Inequalities in prosthetic rehabilitation among elderly people: the importance of context

Objective: It has been demonstrated that social, economic, and environmental factors may influence individuals' oral health conditions, particularly among vulnerable groups such as elderly people. The aim of this study was to investigate the association between contextual factors and the need for full dental prosthesis among elderly people. Methods: This was a cross-sectional population-based epidemiological study of multilevel nature, with two levels of analysis: individual and contextual (municipal). Data at the individual level were obtained from oral clinical examinations (WHO criteria) in 5349 individuals aged 65-74. Data at the contextual level were obtained from the United Nations Development Program for the 250 Brazilian municipalities participating in the survey. The outcome was the need for a full dental prosthesis for at least one arch. Exposures at the contextual level included socioeconomic, demographic, and dental service data. Data analysis used multilevel logistic regression. Results: After controlling for individual socioeconomic, demographic, and dental service variables, the chance of needing full prosthesis was higher in municipalities with lower educational levels than in better-off ones (OR 1.57; 95% CI: 1.09-2.27) and lower in municipalities with fewer dentists (per capita) (OR 0.71; 95% CI: 0.52-0.97), compared to those with more dentists. Conclusion: This study can contribute to the identification of priority municipalities, helping healthcare authorities and communities to formulate equitable public oral healthcare policies that improve the quality of life for this population.