Surveillance for Dental Caries, Dental Sealants, Tooth Retention, Edentulism and Enamel Fluorosis—United States, 1988–1994 and 1999–2002
Primary (Baby) Teeth
Prevalence of Decay (Children Aged 2–11):
41% of children in this age group had tooth decay in their primary
teeth. This represents no change in the prevalence of tooth decay in
primary (baby) teeth since 1988–1994.
Mexican-American children had the highest amount of decay (55%)
compared with non-Hispanic white (38%) or black (43%) children.
Nearly twice as many children from lower income families had tooth
decay — 55% of children from low income (<100% of the federal poverty
level (FPL) families had decay, compared with 31% of children from higher
income (≥200% FPL) families.
Untreated Decay (Children Aged 2–11):
21% had untreated decay in their primary teeth.
Fewer non-Hispanic white children (18%) and children from families
with incomes ≥200% of the FPL (13%) had untreated tooth decay, compared
with non-Hispanic black (27%) and Mexican-American (32%) children.
One-third (34%) of low-income children (families with incomes <100%
of the FPL) aged 2–11 years had untreated tooth decay in their primary
teeth, compared with only 13% of children in families with incomes ≥200%
Secondary (Permanent) Teeth: Children and Adolescents
Prevalence of Decay (Children and Adolescents Aged 6–19):
There was an overall decrease of nearly 15% in tooth decay in the
Prevalence of tooth decay is higher with age. One in five (20%) of
children aged 6–11 years had tooth decay in their permanent teeth,
compared with half (50%) of children aged 12–15 years and two-thirds (68%) of
adolescents aged 16–19 years.
Low-income children were more likely to have decay. Nearly half (48%)
of children/adolescents aged 6–19 years whose families had lower incomes
(<100% FPL) had decay, compared with 36% of children whose families
earned ≥200% FPL.
Disparities were noted in prevalence of decay. Nearly half (49%) of
Mexican-American children/adolescents had decay experience, compared with
non-Hispanic white (40%) and black (39%) children/adolescents.
Untreated Decay (Children and Adolescents Aged 6–19):
Untreated decay in the permanent teeth for children/adolescents
decreased by 10%
Overall, in the current survey, about 14% of children and adolescents
had untreated tooth decay in their permanent teeth. The prevalence of
untreated decay in the permanent teeth was 7% for children aged 6–11
years, 16% for adolescents 12–15 years, and 22% for adolescents 16–19
Low-income children/adolescents (20%) had more than twice as much
untreated decay as those from families with higher incomes (>200% FPL)
Mexican-American and non-Hispanic black children (22% and 18%,
respectively) had about twice as much decay as non-Hispanic white
Dental Sealants* (Children and Adolescents Aged 6–19):
There was a 64% increase in the percentage of children and
adolescents who had received a dental sealant.
32% of children had at least one dental sealant on one or more
permanent molar, premolar, or upper lateral incisor, compared with 20% in
the previous survey.
Half as many (22%) low-income children (family income <100% of the
FPL) had received a dental sealant as children (42%) from higher income
families (≥200% FPL).
The current survey found that more than twice as many non-Hispanic
black and Mexican-American children had received sealants, compared to
the previous survey. For non-Hispanic black and Mexican-American
children, the percent that had sealants increased from 9% to 23%. White,
non-Hispanic children had the highest level of sealant receipt (38%).
Secondary (Permanent) Teeth: Adults (Aged 20 and Older)
Prevalence of Decay:
There was a small (4%) decrease in the prevalence of decay on the pit
and fissure (coronal) surfaces of the permanent teeth in adults aged 20
years and older.
87% of adults aged 20–39 years had coronal decay.
95% of adults aged 40–59 years had coronal decay.
93% of adults 60 years and older had coronal decay.
More white, non-Hispanics had coronal decay (93%) than non-Hispanic
blacks (85%) and Mexican-Americans (84%).
The percentage of adults aged 20 years and older with decay on the
roots of their teeth (root caries) decreased slightly by 6%.
The percentage of adults with decay on the roots of their teeth (root
caries) was higher with age: 9% of adults aged 20–39 years had root
decay, compared with 18% of adults aged 40–59 years and 32% of adults 60
years and older.
The greatest disparities in the prevalence of root caries were seen
for current smokers. Twice as many current smokers (28%) as non-smokers
(14%) had root caries.
Untreated Decay (Aged 20 and older):
The percentage of untreated decay decreased by 18%.
More than twice as many low income (<100% of the FPL) adults had
untreated decay (41%), compared with 16% of adults with higher (≥200%
41% of non-Hispanic blacks had untreated decay, compared to 36% of
Mexican-Americans and 18% of non-Hispanic whites.
41% of adults with less than a high school education had untreated
decay, compared with 14% of adults with greater than a high school
Total Tooth Loss (Edentulism) Among Adults:
A nearly 20% reduction was seen in the percentage of adults aged 60
and older who had lost all of their teeth (edentulism). In the current
survey, one-quarter (25%) of these adults had lost all of their teeth,
compared with 31% in the previous survey.
Only 6% of Mexican-Americans were edentulous, compared to 8% of
non-Hispanic whites and 10% of non-Hispanic blacks.
15% of low-income adults (<100% of the FPL) had lost all of their
teeth, compared with only 5% of people with higher incomes (≥200% FPL).
14% of people with less than a high school education were edentulous,
compared with 9% of people who had completed high school and only 4% of
people with more than a high school education.
13% of current smokers were edentulous, compared with 8% of former
smokers and 5% of people who had never smoked.
32% of children and adolescents aged 6 to 19 years had very mild or greater enamel fluorosis.
The prevalence of fluorosis was lowest among persons aged 20–39 years
(16%), 6–11 years (28%), 16–19 years (32%), and
followed by persons aged 12–15 years (37%).
Non-Hispanic blacks had the highest prevalence of fluorosis (33%),
compared to non-Hispanic whites (20%).
* Dental sealants are thin plastic coatings that are applied to the pit
and fissure surfaces of teeth to prevent decay.
Recommendations for Public Health Action
Based on the findings of this report, the authors made the following
recommendations for public health action.
Public health interventions to prevent tooth decay should extend to
all age and sociodemographic groups.
Research should be conducted to learn more about factors related to
the lack of reduction of tooth decay in children’s primary teeth.
As the U.S. population continues to age and more adults keep their
natural teeth, preventive interventions are needed for adults at the
individual, clinical, and community level.
Programs designed to promote oral health (e.g., dental sealant and
smoking cessation programs) should include interventions designed to
reduce disparities in racial/ethnic minorities, people of lower income
and lower education levels, and for current smokers.