Association Between Caries Risk and Public Water Fluoridation in Balsas, Maranhão: A Cross-Sectional Study

Area of Science:

• Public Health
• Pediatric Dentistry
• Environmental Health

Background:

• Dental caries presents a significant public health challenge in Brazil, disproportionately affecting children in the North and Northeast regions.
• Regional disparities in healthcare access and environmental factors contribute to varying dental caries prevalence.

Purpose of the Study:

• To assess the prevalence and severity of dental caries in preschool children in Balsas, Maranhão (MA).
• To investigate the association between dental caries and fluoride concentrations in the public water supply in Balsas.

Main Methods:

• A cross-sectional study involving 256 preschool children (aged 3-5 years) in municipal schools.
• Stratified sampling based on water network, with fluoride levels analyzed using an ion-selective electrode.
• Clinical examinations assessed caries and hygiene (biofilm, gingivitis) using the FOA-UNESP risk scale; statistical analysis included Fisher's exact test, Kruskal-Wallis, and Multiple Correspondence Analysis (MCA).

Main Results:

• Caries prevalence was 60.16%, with 41.8% of children in severe risk categories.
• Water analysis revealed universal hypofluoridation (0.02-0.34 µg F/mL).
• A significant association was found between low fluoride levels (0.02 µg F/mL) and increased caries severity (p=0.04); poor hygiene was also linked to more decayed teeth (p<0.05).

Conclusions:

• High caries prevalence in Balsas is associated with inadequate water fluoridation, reflecting critical regional health inequalities.
• Urgent policy interventions are needed to ensure universal water fluoridation and enhance school-based preventive strategies.
• Addressing social determinants is crucial for mitigating the impact on child oral health and development.