Increasing inequalities in the distribution of dental caries in the Brazilian context in Finland

Abstract

Objective: To document the process of concurrent decline and polarization of dental caries distribution in the Brazilian context.

Basic research design: Ecologic assessment of dental outcomes of surveys performed in 1998 and 2002, and several covariates using data aggregated at city-level.

Participants: 9,327 (1998) and 5,722 (2002) 12-year-old schoolchildren surveyed for oral health status in 131 and 34 towns respectively of the state of São Paulo, Brazil.

Main outcome measures: DMFT index and Gini coefficient for caries distribution.

Results: The DMFT index declined from 3.72 in 1998 to 2.52 in 2002, while the Gini coefficient for the distribution of caries increased from 0.479 to 0.565. An improved profile of socio-economic standings, preventive dental treatment, access to fluoridated tap water and initiatives of dental education associated significantly with reduced levels of caries distribution. However, as these conditions were non-homogeneously distributed in the population, they are also associated with increasing levels of inequality in the distribution of caries. These observations indicate that there is room for further reduction of caries levels, by targeting the expansion of dental services and access to fluoridated water to groups and areas with higher levels of needs.

Conclusions: Improved characterisation of the skewed distribution of caries experience demands that monitoring of the inequality in the distribution of caries by statistics such as the Gini coefficient be used. This information will inform programmes aimed at reducing levels of caries without reinforcing inequalities in the experience of the disease, a strategy that may contribute to the development of socially appropriate programmes of oral health promotion.