Municipal wealth and tooth extractions in the Unified Health System: limits to changing the healthcare model

To analyze the time trend of dental extractions performed in primary health care and their association with human development indicators and oral health coverage in municipalities at the extremes of wealth distribution.

An ecological study using secondary data from August 2019 to July 2024, with Brazilian municipalities as the units of analysis. A total of 200 municipalities were selected, comprising the 100 with the lowest and the 100 with the highest gross domestic product per capita. The number of tooth extractions was obtained from national health information systems, and rates were calculated per 1,000 inhabitants. The temporal trend was estimated using generalized least squares regression with an autoregressive structure, and the annual percentage change was calculated. Comparisons between the groups were performed using a mixed-effects model with a negative binomial distribution, adjusted for indicators of oral health coverage, socioeconomic status, and demographics. A significance level of 5% was used.

A total of 355,218 tooth extractions were recorded during the study period. The rates showed stationary trends in both groups, although municipalities with higher per capita gross domestic product exhibited a borderline trend towards an increase (p = 0.06). The Municipal Human Development Index was inversely associated with the outcome, while population coverage of primary patternsoral health care was positively associated with it. Per capita gross domestic product was not significantly associated with tooth extraction rates in the adjusted model.

The stability of tooth extraction rates throughout the time series, regardless of municipal wealth, suggests that factors related to human development and the organization of services may be more relevant for understanding the distribution of this procedure within the Unified Health System.