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Memorias del Instituto de Investigaciones en Ciencias de la Salud

On-line version ISSN 1812-9528

Mem. Inst. Investig. Cienc. Salud vol.16 no.1 Asunción Apr. 2018 


Endemic fluorosis in localities of Paraguay

Heriberto Atanacio Núñez Mendieta1 

1Dirección General de Investigación Científica y Tecnológica. Universidad Nacional de Asunción. Paraguay

The use of fluorides in the prevention of caries is well known, administered systemically or applied topically on the teeth.

Water fluoridation, in countries such as the United States, has been installed since 1945, using fluoride concentrations between 0.7 and 1.2 mg / L recommended by the Public Health Service (PHS)1.

The initial history of water fluoridation in Paraguay, which lasted only a couple of years, was recorded in the head of the Editorial of the Dental Journal of the Circle of Dentists of Paraguay of 1959: "Asunción: First South American capital with fluorinated tap water "2.

The Center for Disease Control and Prevention (CDC) of the United States recommends a fluoride concentration of 0.8 mg/L with a minimum of 0.7 mg/L and a maximum of 1.3 mg/L in water of consumption for localities with average annual temperature between 21.5ºC and 26.2ºC3. In 2015, the average annual temperature reported in the departments of Paraguay was in the range of 21.5 ºC and 25.4 ºC4.

Fluoride has beneficial and harmful effects on human health depending on the manifestations of concentration, periodicity and time of exposure5,6. In humans, most fluoride is present in calcified tissues (bones and teeth), due to its high affinity for calcium7, so that the manifestations of excess consumption are observed in these structures. Effects on bone (skeletal fluorosis) are considered the most relevant for the evaluation of the adverse effects of long-term exposure5. Dental fluorosis is an irreversible condition and is the first visible sign that a child has been overexposed to fluorides8. It is produced by the consumption of high concentrations of fluoride in the period of tooth formation, causing aesthetic and biological deficiency, which predisposes to the appearance of decay, tooth sensitivity, malocclusion, and self-esteem problems due to the appearance of the teeth. with repercussions in public health given the high costs of restorative treatments9,10.

In a country like ours, with a high prevalence of caries, where fluoridation of water and salt would be recommended, paradoxically there are localities with a high concentration of fluoride in drinking water naturally, with the adverse effects that this entails. In 1949, patients with chalky white color teeth in the city of Concepción of Paraguay were reported11. Since 1998, it is recorded that in Paraguay there are localities that naturally have fluoride concentrations equal to or greater than 1.5 mg/L, even reaching values ​​of 8 mg/L; these localities are in the Departments of Alto Paraná, Concepción, San Pedro and Paraguarí12. In 2002, a study showed a frequency of 50% of dental fluorosis in children of 12 years of age who resided since birth in the localities. More cases were observed in Loreto with 86% of the schoolchildren examined, followed by Yatayty del Norte (66%); Ñacunday presented the fewest number of cases of fluorosis dental (22%)13. In 2018, the Ministry of Public Health and Social Welfare (MSPyBS), together with the Dirección General de Investigación Científica y Tecnológica (DGICT) and the Centro Multidisciplinario de Investigación Tecnológica (CEMIT) of the Universidad Nacional de Asunción (UNA) carried out a study based on reports of cases of dental fluorosis by dentists of the IV Sanitary Region. This study showed high concentrations of fluoride in drinking water in these localities.

Researchers of the Faculty of Odontology of the UNA in association with researchers of CEMIT of the DGICT, and the co-financing of the Consejo Nacional de Ciencia Y Tecnología (CONACYT) within the framework of the PROCIENCIA Program in its component "Promotion of Scientific Research" are developing epidemiological studies in Paraguayan localities with high fluorine content in drinking water.

Currently, the Department of Oral Health of the Ministerio de Salud Pública y Bienestar Social (DSBD-MSPyBS) forms an inter-institutional team with the DGICT-UNA, continuing the line of research through the development of multidisciplinary projects in localities of the Department of Guairá, to determine the frequency of fluorosis and the identification of water sources with low concentrations, which could be an alternative in these localities, after studying the corresponding potability.

In addition, projects are being developed to evaluate the best water treatment system to provide the inhabitants with the benefits of caries prevention and to reduce the incidence of dental fluorosis with the adequate concentration of fluorides. It is intended to install a plan to promote general and oral health, with the provision of aesthetic and functional services in an interdisciplinary and multiprofessional manner that will have a great social impact on the inhabitants of these localities.

If immediate intervention is not carried out by means of a treatment that regulates the concentration of fluoride in the water or the change of sources of supply, with the reported findings on the frequency of dental fluorosis and the concentration of fluorides determined in drinking water, aesthetic and functional, psychological and/or social dental rehabilitation treatments will be only a patch, since future generations will continue to be affected.


1. Beltrán Salazar, M. Investigar las consecuencias del efecto acumulativo del flúor, una necesidad imperante de la profesión odontológica. Rev. Colomb investig odontol. [internet]. 2012 [Consultado febrero 22, 2018];3 (7):55-72. Disponible en: Disponible en: ]

2. Boettner A. Asunción: Primera capital Sud-Americana con agua corriente fluorurada. Editorial. Rev Odontol. COP.1959; 5(2): 7 [ Links ]

3. Centers for Disease Control and Prevention(CDC) Engineering and administrative recommendations for water fluoridation. MMWR. [internet]. 1995 [Consultado marzo 6, 2018] 44 (13):1-40. Disponible en: Disponible en: ]

4. Dirección General de Estadística, Encuestas y Censos (dgeec). Compendio estadístico ambiental del Paraguay 2015. [internet] dgeec, Paraguay; 2017. [Consultado marzo 6, 2018] Disponible en: ]

5. Boischio A. Flúor en el agua de consumo. Nota técnica a partir de los Criterios de Salud Ambiental 227 - Fluoruro. 2002.[internet]. Organización Mundial de la Salud, Ginebra; 2013. [Consultado marzo 6, 2018] Disponible en:Disponible en: ]

6. Romero V, Norris F, Ríos J, Cortés I, González A, Gaete L, et al. Consecuencias de la fluoración del agua potable en la salud humana de la ingesta de fluoruros en el organismo. Salud Pública. Rev Med Chile [revista en Internet] 2017 [consultado marzo 15, 2018]; 145: 240-249. Disponible en: Disponible en: Links ]

7. Recomendaciones sobre el uso de fluoruros para prevenir y controlar la caries dental en los Estados Unidos. Rev Panam Salud Publica. [internet]. 2002 [Consultado marzo 15, 2018] 11(1) Disponible en: Disponible en: ]

8. Hidalgo I, Duque de Estrada J, Mayor F, Zamora J. Fluorosis dental: no solo un problema estético. Rev Cubana Estomatol [Internet]. 2007 [Consultado Marzo, 20 2018]; 44 (4). Disponible en: Disponible en: ]

9. Koch G, Modeér F, Poulsen S, Rasmussen P. Odontopediatria. Enfoque clínico. Montevideo: Medica Panamericana; 1994. [ Links ]

10. Pinkham J. Odontología Pediátrica. 3º ed. México: Mc Graw - Hill; 2001. [ Links ]

11. Circulo de Odontologos del Paraguay. Datos Nacionales. Revista C.O.P. 1960; 3 (5):67. [ Links ]

12. Báez R, Estupiñán S. Análisis Institucional para el Desarrollo de un Programa de Fluoración de la sal. OPS / OMS 1998: 6-41. [ Links ]

13. Núñez HN. Fluorosis dental en niños de localidades del Paraguay con elevado tenor de flúor en las aguas de consumo humano. Mem Inst Investig Cienc Salud. 2011; 9 (1):35-42. [ Links ]

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