Tooth loss in Brazilian adolescents: a multilevel cross-sectional study

Objective: To investigate factors associated with tooth loss among Brazilian adolescents aged 15 and 19 years. Methods: This is a cross-sectional study conducted based on secondary data from the National Survey of Oral Health (SB Brasil 2023), carried out by the Ministry of Health. Variables were analyzed at the individual (sociodemographic characteristics, oral morbidity, and use of dental services), municipal, and state levels. Multilevel Poisson regression models with robust variance were developed to estimate unadjusted and adjusted prevalence ratios. The present study included 8,053 adolescents who participated in the SB Brasil 2023. Results: The prevalence of tooth loss in this population was 13.77%. Individual and contextual factors were associated with this condition. Each one-year increase in age was associated with a 19% higher prevalence of tooth loss. Higher prevalence was identified among beneficiaries of social programs (25%), adolescents reporting toothache (66%), and users of public health services (23%) compared with those using private services. Greater oral health coverage in Primary Health Care, Gross Domestic Product, and Human Development Index were associated with lower prevalence of the outcome. Conclusion: Tooth loss among Brazilian adolescents aged 15 to 19 years remains a condition influenced by sociodemographic factors, socioeconomic inequalities, oral morbidity, and predominantly curative access to dental services. Our findings highlight the need to strengthen preventive and equitable actions, especially for vulnerable populations, to reduce regional disparities and promote better oral health outcomes at the national level.