The scope of this study was to estimate the prevalence of tooth loss and associated factors among Brazilian adults aged 20 to 59 years in rural areas in the state Pernambuco, Brazil. A cross-sectional study was conducted on a random sample of 568 participants. The number of lost teeth (d" 12 and > 12) was the outcome investigated. The independent variables were as follows: sociodemographic characteristics, subjective oral health conditions, impact of oral health on quality of life using the short version of the Oral Health Impact Profile (OHIP-14), and the use of dental services. Crude and adjusted prevalence ratios were estimated using a Poisson regression model. The prevalence of subjects with at least one tooth lost was 91.4%. Tooth loss was strongly associated with age group, self-perceived oral health and oral health impact on quality of life. The high prevalence of tooth loss among Brazilian adults in rural areas shows a need for a reorientation of public dental services aimed at this population group.