Literacia, cárie dentária, eficácia e segurança dos fluoretos e acessibilidade ao dentifrício fluoretado em zona rural da Paraíba

Abstract

Low educational level and restrictions on access to oral health services can lead to unfavorable oral conditions in rural populations. Data on the prevalence of tooth decay in rural areas are scarce in Paraíba (PB). This study distributed different objectives from two analysis plans (PA). PA 1 (article 1) was an epidemiological survey of dental caries and determining factors and modulators of the disease in the rural and urban area of Alhandra, PB. This was a cross-sectional observational epidemiological study. All rural permanent residents aged 5, 12, 15 to 19, 35 to 44, and 65 to 74 were invited to participate in the study and 50 were included. Then, 50 residents (“match pair” for age and gender) from the urban area were included, totaling 100 participants. During the home visit, participants were asked about socioeconomic and behavioral conditions and accessibility rates to fluoride toothpaste (FTAR). A team of calibrated examiners (Kappa>0.60) performed an intraoral clinical examination to assess the dental caries index (DMFT-d/dmft) (WHO, 1997) and administered the oral health literacy questionnaire (LSB) for adults (BOHAL-AQ). The data were entered into Excel and analyzed in JAMOVI, considering p<0.05. For normal data, the Student's T test and factorial ANOVA with Tukey's post test were used; for non-normal data, Mann-Whitney U and Kruskal-Wallis with Dwass-Steel-Critchlow-Fligner multiple comparisons. The Pearson correlation test (normal data) and Spearman correlation test (non-normal data) were performed between DMFT, FTAR and LSB. PA2 (article 2) was an exploratory, observational and field study with complementary laboratory analyzes: samples of drinking water (n=8) and toothpastes (n=50). The objective was to estimate the effectiveness and safety of drinking water and toothpastes consumed by schoolchildren (5 to 12 years old) from rural areas exposed to different levels of fluoride (F-) in two locations: A) Alhandra, coast, PB (n=25, low levels of F- in drinking water; B) São João do Rio do Peixe, hinterland, PB (n=25, moderate levels of F- in drinking water). The concentrations of F- (Total Fluoride-FT; Total Soluble Fluoride-FST; Ionic Fluoride-FI) were determined by an ion-specific electrode, expressed in ppm F. The PA 1 results showed that the DMFT means (standard deviation) in the rural area were 2.20 (3.68), 0.91 (0.94), 1.00 (1.05), 6.10 (3.04), 8.10 (1.66) for groups of 5, 12, 15–19, 35–44 and 65–74 years, respectively. While in the urban area they were 4.10 (3.11), 0.90 (1.52), 1.10 (1.66), 5.80 (3.74), 6.90 (4.18), respectively. As for LSB, 55% of those interviewed in rural areas had inadequate LSB, 20% marginal and 10% adequate; in the urban area, the values were 50%, 20% and 15%, respectively. There was no statistically significant difference in the LSB of adults between zones (p=0.331) and tooth brushing (p=0.408), but there was for education (p<0.001), with a higher LSB among adults with secondary and higher education in both zones. For the elderly, there was no statistically significant difference for LSB between zones (p=0.269), education level (p=0.405) and tooth brushing (p=0.222). Fluoride toothpaste was inaccessible to 5.88% of participants in rural areas and 2.04% in urban areas. Increased (rural) literacy resulted in greater accessibility to toothpaste in moderate purification (𝜌=-0.681). PA 2 showed that the average FT of toothpastes was around 850 ppm F on the coast and hinterland. The majority of toothpastes presented FST>700 ppm F (56%) and only 6% were above 1000 ppm F. For FI, the values were between 400-500 ppm F, being higher in the hinterland. The average F- concentrations in drinking water on the coast and in the hinterland ranged from 0.15 to 0.52 ppm F and 0.07 to 0.96 ppm F, respectively. It is concluded that the rural area had average dmft/DMFT-d similar to those of the urban area, less accessibility to fluoridated toothpaste and a higher proportion of inadequate LSB. Furthermore, although the concentrations of F- in drinking water and toothpastes are safe for human consumption, drinking water has no anti-cavity benefit and toothpastes contain FST<1000 ppm F. Therefore, there is an indication of greater vulnerability in rural areas, where, even with access to toothpaste, its effectiveness may be compromised. This study helps in the implementation of public policies and individual and collective strategies for the promotion and prevention of oral health.