Tip Sheets

Getting stories out of NHANES

Bruce Dye
Bruce Dye


By Mary Otto

Here’s the good news: Tooth decay among American preschoolers appears to be on the decline.

Federal officials are basing their hopeful assessment on preliminary data from the most recent National Health and Nutrition Examination Survey (NHANES).

The findings are not all upbeat, however. The NHANES report suggests that deep disparities in oral health endure. Tooth decay is a problem for millions of teens. A new look at the oral health of Asian American children offers a mixed picture.

When NHANES findings are released, they are often newsworthy. And beyond a daily story, NHANES data can be of continuing usefulness to reporters.

That is because the survey, really an ongoing series of surveys, serves as a major tool for assessing the status of the nation’s oral health. NHANES’ size and depth make it unique. The study combines face-to-face interviews and physical examinations of a nationally representative sample of about 5,000 people each year. The work is overseen by the National Center for Health Statistics, which is part of the Centers for Disease Control and Prevention.

This tip sheet offers highlights from the new NHANES assessments. They provide a fresh look at the status of the oral health of over 40 million American children and 32 million adolescents and teens.

It also offers insights gleaned from a recent webinar hosted by the National Institute of Dental and Craniofacial Research (NIDCR) and the Centers for Disease Control and Prevention’s Division of Oral Health.

The program features NIDCR dental epidemiology officer Bruce A. Dye, D.D.S., M.P.H., lead author of the new report, as well as previous reports on the NHANES.

Are you looking for a story about tooth decay or sealants or racial disparities? Do you need new data on oral health among teens or Asian American children? You will find something useful here.

One key finding: approximately 23 percent of American children age 2 to 5 years had decay in their primary teeth in the 2011-12 survey.

While oral health advocates have been quick to note the level remains troubling, Dye observes that the figure suggests an improvement from past reports.

“This is the lowest percentage we have seen in the past 25 years,” he said.

Previous NHANES showed tooth decay in the primary teeth of American preschoolers increasing from 24 percent to 28 percent between 1999 and 2004.

In another positive piece of news, more young children seem to be getting restorative dental services, the report suggests. It indicates that 10 percent of preschoolers had untreated decay, compared with the last report where that figure stood at nearly 19 percent.

But decay, including untreated decay remains prevalent among older children. Overall, among 6 to 8 year olds, 56 percent experienced tooth decay; and 20 percent of that age group had untreated cavities, the report finds. In another troubling finding, the rates of decay continue to vary significantly among children of different racial and ethic groups.

“Among children aged 2 to 8, approximately 31 percent of white children had caries (in primary teeth). This compares to approximately 44 percent of black children and 46 percent of Hispanic children who had caries,” notes Dye.

For the first time, NHANES has offered an assessment of the oral health of Asian American children, Dye said. In the 2-to-8 year old group, about 36 percent had dental caries in their baby teeth.

Dental sealants, thin, protective plastic-like coatings applied to the chewing surfaces of the back teeth, have been shown to be effective against decay. But their use continues to vary across racial and ethnic groups.

According to the new data, 44 percent of white children received preventive care in the form of dental sealants, compared with only 31 percent of non-Hispanic black and Asian children. Among Hispanic children, 40 percent had sealants.

The study also found that high disease rates persist among teenagers, with nearly three in five experiencing decay in permanent teeth.

In the study, 58 percent of adolescents age 12 to 19 years had cavities.

“In the United States we estimate about 8-1/2 million teenagers between the ages of 12 and 15 have had tooth decay and 2-1/2 million of these teenagers aged 12 to 15 have untreated tooth decay,” Dye said. “Among older teenagers 16 to 19, nearly 3 million teenagers have untreated tooth decay in the United States.”

Among teenagers, decay rates are high across all ethnic groups, Dye observed.

“When we look at dental caries by race/ethnicity in the United States, we can see that regardless of race/ethnicity status, the prevalence of caries is similar,” he said “It ranges from approximately 56 percent for white teenagers to 61 percent for Hispanic teenagers.”

Untreated decay stands at more than 15 percent across all teens, with black and Hispanic teens more likely to have untreated decay than white or Asian American teens.

Reflecting upon the presence of tooth decay among more than half of American teens, Dye offered this insight:

“Teenagers have more teeth than young children which means more teeth that are susceptible to decay,” he said, “In addition brushing habits often go downhill in adolescence, and diets get worse as teens become more independent and make more of their own choices about what to eat and what to drink. And all of this contributes to teenagers having more opportunities for tooth decay to occur.”

Dye stressed the limitations of the preliminary figures presented in the brief, which was issued in March.

He called the findings “a two-year snapshot” from a multi-year effort. “Because of the survey design we cannot determine reasons why tooth decay is at the level we are estimating.”

He offered these takeaways from the new data:

  • The most important finding is that tooth decay is still a problem especially in adolescents.

  • The prevalence of untreated tooth decay varies by age.

  • Oral health disparities between race ethnic groups in the United States are evident.


Survey shows improvement in preschoolers’ dental health, but disparities persist, an AHCJ blog post about the latest NHANES survey.

AHCJ tip sheet on pediatric oral health.

AHCJ tip sheet on story ideas during National Children’s Dental Health Month.

Children’s Dental Health Project, a Washington, D.C., nonprofit advocacy group.

The professional group American Dental Association, has a resource page for its MouthHealth initiative.