Contextual determinants of the occurrence of caries and untreated caries among adults in Brazil: A multilevel study

This multilevel cross-sectional study aimed to identify the contextual factors associated with dental cariesamong adults in Brazil. Data from adults who participated in the National Oral Health Research- SBBrazil 2010 project were included. The dependent variables were “caries occurrence” (measured using the decayed, missing, and filled teeth (DMFT) index) and “untreated caries” (decay component of the DMFT index). To adjust the models, individual independent and independent contextual variables were considered. Negative multilevel binomial regression was conducted, and the mean ratio (MR) was estimated. The study included 9,564 individuals. The mean DMFT among the participants was 16.89 (± 7.27), and the mean number of decayed teeth was 1.79 (± 2.90). In the final model, DMFT was higher for residents in municipalities with lower social inequality and without fluoridated water. On the other hand, the average number of decayed teeth was higher among residents of municipalities with higher social inequality and a lower proportion of dentists per capita, even after adjusting for individual variables. Therefore, social inequality is associated with both outcomes. These findings reinforce the need to reduce social inequalities and ensure greater access to dental care.