.21	0.32	0.21	0.23	0.08	0.31	0.21	0.29	0.12	0.44	0.28	0.24	0.06	0.35	0.13
Nova Castilho	0.53	0.10	0.52	0.09	0.78	0.32	0.63	0.54	0.61	0.21	0.94	0.36	0.83	0.28	0.77	0.36	0.80	0.38	0.85	0.28	0.85	0.49	0.93	0.34	0.71	0.31
Nova Independência	0.71	0.10	0.69	0.40	0.58	0.44	0.34	0.21	0.59	0.17	0.75	0.11	0.67	0.24	0.69	0.16	0.54	0.22	0.66	0.26	0.93	0.17	0.71	0.11	0.81	0.14
Nova Luzitânia	0.59	0.06	0.57	0.11	0.61	0.10	0.55	0.13	0.58	0.06	0.76	0.01	^* * no water samples were sent in any month of the year.	^* * no water samples were sent in any month of the year.	0.66	0.07	0.63	0.05	0.78	0.19	0.56	0.27	0.53	0.26	0.52	0.20
Penápolis	0.83	0.07	0.66	0.06	0.73	0.11	0.76	0.10	0.64	0.06	0.60	0.06	0.60	0.07	0.63	0.11	0.74	0.13	0.76	0.09	0.78	0.16	0.77	0.10	0.70	0.11
Pereira Barreto	0.88	0.10	0.79	0.07	0.88	0.05	0.91	0.07	0.90	0.04	0.88	0.04	0.88	0.02	0.85	0.06	0.88	0.15	0.82	0.14	0.84	0.10	0.75	0.14	0.76	0.16
Piacatú	0.70	0.06	0.61	0.09	0.67	0.09	0.67	0.05	0.64	0.10	0.73	0.06	0.74	0.05	0.75	0.17	0.78	0.22	0.81	0.09	0.88	0.11	0.71	0.10	0.87	0.15
Rubiácea	0.78	0.06	0.64	0.21	0.70	0.14	0.63	0.10	0.60	0.10	0.58	0.12	0.74	0.21	0.72	0.12	0.76	0.15	0.87	0.19	0.84	0.16	0.74	0.10	0.80	0.17
Sto. Ant. do Aracanguá	0.07	0.01	0.40	0.36	0.72	0.15	0.51	0.24	0.52	0.18	0.37	0.30	0.79	0.38	0.64	0.14	0.57	0.23	0.61	0.13	0.74	0.17	0.69	0.15	0.83	0.15
Santópolis do Aguapeí	0.69	0.02	0.66	0.12	0.69	0.08	0.68	0.06	0.67	0.07	0.63	0.16	0.66	0.05	0.68	0.12	0.79	0.10	0.80	0.08	0.84	0.16	0.97	0.13	0.73	0.15
Sud Mennucci	0.51	0.06	0.57	0.07	0.63	0.07	0.57	0.06	0.57	0.04	0.63	0.05	0.58	0.03	0.68	0.08	0.79	0.06	0.74	0.11	0.78	0.06	0.67	0.04	0.68	0.07
Suzanápolis	1.05	0.02	0.91	0.13	0.61	0.30	0.82	0.36	0.81	0.35	0.61	0.52	0.54	0.35	0.55	0.26	0.46	0.20	0.46	0.20	0.46	0.21	0.33	0.12	0.34	0.08
Turiúba	0.64	0.04	0.59	0.07	0.58	0.05	0.66	0.08	0.64	0.05	0.65	0.06	0.68	0.07	0.70	0.15	0.76	0.10	0.73	0.12	0.86	0.17	0.71	0.08	0.65	0.14
Valparaíso	0.53	0.26	0.72	0.20	0.79	0.25	0.79	0.21	0.73	0.13	0.73	0.14	0.80	0.13	0.82	0.07	0.84	0.12	0.83	0.10	0.86	0.16	0.99	0.33	0.83	0.82

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[1] Collaborations

SAS Moimaz: idealization and critical review of the article regarding the fluoridation theme and its benefits. LFP Santos: conception of the wording and verification of the data. TA Saliba: idealization and critical review of methodological aspects. NA Saliba: critical review on the theme “history of fluoridation in Brazil”. O Saliba: critical review of the statistics used in the article, as well as of the methodological aspects.