Temporal trends in outpatient dental care in Brazil’s SUS by complexity (2011–2025)

Resumo

Objective: To analyze trends in outpatient dental service production within Brazil’s Unified Health System (SUS) from 2011 to 2025, considering procedure volume, approved financial values, and levels of care complexity. Methods: An ecological, longitudinal study was conducted using national secondary data from the SUS Outpatient Information System (SIA/SUS). Annual numbers of approved dental procedures and corresponding financial values were analyzed descriptively and stratified by primary, medium-, and high-complexity care. Due to inconsistencies in primary care financial records, financial analyses focused on medium- and high-complexity services. Results: Total outpatient dental production increased until 2015, followed by a sustained decline, reaching its lowest level in 2020. Although partial recovery occurred after 2021, production in 2025 remained well below pre-2016 levels. Primary care experienced the greatest absolute reduction and did not recover pre-pandemic volumes. In contrast, medium- and especially high-complexity care showed greater resilience, with high-complexity procedures exceeding pre-pandemic levels. Despite reduced service volume, approved financial values recovered and reached their highest levels after 2021, indicating increased average cost per procedure. Conclusion: The findings indicate a structural shift in SUS dental care, with reduced overall production and progressive reorientation of financing toward higher-complexity services, raising concerns about access, equity, and the central role of primary care.