Time-series trends and regional disparities in complete denture production in Brazil (2000–2023): an epidemiological analysis

Abstract

Tooth loss remains a public health problem in Brazil, reflecting social inequality, population aging, and limited access to oral rehabilitation. For many individuals, complete dentures (CD) are the only option available free of charge through the Brazilian Unified Health System (Sistema Único de Saúde, SUS). However, nationwide assessments of service delivery and regional equity in prosthetic rehabilitation are limited. Objective: To quantify national trends and regional disparities in CD production within the SUS and examine how prosthetic output relates to demographic, socioeconomic, and infrastructure indicators using the most recent data available. Methodology: This ecological-analytical time-series study used open data from the SUS Outpatient Information System (SIA/SUS). The analysis included maxillary and mandibular CD procedures recorded between 2000 and 2022, representing the most recent consolidated period for temporal modeling, and a state-level snapshot for 2023 to describe the latest correlational scenario. Production rates were standardized per 100,000 inhabitants. Temporal trends were analyzed using segmented linear regression to estimate the average annual percent change (AAPC), which summarizes overall long-term changes in complete denture production, and to identify inflection points. Correlations between CD production and demographic or socioeconomic indicators were tested using Spearman's rho (α = 0.05). Results: Between 2000 and 2022, a total of 5,239,089 complete dentures were delivered through the Brazilian Unified Health System. CD production increased significantly nationwide from 2000 to 2022 (AAPC = 9.7%; 95% CI: 4.8–14.9), a relatively high annual growth rate for public health service expansion, with the steepest rise between 2006 and 2014 (AAPC = 29.2%; 95% CI: 18.6–40.7). Regional trends varied across the country, with the highest growth observed in the Northeast (AAPC = 16.4%; 95% CI: 11.7–21.3), followed by the North (AAPC = 14.3%; 95% CI: 10.9–17.7), Central-West (AAPC = 13.4%; 95% CI: 4.9–22.5), and South (AAPC = 12.8%; 95% CI: 9.0–16.7), whereas the Southeast showed the smallest expansion (AAPC = 8.0%; 95% CI: –1.7–18.8). In 2023, the SUS network included 2,903 prosthetic laboratories, highlighting the organizational infrastructure supporting prosthetic rehabilitation services. In 2023, São Paulo (Southeast region) produced 111,396 dentures, and Piauí (Northeast region) recorded the highest production rate (833.36 per 100,000 inhabitants). Strong correlations were observed between CD production and population size (ρ = 0.742, p < 0.001) and number of municipalities (ρ = 0.938, p < 0.001). Conclusion: Over the past two decades, complete denture production within the SUS expanded substantially, reflecting the consolidation of Brazil's public oral health policies. However, persistent regional disparities and heterogeneous production rates indicate that service expansion has not translated into equitable coverage nationwide. These findings highlight the importance of demographic and organizational factors in shaping prosthetic service provision and underscore the need for targeted planning and resource allocation to reduce inequalities in access to oral rehabilitation.