Prevalence of dental fluorosis in regions supplied with non-fluoridated water in the Brazilian territory: a systematic review and meta-analysis

• Published in: Ciência & saude coletiva Vol. 24; no. 8; pp. 2909 - 2922
• Main Authors: Lima, Igor Felipe Pereira, Nóbrega, Diego Figueiredo, Cericato, Graziela Oro, Ziegelmann, Patrícia Klarmann, Paranhos, Luiz Renato
• Format: Journal Article
• Language: English
• Published: Brazil Associacao Brasileira de Pos-Graduacao em Saude Coletiva - ABRASCO 01.08.2019; Associação Brasileira de Saúde Coletiva
• Subjects: Brazil - epidemiology; Cities; Dental fluorosis; Fluoridation; Fluorides - chemistry; Fluorosis, Dental - epidemiology; Groundwater; Groundwater - chemistry; Heterogeneity; Humans; Mathematical models; Meta-analysis; Prevalence; Risk analysis; Risk Factors; Statistical tests; Subgroups; Systematic review; Brazil; Cities; Brasil
• ISSN: 1413-8123; 1678-4561
• DOI: 10.1590/1413-81232018248.19172017

This systematic review and meta-analysis aimed to estimate and compare the prevalences of dental fluorosis in Brazilian cities supplied with non-fluoridated water and in locations that uses groundwater. In December of 2016, cross-sectional studies were searched in eight databases, including the "grey literature". The prevalences were estimated through a mixed random effects model considering the locations as subgroups. The heterogeneity among the studies was assessed with I2 statistics and the Cochran's Q test. A total of 1038 records were found, from which only 18 articles met the inclusion criteria and were subjected to analysis. The meta-analytic model estimated a prevalence of dental fluorosis of 8.92 % (95 % CI: 5.41 % to 14.36 %) in cities supplied with non-fluoridated water, and of 51.96 % (95 % CI: 31.03 % to 72.22 %) in cities supplied by artesian wells. The heterogeneity among the studies was high: I2 = 95 % (p < 0.01) in the first subgroup of cities and I2 = 98 % (p < 0.01) in the second subgroup. The prevalence was significantly higher (p < 0.001) in populations exposed to artesian well water, indicating that the presence of natural fluoride at high concentrations represents a risk factor for the occurrence of dental fluorosis.