Abstract 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.

Resumo Os dentifrícios fluoretados comercializados para crianças devem conter concentração mínima de 1000 ppm de fluoreto (F), que deve ser quimicamente solúvel para ter efeito anticárie. Portanto, determinamos as concentrações de fluoreto total (FT) e fluoreto solúvel total (FST) em dentifrícios comercializados para crianças no Brasil e no México e analisamos as regulamentações vigentes em ambos os países. Vinte e quatro marcas foram encontradas e adquiridas no Brasil (19 formuladas com NaF/SiO2, três com Na2FPO3/CaCO3 e duas com Na2FPO3/SiO2) e seis no México (todas com NaF/SiO2). As concentrações de FT e FST foram determinadas após a compra (amostras frescas), e a estabilidade do fluoreto nas formulações de Na2FPO3/CaCO3 foi verificada após 18 meses. As análises foram realizadas com eletrodo íon-específico e os resultados expressos em ppm F (mg F/kg). As concentrações de FT encontradas variaram de 476,0 a 1.385,3 ppm F e foram próximas às declaradas pelos fabricantes (500 a 1.450 ppm F). As concentrações de FT encontradas não ultrapassaram 1.500 ppm F, de acordo com as regulamentações vigentes de ambos os países. No entanto, dentifrícios com concentrações de FST inferiores a 1.000 ppm F foram encontrados tanto em dentifrício com baixa concentração (500 ppm F) formulado com NaF/SiO2 como em dentifrícios com Na2FPO3/CaCO3 frescos e envelhecidos, originalmente fabricados com 1.000-1.100 ppm de FT. Em conclusão, embora a maioria dos dentifrícios analisados apresentasse concentração de FST superior a 1.000 ppm F, as regulamentações vigentes em ambos os países permitem que produtos que não estejam de acordo com a melhor evidência disponível estejam presentes no mercado.

Abstract Fluoride toothpastes market to children should contain a minimum concentration of 1000 ppm of fluoride (F), which must be chemically soluble to provide anti-caries effect. Therefore, we determined the concentrations of total fluoride (TF) and total soluble fluoride (TSF) in toothpastes marketed to children in Brazil and Mexico and analyzed the current regulations in force in both countries. Twenty-four brands were found and purchased in Brazil (19 formulated with NaF/SiO2, three with Na2FPO3/CaCO3 and two with Na2FPO3/SiO2) and six in Mexico (all with NaF/SiO2). TF and TSF concentrations were determined after the purchase (fresh samples) but fluoride stability in Na2FPO3/CaCO3-formulations was checked after 18 months. The analyses were performed with an ion-specific electrode and the results expressed in ppm F (mg F/kg). The TF concentrations found ranged from 476.0 to 1385.3 ppm F and they were close the declared by the manufactures (500 to 1450 ppm F). The TF concentrations found were not greater than 1500 ppm F, in accordance with the current regulations of both countries. However, toothpastes presenting TSF concentrations lower than 1000 ppm F were found either in low fluoride toothpaste (500 ppm F) formulated with NaF/SiO2 as in fresh and aged Na2FPO3/CaCO3-toothpastes, originally fabricated with 1000-1100 ppm of TF. In conclusion, although most toothpastes analyzed showed TSF concentration higher than 1000 ppm F, the regulations in force in both countries allow that products not in agreement with the best available evidence are available in the market.

Abstract Dental caries remains highly prevalent in Latin American and Caribbean countries (LACC). However, this disease can be controlled through interventions that implement evidence-based strategies in an affordable manner and that target all population groups instead of the most affluent only. Therefore, the aim of this report was to summarize the main scientifically documented community interventions and strategies based on restriction of sugars consumption, use of fluoride, and the use of occlusal sealants for caries control in LACC. A critical literature review was carried out in a systematic manner that included defined search strategies, independent review of the identified publications, and compilation of results in this report. Three systematic searches were conducted using the PubMed, LILACS, and SciELO databases to identify studies related to community interventions and strategies for caries control in LACC. Of the 37 publications identified, twenty-six focused on fluoride use, eight on occlusal sealant use, and three on the restriction of sugar consumption. Documented community interventions for sugars restriction were scarce in the region and were based on food supplementation, sugar replacement, and education. Thus, local and/or national policies should prioritize investment in upstream, coherent, and integrated population-wide policies such as taxes on sugary drinks and stronger regulation of advertising and promotion of sugary foods and drinks mainly targeting children. The main fluoride-based strategies used drinking water, refined domestic salt, cow milk, toothpaste and, to a lesser extent, mouth-rinses, acidulated phosphate fluoride (APF) gels, and varnishes to deliver fluoride to the population. Evidence of fluoride use was seen in Argentina, Belize, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay, and Venezuela. Studies reporting the use of occlusal sealants were mainly located in Brazil, Chile, Colombia, Costa Rica, Peru, Mexico, and Venezuela. Community interventions restricting sugar consumption should be implemented at the individual level and through public policies. The use of fluoride must be monitored at the local, regional, and national levels so as to achieve maximum anti-caries effect while also minimizing the risk of dental fluorosis. Moreover, fluoridated water and salt programs, used as a mutually exclusive community level strategy for caries control, should expand their benefits to reach non-covered areas of the LACC while also simultaneously providing adequate surveillance of the fluoride concentration delivered to the population. Regulating the concentration of soluble fluoride (for anti-caries effect) in dentifrice formulations is also necessary in order to provide the population with an effective strategy for disease control. Targeting culturally appropriate, economically sustainable caries control interventions to rural populations and native ethnic groups such as indigenous people, quilombolas (African-origin), and riverside Amazonian people remains a crucial challenge.

Para ter relevância em termos de saúde pública, os cremes dentais amplamente utilizados pela população devem ter fluoreto (F) solúvel numa concentração mínima de 1.000 ppm F. Assim, as concentrações de fluoreto total (FT) e flureto solúvel total (FST) nos cremes dentais mais vendidos no Brasil foram avaliados. Os cremes dentais (n=3) Colgate Anti-cáries®, Colgate Total 12 Clean Mint®, Colgate Tripla Ação Menta Original®, Colgate Tripla Ação Menta Suave® e Sorriso Dentes Brancos® foram obtidos nas cinco regiões do país. As concentrações de FT e FST foram analisadas com eletrodo íon-específico calibrado com padrões de F e os resultados foram expressos em ppm (µg F/g). Todos os cremes dentais apresentaram concentração de FT inferior a 1.500 ppm F (1.388,2 ± 25,8 a 1.483,2 ± 98,2). Os valores de FST foram superiores a 1.000 ppm F e variaram de 1.035,5 ± 61,5 a 1.221,8 ± 35,2 para cremes dentais a base de carbonato de cálcio/monofluorfosfato e de 1.455,6 ± 12,5 a 1.543,0 ± 147,3 para o creme dental à base de sílica/fluoreto de sódio. Os cremes dentais mais vendidos no Brasil apresentaram concentração de fluoreto solúvel para controlar cárie, independentemente da região onde foram comprados.

To be relevant in terms of public health, widely-used toothpastes should have at least 1,000 ppm of soluble fluoride (F) concentration. Thus, the concentrations of total fluoride (TF) and total soluble fluoride (TSF) in the top-selling Brazilian toothpastes were evaluated. Samples (n=3) from toothpastes Colgate Anti-cáries®, Colgate Total 12 Clean Mint®, Colgate Tripla Ação Menta Original®, Colgate Tripla Ação Menta Suave® and Sorriso Dentes Brancos® were obtained from each of the five regions of the country. The concentrations of TF and TSF were analyzed with ion-specific electrode calibrated with F standards and the results were expressed in ppm (µg F/g). All toothpastes showed TF concentration lower than 1,500 ppm F (1,388.2 ± 25.8 to 1,483.2 ± 98.2). The TSF values were higher than 1,000 ppm F and ranged from 1,035.5 ± 61.5 to 1,221.8 ± 35.2 for calcium carbonate/monofluorophosphate-based toothpastes and from 1,455.6 ± 12.5 to 1,543.0 ± 147.3 for silica/sodium fluoride-based toothpaste. Top-selling Brazilian toothpastes presented available fluoride concentration to control caries regardless of the region where they are purchased.

A perda da pré-carga pode favorecer o desajuste da interface implante-pilar e a colonização bacteriana nesta interface pode levar a perda de implantes. O objetivo deste estudo foi avaliar a perda de pré-carga e a infiltração bacteriana através da interface implante-pilar de sistemas de conexão cônica e hexágono externo, submetidos à ciclagem térmica e fadiga mecânica (CF). Quatro diferentes sistemas de conexão implante-pilar foram avaliados (n=6): hexágono externo com munhão universal, cone Morse com munhão universal, cone Morse com munhão universal parafuso passante e cônica justaposição com pilar padrão. Os espécimes (implante-pilar) foram submetidos à ciclagem térmica (1000 ciclos a 5°C e 55°C) e à fadiga mecânica (1,0 milhão de ciclos, 1,0 Hz, 120 N). Os espécimes foram imersos em caldo Tryptic Soy + Yeast Extract contendo Streptococcus sanguinis e incubados a 37°C e 10% de CO2 por 72 h. Os valores de destorque foram registrados. A infiltração bacteriana foi avaliada e os pilares foram observados por microscopia eletrônica de varredura. Os dados de pré-carga foram analisados estatisticamente por ANOVA a dois critérios e teste de Tukey, com nível de significância de 5%. Todos os sistemas de pilares parafusados apresentaram maiores valores de destorque quando submetidos à CF (p<0,05) e todos os sistemas cônicos apresentaram infiltração bacteriana. Os resultados mostram que não houve relação entre a perda da pré-carga e a infiltração bacteriana.

Preload loss can favor the occurrence of implant-abutment interface misfit, and bacterial colonization at this interface may lead to implant failure. The aim of this study was to evaluate the preload loss and bacterial penetration through the implant-abutment interface of conical and external hexagon connection systems subjected to thermal cycling and mechanical fatigue (TM). Four different implant-abutment connection systems were evaluated (n=6): external hexagon with universal post, Morse taper with universal post, Morse taper with universal post through bolt, and locking taper with standard abutment. The assemblies (implant-abutment) were subjected to a thermal cycling regimen (1,000 cycles of 5°C and 55°C) and to mechanical fatigue (1.0 million cycles, 1.0 Hz, 120 N). The assemblies were immersed in Tryptic Soy + Yeast Extract broth containing Streptococcus sanguinis and incubated at 37°C and 10% CO2 for 72 h. Detorque values were recorded. The bacterial penetration was assessed and the abutments were observed by scanning electron microscopy. The preload data were analyzed statistically by two-way ANOVA and Tukey’s test at 5% significance level. All screw abutment systems showed significantly higher (p<0.05) detorque values when subjected to TM and all conical systems presented bacterial penetration. The results show no relationship between the preload loss and the bacterial penetration.