Social intersectional differences in pulpal clinical consequences of untreated dental caries among Brazilian adolescents: analysis of the SB Brasil 2023 survey

Objective: To examine differences in the occurrence of consequences of untreated dental caries (pulpal involvement, ulceration, fistula, and abscess-PUFA) across intersectional social positions defined by sex, skin color, and household income among adolescents. Methods: This study analyzed data from the Brazilian National Oral Health Survey (SB Brasil 2023), using a multi-stage stratified probability sampling design to represent adolescents aged 15–19 years. Social variables were combined into eight intersectional groups based on sex, skin color, and family income. Outcomes included PUFA prevalence ≥1 and counts of its components. Survey-adjusted Poisson regression with robust variance and a three-way interaction term was applied. Results: The sample comprised 8,041 adolescents. Compared to high-income White males, prevalence was higher among low-income Black males (PR=5.93; 95%CI:2.60–13.51) and low-income Black females (PR=4.06; 95%CI:1.85–8.90). The predicted prevalence of PUFA ≥1 ranged from 4.0% (95%CI:2.0–7.0) among high-income White males to 21.0% (95%CI:11.0–32.0) among low-income Black males. Among females, prevalence estimates were 15.0% (95%CI:9.0–20.0) in high-income Black, 16.0% (95%CI:5.0–28.0) in low-income White, and 18.0% (95%CI:12.0–24.0) in low-income Black individuals. Conclusion: Marked differences in PUFA occurrence were observed across intersectional social positions, with the highest burden observed among low-income Black adolescents, particularly males for prevalence ratios, although females also presented high absolute prevalence. These findings reinforce the need for policies addressing structural social inequalities in oral health.