Oral Health for Adults

Fact Sheet: Key Findings from NHANES 1999–2002

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% FPL.

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 permanent teeth
• 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 years.
• Low-income children/adolescents (20%) had more than twice as much untreated decay as those from families with higher incomes (>200% FPL) (8%).
• Mexican-American and non-Hispanic black children (22% and 18%, respectively) had about twice as much decay as non-Hispanic white children/adolescents (11%).

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% FPL) incomes.
• 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 education.

Total Tooth Loss (Edentulism) Among Adults:

• A nearly 20% reduction was seen in the percentage of adults aged 60 years 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.

Fluorosis:

• 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.
• Better surveillance tools are needed to monitor fluoride exposure from multiple sources. The increase in the prevalence of enamel fluorosis should be evaluated in the context of total fluoride exposure for people born since 1980 (see previous CDC recommendations issued in 2001, Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States). 

Page last reviewed: June 25, 2007
Page last modified: November 21, 2006
Content source: Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion