Cost-Effectiveness of Oral Diseases Interventions
Oral diseases—which range from cavities to gum disease to oral cancer—cause pain and disability for millions of Americans.1 Cavities (also called tooth decay) are one of the most common chronic conditions in the United States. Non-Hispanic blacks, Hispanics, and American Indians and Alaska Natives generally have the poorest oral health compared to other US racial and ethnic groups.2
Oral Diseases in the United States
- About 1 in 6 children aged 6 to 11 years have had at least one cavity. More than half of children aged 12 to 19 have had cavities during adolescence, and about 1 in 6 have untreated cavities.2
- More than 1 in 4 adults have untreated cavities, and nearly half of those aged 30 or older show signs of gum disease.2,3 If left untreated, these conditions can lead to tooth loss.
- More than 1 in 6 adults aged 65 or older have lost all their teeth, which can affect nutrition.2
- People who smoke are 3 times as likely as nonsmokers to lose all of their teeth.2
Strategies That Work
CDC works to improve the nation’s oral health by reducing disparities in the rate of cavities in the United States and integrating oral health programs into chronic disease prevention and medical care. The agency and its partners promote effective interventions, including dental sealants and community water fluoridation, which are strongly recommended by the US Preventive Services Task Force because they prevent cavities and save money.
- Dental sealants are a quick, easy, and painless way to prevent most of the cavities that children get in their permanent back teeth, where 9 in 10 cavities occur.
- School sealant programs provide dental sealants at no charge to children who are less likely to receive private dental care. Almost 1 million cavities have been prevented in low-income children as a result of dental sealant programs supported by CDC funding.5
- Community water fluoridation is an equitable and effective way to deliver fluoride to all community members regardless of age, education, or income. It also saves money for families and the US health care system.8
- CDC is working to meet the Healthy People 2030 objective of 77.1% of the US population being on community water systems with the recommended amount of fluoride. Currently, more than 70% of the population served by community water systems (more than 200 million people) drink water that contains enough fluoride to protect their teeth.9
The Benefits of Using Proven Strategies
- The benefits of school sealant programs are greater than their cost when they serve children at high risk for tooth decay. These programs become cost-saving after 2 years and save more than $11*(a) for every tooth sealed over 4 years.4
- Providing sealants to the nearly 7 million low-income children who need them could save up to $300 million*(a) in averted dental treatment costs.5
- One year of providing fluoridated water is estimated to save $6.5 billion*(b) in averted direct and indirect treatment costs.6
- Communities served by fluoridated water save an average of $32*(b) per person a year by avoiding treatment for cavities. Communities of 1,000 or more see an average estimated return on investment of $20 for every $1 spent on water fluoridation.6
- The US health care system could save up to $100 million*(c) a year if dental offices screened patients for diabetes, high blood pressure, and high cholesterol and referred them for treatment.7
Dental sealants reduce cavities in permanent molars by 80% for 2 years after placement and continue to protect against 50% of cavities for up to 4 years.5
total annual costs
related to dental care10
The High Cost of Oral Diseases
- On average, over 34 million school hours are lost each year because of unplanned (emergency) dental care.11
- Over $45 billion*(e) is lost in productivity in the United States each year because of untreated oral disease.12
- In 2017, there were 2.1 million emergency room visits for dental emergencies. Medicaid pays for about 69% of these visits for children and about 40% for adults.13
- During 1996–2013, $26.5 billion*(e) was spent on dental care for children and adolescents. About 70% of this total was used for preventive services, such as general exams and cleanings, X-rays, and orthodontic treatment (such as braces).14
- Nearly 18% of working-age adults report that the appearance of their mouth and teeth affects their ability to interview for a job. For people with low incomes, the percentage increases to 29%.15
- US Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Bethesda, MD: National Institutes of Health, US Dept of Health and Human Services; 2000.
- 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. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2019.
- Eke PI, Dye, BA, Wei L, et al. Update on prevalence of periodontitis in adults in the United States: NHANES 2009 to 2012. J Periodontol. 2015;86(5):611–622.
- Community Preventive Services Task Force. Dental Caries (Cavities): School-Based Dental Sealant Delivery Programs website. https://www.thecommunityguide.org/findings/dental-caries-cavities-school-based-dental-sealant-delivery-programsexternal icon. Accessed January 8, 2020.
- Centers for Disease Control and Prevention. Vital Signs website. Dental Sealants Prevent Cavities. https://www.cdc.gov/vitalsigns/dental-sealants/index.html. Accessed September 17, 2019
- O’Connell JM, Rockwell J, Ouellet J, Tomar SL, Maas W. Costs and savings associated with community water fluoridation in the United States. Health Aff. 2016;35(12):2224–2232.
- Nasseh K, Greenberg B, Vujicic M, Glick M. The effect of chairside chronic disease screenings by oral health professionals on health care dollars. Am J Public Health. 2014;104(4):744–750.
- Centers for Disease Control and Prevention. Achievements in public health, 1900-1999: fluoridation of drinking watepr to prevent dental caries. MMWR Morbid Mortal Wkly Rep. 1999;48(41):933–940.
- Centers for Disease Control and Prevention. Fluoridation Statistics website: 2014. https://www.cdc.gov/fluoridation/statistics/2014stats.htm. Accessed September 18, 2019.
- Centers for Medicare & Medicaid Services. 2018 National Health Expenditure Data. NHE Tables: Table 12. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistoricalexternal icon. Accessed February 18, 2020.
- Naavaal S, Kelekar U. School hours lost due to acute/unplanned dental care. Health Behav Policy Rev. 2018;5(2);66–73.
- Righolt AJ, Jevdjevic M, Marcenes W, Listl S. Global-, regional-, and country-level economic impacts of dental diseases in 2015. J Dent Res. 2018;97(5):501–507.
- Healthy Policy Institute. Emergency Department Visits for Dental Conditions — A Snapshot. American Dental Association. April, 2020. Accessed May 7, 2021. https://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIgraphic_0420_1.pdf?la=enpdf iconexternal icon.
- Bui AL, Dieleman JL, Hamavid H, et al. Spending on children’s personal health care in the United States, 1996-2013. JAMA Pediatr. 2017:171(2):181–189.
- Health Policy Institute. American Dental Association website. Oral Health and Well‐Being in the United States. https://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/OralHealthWell-Being-StateFacts/US-Oral-Health-Well-Being.pdf?la=enpdf iconexternal icon. Accessed December 11, 2019.