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FUTURE OFDENTISTRY

shown improvement in the amount of untreated

caries in the primary dentition (Brown et al, 2000a).

Overall, the average number of untreated carious

primary teeth dropped 55.6% between the

NHANES I and NHANES III studies. This

improvement occurred in both the group two to five

years old (primary dentition period) and the group

six to ten years old (mixed dentition). Untreated

caries in primary teeth has diminished both in

prevalence and extent across time for broad seg-

ments of two to ten year old children (African

American and White, male and female). However,

the reduction in untreated decay among children aged

two to five years old who were at or below the pover-

ty level was not found to be statistically significant.

Cumulative Caries

Trends in cumulative caries experience (both

treated and untreated caries) and the percent of

caries that was treated also demonstrate improve-

ment for both the primary and permanent dentitions

of United States children between

the early 1970s and the early

1990s (Brown et al, 2000b).

However, the extent and scope of

the improvements are somewhat

different in the two dentitions

(primary and permanent).

Cumulative caries in permanent

dentitions declined by over 60%

among the 6-11 year olds and

over 50% among the 12-18 year

olds. These improvements were

seen in children living below the

poverty level as well as children

living above poverty.

Cumulative caries experience

was less diminished in the pri-

mary dentitions of United States

children, aged two to ten years

old. This was especially true of

preschool children among whom

only primary teeth typically are

present. The amount of caries in

children, aged two to five years

old living below poverty was the

same in the early 1990s as it was

in the early 1970s. Among chil-

dren living above poverty the

picture was somewhat better.

Their average cumulative number of decayed or

filled primary teeth declined from 1.16 to 0.78.

Adult Edentulism

Adults of all age groups are retaining more teeth.

As shown in Figure 4.2, total loss of teeth or eden-

tulism occurs in a smaller percentage of today's eld-

erly Americans compared to previous generations

(Brown and Lazar, 1998). Despite the significant

decrease in complete edentulism, almost 30% of the

population over 65 years old are edentulous and

will require substantial care.

ACCESS TO DENTAL CARE SERVICES

Most Americans can and do access dental servic-

es, and the dental care delivery system efficiently

provides care for those who demand it. Nevertheless,

important barriers impede access for too many people.

Most policy analyses of access to dental care have

focused on two approaches: a "demand approach to

Financing of and Access to Dental Services

At or Below the Poverty Level

Above 300% of the Poverty Level

Source: Brown et al, 1999.

2.50

2.00

1.50

1.00

0.50

0.00

2.1 4

0. 78

FIGURE 4 .1

Average Number of Untreated Carious Permanent Teeth

Among Children 6 to 18 Years Old at or Below the Poverty Level

Compared with Those with Income Above 300% of the Poverty Level

0. 46

0.11

NHANES I ( 1971 - 1974 ) NHANES III ( 1988 - 1994 )

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DATA SOURCE