The structural determinants of health are the root causes that frame the context where people are born, grow, live, work, and get old [1]. Among them, there are the macro determinants of health, which encompass the broader economic, political, and social systems shaping the power and resources distribution in society and include at least five aspects in consonance with the Commission for Social Determinants of Health: Governance, Macroeconomic policies, Social policies, Public policies, and Culture or Societal values [2]. While the individual social determinants of health - like education, social position, healthcare access, ethnicity, among others - focus on the conditions that affect health outcomes, the macro determinants of health focus on the underlying contextual factors that create and perpetuate these conditions, and, therefore, are also called “the causes of the causes” [3].

Oral health inequities are a demanding issue of social injustice globally and have not decreased over the last decades, with disadvantaged groups still enduring higher morbidity burden [4]. The complete loss of natural teeth, in particular, causes disabilities at proportional degrees to other relevant chronic diseases [5]. However, when comparing countries and territories, evidence shows that the burden of oral conditions is more significant in more economically developed countries and that edentulism is accountable for a substantial part of this burden globally [6,7]. As a result, while countries keep growing economically and development increases, the burden of oral conditions may be responsible for a bigger amount of overall disabilities and the indirect effects of total tooth loss may also have the inadvertent impact of aggravating population-level disparities within the country [8].

Understanding the macro determinants of health is essential for addressing unjust disparities as well as promoting health equity. Still, there is a research gap on the position of the macro determinants on generating oral health inequities worldwide, since investigations tend to target mostly intermediary determinants. The knowledge of oral health conditions globally, taking into account the upstream factors that underline their occurrence, has the potential to highlight health inequities between locations and provide ground for policy and action. Thus, this study sought to describe the distribution of edentulism by the five dimensions of the macro determinants of health in 2000, 2010, and 2019 in 204 countries and territories.