Summary

Dental Caries in Primary Teeth

Children Aged 2–5 Years

Overall, the prevalence of dental caries in the primary teeth of children aged 2–5 years was 23%, reflecting a decrease of 5 percentage points since 1999–2004. Significant declines occurred among Mexican American and poor children, although these groups that had the highest caries prevalence (more than 30%). Untreated tooth decay prevalence declined by almost half, to 10%. All sociodemographic groups experienced a decrease. Untreated decay prevalence among poor and near-poor children decreased by more than 13 percentage points, about twice the decrease among not- poor children.
The composition of caries also changed. Among children with caries, the number of untreated decayed teeth declined (2.6 vs. 1.6), and the number of restored teeth increased. As a result, the mean percentage of carious primary teeth that were untreated decreased from over 70% during 1999–2004 to less than 50% during 2011–2016.

Children Aged 6–8 Years

Although no change was detected in the prevalence of caries in primary teeth (52% during 2011–2016), untreated decay prevalence declined overall (28% vs. 16%), and decreases occurred across all sociodemographic groups, consistent with findings among younger children. The decline among poor and near-poor children was 2 to 3 times that among not-poor children. Like younger children, a significant decrease was found in the number of untreated decayed teeth, accompanied by increases in the number of restored teeth. Similarly, the mean percentage of carious primary teeth that were untreated decreased from 40% during 1999–2004 to 22% during 2011–2016.

Dental Caries in Permanent Teeth of Children and Adolescents

Children Aged 6–11 Years

Overall, both prevalence of caries (21% vs. 17%) and untreated decay (8% vs. 5%) decreased. The largest decreases were among older children aged 9–11 years and Mexican American children—groups with the highest prevalence during 1999– 2004. Similarly, for prevalence of untreated decay, Mexican American children had the highest prevalence during 1999– 2004 and the third highest prevalence during 2011–2016, but they also experienced a notable decline. The largest decrease was observed among near-poor children (12% vs. 6%).

Among children with caries, the mean number of affected teeth (0.2) increased, and this increase was attributed to a corresponding increase in filled teeth (0.2). Similarly, a significant decrease in the mean percentage of carious permanent teeth that were untreated was observed among near-poor children. Among children with caries, the first permanent molars remained the most commonly affected teeth.

Adolescents Aged 12–19 Years

Overall, untreated tooth decay prevalence decreased (20% vs. 17%), whereas dental caries prevalence had no detectable decrease (59% vs. 57%). More than half of adolescents had caries, and about 1 in 6 had untreated tooth decay. Among poor, Mexican American, and non-Hispanic black adolescents with caries, the mean percentage of permanent teeth with caries that were untreated decreased, whereas the mean percentage filled increased. Among adolescents with caries, permanent molars were most commonly affected.

Dental Sealants

Children Aged 6–11 Years

Since 1999–2004, the prevalence of sealants increased by about 40% overall (31% vs. 42%). Increases were observed across all sociodemographic characteristics, except for not- poor children. Increases of more than 16 percentage points occurred among poor, near-poor, and Mexican American children. By 2011–2016, no difference was detected between Mexican American and non-Hispanic white children or between near-poor and not-poor children. Overall, children with sealants had an average of 3 first permanent molars sealed in both survey periods. Among poor children with sealants, the mean number of first permanent molars sealed increased since 1999–2004, and no difference was detected between this group and their not-poor counterparts during 2011–2016.

Adolescents Aged 12–19 Years

The prevalence of sealants increased from 38% to 48% overall. Increases were observed across all sociodemographic groups, except for not-poor adolescents. Prevalence increased by 14 percentage points among poor children and 18 percentage points among near-poor and Mexican American children. By 2011–2016, no difference was detected between near-poor and not-poor children. Although prevalence among non- Hispanic black, Mexican American, and poor adolescents increased by about 50% or more since 1999–2004, estimates remained lower than those for non-Hispanic white and not-poor adolescents during 2011–2016.

Among those with sealants, the mean number of sealed first and second permanent molars increased overall and across most sociodemographic groups, with the largest increases among non-Hispanic black adolescents. By 2011–2016, no differences were detected in the mean number of sealed second molars by poverty status or race or ethnicity.

Dental Caries Among Adults and Older Adults

Adults Aged 20–64 Years

Between the two survey periods, the overall prevalence of caries decreased slightly, but no difference was detected in untreated decay, with 9 in 10 adults affected by caries and 1 in 4 affected by untreated tooth decay. No detectable changes in caries prevalence were observed among adults who were non-Hispanic black, Mexican American, poor and near-poor combined, less educated, and current smokers. Prevalence of untreated decay increased among adults with a high school education and current and former smokers. No declines were detected in the prevalence of untreated tooth decay for any sociodemographic group.

Disparities by race or ethnicity, poverty, education, and smoking status persisted during 2011–2016. Among older adults who were non-Hispanic black, Mexican American, poor, near-poor, or current smokers, the prevalence of untreated decay was about 2 to 3 times that of those who were non-Hispanic white or not-poor or who never smoked.

Among adults with caries, the mean number of teeth affected was lower during 2011–2016 (7.4) than during 1999–2004 (8.2). However, this change appears to be primarily associated with a decrease in the mean number of filled teeth and no detectable change in untreated decay. No decreases in the number of teeth with untreated decay or increases in filled teeth were found across sociodemographic groups between the two survey periods. Consistent with these findings, small increases in the mean percentage of teeth with caries (DFT ≥1) that were untreated and corresponding decreases in the mean percentage that were filled were found among adults who had a high school education or more and who were current and former smokers.

Older Adults Aged 65 Years or Older

Among older adults, a small increase was found in the prevalence of caries, but no change was detected in the prevalence of untreated decay. More than 9 in 10 adults had experienced dental caries, and 1 in 6 had untreated tooth decay. Although the percentage with untreated decay was smaller than that found among working-age adults, relative differences for some groups defined by race or ethnicity, poverty, and smoking status were larger. Among older adults who were non-Hispanic black, Mexican American, poor, near-poor, or current smokers, the prevalence of untreated decay was about 2 to 3 times that of those who were non-Hispanic white, not-poor, or never smoked.

Mean DFT increased by about 10% between the two survey periods (9.1 vs. 10.1). The increase was associated with a similar increase in the mean number of filled teeth among adults who were aged 65–74 years, non-Hispanic white, not-poor, and former smokers. For older adults who were aged 75 years or older or non-Hispanic black, the increase reflected both an increase in filled teeth and a decrease in teeth with untreated decay. Among older non-Hispanic black adults, a noticeable decrease was found in the mean percentage of teeth with caries that were untreated. A corresponding increase was found in the mean percentage that were filled.

Edentulism and Tooth Retention

Adults Aged 20–64 Years

The percentage of adults who have lost all of their teeth decreased from 4% during 1999–2004 to 2% during 2011–2016. Among younger adults aged 20–34 years, too few people were edentate to generate stable estimates, suggesting that edentulism is rare among this group. Since 1999–2004, no significant decrease in edentulism has been found among those who are Mexican American or current smokers—groups who also had no detectable increases in the number of teeth retained. The percentage who have lost all their teeth remains higher (6%) among people who are poor and current smokers, compared to about 1% among those who are not-poor or who have never smoked.

By 2011–2016, the mean number of teeth retained among working-age adults aged 20–64 years with at least 1 tooth, overall and across most sociodemographic groups, increased by less than 1 tooth to about 26 teeth. Although the mean number of retained teeth was never less than 23 for any group, some groups—those who were poor, near-poor, non-Hispanic black, or Mexican American; who had a high school education or less; and who were current and former smokers—had a lower mean number of remaining teeth than the reference group for each characteristic.

Older Adults Aged 65 Years or Older

Overall, about 1 in 6 (17%) older adults had lost all of their teeth during 2011–2016, a decrease of more than 30% compared to 1999–2004 (27%). The percentage who had lost all of their teeth declined by almost 50% among those aged 65–74 years and by 28% among those aged 75 years or older. By 2011–2016, edentulism among older adults who were poor, had less than a high school education, or were current smokers was more than 3 times that of older adults who were not-poor, had more than a high school education, or never smoked.

By 2011–2016, the mean number of teeth retained by older adults also increased by about 2 teeth, to 21.7 among those aged 65–74 years, and by 1 tooth, to 19.5 among those aged 75 years or older. No increases were detected among older adults who were non-Hispanic black, Mexican American, or poor; who had less than a high school education; or who were current smokers.