Recomendações para o uso de fluoretos em serviços públicos de saúde: análise de protocolos e consonância com evidências científicas

Esther Ferreira Marques; Caroline Pagani Martins; Pablo Guilherme Caldarelli

doi:10.18593/evid.34634

Authors

Esther Ferreira Marques Universidade Estadual de Londrina
Caroline Pagani Martins Universidade Estadual de Londrina
Pablo Guilherme Caldarelli Universidade Estadual de Londrina

DOI:

https://doi.org/10.18593/evid.34634

Keywords:

Fluorine, Evidence Based Dentistry, Clinical Protocols, Dental Health Services

Abstract

The use of fluorides in public health services is essential as a preventive and therapeutic way for the control of dental caries. Therefore, it is necessary that fluoride use protocols at the municipal, state and national levels are based on the best scientific evidence. Thus, the objective of this study was to analyze whether the recommendations for the use of fluorides products published by the State Department of Health of Paraná and the Municipal Department of Health of Londrina are in line with the scientific evidence available on the subject in the “Recommendation guide for the use of fluorides in Brazil” of the Ministry of Health. The document analysis of the three protocols resulted in the elaboration of four categories, namely: a) Fluoridated products indicated in one or more protocols in a manner that diverges from scientific evidence; b) Fluoridated products indicated in one or more protocols in a manner converging with scientific evidence; c) Fluoridated products that, although scientifically validated, have not been mentioned in one or more protocols; and d) Fluoridated products that are scientifically invalidated and not mentioned in any of the protocols. The results indicate that the documents, especially the municipal one, need to be reviewed and updated. Otherwise, clinical practice performed out of step with scientific evidence can contribute to the waste of resources and harm to the health of individuals and communities, especially in the public sphere.

Downloads

Download data is not yet available.

References

Bardin, L. (2010). Análise de conteúdo. Edições 70.

Benedito, L. C. D. B., Pedro Ricomini-Filho, A., Tabchoury, C. P. M., & Cury, J. A. (2023). Anticaries potential of a fluoride foam. Brazilian Dental Journal, 34(1), 89–98. https://doi.org/10.1590/0103-6440202305287 DOI: https://doi.org/10.1590/0103-6440202305287

Bonifácio, C. C., & Hesse, D. (2023). Is silver diammine fluoride effective in arresting dental caries in cavitated primary molars? Evidence-Based Dentistry, 24(2), 50–51. DOI: https://doi.org/10.1038/s41432-023-00874-8

Caldarelli, P. G. (2017). Diretrizes de uso de fluoretos em cursos de odontologia e na prática dos serviços públicos de saúde bucal do Paraná: Um estudo quali-quantitativo [Tese de Doutorado]. Universidade Estadual de Campinas. https://doi.org/10.47749/T/UNICAMP.2017.987060 DOI: https://doi.org/10.47749/T/UNICAMP.2017.987060

Calvo, A. F. B., Tabchoury, C. P. M., Del Bel Cury, A. A., Tenuta, L. M. A., Da Silva, W. J., & Cury, J. A. (2012). Effect of Acidulated Phosphate Fluoride Gel Application Time on Enamel Demineralization of Deciduous and Permanent Teeth. Caries Research, 46(1), 31–37. https://doi.org/10.1159/000335125 DOI: https://doi.org/10.1159/000335125

Colombo, S., & Beretta, M. (2018). Dental Sealants Part 3: Which material? Efficiency and effectiveness. European Journal of Paediatric Dentistry, 3, 247–249. https://doi.org/10.23804/ejpd.2018.19.03.15

Cury, J. A., Oliveira, B. H., Santos, A. P. P., & Tenuta, L. M. A. (2016). Are fluoride releasing dental materials clinically effective on caries control? Dental Materials, 32(3), 323–333. https://doi.org/10.1016/j.dental.2015.12.002 DOI: https://doi.org/10.1016/j.dental.2015.12.002

Cury, J. A., & Tenuta, L. M. A. (2014). Evidence-based recommendation on toothpaste use. Brazilian Oral Research, 28(spe), 1–7. https://doi.org/10.1590/S1806-83242014.50000001 DOI: https://doi.org/10.1590/S1806-83242014.50000001

Cury, J. A., & Tenuta, L. M. A. (2011). Intoxicação aguda por ingestão de flúor. In E. D. Andrade, & J. Ranali. (Coord.), Emergência médicas em Odontologia. (3ª ed., pp. 145-152). Artes Médicas.

Cury, J. A., & Tenuta, L. M. A. (2012). Riscos do uso do dentifrício fluoretado na prevenção e controle de cárie na primeira infância. Revista da Faculdade de Odontologia de Porto Alegre, 53(3), 21–27. https://doi.org/10.22456/2177-0018.50477 DOI: https://doi.org/10.22456/2177-0018.50477

Cury, J. A., Tenuta, L. M. A., Ribeiro, C. C. C., & Paes Leme, A. F. (2004). The importance of fluoride dentifrices to the current dental caries prevalence in Brazil. Brazilian Dental Journal, 15(3), 167–174. https://doi.org/10.1590/S0103-64402004000300001 DOI: https://doi.org/10.1590/S0103-64402004000300001

Cury, J. A., Tenuta, L. M. A., & Serra, M. C. (2010) Paradigmas no Ensino da Cariologia. In C. P. Fernandes. (Coord.), Uma Odontologia de Classe Mundial. (pp. 91-110). FDI Santos.

Dall Agnol, M. A., Battiston, C., Tenuta, L. M. A., & Cury, J. A. (2022). Fluoride Formed on Enamel by Fluoride Varnish or Gel Application: A Randomized Controlled Clinical Trial. Caries Research, 56(1), 73–80. DOI: https://doi.org/10.1159/000521454

Frazão, P. (2022). The Use of Fluorides in Public Health: 65 Years of History and Challenges from Brazil. International Journal of Environmental Research and Public Health, 19(15), 9741. https://doi.org/10.3390/ijerph19159741 DOI: https://doi.org/10.3390/ijerph19159741

Gao, S. S., Zhang, S., Mei, M. L., Lo, E. C.-M., & Chu, C.-H. (2016). Caries remineralisation and arresting effect in children by professionally applied fluoride treatment – a systematic review. BMC Oral Health, 16(1), 12. https://doi.org/10.1186/s12903-016-0171-6 DOI: https://doi.org/10.1186/s12903-016-0171-6

Kriger, L., Moysés, S. T., & Morita, M. C. (2016). Odontologia baseada em evidencias e intervenção mínima em odontologia. Grupo A.

Leverett, D. H., Adair, S. M., Vaughan, B. W., Proskin, H. M., & Moss, M. E. (1997). Randomized Clinical Trial of the Effect of Prenatal Fluoride Supplements in Preventing Dental Caries. Caries Research, 31(3), 174–179. https://doi.org/10.1159/000262394 DOI: https://doi.org/10.1159/000262394

Marinho, V. C., Chong, L.-Y., Worthington, H. V., & Walsh, T. (2016). Fluoride mouthrinses for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews, 2021(2). https://doi.org/10.1002/14651858.CD002284.pub2 DOI: https://doi.org/10.1002/14651858.CD002284.pub2

Maturo, P., Costacurta, M., Perugia, C., & Docimo, R. (2011). Fluoride supplements in pregnancy, effectiveness in the prevention of dental caries in a group of children. ORAL & Implantology, 4(1–2), 23–27.

Ministério da Saúde. (2009). Guia de recomendações para o uso de fluoretos no Brasil. (Série A. Normas e Manuais Técnicos). https://bvsms.saude.gov.br/bvs/publicacoes/guia_recomendacoes_uso_fluoretos.pdf

Narvai, P. C., Frazão, P., & Castellanos Fernandez, R. A. (1999). Declínio na experiência de cárie em dentes permanentes de escolares brasileiros no final do século XX. Odontologia Social, 1( 1-2), 25-29.

Narvai, P. C., Frazão, P., Roncalli, A. G., & Antunes, J. L. F. (2006). Cárie dentária no Brasil: Declínio, polarização, iniqüidade e exclusão social. Revista Panamericana de Salud Pública, 19(6), 385–393. https://doi.org/10.1590/S1020-49892006000600004 DOI: https://doi.org/10.1590/S1020-49892006000600004

O’Mullane, D. M., Baez, R. J., Jones, S., Lennon, M. A., Petersen, P. E., Rugg-Gunn, A. J., Whelton, H., & Whitford, G. M. (2016). Fluoride and Oral Health. Community Dental Health, 33(2), 69–99. DOI: https://doi.org/10.1177/0265539X2016033004003

Ramos, C.D, Lima, C. V, Noronha, M. S, Pacheco, D. S, Oliveira, B. E. C, & Caldarelli, P. G. (2018). Uso de diamino fluoreto de prata em crianças atendidas em uma unidade básica de saúde do norte do Paraná. Revista de Saúde Pública do Paraná, 1(1), 68–73. https://doi.org/10.32811/2595-4482.2018v1n1.44 DOI: https://doi.org/10.32811/2595-4482.2018v1n1.44

Ricomini Filho, A. P., Chávez, B. A., Giacaman, R. A., Frazão, P., & Cury, J. A. (2021). Community interventions and strategies for caries control in Latin American and Caribbean countries. Brazilian Oral Research, 35, e054. DOI: https://doi.org/10.1590/1807-3107bor-2021.vol35.0054

Santos, A. P. P. D., Nadanovsky, P., & Oliveira, B. H. D. (2010). Survey of Brazilian governmental health agencies shows conflicting recommendations concerning oral hygiene practices for children. Cadernos de Saúde Pública, 26(7), 1457–1463. https://doi.org/10.1590/S0102-311X2010000700025 DOI: https://doi.org/10.1590/S0102-311X2010000700025

Santos, A. P. P., Oliveira, B. H., & Nadanovsky, P. (2013). Effects of Low and Standard Fluoride Toothpastes on Caries and Fluorosis: Systematic Review and Meta-Analysis. Caries Research, 47(5), 382–390. https://doi.org/10.1159/000348492 DOI: https://doi.org/10.1159/000348492

Secretaria de Estado da Saúde do Paraná (2021). Linha de cuidado em saúde bucal. (3a ed.). https://www.saude.pr.gov.br/sites/default/arquivos_restritos/files/documento/2021-09/linha_de_cuidado_em_saude_bucal_-_3_edicao_II.pdf

Secretaria Municipal de Saúde de Londrina (2009). Manual de Saúde Bucal.

Sousa, F. S. D. O. D., Santos, A. P. P. D., Barja-Fidalgo, F., & Oliveira, B. H. D. (2016). Evidence-based pediatric dental practice within the clinician’s reach: The case of the esthetic effect of topical silver diamine fluoride for caries control in primary dentition. RGO – Revista Gaúcha de Odontologia, 64(4), 369–375. https://doi.org/10.1590/1981-863720160003000013231 DOI: https://doi.org/10.1590/1981-863720160003000013231

Sousa, F. S. O. (2018) Efeito das aplicações periódicas de verniz fluoretado na prevenção de cárie dentária em pré-escolares: revisão sistemática e meta-análise. [Dissertação de Mestrado]. Universidade do Estado do Rio de Janeiro]. BDTD – Biblioteca digital de teses e dissertações. http://www.bdtd.uerj.br/handle/1/14094

Sousa, G. P. D., Lima, C. C. B., Braga, M. M., Moura, L. D. F. A. D. D., Lima, M. D. D. M. D., & Moura, M. S. D. (2022). Early childhood caries management using fluoride varnish and neutral fluoride gel: A randomized clinical trial. Brazilian Oral Research, 36, e099. https://doi.org/10.1590/1807-3107bor-2022.vol36.0099 DOI: https://doi.org/10.1590/1807-3107bor-2022.vol36.0099

Tenuta, L. M. A., Chedid, S. J., & Cury, J. A (2012). Uso de fluoretos em Odontopediatria – Mitos e evidências. In L. C. Maia, & L. Guimarães Primo. (Orgs.), Odontologia Integrada na Infância (pp. 153-177). Editora Santos.

Walsh, T., Worthington, H. V., Glenny, A.-M., Marinho, V. C., & Jeroncic, A. (2019). Fluoride toothpastes of different concentrations for preventing dental caries. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD007868.pub3 DOI: https://doi.org/10.1002/14651858.CD007868.pub3