Surveillance for Dental Caries, Dental Sealants, Tooth Retention, Edentulism, and Enamel Fluorosis — United States, 1988–1994 and 1999–2002


Problem/Condition: Dental caries is a common chronic disease that causes pain and disability across all age groups. If left untreated, dental caries can lead to pain and infection, tooth loss, and edentulism (total tooth loss). Dental sealants are effective in preventing dental caries in the occlusal (chewing) and other pitted and fissured surfaces of the teeth. Enamel fluorosis is a hypomineralization of enamel related to fluoride exposure during tooth formation (first 6 years for most permanent teeth). Exposure to fluoride throughout life is effective in preventing dental caries. This is the first CDC Surveillance Summary that addresses these conditions and practices.

Reporting Period: 1988–1994 and 1999–2002.

System Description: The National Health and Nutrition Examination Survey (NHANES) is an ongoing survey of representative samples of the civilian, noninstitutionalized U.S. population aged >2 months in NHANES 1988–1994 and all ages during 1999–2002. The dental component gathered information on persons aged >2 years.

Results: During 1999–2002, among children aged 2–11 years, 41% had dental caries in their primary teeth. Forty-two percent of children and adolescents aged 6–19 years and approximately 90% of adults had dental caries in their permanent teeth. Among children aged 6–19 years, 32% had received dental sealants. Adults aged >20 years retained a mean of 24 of 28 natural teeth and 8% were edentulous. Among persons aged 6–39 years, 23% had very mild or greater enamel fluorosis. Disparities were noticed across all age groups, among racial/ethnic groups, persons with lower education and income, and by smoking status.

From 1988–1994 to 1999–2002, four trends were observed: 1) no change in the prevalence of dental caries in primary teeth among children aged 2–11 years, 2) a reduction in prevalence of caries in permanent teeth of up to 10 percentage points among persons aged 6–19 years and up to six percentage points among dentate adults aged >20 years, 3) an increase of 13 percentage points in dental sealants among persons aged 6–19 years, and 4) a six percentage point reduction in total tooth loss (edentulism) among persons aged >60 years.

Interpretation: The findings of this report indicate that the dental caries status of permanent teeth has improved since the 1988–1994 survey. Despite the decrease in caries prevalence and severity in the permanent dentition and the increase in the proportion of children and adolescents who benefit from dental sealants, disparities remain.

Public Health Action: These data provide information for public health professionals in designing interventions to improve oral health and to reduce disparities in oral health, for researchers in assessing factors associated with disparities and dental caries in primary teeth, and in designing timely surveillance tools to monitor total fluoride exposure.

Eugenio D. Beltrán-Aguilar, DMD, Laurie K. Barker, MSPH,  María Teresa Canto, DDS,  Bruce A. Dye, DDS,
Barbara F. Gooch, DMD, Susan O. Griffin, PhD, Jeffrey Hyman, DDS,  Freder Jaramillo, DDS,
Albert Kingman, PhD,  Ruth Nowjack-Raymer, PhD,  Robert H. Selwitz, DDS,  Tianxia Wu, PhD

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