More Teeth, More Untreated Decay, Higher Costs: US Adults, 1988-2014

Objectives:
To describe dental caries experience in US middle-aged adults from 1998 to 2014. To describe dental visits, expenditures, and sources of payment in US middle-aged adults from 1996 to 2012.
Methods:
We explored data from NHANES 1988–1994, 1999-2004, and 2011-2014. Prevalence of treated caries, untreated caries, and 20 or fewer teeth were among the variables of interest. Data from the 1996 to 2012 Medical Expenditure Panel Survey (MEPS) from the Agency for Healthcare Research and Quality were used to estimate dental expenditures, dental visits, and dental procedures. Descriptive analyses, analyses of variance, and regression analyses were conducted.
Results:
The number of middle-aged adults with fewer than 20 teeth decreased over time: 21.6(0.85) in 1988 – 1994; 19.0(0.76) in 1999-2004, and 14.6 (0.70) in 2011-2014. In the oldest age group, 50 - 64 year olds, the overall decline was from 46.8(1.38)% to 27.4(1.80)%. The prevalence of untreated decay increased slightly overall, from 27.8(1.10) in 1988-1994 to 29.5(1.35) in 2011-2014. Unmet treatment need also increased. The percentage of persons with at least one visit in the prior year decreased over time, from 43.9(0.8)% in 1996 to 38.3(0.6)% in 2012. The average number of visits per person also decreased, from about 2.5 to about 2. The two-part regression model for total dental visits over the entire time period revealed significant effects of gender, race, dental insurance, and education. The per person expenditure, adjusted to 2012 US$, increased from $526.67(16.53) in 1996 to $609.16(17.79) in 2012. Labor productivity losses caused by dental problems from 1999 to 2012 were predicted by gender, race, income, insurance, and education.
Conclusions: US middle aged adults have more teeth than in the past, but this improvement was not accompanied by improvements in dental outcomes, dental care utilization, or costs for all demographic groups. Differences by gender, race, income, and education remain problematic.