Inequality and damaged teeth: oral sequelae from living in poverty in the Dendê community, Fortaleza, Ceará, Brazil

This anthropological study focuses on the experience of dental disease in the context of poverty in Northeast Brazil. For six months in 2004, ethnographic interviews, narratives, and participatory observation were conducted with 31 residents of the low-income Dendê neighborhood in Fortaleza, Ceará, and the results were analyzed using a hermeneutic-dialectic method. Precarious living conditions make healthcare a difficult priority. Even when individuals experience acute toothache, seeking dental care is perceived as a "luxury" rather than a citizen's right. Difficult access to services and poor-quality restorations favor tooth extraction as the most effective intervention. Local residents complain about their deteriorating oral health and seek help from substandard clinics, patronizing politicians, and traditional healers. In this context, dental disease differs according to social class, leaves the sequelae of inequality, jeopardizes self-esteem, and hinders social inclusion. Dealing with such inequality requires a deeper understanding of the social determinants of health, reducing injustices in access to quality care, eliminating stigma, and empowering community members to confront the structural forces affecting their lives.