The nation’s oral health has greatly improved since the 1960s, but not all Americans have equal access to these improvements.Some racial/ethnic and socioeconomic groups have worse oral health as a result of the social determinants of health—conditions in the places where people are born, live, learn, work, and play. 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.
• 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.

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.In 2015, the percentage of people in the United States with no dental insurance was 29% overall and 62% for older adults. 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.

Among working-age US adults, over 40% of low-income and non-Hispanic Black adults have untreated tooth decay.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.
• Over $45 billion is lost in productivity in the United States each year because of untreated oral disease.
• 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.

• 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.
• 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.

• 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.
• 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.
• Untreated cavities and smoking status. Among adults who smoke cigarettes, over 40% have untreated cavities.
• 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.

• 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.
• 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.
• 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.

• Adults and oral cancer. Head and neck cancers are more than twice as common among men as women. The 5-year survival rate for oral pharyngeal (throat) cancers is lower among Black men (41%) than White men (62%).
• 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%.
  • Severe gum disease is most common among adults aged 65 or older, Mexican American and non-Hispanic Black adults, and people who smoke.

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.

• 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.
• 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.