ORIGINAL ARTICLE The role of municipal public policies in oral health socioeconomic inequalities in Brazil: A multilevel study Violeta Rodrigues Aguiar 1 | Marcos Pascoal Pattussi 2 | Roger Keller Celeste 3 1 Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil 2 University of Vale do Rio dos Sinos, S~ ao Leopoldo, Rio Grande do Sul, Brazil 3 Department of Social and Preventive Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil Correspondence Violeta Rodrigues Aguiar, Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. Email: violetaaguiar@gmail.com Abstract Objectives: It is known that fluoridation has a contextual effect on oral health socioeconomic inequalities, but broad public policies have not been investigated. Thus, the aim of this study was to determine the effects of municipal public policies on oral health across different social strata. Methods: This was a cross-sectional study with 7328 12-year-old children and 5445 15-19-year-old adolescents from 177 Brazilian municipalities. Information at municipal level was collated for dental services, educational services, sanitation and water fluoridation. The main individual-level exposure was the disposable equivalent household income. The dichotomous outcomes were as follows: untreated dental caries (≥1 tooth), missing teeth (≥1 tooth) and filled teeth (≥1 tooth). Analyses were carried out using multilevel logistic regression. Interaction terms were tested between individual-level income and policy variables. Results: The prevalence of untreated dental caries, missing and filled teeth was 47.0%, 15.1% and 47.5%, respectively. There was no significant interaction between income and policy indicators. Individuals living in municipalities with no water fluori- dation had 1.42 (95% CI: 1.08-1.86) higher odds of having untreated dental caries; the odds ratio (OR) for those in municipalities with less education policies was 1.36 (95% CI: 1.07-1.73); those in municipalities with less sanitation had OR = 1.05 (95% CI: 0.78-1.40); and those in municipalities with less dental care had OR = 1.36 (95% CI: 1.02-1.80). Conclusions: Fluoridation and policies about sanitation, education and dental care were similarly associated with oral health in different social strata. Other policies on social and economic fields may be further explored. KEYWORDS health inequalities, health policy, health system, social inequity, social policy 1 | INTRODUCTION Public policies play an important role in population health, 1 and univer- sal access to health services is an example 2 that has beneficial effects on different health outcomes. Similarly, other public policies such as sanitation, infrastructure and education may also have a positive effect on population health. 3 Nevertheless, some evidence has suggested that health services may have relatively little impact on general health 4 or oral health. 5 Few studies have explored the role of broad policies on health inequalities, 6 and there is scant evidence on the effect of public policies on oral health inequalities. 7,8 A recent systematic review concluded that there is high level of inequalities in developed countries, speculating that access to health care may contribute to this gap and that fluoridated water may reduce existing inequalities. 9 Public health policies may both decrease or increase social gap in health. 10-12 Targeted policies can have little effectiveness in reducing Received: 24 April 2017 | Accepted: 7 November 2017 DOI: 10.1111/cdoe.12356 Community Dent Oral Epidemiol. 2017;1–6. wileyonlinelibrary.com/journal/cdoe © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd | 1