Multilevel assessment of determinants of dental caries experience in Brazil.
OBJECTIVE
To examine contextual and individual determinants of dental caries experience, documenting levels of the disease in Brazil.


METHODS
The dental status of 34 550 12-year-old schoolchildren was informed by a country-wide survey of oral health comprising 250 towns and performed in 2002-2003. Indices assessing dental caries experience were compared by sociodemographic characteristics of examined children (gender, ethnic group, localization and type of school), and geographic characteristics of participating towns [the human development index (HDI), and access to fluoridated tap water]. A multilevel model fitted the adjustment of untreated caries to individual and contextual covariates.


RESULTS
Better-off Brazilian regions presented an improved profile of dental health, besides having a less unequal distribution of restorative dental treatments between blacks and whites, rural and urban areas, and public and private schools. Girls [odds ratio (OR)=1.1; 95% confidence interval (CI): 1.0-1.1], blacks (OR=1.6; 95% CI: 1.5-1.7), and children studying in rural areas (OR=1.9; 95% CI: 1.7-2.0) and public schools (OR=1.7; 95% CI: 1.6-1.9) presented higher odds of having untreated decayed teeth. The multilevel model identified the fluoride status of tap water (beta=-0.3), the proportion of households linked to the water network (beta=-0.3), and the HDI (beta=-0.2), as town-level variables associated with caries levels.


CONCLUSIONS
Dental caries experience is prone to sociodemographic and geographic inequalities. The monitoring of contrasts in dental health outcomes is relevant for programming socially appropriate interventions aimed both at overall improvements and at the targeting of resources for groups of population presenting higher levels of needs.
Antunes
José Leopoldo Ferreira
JL
School of Dentistry, University of São Paulo, São Paulo, SP, Brazil. leopoldo@usp.br
Peres
Marco Aurélio
MA
de Campos Mello
Tatiana Ribeiro
TR
Waldman
Eliseu Alves
EA
D044383:Black People / Q000706:statistics & numerical data; D001938:Brazil / Q000453:epidemiology; D002648:Child; D004245:DMF Index; D003731:Dental Caries / Q000453:epidemiology*; D003793:Dental Restoration, Permanent / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D005457:Fluoridation / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D017149:Private Sector / Q000706:statistics & numerical data; D017150:Public Sector / Q000706:statistics & numerical data; D012423:Rural Health / Q000706:statistics & numerical data; D012574:Schools / Q000706:statistics & numerical data; D012737:Sex Factors; D012923:Social Class; D016388:Tooth Loss / Q000453:epidemiology; D014504:Urban Health / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data