Dental pain inequalities in two cross-sectional national oral health surveys

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OBJECTIVE: To evaluate the socioeconomic position (SEP) inequalities in dental pain prevalence in Brazil between 2010 and 2023. METHODS: Data from two Brazilian National Oral Health Surveys (2010, n = 37,519; 2023, n = 40,720) were analyzed. The outcome was self-reported dental pain in the last six months. SEP was modeled as a latent variable using household income, household goods, educational attainment, and housing density. Inequalities were measured using the Slope Index of Inequality (SII) and the Concentration Index of Inequality (CIX) across age groups (5y, 12y, 15-19y, 35-44y, 65-74y). Sensitivity analyses excluded edentulous individuals. RESULTS: The prevalence of dental pain was 23.3% (95%CI:21.3-25.4) in 2010 and 20.4% (95%CI:18.6-22.3) in 2023. Negative SII and CIX values confirmed persistent SEP inequalities concentrated among disadvantaged groups across most age groups in both surveys. A significant inequality reduction was observed among 5-year-olds, where absolute inequality decreased from -23.5 to -5.0 percentage points, becoming non-significant in 2023. This reduction was driven by a convergence across socioeconomic groups, with decreased pain among the poorest and increased pain among the wealthiest. Among older adults (65-74 years), no significant inequalities were detected in the main analysis, but sensitivity analysis excluding edentulous individuals revealed significant inequalities in 2023 (SII=-12.4; CIX=-11.4%). CONCLUSION: The prevalence of dental pain did not significantly change during the study period. SEP inequalities in dental pain remained largely stable and significant in Brazil from 2010 to 2023, except for a reduction among young children (5 years). CLINICAL SIGNIFICANCE: The consistent socioeconomic gap indicates that patients from lower socioeconomic backgrounds continue to bear a higher pain burden. Clinically, this implies that screening for pain should be prioritized in vulnerable populations, and policies aimed at reducing social disparities remain a needed path toward equitable oral health.

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