The nation’s oral health has greatly improved since the 1960s, but not all Americans have equal access to these improvements.1 Some racial/ethnic and socioeconomic groups have worse oral health2 as a result of the social determinants of health—conditions in the places where people are born, live, learn, work, and play.3, 4 For example, some groups of people:
- Can’t afford to pay out of pocket for dental care, do not have private or public dental insurance, or can’t get time off from work to get to dental care.1
- Live in communities where they don’t have access to fluoridated water and school sealant programs, healthy foods, and public transportation to get to dental appointments.1
Regular preventive dental care is essential for good oral health so one can find problems earlier when they are easier to treat, but many don’t get the care they need. More people are unable to afford dental care than other types of health care.5 In 2015, the percentage of people in the United States with no dental insurance was 29% overall and 62% for older adults.6 Traditional Medicare does not cover routine dental care, therefore many lose their benefits upon retirement.
In addition, many low-income adults do not have public dental insurance. Medicaid programs are not required to provide dental benefits to adult enrollees, so dental coverage varies widely from state to state. Currently, 15 states provide no coverage or only emergency coverage.7
Among working-age US adults, over 40% of low-income and non-Hispanic Black adults have untreated tooth decay.8 Untreated oral disease has a large impact on quality of life and productivity:
- Over 34 million school hours were lost in the United States in 2008 because of unplanned urgent dental care.9
- Over $45 billion is lost in productivity in the United States each year because of untreated oral disease.10
- Nearly 18% of all working-age adults, and 29% of those with lower incomes, report that the appearance of their mouth and teeth affects their ability to interview for a job.11
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.
Oral Health Disparities in Children Aged 2 to 19
- Cavities and racial or ethnic groups. Based on data from 2011–2016, for children aged 2 to 5 years, about 33% of Mexican American and 28% of non-Hispanic Black children have had cavities in their primary teeth, compared with 18% of non-Hispanic White children. For children aged 12 to 19, nearly 70% of Mexican American children have had cavities in their permanent teeth, compared with 54% of non-Hispanic White children.12
- Untreated cavities and family income. For children aged 2 to 5 years, 17% of children from low-income households have untreated cavities in their primary teeth, 3 times the percentage of children from higher-income households. By ages 12 to 19, 23% of children from low-income families have untreated cavities in their permanent teeth, twice that of children from higher-income households.12
- Sealants and family income. Children aged 6 to 19 years from low-income households are about 15% less likely to get sealants and twice as likely to have untreated cavities compared with children from higher-income households.12
Oral Health Disparities in Adults Aged 20 to 64
- Untreated cavities and racial or ethnic groups. Nearly twice as many non-Hispanic Black or Mexican American adults have untreated cavities as non-Hispanic White adults.12
- Untreated cavities and education. Adults with less than a high school education are almost 3 times as likely to have untreated cavities as adults with at least some college education.12
- Untreated cavities and smoking status. Among adults who smoke cigarettes, over 40% have untreated cavities.12
- Untreated cavities and income. About 40% of adults with low-income or no private health insurance have untreated cavities. Low-income or uninsured adults are twice as likely to have one to three untreated cavities and 3 times as likely to have four or more untreated cavities as adults with higher incomes or private insurance.8
Oral Health Disparities in Adults Aged 65 or Older
- Untreated cavities and racial or ethnic groups. More than 9 in 10 older adults have had cavities, and 1 in 6 have untreated cavities. Older non-Hispanic Black or Mexican American adults have 2 to 3 times the rate of untreated cavities as older non-Hispanic White adults.12
- Untreated cavities and education. Older adults with less than a high school education have untreated cavities at nearly 3 times the rate of adults with at least some college education.12
- Edentulism (complete tooth loss). Seventeen percent of older adults have lost all their teeth. Low-income older adults, those with less than a high school education, or those who are current smokers are more than 3 times as likely to have lost all of their teeth as adults with higher incomes, more than a high school education, or who have never smoked.12
Disparities in Oral Cancer and Gum Disease
- Adults and oral cancer. Head and neck cancers are more than twice as common among men as women.11 The 5-year survival rate for oral pharyngeal (throat) cancers is lower among Black men (41%) than White men (62%).14,15
- Adults and gum (periodontal) disease. Forty-two percent of adults have some form of gum disease. Among adults aged 65 and older, the rate of gum disease increases to 60%.16
- Severe gum disease is most common among adults aged 65 or older, Mexican American and non-Hispanic Black adults, and people who smoke.16
CDC’s Work to Reduce Oral Health Disparities
CDC works to reduce disparities in the rate of cavities and integrate oral health programs into chronic disease prevention and medical care. The agency and its partners promote two interventions that are strongly recommended by the Community Preventive Services Task Force because they prevent cavities and save money.17
- School sealant programs typically provide dental sealants at no charge to children who are less likely to receive private dental care. Providing sealants to the 5 million children from low-income families could prevent 3.4 million cavities over 4 years.18
- Community water fluoridation is an equal 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.19
Healthy People 2030external icon identifies public health priorities to help individuals, organizations, and communities across the United States improve health and well-being. Oral healthexternal icon is included as 1 of the 23 Leading Health Indicatorsexternal icon in Healthy People 2030.
Oral Health in America: A Report of the Surgeon Generalexternal icon. This major report explains that tooth decay remains a big problem in the United States for low-income and minority populations and suggests ways to improve the situation.
A National Call to Action to Promote Oral Healthexternal icon. The Call to Action builds on the Surgeon General’s report and the Healthy People 2020 oral health objectives.
Improving Access to Oral Health Care for Vulnerable and Underserved Populations.external icon This Institute of Medicine 2011 report provides an overview of the disparities in access to oral care.
Advancing Oral Health in Americapdf iconexternal icon. The Institute of Medicine 2011 report provides an overview on ways HHS can improve oral health In America.
- National Institute of Dental and Craniofacial Research. Oral Health in America: A Report of the Surgeon General. National Institutes of Health, US Department of Health and Human Services; 2000.
- Braveman P, Egerter S, Williams DR. The social determinants of health: coming of age. Annu Rev Public Health. 2011;32:381– doi:10.1146/annurev-publhealth-031210-101218
- Social Determinants of Health. Healthy People 2020. Accessed June 2, 2020. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-healthexternal icon
- Braveman P, Gottlieb L. The social determinants of health: it’s time to consider the causes of the causes. Public Health Rep. 2014;129(suppl 2):19– doi:10.1177/00333549141291S206
- 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):2176–21
- Manski RJ, Rohde F. Dental Services: Use, Expenses, Source of Payment, Coverage and Procedure Type, 1996–2015pdf iconexternal icon. Research Findings No. 38. Agency for Healthcare Research and Quality, US Dept of Health and Human Services; 2017.
- Medicaid Adult Dental Benefits: An Overviewpdf iconexternal icon. Center for Health Care Strategies, Inc.
- 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. 2021;152(1):55–64. doi.org/10.1016/j.adaj.2020.09.019external icon
- 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.
- American Dental Association. Health Policy Institute: Oral Health and Well?Being in the United States. Accessed December 31, 2020. https://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/OralHealthWell-Being-StateFacts/US-Oral-Health-Well-Being.pdf?la=enpdf iconexternal iconpdf iconexternal icon
- 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.
- Griffin SO, Thornton-Evans G, Wei L, Griffin PM. Disparities in dental use and untreated caries prevalence by income. JDR Clin Trans Res. 2020:2380084420934746. doi:10.1177/2380084420934746
- Cancer Facts and Figures 2017external icon. American Cancer Society; 2017.
- US Cancer Statistics Working Group. US Cancer Statistics: Data Visualizations Accessed January 21, 2020. https://gis.cdc.gov/Cancer/USCS/DataViz.html
- Eke PI, Thornton-Evans GO, Wei L, Borgnakke WS, Dye BA, Genco RJ. Periodontitis in US adults: National Health and Nutrition Examination Survey 2009– JADA. 2018:149(7):576–588.e576. doi:https://doi.org/10.1016/j.adaj.2018.04.023
Page last reviewed: February 5, 2021
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