Social inequalities and untreated dental caries in 5-year-old children: an intersectional analysis based on SB Brasil 2023

Azevedo, Monarko Nunes de; Alencar, João Victor Alves; França, Mary Anne de Souza Alves; Melo, Marcos Vinicius Rodrigues de; Santos, Matheus Ribeiro dos; Mendes, Gustavo Adolfo Martins; Pereira, Edsaura Maria

doi:10.1590/1980-549720260014.supl.1

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ORIGINAL ARTICLE • Rev. bras. epidemiol. 29 (Suppl 1) • 2026 • https://doi.org/10.1590/1980-549720260014.supl.1 linkcopy

Social inequalities and untreated dental caries in 5-year-old children: an intersectional analysis based on SB Brasil 2023

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: To identify intersectional vulnerability profiles among 5-year-old children with untreated dental caries and to analyze associated social inequalities in Brazil.

Methods: This is a population-based, cross-sectional study using data from the National Survey of Oral Health (SB Brasil 2023). Five-year-old children examined in the survey were included. The variables used to identify profiles were: race/skin color, household income, maternal level of education, beneficiaries of social welfare programs, and region of residence. For profile comparison, the variables “last dental appointment” and “presence of piped water at home” were used. Descriptive, bivariate (χ²), Two-Step Cluster, and binary and multinomial logistic regression analyses were performed.

Results: A total of 7,185 children were analyzed, of whom 44.8% presented untreated dental caries. Higher prevalence values were observed among children with low maternal education (51.9%), Black (49.9%) and Indigenous (75.0%), low income (54.1%), living in the North (56.3%) region, and beneficiaries of social welfare programs (53.0%) (p<0.001). Three profiles were identified: Profile A (boys, Black, from the Northeast, low income, and high dependence on social welfare programs) showed lower probability of dental appointment in the past 2 years (OR 0.59; 95%CI 0.48-0.73; p<0.001); Profile B (boys, White, from the Northeast, low income, and beneficiaries of social welfare programs) showed worse conditions regarding the presence of piped water at home (OR 0.38; 95%CI 0.19-0.76; p=0.006); and Profile C (girls, Black, from the North, higher income, and lower dependence on social welfare programs) concentrated the best conditions for dental appointment and piped water (p<0.001).

Conclusion: Untreated dental caries among 5-year-old children reflects structural inequities combining racial, socioeconomic, territorial, and income-related inequalities.

Keywords:
Dental caries; Social determinants of health; Health inequalities; Intersectionality

Characteristics	n (%)
Sex
Boys	3,670 (51.1)
Girls	3,515 (48.9)
Region
North	1,767 (24.6)
Northeast	2,633 (36.6)
Southeast	842 (11.7)
South	859 (12.0)
Midwest	1,084 (15.1)
Race/skin color
White	2,488 (34.6)
Black	4,450 (61.9)
Asian	76 (1.1)
Indigenous	24 (0.3)
Not informed	147 (2.0)
Maternal level of education
Illiterate/Youth and Adult Education	658 (9.2)
Incomplete or complete Elementary School	1,847 (25.7)
Incomplete or complete High School	2,926 (40.7)
Incomplete or complete Higher Education	1,115 (15.5)
Not informed	639 (8.9)
Income (minimum wage)^a
Less than 1	1,978 (27.5)
From 1 to 2	1,661 (23.1)
More than 2	1,158 (16.1)
Not informed	2,388 (33.2)
Family beneficiary of social welfare program
Yes	3,499 (48.7)
No	3,029 (42.2)
Not informed	657 (9.1)
Last dental appointment
Has never visited a dentist	2,878 (40.1)
In the last 2 years	3,658 (50.9)
Over 2 years ago	334 (4.6)
Not informed	315 (4.4)
Piped water at home
With plumbing	6,570 (91.4)
Without plumbing	171 (2.4)
Not informed	444 (6.2)
Tooth decay
No decayed teeth	3,965 (55.2)
≥1 decayed tooth	3,220 (44.8)

Characteristics	No decayed teeth n (%)	≥1 decayed tooth n (%)	p-value
Sex
Boys	1,982 (54.0)	1,688 (46)	0.040
Girls	1,983 (56.4)	1,532 (43.6)	0.040
Region
North	773 (43.7)	994 (56.3)	<0.001
Northeast	1,416 (53.8)	1,217 (46.2)
Southeast	576 (68.4)	266 (31.6)
South	563 (65.5)	296 (34.5)
Midwest	637 (58.8)	447 (41.2)
Race/skin color
White	1,607 (64.6)	881 (35.4)	<0.001
Black	2,229 (50.1)	2,221 (49.9)
Asian	43 (56.6)	33 (43.4)
Indigenous	6 (25.0)	18 (75.0)
Maternal level of education
Illiterate/Youth and Adult Education	354 (53.8)	304 (46.2)	<0.001
Incomplete or complete Elementary School	888 (48.1)	959 (51.9)
Incomplete or complete High School	1,586 (54.2)	1,340 (45.8)
Incomplete or complete Higher Education	804 (72.1)	311 (27.9)
Income (minimum wage)
Less than 1	908 (45.9)	1,070 (54.1)	<0.001
From 1 to 2	875 (52.7)	786 (47.3)
More than 2	818 (70.6)	340 (29.4)
Family beneficiary of social welfare program
Yes	1,644 (47.0)	1,855 (53.0)	<0.001
No	1,938 (64.0)	1,091 (36.0)	<0.001
Last dental appointment
Has never visited a dentist	1,605 (55.8)	1,273 (44.2)	0.715
In the last 2 years	2,003 (54.8)	1,655 (45.2)
Over 2 years ago	185 (55.4)	149 (44.6)
Piped water at home
With plumbing	3,610 (54.9)	2,960 (45.1)	<0.001
Without plumbing	69 (40.4)	102 (59.6)	<0.001

Characteristics	Profile A 50.6% (1,030)	Profile B 16.0% (325)	Profile C 33.5% (682)
Sex
Boys	55.7	50.2	48.8
Girls	44.3	49.8	51.2
Region
North	33.5	22.8	31.4
Northeast	49.4	41.5	20.4
Southeast	3.6	4.9	11.6
South	2.7	17.5	17.9
Midwest	10.8	13.2	18.8
Race/skin color
White	0.0	92.0	34.8
Black	100	0.0	64.4
Asian	0.0	4.9	0.3
Indigenous	0.0	3.1	0.6
Maternal level of education
Illiterate/Youth and Adult Education	8.4	8.0	11.1
Incomplete or complete Elementary School	41.7	35.7	21.7
Incomplete or complete High School	45.3	52.3	45.0
Incomplete or complete Higher Education	4.5	4.0	22.1
Income (minimum wage)
Less than 1	66.0	63.1	14.8
From 1 to 2	34.0	30.8	41.3
More than 2	0.0	6.2	43.8
Family beneficiary of social welfare program
Yes	95.9	90.8	8.7
No	4.1	9.2	91.3

Profile	Last dental appointment				Piped water at home
Profile	Has never visited a dentist (%)	In the last 2 years (%)	Over 2 years ago (%)	p-value^§	With plumbing (%)	Without plumbing (%)	p-value^§
Profile A*	47.7	48.0	4.4	<0.001	96.8	3.2	0.018
Profile B^†	43.2	51.2	5.6		94.4	5.6
Profile C^‡	35.0	59.2	5.8		97.8	2.2

Profile	Category	OR	95%CI	p-value^§
Piped water at home
Profile A*	Without plumbing	0.68	0.37-1.26	0.217
Profile B^†	Without plumbing	0.38	0.19-0.76	0.006
Profile C^‡	Ref.	-	-	-
Last dental appointment
Profile A*	Over 2 years ago	0.55	0.35-0.87	0.011
Profile B^†	Over 2 years ago	0.78	0.43-1.42	0.415
Profile C^‡	Ref.	-	-	-
Profile A*	In the last 2 years	0.59	0.48-0.73	<0.001
Profile B^†	In the last 2 years	0.70	0.53-0.93	0.012
Profile C^‡	Ref.	-	-	-

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[TFN1] *The household income variable was self-reported in ranges of minimum wages. During the collection period of SB Brasil 2023 (March/2022 to March/2024), the Brazilian minimum wage ranged from BRL 1,212.00 (2022), BRL 1,302.00 (Jan.-Apr./2023), to BRL 1,320.00 (May/2023-2024).