Individual and contextual factors associated with tooth loss among Brazilian older adults

OBJECTIVE: To assess factors associated with functional dentition, severe tooth loss, and edentulism among Brazilian older adults, investigating individual sociodemographic characteristics and contextual characteristics of municipal oral health services. METHODS: This is a cross-sectional, analytical study with data from the SB Brasil 2023 survey on individuals aged 65-74 years. Tooth loss was evaluated based on three outcomes: functional dentition (≥20 permanent teeth), severe tooth loss (<10 remaining teeth), and edentulism (loss of all permanent teeth). Multilevel logistic regression accounted for the complex sampling design. Individual variables were sex, ethnicity/race, per capita household income, and level of education; contextual variables were oral health coverage in Primary Health Care and the presence of Dental Specialty Centers (CEO) and Regional Dental Prosthesis Laboratories (LRPD) (p<0.05). RESULTS: Oral health coverage in Primary Health Care and the presence of CEO and LRPD were not associated with edentulism (p>0.05). Functional dentition was less likely among women (OR 0.66; 95%CI 0.57-0.76) and among residents of municipalities with oral health coverage ≥80% (OR 0.74; 95%CI 0.56-0.97). Higher income and level of education were associated with higher prevalence of functional dentition (p<0.05). Severe tooth loss and edentulism were more frequent among women and older adults with lower income and lower level of education (p<0.05). Severe tooth loss was less prevalent in municipalities with CEO (p<0.05). CONCLUSION: Individual socioeconomic variables and contextual characteristics of oral health services were associated with tooth loss among older adults, evidencing the persistence of social inequalities in this outcome.