Inequalities in Oral Health among Older Brazilians: A Cross-Sectional Analysis of a National Survey

Rosana Leal do Prado, Cléa Adas Saliba Garbin, Suzely Adas Saliba Moimaz, Nemre Adas Saliba


Objective: To investigate the association of tooth loss and periodontal disease with socioeconomic and demographic factors, the need for and use of health services, and the effect of oral health on the daily lives of older Brazilians. Material and Methods: We abstracted data from a nation-wide, representative, cross-sectional survey of 7619 Brazilians aged between 65 to 74 years. Poisson regression models were created to investigate associations between oral diseases and income, education level, gender, ethnicity, region of residence, and use of dental services; statistical significance was set at 5%. Results: The mean age of the 7619 subjects studied was 69 years (95% Confidence Interval, 68.9–69.1); 61.9% were women. Regarding ethnicity, 46.95% were White, 38.90% were Brown, 11.54% were Black and 2.53% belonged to other ethnic groups. Bleeding on probing or dental calculus was present in 26.67% of subjects, whereas LOA was present in 87.27%. The loss of at least one tooth was observed in 48.90% of subjects, while 47.03% were completely edentulous. Low educational status increased the prevalence ratio (PR) of all diseases (loss of attachment, PR=5.54; bleeding on probing, PR=3.93; tooth loss, PR=2.24; edentulousness, PR=3.34). The prevalence of tooth loss was 2.58 times higher in subjects who reported a monthly income of less than 301 USD. The effect on daily life was occasionally a protective factor and occasionally increased the likelihoods of diseases. Conclusion: These findings substantiate the association of socioeconomic conditions, demographic features, and use of dental services with bleeding on probing, presence of dental calculus, loss of periodontal attachment, tooth loss, and edentulousness among older Brazilian subjects.


Oral Health; Health Status Disparities; Socioeconomic Factors; Tooth Loss.

Full Text:



Simões CCS. Relações entre as alterações históricas na dinâmica demográfica brasileira e os impactos decorrentes do processo de envelhecimento da população. Rio de Janeiro: IBGE; 2016.

Malta DC, Stopa SR, Szwarcwald CL, Gomes NL, Silva Júnior JB, Reis AAC. Surveillance and monitoring of major chronic diseases in Brazil – National Health Survey, 2013. Rev Bras Epidemiol 2015; 18(S2):3-16. doi: 10.1590/1980-5497201500060002.

Gonda T, MacEntee MI, Kiyak A, Persson GR, Persson RR, Wyatt C. Predictors of multiple tooth loss among socioculturally diverse elderly subjects. Int J Prosthodont 2013; 26(2):127-34. doi: 10.11607/ijp.2893.

Holmlund A, Holm G, Lind L. Number of teeth as a predictor of cardiovascular mortality in a cohort of 7,674 subjects followed for 12 years. J Periodontol. 2010; 81(6):870-6. doi: 10.1902/jop.2010.090680.

Rodrigues HL, Scelza MFZ, Boaventura GT, Custódio SM, Moreira EAM, Oliveira DL. Relation between oral health and nutritional condition in the elderly. J Appl Oral Sci 2012;

(1):38-44. doi: 10.1590/S1678-77572012000100008.

Nazir MA. Prevalence of periodontal disease, its association with systemic diseases and prevention. Int J Health Sci 2017; 11(2):72-80.

Grubbs V, Vittinghoff E, Beck JD, Kshirsagar A V, Wang W, Griswold ME, et al. Association between periodontal disease and kidney function decline in African Americans: The Jackson Heart Study. J Periodontol 2015; 86(10):1126-32. doi: 10.1902/jop.2015.150195.

Hayasaka K, Tomata Y, Aida J, Watanabe T, Kakizaki M, Tsuji I. Tooth loss and mortality in elderly Japanese adults: Effect of oral care. J Am Geriatr Soc 2013; 61(5):815-20. doi: 10.1111/jgs.12225.

Shepherd S. Alcohol consumption a risk factor for periodontal disease. Evid Based Dent 2011; 12(3):76. doi: 10.1038/sj.ebd.6400808.

Fonesca FA, Jones KM, Mendes DC, dos Santos Neto PE, Ferreira RC, Pordeus IA, et al. The oral health of seniors in Brazil: Addressing the consequences of a historic lack of public health dentistry in an unequal society. Gerodontology 2015; 32:18-27. doi: 10.1111/ger.12046.

Moreira MSC, Santiago BM, Oliveira CR, Vieira TI, Gondim BL, Valença AMG. Social capital and self-perceived need for complete denture use or exchange. Rev Odonto Cienc 2014; 29(2):57-62. doi: 10.15448/1980-6523.2014.2.13022.

Valente MIB, Vettore MV. Contextual and individual determinants of periodontal disease: Multilevel analysis based on Andersen’s model. Community Dent Oral Epidemiol 2017; 1-8. doi: 10.1111/cdoe.12349.

Listl S, Broadbent JM, Thomson WM, Stock C, Shen J, Steele J, et al. Childhood socioeconomic conditions and teeth in older adulthood: Evidence from SHARE wave 5. Community Dent Oral Epidemiol 2017; 1-10. doi: 10.1111/cdoe.12332.

Sabbah W, Tsakos G, Chandola T, Sheiham A, Watt RG. Social gradients in oral and general health. J Dent Res 2007; 86(10):992-6. doi: 10.1177/154405910708601014.

United Nations Development Programme. Human development report 2016: Human Development for Everyone. New York: UNDP, 2016.

Brasil, Ministério da Saúde. Coordenação Geral de Saúde Bucal. Banco de dados da Pesquisa Nacional de Saúde Bucal – Projeto SBBrasil 2010. [cited 2017 Dec 12]. Available from:

Roncalli AG, Silva NN Da, Nascimento AC, Freitas CHSDM, Casotti E, Peres KG, et al. Relevant methodological issues from the SBBrasil 2010 Project for national health surveys. Cad Saude Publica 2012; 28:S40-57. doi: /10.1590/S0102-311X2012001300006.

World Health Organization. Oral Health Surveys: Basic Methods. 4th ed. Geneva: WHO; 1997.

Hosmer DW, Lemeshow S, Sturdivant RX. Applied Logistic Regression. 3rd ed. New York: John Wiley & Sons; 2013.

Dahlgren G, Whitehead M. European strategies for tackling social inequities in health: Levelling up part 2. Studies on social and economic determinants of population health. Denmark: WHO Collaborating Centre for Policy Research on Social Determinants of Health University of Liver. 2007. p. 137.

Tsakos G, Demakakos P, Breeze E, Watt RG. Social gradients in oral health in older adults: Findings from the english longitudinal survey of aging. Am J Public Health 2011; 101(10):1892-9. doi: 10.2105/AJPH.2011.300215.

Buchwald S, Kocher T, Biffar R, Harb A, Holtfreter B, Meisel P. Tooth loss and periodontitis by socio-economic status and inflammation in a longitudinal population-based study. J Clin Periodontol 2013; 40(3):203-11. doi: 10.1111/jcpe.12056.

Moreira RS, Nico LS, Tomita NE, Ruiz T. Oral health of Brazilian elderly: A systematic review of epidemiologic status and dental care access. Cad Saude Publica. 2005; 21(6):1665-75. doi: 10.1590/S0102-311X2005000600013.

The Brazilian Institute of Geography and Statistics. Brazil in Figures. Rio de Janeiro: IBGE; 2013.

Victora CG, Barreto ML, do Carmo Leal M, Monteiro CA, Schmidt MI, Paim J, et al. Health conditions and health-policy innovations in Brazil: The way forward. Lancet 2011; 377(9782):2042-53. doi: 10.1016/S0140-6736(11)60055-X.

Reichenheim ME, de Souza ER, Moraes CL, de Mello Jorge MHP, da Silva CMFP, Minayo MCS. Violence and injuries in Brazil: The effect, progress made, and challenges ahead. Lancet. 2011; 377(9781):1962-75. doi: 10.1016/S0140-6736(11)60053-6.

Rodrigues SM, Oliveira AC, Vargas AMD, Moreira AN, Ferreira E. Implications of edentulism on quality of life among elderly. Int J Environ Res Public Health 2012; 9(1):100-9. doi: 10.3390/ijerph9010100.

Takeuchi K, Aida J, Kondo K, Osaka K. Social participation and dental health status among older Japanese adults: A population-based cross-sectional study. PLoS One 2013; 8(4):e61741. doi: 10.1371/journal.pone.0061741.

Sabbah W, Tsakos G, Sheiham A, Watt RG. The role of health-related behaviors in the socioeconomic disparities in oral health. Soc Sci Med 2009; 68(2):298-303. doi: 10.1016/j.socscimed.2008.10.030.

Sheiham A, Alexander D, Cohen L, Marinho V, Moysés S, Petersen PE, et al. Global oral health inequalities: task group - implementation and delivery of oral health strategies. Adv Dent Res 2011; 23(2):259-67. doi: 10.1177/0022034511402084.


PBOCI is a member of CrossRef and all the content of its journals are linked by DOIs through CrossRef.