Análisis de la asociación entre las desigualdades raciales y el edentulismo en Brasil: una revisión sistemática y un metaanálisis

Carvalho, Bianca Oliveira de; Galo, Rodrigo; Gusmão, Yure Gonçalves; Soares, Maria Eliza da Consolação

doi:10.1590/0102-311XEN210723

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REVIEW • Cad. Saúde Pública 41 (10) • 2025 • https://doi.org/10.1590/0102-311XEN210723 linkcopiar

Análisis de la asociación entre las desigualdades raciales y el edentulismo en Brasil: una revisión sistemática y un metaanálisis

Autoría SCIMAGO INSTITUTIONS RANKINGS

El objetivo de este estudio fue evaluar si las personas que se identifican a sí mismas como negras y/o morenas tienen una mayor prevalencia de pérdida de dientes en comparación con las personas blancas en Brasil, mediante una revisión sistemática y un metaanálisis. Se consultaron las bases de datos PubMed, Scopus, Web of Science, Biblioteca Virtual en Salud, Embase y la literatura gris. Dos revisores independientes realizaron las búsquedas y la selección de artículos. Se utilizó la Escala Newcastle-Ottawa para los estudios de cohortes observacionales y su versión modificada para los estudios transversales. Se utilizó el índice I² para evaluar la heterogeneidad de los estudios incluidos en los metaanálisis. De los 25 artículos aptos para la evaluación cualitativa, 17 formaron parte de la evaluación cuantitativa. El tamaño de la muestra osciló entre 101 y 18.718 personas de entre 11 y 74 años. La mayoría de los estudios compararon a personas blancas con personas no blancas (negras, morenas, asiáticas e indígenas). En el análisis de la comparación entre blancos y no blancos, no se encontraron diferencias en cuanto al edentulismo (OR = 0,86; IC95%: 0,71; 1,06), la ausencia de dentición funcional (OR = 0,82; IC95%: 0,33; 2,03), el número medio de dientes perdidos (MD = -0,21; IC95%: -2,92; 2,49); pero se encontró asociación con la pérdida de dientes (OR = 1,40; IC95%: 1,26; 1,55). Al comparar a las personas de raza negra/morenas con las de raza blanca, la pérdida de dientes fue mayor en las personas que se declararon de raza negra/morenas (OR = 1,41; IC95%: 1,27; 1,57). Esta diferencia también se observó al comparar a las personas de raza negra/morenas con otras razas/colores de piel (OR = 1,24; IC95%: 1,15; 1,33). Por lo tanto, en los estudios realizados en Brasil, la pérdida de dientes fue más frecuente en las personas que se declararon negras y/o morenas.

Palabras-clave:
Pérdida de Diente; Grupos Raciales; Etnicidad; Inequidades en Salud

DATABASE	SEARCH STRATEGY
MEDLINE (via PubMed)	(((Racial Groups) OR (race) OR (Ethnicity) OR (racial stock) OR (Blacks) OR (Negro) OR (Ethnic Group) OR (negroes) OR (Negroid Race) OR (Ethnic and Racial Minorities) OR (Ethnic Minority) OR (Racial Minority) OR (race factor) OR (racial factor) OR (African Continental Ancestry Group) OR (racial inequalities) OR (White; European Continental Ancestry Group) OR (Caucasoid Race) OR (Caucasian Race)) AND ((Dental Caries) OR (Dental Decay) OR (Dentin, Carious) OR (Periodontal Diseases) OR (Parodontosis) OR (Parodontoses) OR (Pyorrhea Alveolaris) OR (Tooth Loss) OR (Mouth, Edentulous) OR (Mouth, Toothless) OR (Jaw, Edentulous, Partially) OR (DMF Indices) OR (Decayed, Missing, and Filled Teeth) OR (Dental Prosthesis) OR (Removable Partial Denture) OR (Denture complete) OR (edentulism) OR (DMF Index) OR (Jaw, Edentulous)) AND ((brazil) OR (Brazilian)))
Web of Science (via CAPES Periodicals)	(Racial Groups OR race OR Ethnicity OR racial stock OR Blacks OR Negro OR Ethnic Group OR negroes OR Negroid Race OR Ethnic and Racial Minorities OR Ethnic Minority OR Racial Minority OR race factor OR racial factor OR African Continental Ancestry Group OR racial inequalities OR White European Continental Ancestry Group OR Caucasoid Race OR Caucasian Race) AND (Dental Caries OR Dental Decay OR Dentin, Carious OR Periodontal Diseases OR Parodontosis OR Parodontoses OR Pyorrhea Alveolaris OR Tooth Loss OR Mouth, Edentulous OR Mouth, Toothless OR Jaw, Edentulous, Partially OR DMF Indices OR Decayed, Missing, and Filled Teeth OR Dental Prosthesis OR Removable Partial Denture OR Denture complete OR edentulism OR DMF Index OR Jaw, Edentulous) AND (brazil OR Brazilian)
Virtual Health Library	(((Racial Groups) OR (race) OR (Ethnicity) OR (racial stock) OR (Blacks) OR (Negro) OR (Ethnic Group) OR (negroes) OR (Negroid Race) OR (Ethnic and Racial Minorities) OR (Ethnic Minority) OR (Racial Minority) OR (race factor) OR (racial factor) OR (African Continental Ancestry Group) OR (racial inequalities) OR (White; European Continental Ancestry Group) OR (Caucasoid Race) OR (Caucasian Race)) AND ((Dental Caries) OR (Dental Decay) OR (Dentin, Carious) OR (Periodontal Diseases) OR (Parodontosis) OR (Parodontoses) OR (Pyorrhea Alveolaris) OR (Tooth Loss) OR (Mouth, Edentulous) OR (Mouth, Toothless) OR (Jaw, Edentulous, Partially) OR (DMF Indices) OR (Decayed, Missing, and Filled Teeth) OR (Dental Prosthesis) OR (Removable Partial Denture) OR (Denture complete) OR (edentulism) OR (DMF Index) OR (Jaw, Edentulous)) AND ((brazil) OR (Brazilian)))
Scopus (via CAPES Periodicals)	(((Racial Groups) OR (race) OR (Ethnicity) OR (racial stock) OR (Blacks) OR (Negro) OR (Ethnic Group) OR (negroes) OR (Negroid Race) OR (Ethnic and Racial Minorities) OR (Ethnic Minority) OR (Racial Minority) OR (race factor) OR (racial factor) OR (African Continental Ancestry Group) OR (racial inequalities) OR (White; European Continental Ancestry Group) OR (Caucasoid Race) OR (Caucasian Race)) AND ((Dental Caries) OR (Dental Decay) OR (Dentin, Carious) OR (Periodontal Diseases) OR (Parodontosis) OR (Parodontoses) OR (Pyorrhea Alveolaris) OR (Tooth Loss) OR (Mouth, Edentulous) OR (Mouth, Toothless) OR (Jaw, Edentulous, Partially) OR (DMF Indices) OR (Decayed, Missing, and Filled Teeth) OR (Dental Prosthesis) OR (Removable Partial Denture) OR (Denture complete) OR (edentulism) OR (DMF Index) OR (Jaw, Edentulous)) AND ((brazil) OR (Brazilian)))
Embase (via CAPES Periodicals)	(‘ancestry group’ OR race OR ethnicity OR ‘Black person’ OR ‘ethnic group’ OR ‘racial disparity’ OR Caucasian) AND (‘dental caries’ OR ‘dentin carious’ OR ‘periodontal disease’ OR periodontosis OR ‘pyorrhea alveolaris’ OR ‘tooth loss’ OR edentulism OR ‘edentulous jaw’ OR ‘DMF index’ OR ‘DMFT index’ OR ‘tooth prosthesis’ OR ‘complete denture’) AND (Brazil OR Brazilian)
Google Scholar	((Tooth loss) AND (Healthcare Disparities) AND (Racial Groups) AND (Race) AND (Ethnicity) AND (Brazil))
Brazilian Digital Library of Theses and Dissertations	(((Racial Groups) OR (race) OR (Ethnicity) OR (racial stock) OR (Blacks) OR (Negro) OR (Ethnic Group) OR (negroes) OR (Negroid Race) OR (Ethnic and Racial Minorities) OR (Ethnic Minority) OR (Racial Minority) OR (race factor) OR (racial factor) OR (African Continental Ancestry Group) OR (racial inequalities) OR (White; European Continental Ancestry Group) OR (Caucasoid Race) OR (Caucasian Race)) AND ((Dental Caries) OR (Dental Decay) OR (Dentin, Carious) OR (Periodontal Diseases) OR (Parodontosis) OR (Parodontoses) OR (Pyorrhea Alveolaris) OR (Tooth Loss) OR (Mouth, Edentulous) OR (Mouth, Toothless) OR (Jaw, Edentulous, Partially) OR (DMF Indices) OR (Decayed, Missing, and Filled Teeth) OR (Dental Prosthesis) OR (Removable Partial Denture) OR (Denture complete) OR (edentulism) OR (DMF Index) OR (Jaw, Edentulous)) AND ((brazil) OR (Brazilian)))

STUDY (YEAR)	LOCATION	SAMPLE ORIGIN	STUDY DESIGN	SAMPLE SIZE	AGE GROUP	DENTITION	VARIABLES STUDIED	MAIN RESULTS
Antoniazzi et al. ³² (2021)	Santa Maria (Rio Grande do Sul State)	Studying in a public institution	Cross-sectional	106 cocaine and crack users and 106 controls matched for age, sex, and smoking status	13 to 46 years old	Permanent	Dental caries: DMFT Tooth loss: presence or absence. Periodontal disease: presence or absence Skin color: (white and non-white)	Multivariate analysis revealed that tooth loss was significantly higher among non-white individuals, those over 24 years old, and those with severe caries (p-value < 0.001)
Antunes et al. ²³ (2003)	São Paulo State	Population-based survey	Cross-sectional	18,718 oral examination records	11 and 12 years old	Mixed	Dental caries: DMFT Care Index Tooth loss: proportion of missing teeth Ethnicity: white (European ancestry); black (Afro-descendant)	White children had higher caries rates in permanent teeth than black children The difference in caries prevalence between black and white children was reduced in cities with a better socioeconomic status profile Caucasian children also had a better profile of cared-for teeth, with lower numbers of missing and untreated decayed teeth, higher rates of attendance, lower averages of teeth with preventive and restorative treatment needs, and higher proportions of children without dental treatment
Azevedo et al. ³⁷ (2017)	Brazil	Population-based survey	Cross-sectional	7,496	65 to 74 years old	Permanent	Edentulism: use or need for dentures Race/color: white, black, mixed-race, yellow, Indigenous	After adjusting for confounding variables, females were associated with greater use of prostheses, as well as those with five to seven years of schooling, compared to those with fewer years of education. black and mixed-race individuals had lower use of prostheses compared to white individuals Prevalence of prosthesis use (p < 0.001 ) Prevalence of need for prosthesis (p = 0.008)
Carvalho ²⁴ (2012)	Reginópolis (São Paulo State)	Population-based survey	Cross-sectional	101 adolescents	11 to 13 years old 14 to 16 years old	Permanent	Dental caries: DMFT Tooth loss: component “P” of DMFT Periodontal disease: CPI Quality of life: OHIP-14 Significant caries index Dental Care Index (caries) Ethnicity: white and non-white (yellow, mixed-race, black)	The carious component showed a similar mean regarding age and sex However, the mean was higher than that of non-white adolescents living in the rural area of the municipality The prevalence of gingival bleeding and dental calculus was also observed in adolescents aged 11 to 13 years who were white and lived in urban areas (p-value = 0.297)
Colaço et al. ³³ (2020)	Cruz Alta (Rio Grande do Sul State)	Household surveys	Cross-sectional	287 older people	The median age was 69 years old	Permanent	Tooth loss: clinical examination Quality of life: OHIP-14 Ethnicity/race: white and non-white (black, mixed-race, yellow, Indigenous)	Divorced individuals and those who reported not using dental floss had 77% and 54%, respectively, the highest prevalence ratio of having a more significant impact on OHRQoL Older adults who do not need dental prostheses showed less effect on OHRQoL (p < 0.01)
Drummond ³⁸ (2016)	Brazil	Population-based survey	Cross-sectional	2003 (n = 16,833) and 2010 (n = 5,367)	15 to 19 years old	Permanent	Tooth decay: DMFT Tooth loss: DMFT component “P” (0 = no tooth loss, ≥ 1 tooth loss) Race/ethnicity: white, people of African descent, people of East-Asian descent, mixed-race, Indigenous descent	White individuals had fewer untreated decayed teeth, and mixed-race individuals had more missing teeth A hierarchical conceptual model analysis confirmed the association between untreated caries, missing and restored teeth, and race/ethnicity The adjusted odds ratio confirmed that, compared to white individuals, Mixed-race individuals were 1.52 times more likely to have missing teeth, and black and mixed-race groups were 0.72 and 0.89 times less likely to have restored teeth
Moreira et al. ³⁹ (2010)	Brazil	Population-based survey	Cross-sectional	13,431 subjects	35 to 44 years old	Permanent	Tooth loss: clinical examination measured on a scale of 0 to 32 Ethnicity: caucasian and other	When adjusted for the variables studied, ethnicity did not affect tooth loss However, having nine or more years of schooling was associated with protection against tooth loss Not having been to the dentist and not having been to the dentist in the last three years represented increases of 33.5% and 21.3%, respectively, in the risk of tooth loss (p < 0.05)
Gaio et al. ³⁴ (2012)	Porto Alegre (Rio Grande do Sul State)	Population-based survey	Cross-sectional	217 subjects	60 years old or older	Permanent	Edentulism: defined as the complete absence of all teeth Dental caries and periodontal disease: clinical examination Race: white and non-white	Edentulism was significantly more likely to occur in older individuals, women, white individuals, those with low socioeconomic status, and smokers (p = 0.01) Race-associated periodontitis and race-associated mean periodontal attachment loss were not statistically significant, p = 0.92 and p = 0.44, respectively
Guiotoku et al. ⁵ (2012)	Brazil	Population-based survey	Cross-sectional	12,811 adults	35 to 44 years old	Mixed	Caries experience: DMFT Tooth loss: number of missing teeth Anterior edentulism: yes or no Dental pain experience: yes or no Need for prosthesis: 0 = no need; 1 = need for partial denture; 2 = need for full dentures Race/color: white, black, and mixed-race	Correlations were found between oral health outcomes and indicators related to human development profile, average family income, and income inequality by the brazilian state for the black group Mean DMFT associated with race/ethnicity (p < 0.01) Mean tooth loss (number of teeth) (p < 0.01) Number of anterior edentulism (p < 0.01) Need for partial dentures (p < 0.01) Need for total dentures (p < 0.01)
Gushi et al. ²⁵ (2005)	São Paulo State	Population-based survey	Cross-sectional	1,825 adolescents	15 to 19 years old	Permanent	Dental caries: DMFT Tooth loss: Component “P” of DMFT Ethnicity: white and non-white	There were differences in components of the DMFT index: the non-white group had a higher percentage of decayed (p = 0.000) and missing (p = 0.000) teeth At the same time, white individuals had a higher rate of restored teeth (p = 0.000)
Lopez et al. ⁴⁰ (2010)	Brazil	Population-based survey	Cross-sectional	13,431 subjects	35 and 44 years old	Permanent	Dental caries: DMFT Periodontal disease: CPI Tooth loss: absence and presence Ethnic group: Asian, white, Indigenous, black	Regarding ethnicity, results showed a loss of six teeth across all ethnicities examined However, white individuals had fewer missing teeth than the other ethnic groups
Martins et al. ³¹ (2007)	Brazil	Population-based survey	Cross-sectional	5,319 seniors	65 to 74 years old	Permanent	Dental caries: DMFT Edentulous: use and necessity of prosthesis Periodontal disease: CPI Race: white and non-white	Among the edentulous, the use was higher among those with a higher level of education and those who reported pain sensitivity and lower among older people identified as non-white and those who did not receive information on oral health There was no association with the distribution of edentulous subjects according to race (p = 0.091)
Mendes et al. ²⁶ (2012)	Montes Claros (Minas Gerais State)	Studying in a public institution	Cross-sectional	200 older people	60 years old or older	Permanent	Dental caries: DMFT (absence and present) Edentulism: absence of teeth Periodontal disease: CPI (absence and present) Ethnicity: white and non-white	The study showed no statistical difference considering dental caries, periodontal disease, edentulism, and lesions in the oral mucosa associated with ethnicity Ethnicity and dental caries (p= 0.674) Ethnicity and periodontal disease (p= 0.509) Ethnicity and edentulism (p = 0.085)
Nogueira et al. ²⁷ (2019)	São Paulo State	Population-based survey	Cross-sectional	6,051 adults	35 to 44 years old	Permanent	Dental caries: DMFT Missing teeth: dichotomized by median in < 4 > 4 Ethnicity: white and non-white	Income up to BRL 1,500, schooling up to 8 years, low and medium social capital, and women were more likely to have missing teeth The results also showed that income of up to BRL 1,500, schooling up to 8 years and non-white ethnicities were more likely to have decayed teeth
Peres et al. ⁸ (2013)	Brazil	Population-based survey	Cross-sectional	5,445 (15 and 19 years old) 9,779 (35 and 44 years old) 7,619 (65 and 74 years old)	15 to 74 years old	Permanent	Dental caries: DMFT Prevalence of individuals without functional dentition: presence of < 21 natural teeth Edentulism: total loss of all teeth Skin color: white, mixed-race, black, yellow, Indigenous	Among adolescents, women, mixed-race, and black individuals, those with lower income and schooling had a higher prevalence of losses Absence of functional dentition occurred in approximately 1/4 of adults, being higher among women, black, and mixed-race groups and those with lower income and schooling Higher prevalences of edentulism in older people were observed in women and those with lower income and education Prevalence of tooth loss and ethnicity (p = 0.039) Prevalence of no functional dentition and ethnicity (p = 0.019) Prevalence of edentulous and ethnicity (p = 0.662)
Prado ⁴² (2015)	Brazil	Population-based survey	Cross-sectional	9,779 7,619	35 to 44 years old 65 to 74 years old	Permanent	Dental caries: DMFT Periodontal disease: CPI Ethnicity: white, black, mixed-race, other	All ethnic groups, both adults and older adults, had a high prevalence of impacts compared to white ethnicity Adjusted prevalence ratio for tooth loss and race in older people (p < 0.001) Adjusted prevalence ratio for tooth loss and race in adults (p < 0.001)
Rihs et al. ²⁹ (2009)	São Paulo (São Paulo State)	Population-based survey	Cross-sectional	1,192 older people	65 to 74 years old	Permanent	Dental caries: DMFT Tooth loss: component “P” of DMFT Race: Caucasian and non-Caucasian	There was no association between tooth absence and race (p < 0.32); however, regarding race, DMFT was the only variable that showed differences between groups, with higher DMFT for Caucasians (p < 0.02)
Rihs et al. ²⁸ (2009)	São Paulo (São Paulo State)	Population-based survey	Cross-sectional	1,159 teachers and school workers	35 to 44 years old	Permanent	Dental caries: DMFT Tooth loss: “P” component of DMFT Ethnicity: white and non-white	The white group had more caries-free individuals and a higher mean number of teeth than the non-white group (p < 0.05) The DMFT index was higher for men and non-white individuals, and the missing teeth component was higher among men, older people, non-white individuals, and those living in regions without water fluoridation
Sachetti et al. ³⁵ (2020)	Cruz Alta and Veranópolis (Rio Grande do Sul State)	Population-based survey	Cross-sectional	569 subjects	60 years old or older	Permanent	Tooth loss was categorized into edentulism (no teeth at all) and non-edentulism (one or more teeth) Race/skin color: white and non-white (black, mixed-race, yellow, Indigenous)	Cruz Alta: mean tooth loss in white individuals was 19.57, and 29.6% of the sample were edentulous Of non-white individuals, 19.96 had a mean tooth loss, and 30.8% of were edentulous Veranópolis: mean tooth loss in white individuals was 20.69, and 48.8% were edentulous Of non-white individuals, mean tooth loss was 20.93, and 46.7% were edentulous Older adults without access to a dentist in the last 12 months had a higher prevalence ratio (p = 0.006) of concern about dental appearance than those with access to dental care Older people with teeth had a 219% higher prevalence ratio for concern with dental appearance compared to edentulous individuals
Silva Júnior et al. ¹² (2019)	Piracicaba (São Paulo State)	Population-based survey	Cohort	143 adults	20 to 64 years old	Permanent	Dental caries: DMFT Periodontal disease: CPI Tooth loss: 0 (no missing) and 1 (missing ≥ 1 tooth in 4 years) Skin color: White and Non-white (black, mixed-race, yellow, or Indigenous)	The incidence of tooth loss due to ethnicity was not statistically significant (p = 0.801) Among risk factors for tooth loss, the following were reasons for seeking dental services due to pain: decayed teeth
Sanchez ³⁰ (2018)	São Paulo (São Paulo State)	Population-based survey	Cross-sectional	5,951 older people	65 years old or older	Permanent	Functional dentition: ≥ to 21 teeth < 21 teeth Ethnicity/race: Caucasian and non-Caucasian	Regarding ethnicity, 12.65% of Caucasian and 9.97% of non-Caucasian had functional dentition, compared to 87.35% of Caucasian and 90.03% of non-Caucasian who did not have functional dentition There was no association with the frequency of the presence of functional dentition according to ethnicity/race (p < 0.1)
Brizolara ¹⁷ (2017)	São Paulo (São Paulo State)	Population-based survey	Cross-sectional	373 adults in 2010 and 308 in 2015	35 to 44 years old	Permanent	Edentulism and tooth loss: absent and present Functional dentition loss: < 20 functional teeth Dental caries: DMFT Periodontal disease: CPI Ethnic group: White and non-white (yellow or Indigenous, mixed-race or black)	Edentulism and ethnic group: no statistical association was observed in 2010 (p = 0.5323) and 2015 (p = 0.4736) Tooth loss and ethnic group: no statistical association between 2010 (p = 0.1961) and 2015 (p = 0.2068) Loss of functional dentition and ethnic group: no statistical association between 2010 (p = 0.8114) and 2015 (p = 0.6364)
Martins et al. ⁴¹ (2009)	Brazil	Population-based survey	Cross-sectional	241 subjects	35 to 44 years old	Permanent	Tooth loss and edentulism: component “P” of DMFT Ethnic group consisting of two categories: white and yellow; and black and mixed-race	Among variables at the individual level, monthly income of less than 170 dollars, household density of more than one individual per room, being black or mixed-race, no family member having insurance, and medical care were associated with the loss of 12 teeth or more in individuals over 40 years of age Risk factors for tooth loss: being black or mixed-race (p = 0.032)
Landim et al. ³⁶ (2013)	Fortaleza (Ceará State)	Household surveys	Cross-sectional	141 subjects	Over 35 years old	Permanent	Dental caries: DMFT Edentulism: use or need for dentures Race/ethnicity: yellow, black, mixed-race, Indigenous	Economic class and race/ethnicity did not statistically show their relationship with the use and need for upper and lower dentures, having been related only to the higher use of lower dentures among mixed-race individuals In the black population, 118 people, which represents the most significant portion of the sample, had a lower average number of decayed teeth than that of white and Indigenous groups Need for upper prosthesis (p = 0.496) Need for lower prosthesis (p = 0.069)
Meira ⁴³ (2016)	Brazil	Population-based survey	Cross-sectional	7,208	12 years old	Mixed	Dental caries: DMFT (presence or absence) Gingivitis: CPI (presence or absence) Tooth loss: component “P) of DMFT (P ≥ 1) Race/ethnicity: white, mixed-race, black, yellow, and Indigenous	Dental caries, tooth loss, and gingivitis predominated in mixed-race male children, with low family income, and among those with five years or less of schooling Mixed-race children with lower family income and fewer household assets were more likely to have a higher number of oral clinical conditions, suggesting that the number of oral medical conditions is related to social inequities

STUDIES	SELECTION	COMPARABILITY	OUTCOME	RESULT	CLASSIFICATION
Cohort
1	★ ★ ★ ★	★ ★ ★	★	8★	High quality
Cross-sectional
9	★ ★ ★	★ ★	★ ★	7★	High quality
15	★ ★	★ ★	★ ★	6★	Intermediate quality

STUDY (YEAR)	SELECTION			COMPARABILITY		RESULT
STUDY (YEAR)	REPRESENTATIVENESS OF THE EXPOSED	NON-RESPONDENTS	DETERMINATION OF EXPOSURE (RISK FACTOR)	COMPARABILITY OF GROUPS BASED ON DESIGN OR ANALYSIS		EVALUATION OF RESULTS	STATISTICAL TEST	SCORE
Antoniazzi et al. ³² (2021)	★	★	★	★	★	★	★	7
Antunes et al. ²³ (2003)	★		★	★	★	★	★	6
Azevedo et al. ³⁷ (2017)	★		★	★	★	★	★	6
Carvalho ²⁴ (2012)	★	★	★	★	★	★	★	7
Colaço et al. ³³ (2020)	★	★	★	★	★	★	★	7
Moreira et al. ³⁹ (2010)	★		★	★	★	★	★	6
Drummond ³⁸ (2016)	★		★	★	★	★	★	6
Gaio et al. ³⁴ (2012)	★		★	★	★	★	★	6
Guiotoku et al. ⁵ (2012)	★		★	★	★	★	★	6
Gushi et al. ²⁵ (2005)	★	★	★	★	★	★	★	7
Lopez et al. ⁴⁰ (2010)	★		★	★	★	★	★	6
Martins et al. ³¹ (2007)	★		★	★	★	★	★	6
Mendes et al. ²⁶ (2012)	★	★	★	★	★	★	★	7
Nogueira et al. ²⁷ (2019)	★		★	★	★	★	★	6
Rihs, et al. ²⁹ (2009)	★		★	★	★	★	★	6
Rihs et al. ²⁸ (2009)	★	★	★	★	★	★	★	7
Sachetti et al. ³⁵ (2020)	★	★	★	★	★	★	★	7
Peres et al. ⁸ (2013)	★		★	★	★	★	★	6
Sanchez ³⁰ (2018)	★		★	★	★	★	★	6
Brizolara ¹⁷ (2017)	★		★	★	★	★	★	6
Martins et al. ⁴¹ (2009)	★	★	★	★	★	★	★	7
Prado ⁴² (2015)	★		★	★	★	★	★	6
Landim et al. ³⁶ (2013)	★	★	★	★	★	★	★	7
Meira ⁴³ (2016)	★		★	★	★	★	★	6

STUDY (YEAR)	SELECTION			COMPARABILITY				RESULT
STUDY (YEAR)	REPRESENTATIVENESS OF THE EXPOSED COHORT	SELECTION OF THE UNEXPOSED COHORT	DETERMINATION OF EXPOSURE	DEMONSTRATION THAT THE DEVELOPMENT OF INTEREST WAS NOT PRESENTED AT THE BEGINNING OF THE STUDY	COMPARABILITY OF COHORTS BASED ON DESIGN OR ANALYSIS		RESULT EVALUATION	FOLLOW-UP WAS LONG ENOUGH FOR THE RESULTS TO OCCUR		SUITABILITY OF MONITORING OF COHORTS	SCORE
Silva Júnior et al. ¹² (2019)	★	★	★	★	★	★	★	★		8

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Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Rua Leopoldo Bulhões, 1480 , 21041-210 Rio de Janeiro RJ Brazil, Tel.:+55 21 2598-2511, Fax: +55 21 2598-2737 / +55 21 2598-2514 - Rio de Janeiro - RJ - Brazil
E-mail: cadernos@ensp.fiocruz.br

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[TFN1] CPI: Community Periodontal Index; DMFT: Decay, Missing and Filled Teeth Index; OHIP-14: Oral Health Impact Profile; OHRQoL: oral health related quality of life.