The silence of lost smiles: multilevel analysis of edentulism among older adults in contextual and individual interfaces in Brazil (SB Brasil 2023).

OBJECTIVE

To analyze contextual and individual factors associated with edentulism among older adults aged 65-74 years in Brazil, based on data from the SB Brasil 2023 national survey.

METHODS

A cross-sectional study was conducted with 9,745 participants from the 27 Federative Units. Data collection was conducted using standardized questionnaires and clinical examinations. Contextual municipal variables and individual demographic, socioeconomic, service utilization variables were analyzed. Associations were estimated using the Rao-Scott test, adjusted residual analysis, and simple and multiple logistic regression, calculating Odds Ratios (OR) and 95% confidence intervals (95%CI).

RESULTS

The prevalence of edentulism was 36.5%. A higher number of dentists per 3,500 inhabitants showed a protective effect (OR 0.96; p<0.01). The Brazilian Deprivation Index remained positively associated with the outcome, with the highest odds observed in the fifth quintile (OR 1.92; p<0.01). The absence of Dental Specialty Centers (OR 1.25; p=0.03) and Regional Dental Prosthesis Laboratories (OR 1.24; p=0.03) increased the prevalence of edentulism. Women (OR 1.24; p<0.01), age≥median of 69 years (OR 1.74; p<0.01), and low level of education (OR 4.25; p<0.01) were independent odds factors.

CONCLUSION

Edentulism reflects social and structural inequalities in oral health. Expanding access to care and strengthening the public dental service network are essential measures to reduce inequities.