Avaliação de impacto da política de oferta de prótese dentária no SUS do Brasil entre 2003 e 2010 e determinantes sociais.

Abstract

Introduction: Tooth loss is recognized as a major public health problem in Brazil, with significant functional, aesthetic, and psychosocial consequences. The National Oral Health Policy, launched in 2004, incorporated oral rehabilitation into public care through the provision of dental prostheses, including the creation of Regional Dental Prosthesis Laboratories (LRPD). Despite these institutional advances, challenges remain regarding service provision, reduction of regional inequalities, and systematic evaluation. Objective:This study aimed to assess the impact of the dental prosthesis policy on prosthesis use among young people, adults, and older adults in Brazil between 2003 and 2010, considering social determinants of health. Methodology: A quasi-experimental impact evaluation study was conducted using data from the national epidemiological surveys SB Brasil 2003 and 2010, restricted to municipalities participating in both surveys. Difference-in-differences analyses were employed, comparing municipalities with and without LRPD implementation over time. Outcome variables included prosthesis use and need by age group, while explanatory variables comprised socioeconomic, demographic, and oral health coverage indicators. Nonparametric Spearman correlation tests were used to estimate adjusted associations and bivariate analyses, adopting a 5% significance level. Results: The study revealed a significant impact on the increased supply of dental prostheses in municipalities with LRPD compared to those without. However, no impact was observed on prosthesis use. The average number of prostheses provided in LRPD municipalities increased substantially, from 212.26 in 2003 to 564.82 in 2010 (p = 0.031). Although a similar increase occurred in municipalities without LRPD, the variation was not statistically significant (p = 0.301). These findings suggest that LRPD implementation stimulated prosthesis production in the Unified Health System (SUS), strengthening installed capacity and expanding the availability of rehabilitative care. It is worth noting that LRPD implementation was concentrated between 2009 and 2010, resulting in a short time window to assess potential impacts on population-level prosthesis use in the 2010–2013 survey cycle. The significant reduction in prosthesis need among adolescents and adults, regardless of LRPD presence, suggests improvements in oral health conditions driven by broader structural transformations, such as enhanced human development and educational attainment, alongside the expansion of the Family Health Strategy, preventive initiatives, and the consolidation of the National Oral Health Policy (Brasil Sorridente). Conclusion: Social inequalities, particularly those associated with the Human Development Index (HDI), illiteracy, and dental insurance coverage, remain strong determinants of prosthesis need and use. These findings reinforce the importance of integrated strategies to reduce tooth loss, expand access to oral rehabilitation, and promote greater equity in oral health.