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Oral health status measured in national survey

CDC's Vital and Health Statistics Series

Image: CDC Vital and Health Statistics Series-Oral Health Status and Access to Oral Health Care for U.S. Adults aged 18-64: National Health Survey, 2008
Oral Health Status and Access to Oral Health Care for U.S. Adults aged 18-64: National Health Survey, 2008
Hyattsville, Md.—Most American adults say their oral health is good, says a survey responding to the Surgeon General's call for more information about the status of the U.S. population's oral health and the ability to access care.

Based on recommendations of the Surgeon General's year 2000 report Oral Health in America and subsequent initiatives, the National Institute of Dental and Craniofacial Research sponsored a set of supplementary questions about oral health on the 2008 National Health Interview Survey conducted by U.S. Census Bureau interviewers.

The purpose of the collaboration was twofold, said the National Center for Health Statistics report published July 18 in the Centers for Disease Control and Prevention's Vital and Health Statistics Series:

  • to develop and expand oral health outcome measures, and
  • to produce estimates for the U.S. population as a whole, and for racial and ethnic minorities, rural populations, the young, the elderly and other subpopulations that could be used to study the impact of the initiatives to improve oral health.

The report uses data from the survey's oral health supplement to provide prevalence estimates of oral health status; oral health status compared with others the same age; length of time since last dental visit; mouth problems, including bad breath, dry mouth, difficulty eating or chewing, jaw pain and mouth sores; tooth problems, including toothache or sensitive teeth, stained or discolored teeth, broken or missing teeth, crooked teeth, bleeding gums, broken or missing fillings and loose teeth not due to injury; reasons for not seeing a dentist for mouth or tooth problems, and unmet dental need due to cost for adults aged 18-64 living in households throughout the United States.

Interviewers questioned more than 17,000 men and women.

In the report, oral health is defined as health of the mouth and teeth, and oral health status is based on the sample adult's self-assessment of the condition of his or her mouth and teeth. No clinical measurements were taken. An individual's reported oral health status may differ from a dental professional's evaluation of oral health status.

The report includes these "selected highlights" on oral health status:

  • among adults aged 18–64, about three-quarters had very good or good oral health, 17 percent had fair oral health and 7 percent had poor oral health;
  • non-Hispanic white (37 percent) and non-Hispanic Asian (37 percent) adults were more likely than Hispanic (25 percent) or non-Hispanic black (26 percent) adults to have very good oral health;
  • adults with Medicaid (19 percent) were almost five times as likely as adults with private health insurance (4 percent) to have poor oral health.

Among other findings:

  • level of education was positively associated with having better comparative oral health status;
  • adults with diabetes (29 percent) were almost twice as likely as adults without diabetes (16 percent) to have worse oral health status than others the same age;
  • adults in poor families (28 percent) were more than twice as likely as adults in families that were not poor (13 percent) to have worse oral health status than others the same age;
  • overall, 6 of 10 adults last visited a dentist or other dental health professional within the past year;
  • adults with Medicaid (21 percent) were almost twice as likely as adults overall (12 percent) to not have had a dental visit in more than five years;
  • diabetic adults (19 percent) were almost twice as likely as nondiabetic adults (11 percent) to not have had a dental visit in more than five years;
  • non-Hispanic Asian adults aged 18–64 experienced fewer mouth problems than Hispanic, non-Hispanic white or non-Hispanic black adults, including problems with bad breath, dry mouth, difficulty eating or chewing or jaw pain;
  • former drinkers were about twice as likely as lifetime abstainers and one and one-half times as likely as current drinkers to have experienced bad breath, dry mouth or difficulty eating or chewing;
  • edentulous adults (17 percent) were almost twice as likely as dentate adults (9 percent) to have had dry mouth; edentulous refers to persons who have lost all their permanent teeth and dentate to persons who have not lost all their teeth; an edentulous person may have dentures;
  • non-Hispanic Asian adults were less likely than Hispanic, non-Hispanic white or non-Hispanic black adults to have a variety of problems with their teeth, including stained or discolored teeth, broken or missing teeth, crooked teeth, bleeding gums, broken or missing fillings or loose teeth not due to injury;
  • adults with Medicaid were more likely than uninsured adults to experience toothache or sensitive teeth, stained or discolored teeth, broken or missing teeth, broken or missing fillings or loose teeth not due to injury;
  • in general, lifetime abstainers from alcohol were less likely to have had problems with their teeth than current or former drinkers;
  • the main reason to forgo a dental visit for an oral health problem in the past six months was cost; 42 percent said they could not afford treatment or did not have insurance; fear was cited by 1 of 10 adults as the reason they did not visit the dentist for an oral health problem;
  • adults with a bachelor's degree or higher (33 percent) were almost twice as likely as those with less than a high school diploma (18 percent) to forgo a dental visit because they thought it was not important;
  • overall, 16 percent of dentate adults had an unmet dental need due to cost in the past 12 months;
  • among dentate adults with one or more mouth or teeth problems, more than one-half of those who were uninsured had unmet dental need due to cost; one-third of those with Medicaid had unmet dental need compared with almost one-quarter of those with private health insurance but no dental coverage and more than one-tenth of those with private health insurance with dental coverage. 
  • It is likely that some of the prevalence estimates presented in this report are conservative," the report said.

Oral Health in America: A Report of the Surgeon General was the first report focused exclusively on oral, dental and craniofacial health by the Surgeon General of the U.S. Public Health Service. The report called attention to a "silent epidemic" of dental and oral disease and emphasized the importance of oral health to overall health.

The National Health Interview Survey is a multistage probability sample survey conducted annually for the CDC National Center for Health Statistics and is representative of the civilian noninstitutionalized population of the United States.