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Background <p>The Brazilian Unified Health System (SUS), a public and universal system, has expanded its role in oral healthcare over the last two decades, which has been associated with improvements in epidemiological indicators of the population’s oral health. In the context of significant social inequities, the coexistence of SUS and a strong private sector in the provision of dental services raises questions about SUS’s role and limits in reducing inequities in access to dental care. This study aims to identify, among Brazilian urban adults, factors associated with the use of dental services in the public and private sectors, compared with non-use, and, among those who use dental services, factors associated with the use in the private sector, compared with the public sector.</p> Methods <p>This was a national cross-sectional study based on the <i>SB Brasil 2023</i> survey. The complex sample included 9,019 adults aged 35–44 years. Multinomial logistic regression was employed to examine use versus non-use of public and private dental services, and binomial logistic regression to examine private versus public use among users.</p> Results <p>Almost 1/3 of adults did not use dental services in two years. Higher education and dental insurance were strong predictors of private-sector use, whereas income ≤ 2 minimum wages (MW) was associated with higher odds of public-sector use, compared with non-use. A relevant interaction between education and income was observed. In considering service use between the private and public sectors, greater access was noted among men, those with higher education, those with higher income, and those with dental insurance, with the conjunction of the latter two factors potentiating their individual effects. Specialized dental treatments were also mostly accessed in the private sector.</p> Conclusions <p>Socioeconomic inequalities remain the main explanation for variation in the use of dental services in Brazil, but results suggest that the SUS has helped expand access for more socioeconomically vulnerable populations, enabling a higher likelihood of dental services use (vs. non-use), and providing the most likely services to be used by them, in contrast with the private sector. Expanding coverage and offering specialized dental services remain challenges for the system.</p>

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Oral health services use among adults in Brazil: inequities and the role of SUS in mitigating them (SB Brasil 2023)

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月13日

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  • Iêda Lenzi Durão,
  • André Walace Nery da Costa,
  • Maurício Teixeira Leite de Vasconcellos,
  • Margareth Crisóstomo Portela

摘要

Background

The Brazilian Unified Health System (SUS), a public and universal system, has expanded its role in oral healthcare over the last two decades, which has been associated with improvements in epidemiological indicators of the population’s oral health. In the context of significant social inequities, the coexistence of SUS and a strong private sector in the provision of dental services raises questions about SUS’s role and limits in reducing inequities in access to dental care. This study aims to identify, among Brazilian urban adults, factors associated with the use of dental services in the public and private sectors, compared with non-use, and, among those who use dental services, factors associated with the use in the private sector, compared with the public sector.

Methods

This was a national cross-sectional study based on the SB Brasil 2023 survey. The complex sample included 9,019 adults aged 35–44 years. Multinomial logistic regression was employed to examine use versus non-use of public and private dental services, and binomial logistic regression to examine private versus public use among users.

Results

Almost 1/3 of adults did not use dental services in two years. Higher education and dental insurance were strong predictors of private-sector use, whereas income ≤ 2 minimum wages (MW) was associated with higher odds of public-sector use, compared with non-use. A relevant interaction between education and income was observed. In considering service use between the private and public sectors, greater access was noted among men, those with higher education, those with higher income, and those with dental insurance, with the conjunction of the latter two factors potentiating their individual effects. Specialized dental treatments were also mostly accessed in the private sector.

Conclusions

Socioeconomic inequalities remain the main explanation for variation in the use of dental services in Brazil, but results suggest that the SUS has helped expand access for more socioeconomically vulnerable populations, enabling a higher likelihood of dental services use (vs. non-use), and providing the most likely services to be used by them, in contrast with the private sector. Expanding coverage and offering specialized dental services remain challenges for the system.