OBJECTIVE:To estimate the mean number of missing teeth, lack of functional dentition and total tooth loss (edentulism) among adolescents, adults and the elderly in Brazil, comparing the results with those of 2003. METHODS:Data from 5,445 adolescents aged 15-19, 9,779 adults aged 35-44 and 7,619 elderly individuals aged 65-74, participants in the Brazilian Oral Health Survey (SBBrasil) 2010, were analyzed. The mean missing teeth, proportion of lack of functional dentition (< 21 natural teeth) and proportion of edentulism (total tooth loss) were estimated for each age group, each state Capital and each macro region. Multivariable logistic regression (tooth loss) and Poisson (absence of functional dentition and edentulism) analyses were performed in order to identify socioeconomic factors and demographic characteristics associated with each outcome. RESULTS:The prevalence of tooth loss among adolescents was 17.4% (38.9% in 2002-03) ranging from 8.1% among those earning higher income to almost 30% among those with less schooling. Among adolescents, females, those with black or brown skin and those with the lowest levels of income and schooling had a higher prevalence of tooth loss. Lack of functional dentition affected nearly ¼ of adults, it was higher among women, among those with black and brown skin and among those with the lowest levels of income and schooling. Mean missing teeth in adults decreased from 13.5 in 2002-03 to 7.4 in 2010. More than half of elderly is edentulous (similar to the 2002-03 fi ndings); higher prevalence of edentulism was found among women and those with the lowest levels of income and schooling. Among adolescents the mean missing teeth ranged from 0.1 (in Curitiba, South Brazil and Vitória, Southeast Brazil) to 1.2 (in the North countryside). Among adults the lowest mean missing teeth was found in Vitória (4.2) and the highest in Rio Branco, North Brazil (13.6). CONCLUSIONS:A remarkable reduction in tooth loss among adolescents and adults was identifi ed between 2010 and 2003. Among the elderly, tooth loss fi gure remained the same. In spite of important achievements in tooth loss fi gures, social and regional inequalities persist.

O objetivo deste estudo foi estimar a prevalência de perdas dentárias em adultos de 35 a 44 anos de idade. Além disso, foram testadas associações entre as perdas dentárias e condições demográficas, sócio-econômicas e com utilização de serviços odontológicos. Foram analisados os dados de 13.431 participantes do estudo epidemiológico nacional de saúde bucal realizado em 2002-2003. O número de perdas dentárias (£ 12 e > 12) foi o desfecho investigado. As variáveis independentes incluíram localização geográfica, gênero, cor da pele, idade, renda per capita, escolaridade, tempo decorrido desde a última consulta odontológica e tipo de serviço utilizado. Foram estimadas as razões de prevalência bruta e ajustada através de regressão de Poisson. Edentulismo atingiu 9% da amostra; a mediana de dentes perdidos foi igual a 11. Perdas dentárias foram fortemente associadas com indivíduos residentes em zona rural, com as mulheres, com os mais pobres, com os de menor escolaridade e com aqueles de idade mais avançada. Usuários do serviço público e aqueles que consultaram dentista há mais tempo também apresentaram maior prevalência do agravo mesmo após o ajuste por variáveis sócio-econômicas e demográficas.

Total tooth loss is associated with increased levels of SBP in this adult population.

Systematic reviews have found no evidence to support a benefit of water fluoridation (WF) to prevent dental caries in adult populations. The aim of this natural experiment was to investigate whether lifetime access to fluoridated water is associated with dental caries experience among adults from Florianópolis, Brazil. The data originated from a population-based cohort study (EpiFloripa Adult) initiated in 2009 (n = 1,720) when participants were aged 20 to 59 years. The second wave was carried out in 2012 (n = 1,140) and included a dental examination and a face-to-face questionnaire. Participants residing at the same address since the age of 7 y or before were included in the primary analyses. Sensitivity analyses were also performed. WF was implemented in the city in 2 different periods of time: 1982 (60% of the population) and 1996. Dental caries was assessed by the decayed, missing, and filled teeth (DMFT) index. A combination of residential status, participant's age, and year of implementation of WF permitted the creation of participants' lifetime access to fluoridated water: >75%, 50% to 75%, and <50% of a participant's lifetime. Covariates included sex, age, socioeconomic mobility, educational attainment, income, pattern of dental attendance, and smoking. Participants who accessed fluoridate water <50% of their lifetime presented a higher mean rate ratio of DMFT (1.39; 95% CI, 1.05-1.84) compared with those living >75% of their lifetime with residential access to fluoridated water. Participants living between 50% and 75% and <50% of their lives in fluoridated areas presented a decayed and filled teeth mean ratio of 1.34 (95% CI, 1.02-1.75) and 1.47 (95% CI, 1.05-2.04) higher than those with residential access to fluoridated water >75% of their lifetime, respectively. Longer residential lifetime access to fluoridated water was associated with less dental caries even in a context of multiple exposures to fluoride.

This study lends support to hypothesized association between tooth loss and severe cognitive impairment. Older adults seem to be particularly vulnerable to such effects. However, the bidirectional association between tooth loss and severe cognitive impairment cannot be ruled out.

We suggest the standardization of outcome formats and exposures in order to favor the comparison between studies and their quantitative analysis.

OBJECTIVE:To estimate tooth loss among adolescents and its factors associated. METHODS:Data from 16,833 participants of the Brazilian Oral Health Survey 2002-2003 were analyzed. The outcome studied was tooth loss of at least one tooth. Independent variables included geographical localization, gender, skin color, per capita income, education gap, dental service utilization and fl uoridated water supply at the local level. Crude and adjusted prevalence ratios were estimated using Poisson regression for each Brazilian macroregion and nationwide. RESULTS:The prevalence of at least one tooth loss was 38.9% (95% CI 38.2%;39.7%). Adolescents living in localities with non-fl uoridated water supply were 40% more likely to have tooth loss compared with those living in areas with fl uoridated water supply. There was seen a strong association (p<0.01) between non-fl uoridated water supply and tooth loss prevalence in the Northeast. In other Brazilian regions this association was confounded for distal variables, mainly socioeconomic variables, reinforcing regional inequalities. CONCLUSIONS:High prevalence of tooth loss among Brazilian adolescents shows a need for targeted dental actions including prevention at earlier ages, treatment of affected teeth and universal access to fl uoridated water.

OBJECTIVE The objective of this study was to analyze whether socioeconomic conditions and the period of availability of fluoridated water are associated with the number of teeth present.METHODSThis cross-sectional study analyzed data from 1,720 adults between 20 and 59 years of age who resided in Florianópolis, SC, Southern Brazil, in 2009. The outcome investigated was the self-reported number of teeth present. The individual independent variables included gender, age range, skin color, number of years of schooling, and per capita household income. The duration of residence was used as a control variable. The contextual exposures included the period of availability of fluoridated water to the households and the socioeconomic variable for the census tracts, which was created from factor analysis of the tract’s mean income, education level, and percentage of households with treated water. Multilevel logistic regression was performed and inter-level interactions were tested.RESULTS Residents in intermediate and poorer areas and those with fluoridated water available for less time exhibited the presence of fewer teeth compared with those in better socioeconomic conditions and who had fluoridated water available for a longer period (OR = 1.02; 95%CI 1.01;1.02). There was an association between the period of availability of fluoridated water, per capita household income and number of years of education. The proportion of individuals in the poorer and less-educated stratum, which had fewer teeth present, was higher in regions where fluoridated water had been available for less time.CONCLUSIONS Poor socioeconomic conditions and a shorter period of availability of fluoridated water were associated with the probability of having fewer teeth in adulthood. Public policies aimed at reducing socioeconomic inequalities and increasing access to health services such as fluoridation of the water supply may help to reduce tooth loss in the future.