The High Cost of Oral Disease

Oral diseases cause pain and disability for millions of Americans. Proven interventions, like dental sealants and fluoridated water, can improve oral health and save money for communities.

Family enjoying springtime outdoors with kids

Oral diseases can impact your family’s quality of life.

Oral diseases—like cavities and gum disease—cause pain and disability for millions of Americans and cost taxpayers billions of dollars each year.1

Cavities (also known as caries or tooth decay) are one of the greatest unmet health treatment needs. Cavities are the most common chronic disease of childhood,2 and more than 1 in 4 adults in the United States have at least one untreated cavity.3

Gum disease is an inflammatory disease that affects the hard and soft structures that support the teeth4 and is a leading cause of tooth loss.5 Nearly half (46%) of all adults aged 30 or older show signs of gum disease, and severe gum disease affects about 9% of adults.6

Oral Diseases Cost Money and Lower Your Quality of Life

Untreated cavities can cause pain and infections that may lead to problems with eating, speaking, playing, and learning. Left untreated, cavities and gum disease can lead to tooth loss. Tooth loss can affect a person’s self-esteem and contribute to social anxiety, lack of social connectedness, or depression.7 Severe tooth loss—having 8 or fewer teeth—makes it hard to chew food or have a healthy diet,8 which is important for overall health and preventing and controlling other chronic conditions.9,10

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%.7

Treating oral disease also costs time and money. Regardless of age, income, or type of insurance, more people report financial barriers to dental care than to any other type of health care.11 Over $45 billion is lost in productivity in the United States each year because of untreated oral disease,12 and over 34 million school hours are lost each year because of unplanned urgent dental care.13 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.14

Community Water Fluoridation and School Sealant Programs Can Help

Filling up a glass with drinking water from kitchen tap

Fluoride protects your teeth from decay.

The good news is that fluoridated water and dental sealants are effective interventions to improve oral health and save money.

Drinking fluoridated water keeps teeth strong and reduces cavities by about 25% in children and adults. Community water fluoridation is the most efficient and cost-effective way to deliver fluoride to everyone in a community, regardless of their age, income, or education. In fact, 1 year of providing fluoridated water saves an estimated $6.5 billion in averted direct and indirect treatment costs.15 After adjusting for fluoridation costs, communities served by fluoridated water save an average of $32 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.15

Dental sealants prevent 80% of cavities in the back teeth—where almost all cavities occur—up to 2 years after placement.16 Unfortunately, less than 20% of children at highest risk for cavities receive sealants during a dental visit. School sealant programs are an effective and cost-efficient way to provide sealants to these children. School sealant programs that serve students at high risk for cavities can become cost-saving in 2 years and save more than $11 for every tooth sealed over 4 years.17 Providing sealants to the nearly 7 million children from low-income households who need them could save up to $300 million in averted dental treatment costs.18

More Information

  1. American Dental Association. Dental spending exceeds pre-pandemic levels in 2021. December 22, 2022. Accessed June 5, 2023.
  2. Institute for Health Metrics and Evaluation. GBD compare data visualization. Accessed June 5, 2023.
  3. Oral Health Surveillance Report: Trends in Dental Caries and Sealants, Tooth Retention, and Edentulism, United States, 1999–2004 to 2011–2016. Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2019.
  4. American Academy of Periodontology. For patients, gum disease information. Accessed June 5, 2023.
  5. American Dental Association. Mouth healthy, gum disease. Accessed June 5, 2023.
  6. Eke P, Thornton-Evans G, Wei L, Borgnakke W, Dye B, Genco R. Periodontitis in US adults: National Health and Nutrition Examination Survey 2009-2014. JADA. 2018;149(7):576-586.
  7. Health Policy Institute. Oral health and well‐being in the United States. American Dental Association. Accessed May 18, 2023.
  8. Nowjack-Raymer RE, Sheiham A. Association of edentulism and diet and nutrition in US adults. J Dent Res. 2003;82:123-126.
  9. Riegel B, Moser DK, Buck HG, et al; American Heart Association Council on Cardiovascular and Stroke Nursing; Council on Peripheral Vascular Disease; and Council on Quality of Care and Outcomes Research. Self-care for the prevention and management of cardiovascular disease and stroke: a scientific statement for healthcare professionals from the American Heart Association. J Am Heart Assoc. 2017;6(9):e006997.
  10. Evert AB, Dennison M, Gardiner CD, et al. Nutrition therapy for adults with diabetes or prediabetes: a consensus report. Diab Care. 2019;42(5):731-754.
  11. Vujicic M, Buchmueller T, Klein R. Dental care presents the highest level of financial barriers, compared to other types of health care services. Health Aff. 2016;35(12):2176-2182.
  12. 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.
  13. Naavaal S, Kelekar U. School hours lost due to acute/unplanned dental care. Health Behav Policy Rev. 2018;5(2);66–73.
  14. Health Policy Institute. Emergency department visits for dental conditions—a snapshot. American Dental Association. Published April 2020. Accessed June 8, 2023. 
  15. 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.
  16. Community Preventive Services Task Force. Dental caries (cavities): school-based dental sealant delivery programs. The Community Guide. Updated October 28, 2018. Accessed June 5, 2023.
  17. Griffin SO, Wei L, Gooch BF, Weno K, Espinoza L. Vital signs: dental sealant use and untreated tooth decay among U.S. school-aged children. MMWR Morb Mortal Wkly Rep. 2016;65:1141-1145.
  18. Centers for Disease Control and Prevention. Dental sealants prevent cavities: effective protection for children. Published October 2016. Accessed June 5, 2023.