Prevalence of Total and Untreated Dental Caries Among Youth: United States, 2015–2016

April 13, 2018

Eleanor Fleming, Ph.D., D.D.S., M.P.H., Dental Epidemiologist

Questions for Eleanor Fleming, Ph.D., D.D.S., M.P.H., Dental Epidemiologist and Lead Author of “Prevalence of Total and Untreated Dental Caries Among Youth: United States, 2015–2016

Q: What made you decide to focus on the prevalence of dental cavities in young children for this study, versus other dental conditions like gum disease or tooth grinding – or some other critical public health concerns today for America’s youth?

EF: Our intent in conducting this study was to provide up-to-date prevalence estimates for dental caries in children. We decided that our study would focus on dental caries because of the serious and negative impact untreated caries can have on children. By the way, dental “caries” is the scientific term for tooth decay or cavities. Dental caries are the most common chronic disease among youth aged 6-19 years. Untreated caries cause pain and infection. Children miss days from school and have their overall quality of life effected by untreated dental caries. This is an important public health concern for America’s youth. While dental conditions like gum disease or tooth grinding are important, the National Health and Nutrition Examination Survey (NHANES) Oral Health Component does not currently collect data on these dental conditions. The component focuses on collecting data on tooth loss, dental caries, and dental sealants.


Q: In your new report, you examine differences in the prevalence of tooth cavities by income level; what is the motivation to look at income, since many children’s dental care might be paid by either public or private health insurance?

EF: We examined family income in this study for a few reasons. One is that income is a significant social determinant of health. For our study, we decided to include family income in addition to age, race and Hispanic origin. We were curious about the differences in untreated and total caries (tooth decay) by family income level. For both total and untreated caries, prevalence decreased as family income level increased. There is also concern among the public health community that children who may have access to Medicaid dental benefits are not receiving the care that they need. The examination of income levels in our new report might offer some needed insight to this concern.

The prevalence of total dental caries decreased as family income levels increased, from 51.8% for youth from families living below the federal poverty level to 34.2% for youth from families with income levels greater than 300% of the federal poverty level.

The prevalence of untreated dental caries decreased from 18.6% for youth from families living below the federal poverty level to 7.0% for youth from families with incomes greater than 300% of the federal poverty level.


Q: Was there a result in your study that you hadn’t expected and that really surprised you?

EF: Because our motivation for this study was to provide updated national estimates on untreated and total caries (tooth decay) for 2015-2016, all of the results were very interesting in one way or another — and surprising. National estimates for age, race and Hispanic origin, and income are results that we need to understand for public health surveillance purposes. For me though, the overall estimates for youth by age were especially interesting.

While the untreated dental caries prevalence overall for youth is 13.0%, there were age differences that caught my eye. The low prevalence for 2-5 year-olds is an important and encouraging finding. While we don’t know if it is from prevention efforts, access to care, or other factors, the fact that our youngest youth have the lowest untreated and total caries prevalence shows they’re starting off their young lives with healthy teeth.

The prevalence was lowest in youth aged 2-5 years (8.8%) compared with youth aged 6-11 years (15.3%) and 12-19 years (13.4%). The prevalence of the 6-11 and 12-19 years-olds was significantly different from the prevalence of 2-5 year-olds.

The total caries experience was also lowest for youth aged 2-5 years (17.4%) compared to youth aged 6-11 years (45.2%) and 12-19 years (53.5%). As age increased, the total caries prevalence increased.


Q: What, if any, is the difference between the two terms you use in your report – primary teeth and permanent teeth?

EF: Primary teeth are baby teeth, or the first teeth that erupt, or come in, which are later shed and replaced by permanent teeth. Primary teeth erupt from around 6 months to age 2 or 3 years. The permanent teeth replace the primary teeth. These teeth start coming in around the age of 6 years and continue until the third molars, or wisdom teeth come in, somewhere between the ages of 17 to 21 years. In our analysis, we combined the two types of teeth in order to focus on dental caries (tooth decay) regardless of tooth type.


Q: In your report, are untreated dental cavities a subset of the number of total cavities, and therefore included in the total cavity statistics?

EF: Yes, untreated dental caries (tooth decay) are included in the total number of dental caries. When we describe total dental caries, we are focused on both untreated and treated dental caries. Essentially, the total of dental caries take into account any tooth decay experience that someone has had. Untreated dental caries represent tooth decay that has not been treated. Untreated dental caries are also known as cavities. What we capture in the untreated caries measure is the active disease of youth.


Q:  What differences or similarities did you see among race and ethnic groups, and various demographics, in this analysis?

EF: We noted a number of differences among youth by race and Hispanic origin in this analysis. Non-Hispanic black youth had the highest prevalence of untreated caries (tooth decay) (17.1%) compared to other race and Hispanic-origin groups. The prevalence for non-Hispanic black youth was significantly different from non-Hispanic whites (11.7%) and non-Hispanic Asians (10.5%). The prevalence of untreated dental caries in Hispanic youth was 13.5%.

Hispanic youth had the highest prevalence of total caries (52.0%) compared to other race and Hispanic-origin groups. The prevalence was also significantly different from non-Hispanic whites (39.0%) and non-Hispanic Asians (42.6%). The prevalence of total caries for non-Hispanic black youth was 44.3%.


Q: What sort of trend data do you have on this topic so we can see how prevalence has evolved over time?

EF: With six years of data, we can look at the trend in prevalence over time. Because dental caries (tooth decay) is the most common condition of childhood, we thought it was important to include trend analysis in our report.

The results show a significant linear decrease in total caries. From 2011-2012 to 2015-2016, the total caries prevalence decreased from 50.0% to 43.1%. The results show a different pattern for untreated dental caries. The prevalence of untreated dental caries increased from 2011-2012 (16.1%) to 2013-2014 (18.0%), and then decreased in 2015-2016 (13.05). There is significant quadratic trend – a single bend either upward or downward — in untreated dental caries from 2011-2012 to 2015-2016.


Q: What is the take-home message of this report?

EF: The take-home message from this report is that there are differences in untreated and total caries (tooth decay) by age group, race and Hispanic origin, and income. The trend analysis shows that the prevalence of untreated and total caries are decreasing. However, there are still disparities that exist. Because monitoring prevalence of untreated and total caries is key to preventing and controlling oral diseases, these disparities are important.

The prevalence of untreated dental caries in America’s youth is 13.0%. The prevalence decreased as family income increased, with youth with family incomes less than 100% of the federal poverty level having the highest prevalence. Disparities in untreated dental caries exist along race and Hispanic origin. Non-Hispanic black youth have the highest prevalence compared to Hispanic, non-Hispanic white, and non-Hispanic Asian youth.

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Parental Report of Significant Head Injuries in Children Aged 3–17 Years: United States, 2016

February 9, 2018

Questions for Lindsey Black, Health Statistician and Lead Author of “Parental Report of Significant Head Injuries in Children Aged 3–17 Years: United States, 2016.”

Q: What was the reason you undertook this research?

LB: Previous research has indicated that the incidence is increasing and much of this trend is being driven by an increase among adolescents. Current incidence of concussions among children is estimated to be 3.5-16.5/1,000. Despite what is known, studies conducted thus far regarding the epidemiology of childhood concussions have either been regional and limited in size, focused on injuries related to sports, dependent on insurance claims, or based on emergency department visits.

There is a lack of a national prevalence and we need to understand the problem outside of the scope of sports injuries. Depending on ED visits are also problematic because evidence is emerging that there is an increasing trend in the use of primary care physicians and specialty clinics as the point of entry into the healthcare system for concussion diagnosis and treatment. Also relying on ED or medical claims will not include non-medically attended concussions.

Further, much research focuses on high school and collegiate athletes and therefore there is not much data on younger children. Despite this, there has been recent recognition for concern and appropriate treatment by the medical community. The goal of this study was to provide a national estimate of parent-reported significant head injuries as well as examine disparities by various demographics and socioeconomic indicators.


Q: What did you find most significant?

LB: There was a steady increase in the percentage of children that had ever had a significant head injury by age group. Although overall boys were more likely than boys to have ever had a significant head injury, the difference was only significant for the 15-17 age group.


Q: Are there any data that look at what sports might be contributing to the number of significant head injuries among children?

LB: Yes, in fact there are many studies that focus on sport related injuries. Our survey and study did not. What sets our study apart is that it was not limited to sports related injuries, so it is going to include a wider range of causes of injuries. Please see “Emergency Department Visits for Concussion in Young Child Athletes” (Bakhos, 2010) and “Epidemiology of Concussion and Mild Traumatic Brain Injury” (Laker 2011) to learn more.


Q: Do you have any insight about whether this percentage who’ve had significant head injuries has increased or declined over time?

LB: Unfortunately we do not have any other historical data on this topic from our survey. At this time, these questions were asked only in 2016 as part of content sponsored by the National Instutite of Health’s National Institute on Deafness and Other Communication Disorders.


Q: Any other points you’d like to make about this study?

LB: We found that about 1 in 10 children in the oldest age group 15-17 had ever had a significant head injury. We also found that overall, boys were more likely than girls to have ever had a significant head injury and there were also disparities by race and parental educational attainment.


Estimated Prevalence of Children With Diagnosed Developmental Disabilities in the United States, 2014–2016

November 29, 2017

Questions for Ben Zablotsky, Ph.D., Health Statistician and Lead Author of “Estimated Prevalence of Children with Diagnosed Developmental Disabilities in the United States, 2014-2016.”

Q: Why did you decide to analyze children with diagnosed developmental disabilities?

BZ: We decided to analyze children with diagnosed developmental disability because children diagnosed with developmental disabilities typically require a substantial number of services and treatment to address both behavioral and developmental challenges.  Measuring the prevalence of children with these conditions aids in assessing the adequacy of available services and interventions that may improve long-term outcomes.


Q: Can you explain the differences between the diagnosed developmental disabilities studied in this report?

BZ: The three conditions studied in this report included autism spectrum disorder, intellectual disability, and any other developmental delay.  All three conditions are considered to be developmental disabilities.  Autism spectrum disorder refers to a group of neurodevelopmental disorders characterized by impairments in social communication and the presence of repetitive or restricted interests.  Intellectual disability is a term used when there are limits to a child’s ability to learn at an expected level and function in daily life.  Other developmental delay serves as a catch-all for children who are delayed for various developmental milestones, for example taking first steps, smiling for the first time, and speaking.


Q: What do you think is the most interesting demographic finding among your new study’s findings?

BZ: I found the fact that the prevalence of any developmental disability was lowest among Hispanic children compared with all other race and ethnicity groups to be the most interesting finding.  The prevalence of any developmental disability among Hispanic children was 4.69% compared to 7.04% for non-Hispanic white children, 6.20% for non-Hispanic black children, and 6.16% for non-Hispanic other children.


Q: Are there any previous reports released from NCHS on diagnosed developmental disabilities in children?

BZ: Yes, this report can be viewed as a follow-up to a National Health Statistics Report (No. 87) from 2015, where the prevalence of any developmental disability in 2014 was also reported (5.76%).  The current report shows this prevalence subsequently increased to 6.99% in 2016.


Q: Can you explain the methodology used for this analysis?

BZ: Children with developmental disabilities were identified through a series of survey questions within the child component of the National Health Interview Survey (NHIS) from 2014 to 2016.  Characteristics of these children were examined, including whether differences exist in prevalence by survey year.


Q: What do you think is the take home message from this report?

BZ: There was a notable increase in the prevalence of developmental disabilities between 2014-2016, which is largely the result of an increase in the prevalence of children diagnosed with developmental delay other than autism spectrum disorder or intellectual disability.


QuickStats: Percentage of Children and Teens Aged 5–17 Years Who Missed >10 School Days in the Past 12 Months Because of Illness or Injury, by Sex and Age — National Health Interview Survey, 2013–2015

July 7, 2017

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During 2013–2015, 3.9% of boys and 4.3% of girls missed >10 school days in the past 12 months because of illness or injury.

Among children aged 15–17 years, girls were more likely than boys to miss >10 school days (6.8% compared with 3.9%).

Among girls, those aged 15–17 years were more likely than girls aged 5–10 years and girls aged 11–14 years to miss >10 school days (6.8% compared with 3.2% and 4.0%, respectively).

Among boys, there was no difference by age.

Source: https://www.cdc.gov/mmwr/volumes/66/wr/mm6626a8.htm


QuickStats: Percentage of Children and Teens Aged 4–17 Years Ever Diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD), by Sex and Urbanization of County of Residence

June 19, 2017

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During 2013−2015, the percentage of children and teens aged 4–17 years who had ever received a diagnosis of ADHD was significantly higher among boys than among girls within all urbanization levels.

Among boys, those living in small metro and nonmetro micropolitan areas were more likely to have received a diagnosis of ADHD (17.4% and 16.4%, respectively) than were those living in large central (11.4%) and large fringe (12.7%) metropolitan areas.

Among girls, those living in large central areas were less likely to have received a diagnosis of ADHD (4.4%) than those living in each of the other five types of urban/rural areas.

Source: https://www.cdc.gov/mmwr/volumes/66/wr/mm6623a7.htm


QUICKSTATS: Brain Cancer Death Rates Among Children and Teens Aged 1–19 Years by Sex and Age Group — United States, 2013–2015

May 8, 2017

The death rate for brain cancer, the most common cancer cause of death for children and teens aged 1–19 years, was 24% higher in males (0.73 per 100,000) than females (0.59) aged 1–19 years during 2013–2015.

Death rates were higher for males than females for all age groups, but the difference did not reach statistical significance for the age group 5–9 years.

Death rates caused by brain cancer were highest at ages 5–9 years (0.98 for males and 0.85 for females).

Source: https://www.cdc.gov/mmwr/volumes/66/wr/mm6617a5.htm


State by State Health Data Source Updated on NCHS Web Site

April 19, 2017

CDC’s National Center for Health Statistics has updated its Stats of the States feature on the NCHS web site.  This resource features the latest state-by-state comparisons on key health indicators ranging from birth topics such as teen births and cesarean deliveries to leading causes of death and health insurance coverage.

Tabs have been added to the color-coded maps to compare trends on these topics between the most recent years (2015 and 2014) and going back a decade (2005) and in some cases further back.

To access the main “Stats of the States” page, use the following link:

https://www.cdc.gov/nchs/pressroom/stats_of_the_states.htm