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Science in the News

Fewer Young Children Have Untreated Tooth Decay, but Persistent Oral Health Disparities Remain

March 18, 2015

A new data brief from the CDC National Center for Health Statistics (NCHS)1 reports changes in untreated dental caries in the primary teeth of U.S. children aged 2 to 5 years.  When compared with a previous report,2 dental caries prevalence among preschoolers has fallen from 28% in 1999-2004 to just under 23% in 2011-2012, and the prevalence of untreated caries in young children now stands at 10 percent.  The findings of the NCHS data brief were featured in online articles from the New York Times,3 ADA News4 and other websites.

A downward trend in caries prevalence was not observed in permanent teeth of adolescents.  Nearly 60 percent of U.S. adolescents had experienced caries in their permanent teeth.  This caries prevalence rate for teenagers, regardless of race and ethnicity, has remained largely unchanged since the late 1990s.1,2

The new NCHS study also spotlights significant oral health disparities that continue to persist for children and adolescents in some racial and ethnic groups, including:

  •  Hispanic and non-Hispanic black children aged 2 to 8 years had the highest prevalence of dental caries in primary teeth (~44-46%).
  • Untreated caries in primary teeth was nearly twice as high for Hispanic and non-Hispanic black children aged 2-8 (19.4% and 20.5% respectively) than for non-Hispanic white children in the same age range (~10%).
  • Asian and black teenagers had fewer dental sealants (~31%) than any other racial or ethnic group.
  • Non-Hispanic black and Asian children aged 6-11 were less likely to have dental sealants (31%) than children from other racial or ethnic groups.
  • Among adolescents, the prevalence of untreated dental caries was highest for non-Hispanic black and Hispanic teenagers (~21% and ~18% respectively).

The NCHS data brief is part on an ongoing surveillance system and presents data for the first two years of a six-year data-collection cycle; thus, upcoming data will help clarify whether these changes continue.  Data from the National Health and Nutrition Examination Survey are from a representative sample of the non-institutionalized U.S. civilian population, but because they are national averages, the data may mask disease levels of population groups that may be at higher risk or, because of sampling, were not represented in the study.

Because these are results from a cross-sectional study, it is not possible to ascertain the cause or causes for the changes noted.  Any correlation with other factors remains hypothetical and would require further investigation with more refined and formal studies.  At this time, any inference on the causes of such changes remains speculative.  However, it should be noted that, compared with 1999-2004 data, there was a change in the untreated-to-treated ratio of dental caries in primary teeth of preschool-age children, which suggests that more children are receiving dental care.  Overall, the NCHS study demonstrates that a large proportion of children and adolescents still have untreated tooth decay, there has only been a small change in caries prevalence, and important disparities in oral health remain among ethnic and racial groups.

The study findings underscore the importance of caries prevention and the need to maintain oral health and reduce the prevalence and severity of dental caries from infancy through adolescence and into adulthood.  Dental caries remains the most prevalent chronic disease in children.  Appropriate public health interventions and preventive measures, such as oral hygiene with fluoride toothpaste, community water fluoridation and dental sealants, are recommended for patients of all ages and sociodemographic categories.  According to the ADA Center for Evidence-Based Dentistry’s clinical practice guideline for pit-and-fissure sealants,5 dental sealants can be “used effectively as part of a comprehensive approach to caries prevention on an individual basis or as a public health measure for at-risk populations.”

Infants should receive their first dental visit within six months of eruption of the first tooth and no later than 12 months of age.  Parents can also protect the dental health of young children by providing a healthy diet, limiting their intake of sweetened foods and drinks, and by not putting children to bed with a bottle or feeder cup.  The ADA supports dentists’ efforts to provide appropriate oral health education and counseling to parents, caregivers and children.

School-based oral health programs can play an important role in preventing and controlling dental caries in children and adolescents, and can assist those patients in establishing a dental home.  The ADA promotes awareness of oral disease disparities and of dentally underserved populations, and is pursuing the Action for Dental Health initiatives to help improve oral health in the U.S., particularly for underserved people.

 Footnotes

  1. Dye BA, Thornton-Evans G, Li X, Iafolla TJ.  Dental caries and sealant prevalence in children and adolescents in the United States, 2011-2012.  March 2015.  Available at: “http://www.cdc.gov/nchs/data/databriefs/db191.htm”.  Accessed March 10, 2015.
  2. Dye BA, Tan S, Smith V, Lewis BG et al.  Trends in oral health status: United States, 1988-1994 and 1999-2004.  Series 11, Number 248. 104 pp. (PHS) 2007-1698. Preliminary Report.  Available at: “http://www.cdc.gov/nchs/data/series/sr_11/sr11_248.pdf”.  Accessed March 10, 2015.
  3. Saint Louis C.  Untreated dental decay is falling among children.  The New York Times.  March 5, 2015.  Available at: “http://well.blogs.nytimes.com/2015/03/05/untreated-dental-decay-is-falling-among-children/?_r=0”.  Accessed March 10, 2015.
  4. Palmer C.  CDC: ‘disparities in caries continue.’  ADA News, March 5, 2015.  Available at: “http://www.ada.org/en/publications/ada-news/2015-archive/march/cdc-disparities-in-caries-continue?nav=news”.  Accessed March 10, 2015.
  5. Beauchamp J, Caufield PW, Crall JJ, Donly K, Feigal R, Gooch B, Ismail A, Kohn W, Siegal M, Simonsen R. Evidence-based clinical recommendations for the use of pit-and-fissure sealants.  A report of the American Dental Association Council on Scientific Affairs.  J Am Dent Assoc. 2008 Mar;139(3):257-68.  Also available online at: “http://ebd.ada.org/en/evidence/guidelines/pit-and-fissure-sealants”.

 

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Science in the News is a service by the American Dental Association (ADA) to its members to present current information about science topics in the news. The ADA is a professional association of dentists committed to the public's oral health, ethics, science and professional advancement; leading a unified profession through initiatives in advocacy, education, research and the development of standards. As a science-based organization, the ADA's evaluation of the scientific evidence may change as more information becomes available. Your thoughts would be greatly appreciated.