An important decline in DMFT was observed between 1980 and 2003, perhaps as a result of increased access to fluoridated water and toothpaste and of changes in the goals of public oral health programs. Despite the improvement, caries is unevenly distributed in the pediatric population; a small proportion of individuals carries most of the disease burden. In addition, the proportion of teeth with caries that went untreated did not change between 1980 and 2003. Reducing socioeconomic disparities and adopting public health measures that target and reach the most vulnerable groups remain a challenge for policy makers in Brazil.

No início do século XX a cárie dentária era um problema de saúde pública, na maior parte do planeta. As populações conviviam com infecção, dor, sofrimento e mutilação. A descoberta do efeito preventivo do flúor o transformou, ao longo do século, no principal agente utilizado no enfrentamento da doença em todo o mundo. Em vários países e também no Brasil produtos fluorados têm sido apontados como os principais responsáveis pelo declínio observado na prevalência da cárie. No Brasil, estudos pioneiros realizados nos anos 50 e 60 corroboraram a eficácia preventiva da fluoretação das águas. No período 1986-1996, com 42% da população recebendo água fluoretada, a queda na prevalência da cárie entre crianças de 12 anos de idade foi de 53%. Além da água fluoretada também os dentifrícios são, no presente, amplamente utilizados como veículos para uso do flúor em saúde pública. Neste artigo são abordados aspectos históricos do emprego de flúor, algumas características epidemiológicas da cárie dentária no Brasil, e as perspectivas da continuidade do uso de produtos fluorados nas próximas décadas.

An improved characterization of the skewed distribution of caries experience demands the concurrent estimation of figures of prevalence and inequality in dental outcomes. This strategy may contribute to the design of socially appropriate programmes of oral health promotion.

The SBBrasil 2010 Project (SBB10) (5, 12, 15-19, 35-44, and 65-74 years).

This text systematizes available knowledge about the main dental health policies in Brazil in regards to their current degree of implementation and their impact on health inequalities. Although the fl uoridation of publicly distributed water is legally mandated in Brazil, its implementation has been subject to marked regional inequalities. Data are presented about the extent of implementation for the intervention, and studies are reviewed that evaluate the intervention's impact upon increasing inequality in the experience of dental caries. The provision of public dental services, which expanded considerably after the implementation of the National Unifi ed Health Care System, is also discussed in relation to service provision and its impact on reducing inequality in access to dental treatment. The discussion of the differential effect of these interventions allowed for the proposal of targeted strategies (directing fl uoridation to areas of greater need), aiming to reduce inequalities in the experience of dental caries in Brazil.

This essay focuses on the pioneer activities of public health dentistry in Brazil and its evolution in the 20 th century with emphasis on the emergency of a landmark, the sanitary dentistry. Social and preventive dentistry and market dentistry, with reference to the main theoretical works representative of these trends, are presented. The essential characteristics of collective oral health (Brazilian variant of public health dentistry) and buccality are presented. The relationship between collective oral health and collective health as well as the implications of the buccality concept for the development of public health dentistry actions and new guidance of clinical practice in public services of the Brazilian Health System (SUS) are discussed. The key elements of an agenda for collective oral health based on proposals presented at the 3 rd National Conference on Oral Health are addressed.

No abstract

The heterogeneous distribution of caries indexes by areas of the city indicates higher levels of dental decay in areas of social deprivation. The delimitation of areas with increased risk of caries and greater dental treatment needs should be helpful to public health services for the formulation of policies and the targeting of resources to address these problems.