Tooth loss represents a known marker of health inequality. The association between tooth loss and unfavorable socioeconomic conditions is evident when analyzed at an individual level. However, the effects of contextual characteristics on tooth loss need to be better investigated and understood. The objective of this study was to analyze tooth loss among Brazilian adults (35–44 years of age), in accordance with individual and contextual social characteristics. This was a multilevel cross-sectional study with data from 9564 adult participants from the Brazilian Oral Health Survey - SBBrasil 2010. The dependent variable was the number of lost teeth and the independent variables were grouped into structural (socioeconomic & political context) and intermediary (socioeconomic position, behavioral & biological factors, and health services) determinants. Multilevel Hierarchical Negative Binomial Regression was conducted and the Mean Ratio (MR) was estimated. Brazilian adults lost a mean of 7.57 (95% CI 7.1–8.1) teeth. Among the contextual variables, the number of teeth lost was higher among residents of municipalities with high and medium/low Municipal Human Development Index (MHDI) and in municipalities that did not have public water fluoridation. Among the individual variables, dental loss was higher among those who declared themselves yellow/black/brown/indigenous, were older, who had lower income, who had never visited a dentist, who had used dental services for more than a year and those whose most recent visit to the dentist was due to oral health problems. On the other hand, dental loss was lower among adults with higher education levels and males. The number of missing teeth was associated with unfavorable contextual and individual conditions, which reinforces the need to reduce social inequality and guarantee regular, lifetime access to dental services.

中文翻译：

---

成人牙齿脱落的背景和个人决定因素：一项多层次研究。

牙齿脱落代表健康不平等的已知标志。在个体水平上分析牙齿脱落与不利的社会经济状况之间的关联是显而易见的。但是，上下文特征对牙齿脱落的影响需要更好地研究和理解。这项研究的目的是根据个人和背景社会特征分析巴西成年人（35-44岁）的牙齿脱落。这是一项多层次的横断面研究，使用了来自巴西口腔健康调查-SBBrasil 2010的9564名成年参与者的数据。因变量是掉牙的数量，自变量分为结构性（社会经济和政治背景）和中介性（社会经济地位，行为和生物学因素，和卫生服务）的决定因素。进行了多层分层负二项式回归，并估计了平均比率（MR）。巴西成年人平均损失了7.57颗牙齿（95％CI 7.1–8.1）。在上下文变量中，在城市人类发展指数高和中/低的城市居民和没有公共氟化水的城市居民中，牙齿脱落的数量较高。在个人变量中，自称黄色/黑色/棕色/土着，年龄较大，收入较低，从未去过牙医，使用牙科服务超过一年以及使用牙科服务的人中，牙齿损失较高最近去看牙医的原因是口腔健康问题。另一方面，受过高等教育的成年人和男性的牙齿脱落率较低。