Health Disparities in Oral Health

Key points

  • Disparities in oral health exist among many groups of US children and adults.
  • Disparities in oral health are preventable.
  • Efforts to reduce disparities in oral health may help achieve health equity, where everyone has fair and just opportunity to achieve their highest level of health.

Why it's important

The nation’s oral health has greatly improved since the 1960s, but not all Americans have had equal opportunity to experience similar improvements in oral health.12

Poor oral health among some groups of people is partly due to health disparities. Health disparities can be described as preventable differences in disease impact or opportunities in a population due to some type of disadvantage, such as limited access to services where they live or ability to afford health care services.34

For example:

  • As of 2024, approximately 57 million Americans live in a dental health professional shortage area and about 67% of those shortage areas are in rural communities.5
  • From 2016 to 2021, there has been about a 10% decrease in the percentage of low-income children and adolescents (aged 1–17) who had a past-year dental visit to get preventive dental care.6

The conditions in environments where people are born, live, learn, work, play, and age are called social determinants of health. These factors influence oral and overall health.78

Additional factors, such as the policies and systems that shape the conditions of daily life for people across the nation, may also influence disparities in oral health.8

Efforts to reduce disparities in oral health may help achieve health equity, where everyone has fair and just opportunity to achieve their highest level of health.39

Health disparities

Disparities in oral health exist among all age groups. These disparities exist by poverty status, race/ethnicity, education level, smoking status and many other forms of comparison.10

Identifying and understanding how specific factors (e.g., insurance coverage status, health literacy, language barriers) influence access and use of available dental care services may help inform efforts to address disparities in oral health.1

Oral health disparities among US children and adolescents (aged 2 to 19):

  • The prevalence of untreated cavities (tooth decay) in the primary teeth of children (aged 2 to 5) from low-income households is about three times higher (17%) than that of children from higher income households (6%).10
  • About 33% of Mexican American children and 28% of non-Hispanic Black children (aged 2 to 5) have had cavities in their primary teeth, compared with 18% of non-Hispanic White children.10
  • The prevalence of untreated cavities in the permanent teeth of children and adolescents (aged 12 to 19) is about twice as high for children from low-income households (23%) as it is for children from higher income households (11%).10

Oral health disparities among US working-age adults (aged 20 to 64):

  • Untreated cavities are about twice as common among working-age adults with no health insurance coverage (43%) compared with those who have private health insurance coverage (18%).11
  • Among working-age adults, the prevalence of untreated cavities was twice as high for non-Hispanic Black adults (40%) as it was for non-Hispanic White adults (21%) in 2011–2016.11
  • Periodontitis (gum disease with bone loss) was twice as common (60%) among adults (aged 30 or older) with low income compared with adults who had higher income (30%) in 2009–2014.12

Oral health disparities among US older adults (aged 65 or older):

  • Complete tooth loss was more than three times as common among older adults who were current smokers (43%) or had less than a high school level of education (35%) compared with those who never smoked (12%) or had more than a high school level of education (9%) in 2011–2016.10
  • Complete tooth loss was about three times as common among older adults with lower income (34%) compared with older adults who had higher income (11%) in 2011–2016.10
  • The prevalence of untreated cavities is about 2 to 3 times as high for older adults who are Mexican American (36%), non-Hispanic Black (29%), or low-income (29%) as it is for non-Hispanic White older adults (13%) or those with higher income (10%).10

Oral health disparities and dental sealants

From 1999 to 2016, there was an overall increase in the presence of dental sealants among all US children aged 6 to 11. However, non-Hispanic Black children continued to have lower presence of dental sealants (32%) than non-Hispanic White (44%) and Mexican American children (44%).10

Dental sealants can prevent cavities for many years,13 but they are currently underutilized for all US children. School sealant programs are an effective way to help prevent cavities among children across the nation, especially those who may not otherwise have access to dental care.14

Oral health disparities and oral cancer

New oral cancer cases are about three times more common among men than women.15

The highest rates of new oral cancer cases are among non-Hispanic White and American Indian/Alaska Native people. 15

The highest death rates for oral cancer cases are among non-Hispanic Black and non-Hispanic White people.15

About 60% of oral cancer cases are detected when they have already reached an advanced stage.16 Efforts are needed to understand how to further support prevention and early detection of oral cancer, especially for groups experiencing the highest rates of death and new cases. 17

Oral health disparities and health insurance coverage

More people are unable to afford dental care than other types of health care.18 In 2015, the percentage of people in the United States with no dental insurance was 29% overall and 62% for older adults.19

Traditional Medicare does not cover routine dental care. Therefore, many working adults lose their dental benefits upon retirement. In addition, many adults with low income do not have public dental insurance coverage. Medicaid programs are not required to provide dental benefits to adult enrollees, so dental coverage varies widely from state to state.

In 2023, comprehensive Medicaid dental benefits were available to enrolled adults in 28 states and the District of Columbia.2021 The Centers for Medicare & Medicaid Services has announced an initiative to consider options to expand access to oral health coverage.22

What CDC is doing

CDC's Division of Oral Health (DOH) provides leadership to improve the nation's oral health. We promote proven interventions, such as dental sealants and community water fluoridation, to reduce the rate of cavities, especially for people at highest risk. We also support data collection efforts to help monitor progress towards improving the nation's oral health.

DOH efforts to improve oral health include:

  • Developing and promoting infection prevention and control guidelines for dental settings.
  • Working to integrate medical and dental care.
  • Funding state, territorial, and tribal oral health programs.
  • Hosting the CDC Dental Public Health Residency Program.
  • Conducting oral health-related research.
  • Partnering with organizations that support the DOH mission.

Resources

For more information on the high cost of oral disease and the cost-effectiveness of oral disease interventions, see CDC’s Power of Prevention fact sheet.

Print
Content Source:
National Center for Chronic Disease Prevention and Health Promotion; CDC Division of Oral Health
  1. National Institutes of Health. Oral Health in America: Advances and Challenges. US Dept of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research; 2021. Accessed January 18, 2024. https://www.nidcr.nih.gov/sites/default/files/2021-12/Oral-Health-in-America-Advances-and-Challenges.pdf
  2. US Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000. Accessed December 12, 2023. nidcr.nih.gov/sites/default/files/2017-10/hck1ocv.%40www.surgeon.fullrpt.pdf
  3. What is Health Equity. Centers for Disease Control and Prevention. Accessed January 18, 2024. https://www.cdc.gov/healthequity/whatis/index.html
  4. US Dept of Health and Human Services. Health Equity and Health Disparities Environmental Scan. US Dept of Health and Human Services, Office of Disease Prevention and Health Promotion; 2022. Accessed January 18, 2024. https://health.gov/sites/default/files/2022-04/HP2030-HealthEquityEnvironmentalScan.pdf
  5. Health Workforce Shortage Areas: Explore HPSAs. Health Resources & Services Administration. Accessed January 18, 2024. https://data.hrsa.gov/topics/health-workforce/shortage-areas
  6. Healthy People 2030. Oral conditions: Increase the proportion of low-income youth who have a preventive dental visit — OH-09. US Dept of Health and Human Services, Office of Disease Prevention and Health Promotion. Accessed January 18, 2024. https://health.gov/healthypeople/objectives-and-data/browse-objectives/oral-conditions/increase-proportion-low-income-youth-who-have-preventive-dental-visit-oh-09
  7. Healthy People 2030. Social Determinants of Health. US Dept of Health and Human Services, Office of Disease Prevention and Health Promotion. Accessed January 18, 2024. https://health.gov/healthypeople/priority-areas/social-determinants-health
  8. World Health Organization. Social determinants of health. Accessed February 26, 2024. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
  9. Braveman P, Arkin E, Orleans T, Proctor D, Plough A. What Is Health Equity? And What Difference Does a Definition Make? Robert Wood Johnson Foundation; 2017. Accessed January 18, 2024. https://www.rwjf.org/content/dam/farm/reports/reports/2017/rwjf437393
  10. Centers for Disease Control and Prevention. Oral Health Surveillance Report: trends in dental caries and sealants, tooth retention, and edentulism, United States, 1999–2004 to 2011–2016. US Dept of Health and Human Services; 2019. Accessed January 18, 2024.
  11. Williams S, Wei L, Griffin SO, Thornton-Evans G. Untreated caries among US working-aged adults and association with reporting need for oral health care. J Am Dent Assoc. 2021;152(1):55–64. doi.org/10.1016/j.adaj.2020.09.019
  12. Eke PI, Thornton-Evans GO, Wei L, Borgnakke WS, Dye BA, Genco RJ. Periodontitis in US adults: National Health and Nutrition Examination Survey 2009–2014. J Am Dent Assoc. 2018;149(7):576–588. https://doi.org/10.1016/j.adaj.2018.04.023
  13. Ahovuo-Saloranta A, Forss H, Walsh T, Nordblad A, Mäkelä M, Worthington HV. Pit and fissure sealants for preventing dental decay in permanent teeth. Cochrane Database Syst Rev. 2017;7(7):CD001830. doi:10.1002/14651858.CD001830.pub5
  14. Griffin SO, Naavaal S, Scherrer C, Patel M, Chattopadhyay S; Community Preventive Services Task Force. Evaluation of school-based dental sealant programs: an updated Community Guide systematic economic review. Am J Prev Med. 2017;52(3):407–415. doi: 10.1016/j.amepre.2016.10.004
  15. National Cancer Institute. Cancer Stat Facts: Oral Cavity and Pharynx Cancer. Accessed January 18, 2024. https://seer.cancer.gov/statfacts/html/oralcav.html
  16. Cleveland JL, Thornton-Evans G. Total diagnostic delay in oral cancer may be related to advanced disease stage at diagnosis. J Evid Based Dent Pract. 2012 Jun;12(2):84–86. doi: 10.1016/j.jebdp.2012.03.018
  17. U.S. Preventive Services Task Force. Oral Cancer: Screening. Accessed January 19, 2023. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/oral-cancer-screening
  18. Vujicic M, Buchmueller T, Klein R. Dental care presents the highest level of financial barriers, compared to other types of health care services. Health Affairs. 2016;35(12):2176–2182. https://doi.org/10.1377/hlthaff.2016.0800
  19. Manski RJ, Rohde F. Dental Services: Use, Expenses, Source of Payment, Coverage and Procedure Type, 1996–2015. Research Findings No. 38. Agency for Healthcare Research and Quality, US Dept of Health and Human Services; 2017.
  20. State Medicaid Coverage of Dental Services for General Adult and Pregnant Populations. National Academy for State Health Policy. Accessed January 18, 2024. https://nashp.org/state-medicaid-coverage-of-dental-services-for-general-adult-and-pregnant-populations/
  21. Medicaid Adult Dental Coverage Checker. CareQuest. Accessed January 18, 2024. https://www.carequest.org/Medicaid-Adult-Dental-Coverage-Checker
  22. CMS Strategic Plan. Centers for Medicare & Medicaid Services. Accessed January 18, 2024. https://www.cms.gov/about-cms/what-we-do/cms-strategic-plan