Social intersectional differences in pulpal clinical consequences of untreated dental caries among Brazilian adolescents: analysis of the SB Brasil 2023 survey.

OBJECTIVE: To examine differences in the occurrence of consequences of untreated dental caries (pulpal involvement, ulceration, fistula, and abscess-PUFA) across intersectional social positions defined by sex, skin color, and household income among adolescents. METHODS: This study analyzed data from the Brazilian National Oral Health Survey (SB Brasil 2023), using a multi-stage stratified probability sampling design to represent adolescents aged 15-19 years. Social variables were combined into eight intersectional groups based on sex, skin color, and family income. Outcomes included PUFA prevalence ≥1 and counts of its components. Survey-adjusted Poisson regression with robust variance and a three-way interaction term was applied. RESULTS: The sample comprised 8,041 adolescents. Compared to high-income White males, prevalence was higher among low-income Black males (PR=5.93; 95%CI:2.60-13.51) and low-income Black females (PR=4.06; 95%CI:1.85-8.90). The predicted prevalence of PUFA ≥1 ranged from 4.0% (95%CI:2.0-7.0) among high-income White males to 21.0% (95%CI:11.0-32.0) among low-income Black males. Among females, prevalence estimates were 15.0% (95%CI:9.0-20.0) in high-income Black, 16.0% (95%CI:5.0-28.0) in low-income White, and 18.0% (95%CI:12.0-24.0) in low-income Black individuals. CONCLUSION: Marked differences in PUFA occurrence were observed across intersectional social positions, with the highest burden observed among low-income Black adolescents, particularly males for prevalence ratios, although females also presented high absolute prevalence. These findings reinforce the need for policies addressing structural social inequalities in oral health.