Individual and contextual determinants of dental treatment needs of children with primary dentition in Brazil

Abstract

To document levels of dental disease in Brazil, and to appraise contextual and individual determinants of caries experience, we studied the dental status of 26,641 five-year-old schoolchildren, as informed by a country-wide survey of oral health comprising 250 towns and performed in 2002-3. The prevalence of untreated caries was associated with socio-demographic characteristics of examined children (gender, ethnic group, localisation and type of school), and geographic conditions of participating towns (human development index, and differential levels of access to fluoridated tap water), in a multilevel assessment. Better-off Brazilian regions presented an improved profile of dental health. Black children and those studying in rural areas and public schools presented significantly higher odds of having untreated caries. At the town level, dental caries was associated with the fluoride status of tap water, the proportion of households linked to the water network, and with the human development index. Dental caries experience is prone to socio-demographic and geographic inequalities; the monitoring of contrasts in dental outcomes is relevant for programming socially appropriate interventions aimed at improving oral health by targeting groups of population presenting higher levels of needs.