Primary dental care evaluation in Brazil: an item response theory approach Clarice Magalh~ aes Rodrigues dos Reis, DDS, MSc, PhD 1 ; Juliana Vaz de Melo Mambrini, PhD 2 ; Ant^ onio Thomaz Gonzaga da Matta-Machado, PhD 3 ; Jo~ ao Henrique Lara do Amaral, DDS, MSc, PhD 1 ; Marcos Azeredo Furquim Werneck, DDS, PhD 1 ; Mauro Henrique Nogueira Guimar~ aes de Abreu, DDS, MSc, PhD 1 1 Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil 2 Ren e Rachou Research Center, FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil 3 Department of Preventive and Social Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil Keywords health services research; primary health care; health care evaluation mechanisms. Correspondence Mauro Henrique Nogueira Guimar~ aes de Abreu, Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. Tel.: 155 31 34092442; Fax: 155 31 34092442; e-mail: maurohenriqueabreu@gmail.com. Clarice Magalh~ aes Rodrigues dos Reis, Ant^ onio Thomaz Gonzaga da Matta- Machado, Jo~ ao Henrique Lara do Amaral, Marcos Azeredo Furquim Werneck are with the Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. Juliana Vaz de Melo Mambrini is with the Ren e Rachou Research Center, FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil. Ant^ onio Thomaz Gonzaga da Matta-Machado is with the Department of Preventive and Social Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. Received: 7/72016; accepted: 1/13/2017. doi: 10.1111/jphd.12210 Journal of Public Health Dentistry 00 (2017) 00–00 Abstract Objectives: Item response theory (IRT) is a method used to design, analyze, and score tests, questionnaires, and similar instruments measuring abilities, attitudes, or other variables. The aim of this study was to assess the psychometric properties of dental care questions in the “Programa Nacional de Melhoria do Acesso e Qualidade da Atenc¸~ ao B asica—PMAQ-AB,” Brazil, using IRT. Methods: Dentists in primary health care units in Brazil (n 5 12,403) were interviewed face-to-face using a structured questionnaire. The questions were primarily dichotomous, with a no answer/do not know option. The items about dental care from a Brazilian national evaluation survey were analyzed using the IRT model (20 items). Oral health teams (OHTs) received scores that varied from the lowest performance level to the highest performance level. Scores for the Brazilian states and the Federal District were calculated to evaluate the regional distribution of OHT performance. Results: The questions about dental care exhibited higher discrimination power for OHTs with below average performance. In general, the teams, including those with low performance, performed the actions, and procedures included in the questionnaire. Actions such as making prostheses and tracking and monitoring oral cancer cases characterized the high-performing teams. The performance of the teams distributed throughout the Brazilian states indicated that OHTs in the south and southeast performed better than OHTs in the rest of the country. Conclusions: Although the analyzed items are insufficient to determine the performance of OHTs, the items related to prosthesis and oral cancer tend to discriminate high-performing OHTs from other OHTs. Introduction The Brazilian Health System (SUS in Portuguese) is based on the constitutional principle that all citizens have the right of access to healthcare services. Since 1994, the organization and expansion of primary health care (PHC) in Brazil has pro- ceeded under the marked influence of the tenets of the Family Health Strategy (FHS) (1). Dental care has been part of the FHS since 2000. At the primary level, preventive and basic clin- ical examinations are provided. In addition to the PHC serv- ices that are offered, in 2004, the current National Oral Health Policy launched dental specialty centers that are responsible for providing secondary care services including endodontics, V C 2017 American Association of Public Health Dentistry 1 Journal of Public Health Dentistry   ISSN 0022-4006