Factors associated with dental service use in Brazil according to Andersen's Behavioral Model: analysis of the 2023 Brazilian National Oral Health Survey

Monteiro, Debora Lana Alves; Faquim, Juliana Pereira da Silva; Silva, Rênnis Oliveira da; Lucena, Edson Hilan Gomes de; Cavalcanti, Yuri Wanderley

doi:10.1590/1980-549720260016.supl.1

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Original Article • Rev. bras. Epidemiol. 29 (Suppl 1) • 2026 • https://doi.org/10.1590/1980-549720260016.supl.1 linkcopy

Factors associated with dental service use in Brazil according to Andersen's Behavioral Model: analysis of the 2023 Brazilian National Oral Health Survey

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: To analyze factors associated with the time since the last dental visit among Brazilians aged 15–19, 35–44, and 65–74 years, according to Andersen's Behavioral Model.

Methods: This cross-sectional analytical study used microdata from a nationally representative oral health survey. Data from 21,385 individuals were analyzed. The outcome was the time since the last dental visit (≤1 year vs. >1 year). The independent variables were grouped into predisposing, facilitating, and perceived need factors according to Andersen's Behavioral Model. Analyses accounted for the complex sampling design and were performed using multilevel logistic regression with random intercepts at the municipality level, estimating odds ratios (OR) and 95% confidence intervals (95%CI).

Results: Older adults (OR 1.436; 95%CI 1.242–1.660), Black (OR 1.161; 95%CI 1.011–1.334) and Brown individuals (OR 1.096; 95%CI 1.005–1.196) were more likely to report a dental visit more than one year prior. Higher education was strongly associated with lower odds of delayed visits (OR 0.383; 95%CI 0.318–0.461). Poor self-rated oral health (OR 2.486; 95%CI 2.041–3.028) increased the likelihood of delayed visits, whereas dental pain was associated with more recent use (OR 0.413; 95%CI 0.382–0.448). Use of private services was associated with lower odds of delayed visits (OR 0.820; 95%CI 0.732–0.919). Municipal coverage and the presence of specialized centers were not significantly associated.

Conclusion: Sociodemographic characteristics and perceived need factors remain central determinants of recent dental service utilization patterns in Brazil.

Keywords:
Universal health coverage; Health status disparities; Socioeconomic factors; Oral health

		Weighted frequency (%)	95%CI
How long have you been using dental services?
	Up to 1 year	51.89	48.99	54.76
	Over a year ago	48.11	45.24	51.01
Sex
	Masculine	38.76	37.13	40.42
	Feminine	61.24	59.58	62.87
Age range (years old)
	15 to 19	23.59	21.91	25.36
	35 to 44	55.60	53.37	57.80
	65 to 74	20.81	19.23	22.49
Skin color
	White	44.63	41.03	48.28
	Black	12.64	10.99	14.49
	Brown	42.73	39.35	46.19
Education (years of study)
	None	2.95	2.40	3.62
	1 to 4	8.15	6.88	9.62
	5 to 8	14.71	13.19	16.38
	9 or older	74.19	71.52	76.69
Oral health self-assessment
	Very good	8.12	7.09	9.29
	Good	46.01	43.81	48.23
	Regular	33.43	31.59	35.32
	Bad	9.47	8.15	10.96
	Very bad	2.98	2.29	3.86
Self-assessment of treatment need
	No	31.35	28.41	34.44
	Yes	68.65	65.56	71.59
Has a toothache
	No	79.19	77.05	81.17
	Yes	20.81	18.83	22.95
Has pain in the face
	No	83.15	81.03	85.07
	Yes	16.85	14.93	18.97
Impact of oral health on quality of life
	No impact	51.27	47.77	54.77
	With impact	48.73	45.23	52.23
Place of use of dental services
	Public	51.09	47.62	54.55
	Private	48.91	45.45	52.38
Oral Health Coverage in PHC
	Up to 80%	71.81	65.99	76.97
	More than 80%	28.19	23.03	34.01
Has CEO
	No	28.64	20.89	37.88
	Yes	71.36	62.12	79.11

		Model 1 (Individual sociodemographics)			Model 2 (Sociodemographic+PROM)			Model 3 (Sociodemographic+PROM+Service)
		OR	95%CI		OR	95%CI		OR	95%CI
Sex (male)		ref.			ref.			ref.
	Feminine	0.778	0.735	0.823	0.792	0.747	0.839	0.799	0.753	0.848
Age range (15 to 19 years)		ref.			ref.			ref.
	35 to 44 years old	1.191	1.063	1.336	1.099	0.985	1.226	1.115	0.998	1.245
	65 to 74 years old	1.716	1.477	1.995	1.399	1.212	1.615	1.436	1.242	1.660
Skin color (white)		ref.			ref.			ref.
	Black	1.217	1.075	1.378	1.193	1.045	1.362	1.161	1.011	1.334
	Brown	1.122	1.025	1.229	1.105	1.013	1.205	1.096	1.005	1.196
Education (did not study)		ref.			ref.			ref.
	1 to 4 years	0.797	0.649	0.980	0.799	0.643	0.992	0.824	0.657	1.032
	5 to 8 years old	0.633	0.533	0.751	0.620	0.521	0.737	0.631	0.527	0.756
	9 years or older	0.381	0.319	0.455	0.367	0.307	0.440	0.383	0.318	0.461
Oral health self-assessment (very good)					ref.			ref.
	Good				1.267	1.123	1.429	1.250	1.105	1.415
	Regular				1.810	1.562	2.098	1.769	1.523	2.055
	Bad				2.552	2.116	3.079	2.486	2.041	3.028
	Very bad				2.821	2.277	3.494	2.739	2.201	3.408
Self-assessment of need for treatment (no)					ref.			ref.
	Yes				1.206	1.084	1.341	1.202	1.079	1.338
Toothache (no)					ref.			ref.
	Yes				0.419	0.386	0.454	0.413	0.382	0.448
Pain in the face (no)					ref.			ref.
	Yes				0.936	0.842	1.040	0.939	0.843	1.045
Impact of oral health on quality of life (no)					ref.			ref.
	Yes				0.829	0.754	0.912	0.830	0.754	0.914
Type of service used (public)								ref.
	Private							0.820	0.732	0.919
Oral health coverage in PHC (up to 80%)								ref.
	Above 80%							0.904	0.750	1.090
CEO presence (no)								ref.
	Yes							1.084	0.891	1.320
	Null model	Model 1			Model 2			Model 3
ICC	9.05%	8.74%			8.07%			8.20%
AIC	33580.53	31124.33			28018.19			27502.59
BIC	33596.75	31205.07			28138.01			27646.06

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[TFN1] C: confidence interval; PHC: Primary Health Care; CEO: Centro de Especialidades Odontológicas.