Fluoridation Of Public Water Supplies Research Articles

FLUORIDATION AND DISPOSAL OF PUBLIC WATER SUPPLY IN THE MARANHÃO AMAZON

Objective: to investigate access and fluoridation of public water supplies in the state of Maranhão. Method: descriptive, direct documentary research, carried out in governmental databases in 2022, also on-site surveys involving 23 municipalities in Maranhão Amazon belonging to the health macro-region IV. The investigated aspects were: population supplied by water; raw water sources; responsible body; water fluoridation and data availability. Only 38% of the population in the macro-region have access to piped water, of which only 44% is treated, the service performed by the state company and those managed by the municipal body were equivalent (48%). 484 sources of collection were identified, 99% underground supplying 92% of the population, this dependence on groundwater reaches 63% throughout the state, surface collection occurs only in the main municipality (5%). Despite the index that 91% of indicator 6.1.1 of the SDGs, the high rural population and the low demographic density constitute a challenge for the expansion of access. No municipality performs artificial fluoridation and there are no records of fluoride levels or previous analyses. There is a direct relationship between a lower HDI and access to potable water. Conclusion: a small part of the population has access to treated water, therefore fluoridation is not guaranteed and the surveillance system needs to be improved.

Level of natural fluoride in public water supply: geographical and meteorological factors in Brazil's Northeast.

This study analyzed the relationships between the concentration of natural fluoride in public water supply and meteorological and hydrographic factors in a northeastern region of Brazil. This was a descriptive, analytical, ecological, longitudinal, and field study conducted by collecting water in 23 municipalities (2019 to 2020) of four macroregions of Paraíba (Brazil): coast (1), borborema (2), agreste (3), and outback (4). Four collection sites were selected per municipality: two near and two distant from the water treatment plant. Fluoride concentration was determined using a combined ion-specific electrode and classified according to the Collaborating Center of the Ministry of Health in Oral Health Surveillance. Meteorological, hydrographic, and population characteristics were also collected. All analyzed samples showed natural fluoride; macroregions 2 and 4 showed the highest mean fluoride concentration, macroregion 4 presented the highest mean temperature, and all macroregions showed a similar pattern of precipitation. The mean fluoride concentration of the four macroregions was below the appropriate value to prevent caries. An increase in precipitation would decrease the fluoride concentration in water. In conclusion, the concentration of natural fluoride varied according to meteorological and hydrographic factors. The concentration in surface waters increased during periods of low precipitation. Therefore, this study provided important information to support implementation of community water fluoridation in this region.

Situational diagnosis of policies in Latin American and Caribbean countries for the use of fluoride and reduction of sugar consumption.

Policy evaluation and guidance on fluoride use and sugar consumption in Latin American and Caribbean countries (LACC) may provide a scientific evidence basis for policymakers, dental professionals, civil society organizations and individuals committed to improving public oral health. A cross-sectional study was conducted to evaluate the extent of implementation of policies/guidelines on fluoride use, and sugar consumption in LACC. The study had two stages. First a questionnaire covering four major areas was developed: fluoridation of public water supplies; salt fluoridation; fluoride dentifrices, and sugar consumption. Then, the questionnaire was applied to collect data among representative participants in public oral health from LACC. Ninety-six participants from 18 LACC answered the questionnaire. One-hundred seventy documents were attached, and 285 links of websites were provided by the respondents. Implementation of policies and guidelines on water and table salt fluoridation and processed and ultra-processed food consumption were found in most countries, with some issues in the consensus and coverage. Thus, differences were identified in the extent of implementation of public oral health strategies on sugar consumption and fluoridation among the countries. There is no consensus on the policies in LACC to reduce sugar consumption and for the use of fluoride. A few policies and guidelines were applied in isolated countries, with a variety of strategies and standards. For future actions, it will be important to encourage the development of strategies and public policies within countries, and to evaluate the effectiveness of existing policies in reducing dental caries and in improving oral health in LACC.

DISTRIBUIÇÃO ESPACIAL DE FATORES DE RISCO E TEORES DE FLÚOR NA ÁGUA DE ABASTECIMENTO PÚBLICO EM ESCALA MUNICIPAL

Fluoridation of public water supplies is an important measure to prevent dental caries and is linked to Sustainable Development Objective 6. This study aimed to evaluate the fluoride content of Ceará's municipalities. The research used secondary data from SISAGUA (municipality; year, date, source and point of collection; form of supply; supply system; chlorine and fluoride concentrations) and the IBGE (HDI, population, FIRJAN Municipal Development Index, and estimated population) for spatial distribution and the analysis of fluoride risk factors. Of the 26,390 samples collected, only 17.8% had ideal fluoride content, with a higher prevalence in samples collected in 2016, in isolated urban areas, in water supply systems, and in chlorine levels above the ideal. Of the 182 municipalities evaluated, 16.7% had most of the samples with ideal fluoride content. In a multivariate analysis, municipalities with a population below 30 thousand inhabitants had a prevalence of inadequate fluoride content (below or above the ideal) 2.12 (95% CI = 1.92-4.88) times higher than municipalities with large populations. It is concluded that less than a fifth of Ceará's population is exposed to adequate public water fluoride levels, and cities with fewer than 30,000 inhabitants are the most affected. Keywords: Fluoride. Water Fluoridation. Environmental Health Surveillance. Health Geography.

Association of clinical, social and environmental variables with dental caries prevalence in adolescents from a Brazilian municipality supplied with fluoridated water

Abstract Background Although a trend towards dental caries reduction has been observed, further investigations on its pattern and development are still needed. Objective To investigate the influence of clinical, social and environmental variables on dental caries prevalence in adolescents from a Brazilian municipality supplied with fluoridated water in 2018. Method This study was conducted with a non-probabilistic sample of 277 adolescents aged 12 years of public schools in Nova Friburgo, state of Rio de Janeiro, Brazil. Clinical examinations were carried out by calibrated examiners to assess caries, periodontal disease, and fluorosis according to criteria of the World Health Organization (WHO). Semi-structured questionnaires were applied to record socio-environmental information. Results Individuals living in regions supplied with fluoridated water below the minimum required levels (OR=3.60, p=0.0006), with low income (OR=1.90, p=0.0444), presence of gingivitis (OR=3.36; p=0.0016), and whose reason for visiting the dentist was dental treatment (OR=2.41; p=0.0203) were more likely to have dental caries. A significant reduction (p<0.0001) in dental caries indexes was observed between 2012 and 2018. Conclusion Fluoridation of public water supply at unsuitable levels, as well as other social and clinical variables can influence the caries pattern in adolescents.

Surveillance of public water supply fluoridation and municipal indicators: an analysis in the state of Espirito Santo, Brazil

This study investigated the demographic, socioeconomic, and municipal health indicators related to the quality of water fluoridation. An ecological study was carried out in Espirito Santo state (ES), based on data from the Drinking Water Quality Surveillance Information, from 2014 to 2017. The non-parametric Mann-Whitney and Spearman tests were applied to compare municipal indicators with the availability of information and the quality of fluoridation, respectively. Fluoridation quality was calculated to define the percentage of fluoride concentration values in each municipality within the range of the optimal level corresponding to the maximum benefit for preventing dental caries and minimum risk for the occurrence of dental fluorosis. The proportion of 80% or more samples were defined as a compliance criterion. In 2014, 62.8% of the municipalities had information available, and 16.7% performed analyses of fluoride concentration. The percentage of available data increased about 30%, in 2017, with 3.8% referring to fluoride. The quality of fluoridation remained high (> 80%) in ES in almost every year, except in 2014. The municipalities with the largest population, the highest GDP per capita, and the lowest coverage of the oral health team exhibited a greater availability of information about fluoride (p <0.05). The child mortality rate showed a strong negative correlation with the quality of fluoridation. The findings reinforce the importance of directing public policies that ensure the correct practices for monitoring and maintaining the quality of fluoridation.

Dental caries in adolescents from public schools in Maputo, Mozambique

To assess dental caries prevalence in adolescents at urban and sub-urban areas of Maputo-City, Mozambique and to identify its relationship with dental fluorosis, dental plaque, nutritional status, frequency of sugar consumption and the concentration of fluoride in public water supply. Subjects (n=601) were randomly selected from five urban schools and five sub-urban schools. Clinical examinations were performed under standardised conditions by a trained examiner using DMFT index, SiC index, fluorosis index, PHP, BMI, a sugar consumption questionnaire and water supply analysis. The bivariate analysis and Pearson correlation was used (p < 0.05). The mean (DMFT) was 0.9 (+/- 1.65 SD). Children in urban schools showed less dental caries (0.8 +/- 1.49 SD) than children in sub-urban schools (1.1 +/- 1.80 SD, p = 0.03). Only 8.15% had very mild to moderate fluorosis but most presented poor oral hygiene. Cases of malnutrition were found in more sub-urban schools (n=109; 36.22%) than in urban schools (n=66; 22.00%) (p = 0.03). The frequency of sugar consumption was higher among urban children compared to suburban schools (p < 0.00). The level of fluoride in water consumption in urban schools was 0.4 ppmF, above the level of fluoride in sub-urban schools, 0.2 ppmF. Dental caries should not be considered a major oral health problem in Maputo at the moment. However the data suggest the implementation of a population strategy to reduce dental caries rates, in children of both urban and sub-urban areas, in Maputo.

Public water supply fluoridation: an analysis from the equity principle

Introdução: A fluoretação das águas de abastecimento público representa uma importante medida de saúde pública para prevenção da cárie dentária, devendo ser monitorada quanto ao teor de fluoreto em dose ideal, bem como em relação ao seu alcance populacional na perspectiva de reduzir as desigualdades e proporcionar benefícios em saúde bucal. Objetivo: O estudo avaliou a equidade na distribuição de água fluoretada na cidade de Manaus/AM, por meio da relação entre indicadores contextuais de desenvolvimento municipal e os teores de fluoreto na água de abastecimento dos bairros que compõem os distritos sanitários da cidade. Método: Realizou-se estudo ecológico transversal no período de 2016 a 2018. Amostras de água foram coletadas mensalmente de cada distrito sanitário, cujas concentrações de fluoreto foram determinadas utilizando-se um eletrodo específico. Índice de Desenvolvimento Humano Municipal (IDHM), mortalidade Infantil,número de crianças fora da escola e expectativa de vida representaram os indicadores contextuais do município, obtidos a partir do Atlas do Desenvolvimento Humano no Brasil. Os dados foram submetidos a uma análise descritiva, estatística bivariada e análise espacial. Resultados: Observou-se grande variação nos teores de fluoreto das amostras, das quais 50,02% apresentaram concentrações de fluoreto inadequadas e as maiores concentrações predominaram nas amostras coletadas no segundo semestre do ano. A distribuição espacial indicou que os bairros com melhores valores de IDHM, mortalidade infantil, número de crianças fora da escola e expectativa de vida apresentaram melhor concentração de fluoreto na água de abastecimento. Conclusões: Evidenciou-se a ausência de equidade na distribuição de água fluoretada, sugerindo que o acesso à água fluoretada reflete as desigualdades sociais presentes na própria cidade.

Estimation of Fluoride Content of Drinking Water in Dharan

Introduction: Fluoride when present in drinking water at optimal level has been shown to promote oral health by preventing tooth decay. Dental caries represents a health problem that impacts on the medical, functional, nutritional and psychological status of patients in all the age groups. Fluoridation of public water supply is a safe, economical and effective measure to prevent dental caries.&#x0D; Objective: To estimate the level of fluoride present in drinking water supplies in all the wards of Dharan and to compare the fluoride concentration of its different water supply sources.&#x0D; Methods: One hundred water samples were collected from the various sources (ground water and surface water) and its different reservoirs along with random samples of 2-7 from all the wards of Dharan. The samples were then taken to the SEAM-N-MMA laboratory, Biratnagar to be tested for fluoride using the photometric method. Microsoft excel for data entry and SPSS 11.5 version for analysis were used. Significance of the variables was examined by Chi-square test.&#x0D; Results: The results of this study showed that in 96% of the samples taken, fluoride level was below the optimal. Only few samples met the lower range guideline value of Nepal (0.5 mg/l). Also, there was significant difference (p&lt; 0.002) between the surface and consumer level fluoride.&#x0D; Conclusion: The fluoride content in drinking water supplies of Dharan was found to be below optimal level as per the national and WHO guideline values.

Single nucleotide polymorphism rs4284505 in microRNA17 and risk of dental fluorosis

Objectives The aim of this study is to evaluate the association between the single nucleotide polymorphism (SNP) rs4284505 within the gene that codifies microRNA17 (miRNA17) and dental fluorosis (DF) in a group of children.Methods Children living in a city with fluoridation of public water supplies were included. DF was assessed in erupted permanent teeth by Dean’s modified index. The miR-SNP rs4284505 was selected in miRNA17 and genotyping was carried out by real-time PCR. Genotype and allelic distributions between DF and control, and between DF phenotypes (mild, moderate and severe) and control were analysed.Results Among a total of 527 children enrolled for the study, 383 were DF free and 144 presented DF. In the dominant model analysis (AA + AG vs. GG) the miR-SNP rs4284505 was associated with moderate DF, with carriers of the GG genotype having an increased risk of more than two times for DF (p = 0.031; Odds Ratio = 2.26, Confidence Interval 95%= 1.04-4.73). Allelic distribution showed borderline statistical significance for moderate DF with the carriers of G allele having an increased risk for DF (p = .050; Odds Ratio = 1.75, Confidence Interval 95%= 1.00–3.12).Conclusion The miR-SNP rs4284505 in miRNA17 was associated with an increased risk of DF.

External control of water fluoridation in a small municipality of northeast of Brazil

Abstract Introduction Fluoridation of public water supply is an important measure in the prevention of dental caries. Objective This study aimed to monitor the fluoride (F) concentrations of a public water supply with water fluoridation program in a small municipality in the Northeast region of Brazil. Material and method It is a quantitative study with a descriptive approach. Three points of the urban area were selected for collecting water samples twice a month for 12 months. The average of F concentrations was calculated considering these three samples of each collection point at the same occasion. F concentrations in the water samples were determined by potentiometry and the results were classified according to the criterion proposed by criterion set down by Collaborating Center of the Brazilian Ministry of Health for Oral Health Surveillance. The samples were classified according to the best risk-benefit adjustment (0.55 – 0.84 mg F /L). Result Less than 10% of the samples were within the ideal range. Conclusion It was observed that water fluoridation in this municipality was interrupted since many water samples showed f-levels below the minimal acceptable values.

Fluoretação da água de abastecimento público: uma revisão da literatura

INTRODUÇÃO: Os efeitos do flúor na prevenção da cárie dentária foram descobertos ainda na primeira metade do século XX. Atualmente a fluoretação da água de abastecimento público é uma das principais medidas para o controle da cárie em nível populacional. OBJETIVO: Este estudo tem como objetivo apresentar uma revisão da literatura narrativa sobre a fluoretação da água de abastecimento público e seu papel no controle e prevenção da cárie dentária em populações. MATERIAIS E MÉTODO: Para a realização desta revisão da literatura, foram pesquisados artigos científicos, teses e dissertações publicados nas bases de dados Scielo, LILACS, BBO e MEDLINE entre 2000 a 2018, em idioma português e inglês sobre a fluoretação da água de abastecimento, com foco no uso desta tecnologia no Brasil. Utilizou-se a combinação de palavras-chave: fluoretação da água, saúde bucal, cárie dentária e seus correspondentes em inglês: fluoridation of water, oral health, dental caries. RESULTADOS: A revisão da literatura baseou-se no desenvolvimento de aspectos importantes desta medida de saúde pública, tendo como foco o contexto brasileiro. Assim, foram elencados aspectos históricos a ela relacionados, assim como aspectos legais, técnicos, operacionais e éticos. Também foram evidenciados os principais mecanismos de ação do flúor no controle da cárie, relacionado sobretudo com o equilíbrio do processo de desmineralização-remineralização, e a efetividade da fluoretação da água neste controle verificada em estudos recentes. CONSIDERAÇÕES FINAIS: A fluoretação da água de abastecimento público é uma tecnologia de saúde bucal coletiva simples, de baixo custo e com efetividade comprovada cientificamente.

Evaluation of genetic polymorphisms in MMP2, MMP9 and MMP20 in Brazilian children with dental fluorosis

Recent studies suggested that genetics contribute to differences in dental fluorosis (DF) susceptibility among individuals having the same environmental exposure. This study evaluated if MMP2, MMP9 and MMP20 are expressed during enamel development and assessed the association between polymorphisms in these genes with DF. Mice susceptible and resistant to DF were used to evaluate if MMPs were candidate genes for DF. The animals received fluoride and their enamels were used for immunohistochemistry. Additionally, 481 subjects from a city with fluoridation of public water supplies were recruited. Genotyping was performed using real time PCR. Allele/genotype frequencies were compared between groups. MMP2, MMP9 and MMP20 immunostaining was detected in both animal groups. DF was observed in 22.4% of the subjects. A borderline association was observed in MMP2 (rs243865), MMP9 (rs17576) and in MMP20 (rs1784418) (p = 0.06, p = 0.08 and p = 0.06 respectively). Briefly, MMPs were expressed during enamel maturation and genetic polymorphisms were not associated with DF.

Fluoretação das águas de abastecimento público: 10 anos de monitoramento em 38 municípios do Centro-Oeste Paulista, São Paulo, Brasil

Introduction: In the State of Sao Paulo, the concentration of fluoride in the public water supply should be maintained in the range of 0.6 to 0.8 mg/L, in order to prevent caries and avoid the risk of fluorosis. Objective: To evaluate the concentration of fluoride in public water supply in the municipalities covered by the Bauru Sanitary Surveillance Group. Method: Data were extracted from the routine of the Adolfo Lutz Institute – Bauru, from 38 municipalities monitored by the Proagua Program, in the period 2007–2016. Laboratory analyses were performed using the potentiometric method with ion-selective electrode and the interpretation of the results was based on Resolution SS-250/95 and the classification proposed by the Collaborating Center of the Ministry of Health in Oral Health Surveillance (CECOL) Results: Of the 8,887 samples analyzed, 31.1% had inadequate levels of fluoride ions, with 22.7% being below and 8.4% above the limit established by the legislation. According to the CECOL proposal, 59.4% of the samples showed maximum benefit for caries prevention and 0.6% revealed a very high risk for the production of dental fluorosis. Conclusions: These data point out the need to improve the operational control of the fluoridation process and emphasize the importance of water quality surveillance.

O modelo de vigilância da água e a divulgação de indicadores de concentração de fluoreto

RESUMO A vigilância da água é uma estratégia essencial para assegurar padrões de segurança e qualidade para o consumo humano. Entre os parâmetros de qualidade, destaca-se o fluoreto. O objetivo deste estudo foi descrever o modelo de vigilância da qualidade da água e apresentar uma proposta de indicadores e disseminação das informações à população com relação ao parâmetro fluoreto. Com base nas principais evidências científicas, explica-se a importância de se manter o parâmetro sob controle nos sistemas de abastecimento e apresenta-se uma descrição sumária do modelo de vigilância da água no Brasil, mostrando que o desenho não oferece indicadores para monitorar longitudinalmente o parâmetro nem a visibilidade a todos os que têm direito à informação. Em seguida, apresentam-se as bases técnicas e operacionais do Sistema de Vigilância da Fluoretação da Água de Abastecimento Público, uma proposta para aprimoramento do modelo. Indicadores para disseminação das informações são descritos, argumentando-se que o País dispõe de recursos e condições para superar a precariedade das informações sobre a concentração de fluoreto e sobre a cobertura da fluoretação da água em todas as unidades do território nacional.

Polymorphisms in Nonamelogenin Enamel Matrix Genes Are Associated with Dental Fluorosis

The aim of this study was to evaluate whether genetic polymorphisms in AMELX, AMBN, ENAM, TFIP11, and TUFT1 genes are associated with dental fluorosis (DF). A total of 1,017 children from 2 Brazilian cohorts were evaluated. These populations lived in cities with fluoridation of public water supplies. DF was assessed in erupted permanent teeth using the modified Dean index. The polymorphisms rs946252, rs12640848, rs4694075, rs5997096, and rs4970957 were analyzed by real-time PCR from genomic DNA. Associations between DF, genotype, and allele distribution were evaluated using the χ² test, with an alpha of 5%. The polymorphisms rs4694075, rs5997096, and rs4970957 in AMBN, TFIP11, and TUFT1 were associated with DF (p < 0.05). In conclusion, enamel matrix genes are associated with DF.

Qualidade da água tratada: avaliação dos teores de flúor em 10 anos de heterocontrole no município de Lages, Santa Catarina, Brasil

The public water supply fluoridation is the addition of fluorine in the water treatment plants, as a way of preventing tooth decay. This study evaluated the situation of fluoridation of public water supply in the city of Lages, of the State of Santa Catarina, systematizing data from 10 years of external control (2004-2013). Monthly, every other day, 67 water samples from 11 points of supply were collected, totaling 737 samples. To determine the fluoride concentration in the water samples, an electrometric method was used. After analysis, the samples were classified according to the criteria of Ordinance no 635/Bsd of 26/12/1975 (adequate or inadequate) and the criteria proposed by the Ministry of Health Collaborating Centre for Surveillance of Oral Health (CECOL) of the University of Sao Paulo (benefits and health risks of the population). Of the samples analyzed, 58.6% had adequate levels of fluoride and 51.1% had maximum benefit and low risk, according to each criterion. Of the inadequate samples of fluoride concentration, 34.7% stood at levels above 1.0 mg L-1 and 6.7% at low levels of fluoride in water (<0.7 mg L-1). For CECOL criteria, 45% of the samples were characterized by moderate to very high risk of developing fluorosis (fluoride content between 0.95 and ≥ 1.45 mg. L-1). It is recommended to adopt effective measures to ensure that the population ingests treated water quality, including appropriate levels of fluoride in the water and the maintenance of health surveillance by the Public Health authorities.

Polymorphisms in genes involved in enamel development are associated with dental fluorosis

ObjectiveTo evaluate the association between polymorphisms in DLX1, DLX2, MMP13, TIMP1 and TIMP2 genes with dental fluorosis (DF) phenotype. DesignFour hundred and eighty one subjects (108 with DF and 373 DF free) from 6 to 18 years of age were recruited. This population lived in Rio de Janeiro, a city with fluoridation of public water supplies. DF was assessed using the Deańs index modified. Only erupted permanent teeth were assessed. Genetic polymorphisms in DLX1, DLX2, MMP13, TIMP1 and TIMP2 were analyzed by real-time PCR from genomic DNA. Association between DF, genotype, and allele distribution were evaluated using chi-square and logistic regression analyses with an alpha level of 5%. ResultsDF was more prevalent in Afro-descendants than in Caucasians (p=0.08; OR=1.83; CI 95%=1.18–2.82). Logistic regression analysis adjusted by the ethnicity demonstrated a statistical difference for TIMP1 genotype (p=0.033; OR=2.93, 95%CI, 1.09–7.90). When only the severer cases of DF were analyzed, polymorphisms in DLX1 and DLX2 were associated with DF (p<0.05). ConclusionOur results provided evidence that polymorphisms in TIMP1, DLX1 and DLX2 genes may be associated with DF phenotypes.

Comparação da experiência de cárie em moradores de dois municípios brasileiros com e sem a fluoretação das águas de abastecimento público

A fluoretação da água de abastecimento público é uma medida eficaz e de baixo custo para a prevenção da cárie dentária. Este artigo se baseia em um estudo que comparou a experiência de cárie entre dois municípios do Brasil, São Paulo e Manaus, na época, com e sem fluoretação de suas águas. O estudo utilizou dados do projeto SBBrasil 2010 que avaliou três índices para 2.176 indivíduos: ceo-d (dentição infantil com cárie, extraídos e obturados), CPO-D (quantidade de dentes cariados, perdidos e obturados em adultos) e SiC (Significant Caries Index, uma variação do CPO-D). Os resultados mostraram que os índices foram maiores em Manaus quando comparados com os de São Paulo, para indivíduos com 5 e 12 anos de idade e pertencentes à faixa de 15 a 19 anos. O município de São Paulo apresentou melhor condição de saúde bucal em crianças e adolescentes, e não houve diferença entre os índices para adultos e idosos, demonstrando que parte da população com acesso a água fluoretada foi beneficiada pelo método.

Fluoretação da água de abastecimento público em municípios do estado do Maranhão, Brasil

Objective: To evaluate fluoride concentration in public water supply in locations of Maranhao State that, according to agency responsible, presents regular water fluoridation. Methods: Water samples were collected from public schools. According to National Health Foundation (FUNASA), Water Treatment Station (WTS) of 14 rural cities and 03 WTS from Sao Luiz are supplied by the water supply system of state. The fluoride content of the analysis was performed using a specific electrode for fluoride. Three samples from each school were collected, totaling 42 samples of the rural cities and 45 samples from the capital. Results: Most samples were below the optimal concentration, and only 14.28% of samples collected in the municipalities and 6.67% in Sao Luiz, had acceptable values of fluoride (0.6 to 0.8 ppmF). Conclusion: Fluoridation of public water supplies (FPWS) is uncontrolled and therefore no preventive effect on caries. It is important to emphasize the need to implement control measures to ensure the ongoing effectiveness of FPWS in Maranhao State.