The alcohol harm paradox and oral health: Evidence from the 2019 Brazilian national health survey

This study aimed to investigate whether the association between alcohol consumption and two oral health outcomes—tooth loss, measured as non-functional dentition (NFD), and poor self-rated oral health (SROH)—varies according to socioeconomic position (SEP). Data were drawn from the 2019 Brazilian National Health Survey. SEP was operationalised using educational attainment, and average alcohol consumption was categorised in 20 g/day increments. Sex-stratified multivariable Poisson regression models were used to assess whether the association between alcohol consumption and oral health outcomes varied in magnitude and direction across SEP levels. The sample comprised 21,330 men and 13,650 women. Among men, those with low educational attainment consuming >0 to ≤20 g/day (PR: 1.80; 95% CI: 1.13, 2.89) and >40 g/day (PR: 1.90; 95% CI: 1.10, 3.26) had a higher prevalence of NFD and poor SROH, respectively, compared with their highly educated counterparts reporting the same levels of consumption. Among women, those with low educational attainment consuming >0 to ≤20 g/day (PR: 1.59; 95% CI: 1.18, 2.13) had a higher prevalence of poor SROH than their highly educated counterparts. In conclusion, the association between alcohol consumption and oral health outcomes differs across SEP, both in magnitude and direction. Even low-to-moderate alcohol intake was associated with a higher prevalence of NFD and poor SROH, with stronger associations observed among individuals with lower educational attainment. These findings should be interpreted in light of the inherent limitations of the cross-sectional design.