Conclusion and Comment

Although disparities in oral health by race or ethnicity and poverty remain, the findings in this report highlight improvements among children and adolescents since 1999–2004. These improvements include decreases in the prevalence of untreated decay in the primary teeth of children across sociodemographic groups and in the permanent teeth of near-poor and Mexican American children and adolescents and non-Hispanic black adolescents.

Sealant prevalence in the permanent teeth of children and adolescents increased overall and across all sociodemographic groups except for the not-poor. By 2011–2016, no detectable differences were found in sealant prevalence between near- poor and not-poor children and adolescents and between Mexican American and non-Hispanic white children.

In contrast, during 2011–2016, about 1 in 4 working-age adults and 1 in 6 older adults had untreated tooth decay. These proportions reflect no detectable changes since 1999–2004. Differences in the prevalence of untreated decay by race or ethnicity, poverty, education, and smoking also persisted through 2011–2016. Among working-age adults, no decreases in the mean number of teeth with untreated decay or increases in filled teeth were detected. Among older adults, the mean number of filled teeth did increase by about one tooth overall, and increases were significant for males, females, non-Hispanic whites, non-Hispanic blacks, and former smokers. By poverty level, having more filled teeth was only significant for those who were not-poor.

The mean number of teeth retained increased, and the prevalence of edentulism decreased overall for working-age and older adults. However, by poverty or smoking status, changes in the number of teeth retained among poor adults or current smokers since 1999–2004 were not statistically significant for either of these age groups.

Improvements in children’s oral health status likely reflect increased access to preventive and restorative care. State Medicaid and Children’s Health Insurance Programs are major drivers of the use of dental services among poor and near-poor children and adolescents.^31–33 A near-doubling of the percentage of children with public dental insurance from 1996 to 2015 resulted in a 15 percentage point increase to 88% in any dental coverage among all children.³⁴ The percentage of working-age adults aged 21–64 years with any dental insurance increased by 7 percentage points to 72%, also driven by increased public dental insurance coverage.

During the same period, the use of dental services in the past year increased among children by 6 percentage points to 48%, but decreased among working-age adults by 4 percentage points to 40%. Among older adults, past-year dental use increased by 7 percentage points to 47%; this increase may have been associated with a 5 percentage point increase in private dental insurance coverage.

The range of covered services among children and adults with public insurance is a key factor affecting dental care use. Public dental insurance coverage among children offers comprehensive dental benefits (e.g., diagnostic, preventive, and restorative services), whereas coverage for adults is commonly limited to emergency services only.³¹ Cost remains a major barrier to receipt of dental services across the life span and is the most common reason among working-age adults for not seeking dental care.^35,36

Other strategies aimed at increasing the availability and accessibility of dental services among populations who may lack access to dental care include the provision of preventive services in primary medical care,^37,38 school, and community settings^39,40 and the promotion of dental visits for young children at risk of early childhood caries.^37,41 The findings in this report indicate that the improvement in children’s oral health status was not experienced by working-age and older adults.