Education- and sex-related inequalities in toothache and tooth extraction in Brazil

To investigate the association between educational attainment and sex in the prevalence of toothache and tooth extraction, considering the interaction between these variables. This cross-sectional study utilised data from 40,369 participants in the 2019 Brazilian National Health Survey (PNS). Adjusted prevalence ratios (PR) for toothache and tooth extraction were estimated by sex and educational attainment using Poisson regression. These values were also used to estimate the population attributable fraction. Individuals with low education attainment, both women (PR 1.59; 95% CI: 1.38–1.85) and men (PR 1.60; 95% CI: 1.35–1.89), exhibited a higher prevalence of toothache compared to women with high education. However, highly educated men showed a 21% reduction in toothache prevalence (PR: 0.79; 95% CI: 0.66–0.94). Regarding tooth extraction, prevalence was higher among women (PR: 2.40; 95% CI: 2.09–2.76) and men (PR: 3.07; 95% CI: 2.67–3.52) with low education compared to highly educated women. The interaction between sex and educational attainment was significant for tooth extraction on both multiplicative (RPR: 1.24; 95% CI: 1.01–1.52) and additive (REPI: 0.62; 95% CI: 0.27–0.96) scales, and for toothache on the multiplicative scale only (RPR: 1.28; 95% CI: 1.01–1.61). The prevalence of toothache and tooth extraction attributable to men with low educational attainment was 7.8% (95% CI: 5.5%–10.0%) and 21.4% (95% CI: 19.9%–22.8%), respectively. A positive interaction between sex and educational attainment was identified for both toothache and tooth extraction, indicating a disadvantage for men with low education.