{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T08:06:16Z","timestamp":1785139576353,"version":"3.55.0"},"reference-count":32,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Community Dental Health"],"abstract":"<jats:p>\n                    <jats:bold>Objectives:<\/jats:bold>\n                    To examine the association of contextual school performance, individual educational delay, and socioeconomic conditions with untreated dental caries and tooth loss in Brazilian adolescents.\n                    <jats:bold>Methods:<\/jats:bold>\n                    Data from two nationally representative surveys (SB Brasil, 2010, n = 11,895; 2023, n = 9181 after exclusions). Outcomes were untreated caries and any tooth loss from the DMFT index. Contextual exposure was a Public School Performance Score (PSPS) derived by principal component analysis of school dropout, grade retention, and the Basic Education Development Index. Multilevel logistic models estimated odds ratios (ORs) per 1-unit SD increase in the PSPS for each survey year, adjusting for sex, age, equivalised income, educational delay, municipal income tertiles, and water fluoridation.\n                    <jats:bold>Results:<\/jats:bold>\n                    The PSPS distribution shifted rightwards between surveys (median rose from 0.99 to 2.43), reflecting improvements in IDEB and reductions in dropout and grade retention. In 2010, a 1-SD higher PSPS was associated with significantly lower odds of untreated caries (OR = 0.92, 95%CI 0.84, 0.99) and tooth loss (OR = 0.88, 95%CI 0.81, 0.97). By 2023, the associations had weakened and were no longer statistically significant: caries OR = 0.97 (95%CI 0.86, 1.10); tooth loss OR = 0.95 (95%CI 0.83, 1.08). The year-by-score and cross-level interactions were not statistically significant.\n                    <jats:bold>Conclusion:<\/jats:bold>\n                    The contextual gradient in oral health associated with school performance observed in 2010 was not detectable in 2023, despite overall improvements in educational indicators.\n                    <jats:bold>Clinical Significance:<\/jats:bold>\n                    Even when average school performance rises, additional school-based oral health strategies may be needed to maintain the health gradient, as universal improvements do not automatically translate into reduced inequalities.\n                  <\/jats:p>","DOI":"10.1177\/0265539x261471382","type":"journal-article","created":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T01:50:33Z","timestamp":1784944233000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Contextual school performance, individual educational delay, income inequality and oral health among adolescents: A repeated cross-sectional study in Brazil, 2010 and 2023"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5263-6746","authenticated-orcid":false,"given":"Mari\u00e9l","family":"de Aquino Goulart","sequence":"first","affiliation":[{"name":"Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul"},{"name":"School of Medicine, Dentistry, and Nursing, University of Glasgow"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario Vianna","family":"Vettore","sequence":"additional","affiliation":[{"name":"Department of Dentistry and Oral Health, Aarhus University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Ponce de Leon","sequence":"additional","affiliation":[{"name":"Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger Keller","family":"Celeste","sequence":"additional","affiliation":[{"name":"Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul"},{"name":"Karolinska Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"e_1_3_6_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/cdoe.12356"},{"key":"e_1_3_6_3_1","doi-asserted-by":"publisher","DOI":"10.1159\/000550120"},{"key":"e_1_3_6_4_1","doi-asserted-by":"publisher","DOI":"10.1922\/CDH_00020Aravena-Rivas06"},{"key":"e_1_3_6_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2018-000880"},{"key":"e_1_3_6_6_1","doi-asserted-by":"publisher","DOI":"10.1590\/1807-3107bor-2020.vol34.0010"},{"key":"e_1_3_6_7_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0034-8910.2013047004388"},{"key":"e_1_3_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2010.05.015"},{"key":"e_1_3_6_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/10511482.1997.9521280"},{"key":"e_1_3_6_10_1","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1590\/0103-11042022e301","article-title":"Trajet\u00f3ria dos 15 anos de implementa\u00e7\u00e3o do Programa Sa\u00fade na Escola no Brasil","volume":"46","author":"Fernandes LA","year":"2023","unstructured":"Fernandes LA, Shimizu HE, do Prado Neto PF, et al. (2023) Trajet\u00f3ria dos 15 anos de implementa\u00e7\u00e3o do Programa Sa\u00fade na Escola no Brasil. Sa\u00fade Em Debate 46: 13\u201328. https:\/\/doi.org\/10.1590\/0103-11042022E301.","journal-title":"Sa\u00fade Em Debate"},{"key":"e_1_3_6_11_1","first-page":"464","article-title":"The inverse equity hypothesis: analyses of institutional deliveries in 286 national surveys","volume":"108","author":"Gomes Victora C","year":"2018","unstructured":"Gomes Victora C, Joseph G, Silva CM, et al. (2018) The inverse equity hypothesis: analyses of institutional deliveries in 286 national surveys. Public Health 108: 464\u2013471. https:\/\/doi.org\/10.2105\/AJPH.2017.304277.","journal-title":"Public Health"},{"key":"e_1_3_6_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyz032"},{"key":"e_1_3_6_13_1","unstructured":"I. Instituto Nacional de Estudos e Pesquisas Educacionais An\u00edsio Teixeira (2025) \u00cdndice de Desenvolvimento da Educa\u00e7\u00e3o B\u00e1sica (Ideb). https:\/\/www.gov.br\/inep\/pt-br\/areas-de-atuacao\/pesquisas-estatisticas-e-indicadores\/ideb (accessed March 9 2025)."},{"key":"e_1_3_6_14_1","doi-asserted-by":"publisher","DOI":"10.1159\/000485747"},{"key":"e_1_3_6_15_1","doi-asserted-by":"publisher","DOI":"10.1159\/000489570"},{"key":"e_1_3_6_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckab013"},{"key":"e_1_3_6_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/josh.13527"},{"key":"e_1_3_6_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapro\/dag016"},{"key":"e_1_3_6_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/cdoe.12569"},{"key":"e_1_3_6_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/ipd.12572"},{"key":"e_1_3_6_21_1","doi-asserted-by":"publisher","DOI":"10.1590\/0103-6440202104107"},{"key":"e_1_3_6_22_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu13114113"},{"key":"e_1_3_6_23_1","doi-asserted-by":"publisher","DOI":"10.2307\/2586011"},{"key":"e_1_3_6_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/ipd.12441"},{"key":"e_1_3_6_25_1","first-page":"2325","article-title":"Income inequality and early childhood caries in Colombia: a multilevel analysis","volume":"27","author":"Rodr\u00edguez-Godoy M","year":"2022","unstructured":"Rodr\u00edguez-Godoy M, Navarro-Saiz LM, Alzate JP, et al. (2022) Income inequality and early childhood caries in Colombia: a multilevel analysis. Ci\u00eancia & Sa\u00fade Coletiva 27: 2325\u20132336. https:\/\/doi.org\/10.1590\/1413-81232022276.18452021.","journal-title":"Ci\u00eancia & Sa\u00fade Coletiva"},{"key":"e_1_3_6_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/cdoe.12790"},{"key":"e_1_3_6_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/cdoe.12325"},{"key":"e_1_3_6_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.adolescence.2017.02.004"},{"key":"e_1_3_6_29_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6831-15-6"},{"key":"e_1_3_6_30_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17072345"},{"issue":"6","key":"e_1_3_6_31_1","first-page":"e00231021","article-title":"Evaluation of the implementation of the School Health Program from the Program for Access and Quality Improvement in Primary Care: 2012, 2014, and 2018","volume":"38","author":"Wachs LS","year":"2022","unstructured":"Wachs LS, Facchini LA, Thum\u00e9 E, et al. (2022) Evaluation of the implementation of the School Health Program from the Program for Access and Quality Improvement in Primary Care: 2012, 2014, and 2018. Cadernos de Sa\u00fade P\u00fablica 38(6): e00231021. https:\/\/doi.org\/10.1590\/0102-311XPT231021.","journal-title":"Cadernos de Sa\u00fade P\u00fablica"},{"key":"e_1_3_6_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.edurev.2013.05.002"},{"key":"e_1_3_6_33_1","volume-title":"A Conceptual Framework for Action on the Social Determinants of Health","author":"World Health Organization (WHO)","year":"2010","unstructured":"World Health Organization (WHO) (2010) A Conceptual Framework for Action on the Social Determinants of Health. World Health Organization. https:\/\/iris.who.int\/handle\/10665\/44489 (accessed October 31, 2025)."}],"container-title":["Community Dental Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0265539X261471382","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0265539X261471382","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0265539X261471382","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T07:53:55Z","timestamp":1785138835000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0265539X261471382"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,24]]},"references-count":32,"alternative-id":["10.1177\/0265539X261471382"],"URL":"https:\/\/doi.org\/10.1177\/0265539x261471382","relation":{},"ISSN":["0265-539X","2515-1746"],"issn-type":[{"value":"0265-539X","type":"print"},{"value":"2515-1746","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,24]]},"article-number":"0265539X261471382"}}