Race/skin color and educational inequalities in toothache and access to dental care among adults in Brazil: National Oral Health Survey2023.

OBJECTIVE

To assess the association between race/skin color and educational level with toothache and access to dental care among adults aged 35-44 years in Brazil.

METHODS

This cross-sectional study included 8,597 adults who participated in the Brazilian National Oral Health Survey 2023 (SB 2023). Two outcomes were evaluated: the prevalence of toothache in the previous six months and access to dental care among adults who reported toothache. Crude and adjusted Poisson regression models with robust variance were used to estimate the associations of race/skin color, educational level, and the intersection of these two social markers with the outcomes.

RESULTS

The prevalence of toothache in the previous six months was 23.7%. Among adults who reported toothache, 34.1% did not access dental care. Black adults (adjusted prevalence ratio [PRa]=1.32; 95%CI 1.1-1.7; p=0.034) and those with low educational attainment (aPR=2.1; 95%CI 1.4-2.9; p<0.0001) showed a higher prevalence of toothache. In the intersectional analysis, Black adults with low educational attainment had a higher prevalence of toothache (aPR=3.5; 95%CI 2.0-6.0; p<0.0001) and of not having consulted a dentist despite experiencing pain (PRa=2.5; 95%CI 1.3-4.0; p=0.006) compared with White adults with high educational attainment.

CONCLUSION

Black adults with low educational attainment showed a higher prevalence of toothache and lack of access to dental care even when experiencing pain, indicating that race/skin color and educational level are important determinants of oral health inequalities in Brazil.