Abstract
BackgroundAmong the methods currently available to provide fluoride in population levels, fluoridated water is the most successful for presenting high efficacy, safety and good cost–benefit. However, recent studies on external control have shown great variability of fluoride concentrations in the water from treatment stations in Brazilian cities, which must present concentration between 0.6 and 0.8 mg/L to be considered acceptable in most cities. Thus, this study aimed to perform a systematic review of the literature to assess the adequacy of fluoride concentration in the water in Brazilian cities using external control.MethodsThe protocol was registered in PROSPERO. Six databases were used as primary search sources and three databases were used to partially capture the "gray literature". Only observational studies that assessed the fluoride concentration of artificially fluoridated water from the public supply network were included. The JBI Critical Appraisal Tools for Systematic Reviews was used to assess the risk of bias of the studies. A proportion meta-analyses using random-effect models were performed. The heterogeneity between studies was determined by I2 statistic. Meta-regressions were conducted to identify relevant moderators to be used in stratified meta-analyses. Publication bias was investigated by Egger’s tests.ResultsThe search provided 2038 results, from which 14 met the eligibility criteria and were included in the data extraction of the review. Overall, the water samples were collected from 449 different sources in three Brazilian regions. Thirteen studies presented a low risk of bias. The mean concentration of fluoride ranged from 0.17 to 0.89 ppmF. The meta-analyis demonstrated that more than half of the water samples analyzed had fluoride concentration levels outside the acceptable range (56.6%; 95% CI 45.5; 67.3), with high heterogeneity.ConclusionMore than half of the public water supply analyzed in the studies selected had fluoride concentration levels outside the acceptable range, which may affect the risk of developing oral diseases in the Brazilian population, having an important impact on public health.
Highlights
Among the methods currently available to provide fluoride in population levels, fluoridated water is the most successful for presenting high efficacy, safety and good cost–benefit
Several systematic reviews show clear evidence that the presence and addition of fluoride in the water [2], dentifrices [3], gels [5], or varnishes [4] can reduce the prevalence of dental caries
This systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [21] and conducted according to the Joanna Briggs Institute (JBI) Manual [22]
Summary
Among the methods currently available to provide fluoride in population levels, fluoridated water is the most successful for presenting high efficacy, safety and good cost–benefit. In 1942, it was found that natural fluoride in public water supplies could reduce the prevalence of dental caries in different populations [1]. Several systematic reviews show clear evidence that the presence and addition of fluoride in the water [2], dentifrices [3], gels [5], or varnishes [4] can reduce the prevalence of dental caries. The addition of fluoride in the public water supply was initially proposed in 1945 by the United States and since it has been recommended by the World Health Organization as a key strategy to prevent dental caries [8]. Different from the United States, Brazil does not have a national surveillance system and adding fluoride in the public water supply is mandatory since 1974 [10], it is estimated that only 50% of the Brazilian population has access to fluoridated water [11]
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