Pathfinder national surveys of oral health meeting international standards set up by the World Health Organization (WHO) (1) have been performed in Brazil after the return of the country to democracy during the mid-1980s. The comparison of these surveys’ results indicated an impressive reduction of caries indices, which have been attributed to the fluoridation of tap water and major-selling tooth- paste brands, besides an extensive reform of the health system (2). The fluoridation of water sup- plies has been mandatory in Brazil since 1974, but its implementation was progressive mainly after the mid-1980s. Its current population coverage exceeds 50%. Major dentifrice brands began selling fluoride toothpaste in 1988 (3); the market share of fluoride dentifrice in Brazil corresponds to almost 100% since 1990, but its optimal benefit demands the adherence to a regular dental hygiene. A noticeable increase in the dental public service followed the reform of the Brazilian health system in 1990, with an extended promotion of initiatives on oral health education, and the provision of preventive and restorative dental treatment to children. Notwithstanding the overall reduction in caries measures, differential levels of access to fluoridated Community Dent Oral Epidemiol 2006; 34: 146–52 All rights reserved Copyright Ó Blackwell Munksgaard 2006 Multilevel assessment of determinants of dental caries experience in Brazil Antunes JLF, Peres MA, Mello TRC, Waldman EA. Multilevel assessment of determinants of dental caries experience in Brazil. Community Dent Oral Epidemiol 2006; 34: 146–52. Ó Blackwell Munksgaard, 2006 Abstract – Objective: To examine contextual and individual determinants of dental caries experience, documenting levels of the disease in Brazil. Methods: The dental status of 34 550 12-year-old schoolchildren was informed by a country-wide survey of oral health comprising 250 towns and performed in 2002–2003. Indices assessing dental caries experience were compared by sociodemographic characteristics of examined children (gender, ethnic group, localization and type of school), and geographic characteristics of participating towns [the human development index (HDI), and access to fluoridated tap water]. A multilevel model fitted the adjustment of untreated caries to individual and contextual covariates. Results: Better-off Brazilian regions presented an improved profile of dental health, besides having a less unequal distribution of restorative dental treatments between blacks and whites, rural and urban areas, and public and private schools. Girls [odds ratio (OR) ¼ 1.1; 95% confidence interval (CI): 1.0–1.1], blacks (OR ¼ 1.6; 95% CI: 1.5–1.7), and children studying in rural areas (OR ¼ 1.9; 95% CI: 1.7–2.0) and public schools (OR ¼ 1.7; 95% CI: 1.6–1.9) presented higher odds of having untreated decayed teeth. The multilevel model identified the fluoride status of tap water (b ¼ )0.3), the proportion of households linked to the water network (b ¼ )0.3), and the HDI (b ¼ )0.2), as town-level variables associated with caries levels. Conclusion: Dental caries experience is prone to socio- demographic and geographic inequalities. The monitoring of contrasts in dental health outcomes is relevant for programming socially appropriate interventions aimed both at overall improvements and at the targeting of resources for groups of population presenting higher levels of needs. Jose ´ Leopoldo Ferreira Antunes 1 , Marco Aure ´lio Peres 2 , Tatiana Ribeiro de Campos Mello 3,4 and Eliseu Alves Waldman 4 1 School of Dentistry, University of Sa ˜ o Paulo, Sa ˜o Paulo, SP, Brazil, 2 Department of Public Health, Centre for Health Sciences, Federal University of Santa Catarina, Floriano ´ polis, SC, Brazil, 3 Porto Medical School, University of Porto, Porto, Portugal, 4 School of Public Health, University of Sa ˜o Paulo, Sa ˜o Paulo, SP, Brazil Key words: dental caries; dental health services; fluoride; socioeconomic factors Jose ´ Leopoldo Ferreira Antunes, School of Dentistry, University of Sa ˜o Paulo, 2227 Av Prof Lineu Prestes, 05508-900 Sa ˜o Paulo, SP, Brazil Tel: (5511)30917877 Fax: (5511)30917874 e-mail: leopoldo@usp.br Submitted 25 May 2005; accepted 29 September 2005 146