Kelly Polido Kaneshiro Olympio

Surface dental enamel lead levels and antisocial behavior in Brazilian adolescents

Lead poisoning has been reportedly linked to a high risk of learning disabilities, aggression and criminal offenses. To study the association between lead exposure and antisocial/delinquent behavior, a cross-sectional study was conducted with 173 Brazilian youths aged 14-18 and their parents (n=93), living in impoverished neighborhoods of Bauru-SP, with high criminality indices. Self-Reported Delinquency (SRD) and Child Behavior Checklist (CBCL) questionnaires were used to evaluate delinquent/antisocial behavior. Body lead burdens were evaluated in surface dental enamel acid microbiopsies. The dental enamel lead levels (DELL) were quantified by graphite furnace atomic absorption spectrometry (GFAAS) and phosphorus content was measured using inductively coupled plasma optical emission spectrometry (ICP-OES). Logistic regression was used to identify associations between DELL and each scale defined by CBCL and SRD scores. Odd ratios adjusted for familial and social covariates, considering a group of youths exposed to high lead levels (>or=75 percentile), indicated that high DELL is associated with increased risk of exceeding the clinical score for somatic complaints, social problems, rule-breaking behavior and externalizing problems (CI 95%). High DELL was not found to be associated with elevated SRD scores. In conclusion, our data support the hypothesis that high-level lead exposure can trigger antisocial behavior, which calls for public policies to prevent lead poisoning.

Neurotoxicity and aggressiveness triggered by low-level lead in children: a review

Lead-induced neurotoxicity acquired by low-level long-term exposure has special relevance for children. A plethora of recent reports has demonstrated a direct link between low-level lead exposure and deficits in the neurobehavioral-cognitive performance manifested from childhood through adolescence. In many studies, aggressiveness and delinquency have also been suggested as symptoms of lead poisoning. Several environmental, occupational and domestic sources of contaminant lead and consequent health risks are largely identified and understood, but the occurrences of lead poisoning remain numerous. There is an urgent need for public health policies to prevent lead poisoning so as to reduce individual and societal damages and losses. In this paper we describe unsuspected sources of contaminant lead, discuss the economic losses and urban violence possibly associated with lead contamination and review the molecular basis of lead-induced neurotoxicity, emphasizing its effects on the social behavior, delinquency and IQ of children and adolescents.

Total and acid-soluble fluoride content of infant cereals, beverages and biscuits from Brazil

Total fluoride (TF) and HCl 0.01 M (‘gastric juice’)-soluble fluoride (SF) were analysed in infant foods, beverages and calcium-rich biscuits. Samples were divided into seven categories: children cereals (A), chocolate-flavoured milk (B), soy beverages (C), filled biscuits (D), non-filled biscuits (E), wafer biscuits (F) and corn starch biscuits (G). Mean TF concentrations ± SD (amplitude, unit µg F ml−1 or µg F g−1) were: (A) 4.25 ± 3.04 (0.20 − 7.84, n = 6); (B) 0.34 ± 0.47 (0.05−1.27, n = 6); (C) 0.15 ± 0.07 (0.09−0.29, n = 8); (D) 8.44 ± 1.76 (7.65−10.47, n = 4); (E) 12.41 ± 1.15 (10.69−13.68, n = 4); (F) 0.35 ± 0 (0.34−0.36, n = 4) and (G) 7.77 ± 1.12 (6.86−8.68, n = 2). Five samples of cereals, one sample of chocolate-flavoured milk and 10 samples of biscuits were analysed for SF. In cereals analysed for SF, all fluoride was soluble, while for the chocolate-flavoured milk, approximately 50% of TF was soluble. Regarding the biscuits analysed for SF approximately 20% of TF was soluble. It was observed that some of the cereals and beverages, and most of the biscuits analysed, might be important contributors to total daily fluoride intake. When consumed just once per day, cereals and beverages might supply up to 25% of the maximum recommended daily fluoride intake (0.07 mg F kg−1 body weight) for a 2-year-old child (12 kg). For the filled, non-filled and corn starch biscuits, when 3, 32 or 20 units of them, respectively, are consumed just once per day, they may supply up to 16% of the maximum recommended daily fluoride intake. However, only approximately 25% of fluoride absorption occurs from the stomach and 75% from the small intestine. Therefore, a higher fluoride bioavailability is possible.

Low-Fluoride Acidic Dentifrice: A Randomized Clinical Trial in a Fluoridated Area

Background: Low-fluoride dentifrices have been suggested as alternatives to reduce dental fluorosis risk, but there is no consensus regarding their clinical effectiveness, which has been suggested to be increased when their pH is acidic. Aims: This single-blind randomized clinical trial evaluated the caries increment during the use of a low-fluoride acidic liquid dentifrice. Methods: Four-year-old schoolchildren (n = 1,402) living in a fluoridated area (0.6–0.8 ppm F) were randomly allocated to 4 groups differing according to the type of dentifrice used over a 20-month period. Group 1 (n = 345): liquid dentifrice, 1,100 ppm F, pH 4.5. Group 2 (n = 343): liquid dentifrice, 1,100 ppm F, pH 7.0. Group 3 (n = 354): liquid dentifrice, 550 ppm F, pH 4.5. Group 4 (n = 360): toothpaste, 1,100 ppm F, pH 7.0. At baseline and after 20 months, clinical examinations were conducted (dmfs index) and caries increment was calculated. Data were analysed by GLM procedure using classrooms (cluster) as unit of analysis (p < 0.05). Results: The mean ± SD (95% CI) net increments found were as follows. Group 1: 2.06 ± 2.38 (1.8–2.3); group 2: 2.08 ± 2.87 (1.7–2.4); group 3: 2.05 ± 2.79 (1.7–2.4), and group 4: 2.08 ± 2.34 (1.8–2.4). No significant differences were detected among the groups. Conclusion: In a population with high caries risk living in a fluoridated area, as the selected sample, and according to the present protocol, the low-fluoride acidic liquid dentifrice seems to lead to similar caries progression rates as conventional 1,100 ppm F toothpaste.

Low-fluoride dentifrices with reduced pH: fluoride concentration in whole saliva and bioavailability.

This double-blind study assessed the fluoride (F) concentration in whole saliva and F bioavailability after the use of low-F dentifrices with reduced pH. Whole saliva was collected from 10 volunteers after brushing with: experimental dentifrices (pH 5.5) 275, 550 and 1,100 ppm F; commercial 500 ppm F, pH 6.9 and a ‘gold standard’ 1,100 ppm F, pH 6.5. To analyze F bioavailability, 9 volunteers ingested weights of four dentifrices equivalent to 2 mg F: 1,500 ppm F/MFP/CaCO3, pH 9.5; 1,100 ppm F/NaF/silica, pH 5.5; 1,100 ppm F/NaF/silica, pH 7.0 and 1,100 ppm F/NaF/silica, pH 6.5 (‘gold standard’). Ductal saliva and urine were collected. F was analyzed by electrode. Data were tested using ANOVA and Tukey’s post hoc test (p < 0.05). The 550 ppm F/pH 5.5 dentifrice was similar to the ‘gold standard’ in its effect on whole saliva F concentration. The area under the curve of ductal saliva F concentration × time and urinary F excretion rates did not differ among the dentifrices. The results show that acidic low-F dentifrices are effective in increasing salivary F concentration and pH reduction does not seem to affect their F bioavailability.

Fluorine content of several brands of chocolate bars and chocolate cookies found in Brazil

Chocolate bars and chocolate cookies are foodstuffs highly appreciated by children. The possibility of having fluorine (F) among their components, associated with an excessive consumption, may make them decisive contributors to the total daily F intake. Thus, they could participate in the establishment of dental fluorosis. The aim of this study was to analyze the fluorine concentration [F] of the chocolates bars (CB) Baton, Confeti, Garoto Ball, Kinder Ovo, M&M s, Milkybar, Nescau, Nescau Ball, Surpresa, Surpresa Bichos, Tortuguita; and of the chocolate cookies (CC) Danyt s, Hipop , Nescau, Passatempo, Pokémon, S tio do Pica-Pau Amarelo and Trakinas. Samples were purchased in Bauru, São Paulo, Brazil. Three grams of each product were previously ashed at 525 C (CB and cookies fillings) and at 550 C (cookies dough), during 4 hours. Fluorine was separated from the ash by hexamethyldisiloxane (HMDS)-facilitated diffusion. Fluorine analysis was carried out with the specific electrode. Mean [F]s SD and amplitude (unit mg/g) were: CB = 0.30 0.45 (0.07 - 1.60, n = 12) and CC = 1.08 2.64 (0.04 - 7.10, n = 7). It was concluded that some of the analyzed foods may be important contributors to the total daily F intake. As for the product that had the highest [F] (Danyt s), when only 3 units are consumed just once a day, they may supply up to 40% of the maximum recommended daily F intake (0.07 mg/kg body weight) for a 2-year-old child (12 kg). The [F] in these products should be informed on their labels.

Urinary fluoride output in children following the use of a dual-fluoride varnish formulation

Objective: This study evaluated the bioavailability of fluoride after topical application of a dual-fluoride varnish commercially available in Brazil, when compared to Duraphat™. Material and methods: The urinary fluoride output was evaluated in seven 5-year-old children after application of the fluoride varnishes, in two different phases. In the first phase (I), children received topical application of the fluoride varnish Duofluorid XII (2.92% fluorine, calcium fluoride + 2.71% fluorine, sodium fluoride, FGM™). After 1-month interval (phase II), the same amount (0.2 mL) of the fluoride varnish Duraphat (2.26% fluorine, sodium fluoride, Colgate™) was applied. Before each application all the volunteers brushed their teeth with placebo dentifrice for 7 days. Urinary collections were carried out 24 h prior up to 48 h after the applications. Fluoride intake from the diet was also estimated. Fluoride concentration in diet samples and urine was analyzed with the fluoride ion-specific electrode and a miniature calomel reference electrode coupled to a potentiometer. Data were tested by ANOVA and Tukeys post hoc test (p<0.05). Results: There were significant differences in the urinary fluoride output between phases I and II. The use of Duofluorid XII did not significantly increase the urinary fluoride output, when compared to baseline levels. The application of Duraphat caused a transitory increase in the urinary fluoride output, returning to baseline levels 48 h after its use. Conclusions: The tested varnish formulation, which has been shown to be effective in in vitro studies, also can be considered safe.

Fluoridation of the public water supply and prevalence of dental fluorosis in a peripheral district of the municipality of Bauru, SP

Objectives: The objectives of this study were to assess the fluoride concentration in the public water supply and the prevalence of dental fluorosis in schoolchildren between 7 and 15 years old, living in a peripheral district of the municipality of Bauru. Material and Methods: For this, fifty two water samples were collected on three different days of one week. These samples were analyzed for fluoride by means of the ion-sensitive electrode method (Orion 9609) coupled to a potentiometer (Procyon, model 720). In this method, 1.0 mL of TISABII (Orion) was added to 1.0 mL of the sample. For the epidemiological survey of fluorosis, 52 schoolchildren of both genders, aged between 7 and 15 were assessed, with prior authorization from their caretakers. Only one person examined the children, after supervised toothbrushing and drying with cotton wool rolls. The TF index was used. Results: The fluoride concentrations in the water samples ranged from 0.62 to 1.20 mg/L, with a mean of 0.9 mg/L. The prevalence of dental fluorosis was 33%, with severity ranging from TF1 to TF4 (Kappa of 0.73 and concordance of 83.33%). Conclusions: The results from the analysis of water samples indicated a fluoride concentration greater than recommended for Bauru. The fluorosis levels found were higher than expected for a peripheral district, in which water is one of the few sources of fluoride.

Educação e motivação em saúde bucal: prevenindo doenças e promovendo saúde em pacientes sob tratamento ortodôntico

INTRODUCTION: It is incumbent upon dentists to prevent disease, minimize risks and promote health. Patients also need to be made aware of their role in oral health care. Patients undergoing orthodontic treatment find it particularly difficult to maintain satisfactory oral hygiene owing to the presence of bands, wires and ligatures. It is therefore crucial to establish preventive motivation and guidance methods to ensure mechanical control of dental plaque. OBJECTIVES: This study investigated the effects of educational, preventive and motivational actions on the oral health of patients undergoing fixed orthodontic treatment. METHODS: Participants received free toothpaste and toothbrushes throughout the study and instructions on oral hygiene were provided and reinforced throughout the six months of research. Physical examination was performed at baseline and after 6, 12 and 24 weeks for verification of plaque, gingival and bleeding indices. RESULTS: Initially, the oral hygiene of participants was inadequate. During the study, significant improvement in oral health occurred in all indices. Preventive, educational and motivational actions undertaken in this study were statistically effective in improving the oral health of orthodontic patients. CONCLUSION: Health promotion and disease prevention should be part and parcel of the care provided by orthodontists directly to their patients whereas oral health care guidance and motivation should be provided before and during treatment.Introduction: It is incumbent upon dentists to prevent disease, minimize risks and promote health. Patients also need to be made aware of their role in oral health care. Patients undergoing orthodontic treatment find it particularly difficult to maintain satisfactory oral hygiene owing to the presence of bands, wires and ligatures. It is therefore crucial to establish preventive motivation and guidance methods to ensure mechanical control of dental plaque. Objectives: This study investigated the effects of educational, preventive and motivational actions on the oral health of patients undergoing fixed orthodontic treatment. Methods: Participants received free toothpaste and toothbrushes throughout the study and instructions on oral hygiene were provided and reinforced throughout the six months of research. Physical examination was performed at baseline and after 6, 12 and 24 weeks for verification of plaque, gingival and bleeding indices. Results: Initially, the oral hygiene of participants was inadequate. During the study, significant improvement in oral health occurred in all indices. Preventive, educational and motivational actions undertaken in this study were statistically effective in improving the oral health of orthodontic patients. Conclusion: Health promotion and disease prevention should be part and parcel of the care provided by orthodontists directly to their patients whereas oral health care guidance and motivation should be provided before and during treatment.

Dental caries and dental fluorosis in 7-12-year-old schoolchildren in Catalão, Goiás, Brazil

INTRODUCTION Over the last two decades, the prevalence of dental caries in children has decreased and the prevalence of dental fluorosis has increased. Knowledge on the epidemiologic conditions of a population is fundamental for the planning of health programs. OBJECTIVES To determine the prevalence of dental caries and dental fluorosis among schoolchildren, in Catalão, Goiás, Brazil. METHODS A random sample of 432 schoolchildren aged 7-12-years old was obtained. WHO (1997) criteria for dental caries and fluorosis diagnosis were used. RESULTS The DMFT indexes were 0.97; 1.20; 1.80; 1.62; 2.40 and 2.51 for 7, 8, 9, 10, 11 and 12 years old, respectively. Analysis of dental fluorosis for the same ages presented higher prevalence at 12 years old and for the female gender. The percentage of questionable dental fluorosis (Deans classification) was 34.0%. Only 3% of the sample presented dental fluorosis with scores very mild, mild and moderate. CONCLUSIONS The prevalence of caries in schoolchildren of Catalão, Goiás, Brazil, was low. In average, private schools showed better results than public schools; however, all schools presented a low DMFT index. In this study, dental fluorosis is not a public health problem and has not damaged dental esthetics.