National Oral Health Report: A State Of Decay

Strides Made, But Rapidly Growing Population Of Older Americans Still Needs More Access To Oral Healthcare Services

CHICAGOApril 17, 2018 – Oral Health America (OHA) has published a national report examining factors impacting the oral health of older adults. With an expected 72.1 million seniors living in the United States by 2030, OHA’s A State of Decay, Vol. IV, illustrates progress in some areas and the need for continued action to ensure America’s rapidly growing population of seniors age healthily and independently. Top report findings include:

  • One-third (33%) of older adults have lost six or more teeth
  • 25 U.S. states received a poor overall score based on six key performance measures
  • MinnesotaWisconsinIowaConnecticut and Colorado all earned an “Excellent” Composite Score. Iowa and California made big improvements, jumping from 23 and 30, respectively, in 2016, to 3 and 9 in 2018
  • The states with the lowest overall scores are WyomingDelawareWest VirginiaNew JerseyArkansasTexasOklahomaLouisiana and Tennessee, with Mississippi’s score being the least favorable. Alabama improved from 50 in 2016 to 29 in 2018
  • Community water fluoridation (CWF) increased to a state average of 72.6%, a national increase of about 2.2 million people
  • Medicaid coverage of oral health benefits increased
  • Sociodemographic factors, such as income, race, gender and education play a critical role in oral health outcomes

A State of Decay, Vol. IV gives a rating of “Poor,” “Fair,” “Good,” or “Excellent” based on state-level data analyzing six variables impacting older adult oral health: Severe Tooth Loss (loss of 6+ teeth), Dental Visits, Adult Medicaid Dental Benefits, Community Water Fluoridation, State Oral Health Plans and Basic Screening Surveys. For the first time, A State of Decay, Vol IV adds a national analysis of the Centers for Disease Control and Prevention’s (CDC) individual data on severe tooth loss and recent dental visits by considering associations with sociodemographic factors.

“With half of the United States receiving a ‘fair’ or ‘poor’ rating relative to meeting minimal standards for the oral health of older adults, we must identify and address the steps needed to ensure the health of our burgeoning senior population,” said Beth Truett, President and CEO of Oral Health America. “As depicted in this report, even with improvements by certain states, millions of older adults are still at a disadvantage when it comes to oral health care. Access to and utilization of care and to the coverage needed to pay for care is critical to increasing the overall health and wellness of America’s seniors.”

Federal and state policies are needed to address the underlying, systemic variables that prohibit older adults from achieving good oral health outcomes. A State of Decay, Vol. IV recommends the following to promote healthy aging and independence for this rapidly growing cohort of America’s population:

  • Reinstate, establish or maintain a comprehensive adult Medicaid dental benefit.
  • Integrate comprehensive dental coverage in Medicare.
  • Sustain or expand community water fluoridation.
  • Include specific objectives for older adults in all State Oral Health Plans (SOHP).
  • Conduct Basic Screening Surveys (BSS) of older adults in all states.

Through A State of Decay, OHA continues to lead the way toward healthier mouths for older adults. States, advocates and public health coalitions that share OHA’s commitment can use these actions to push forward policies needed to positively impact the oral health of older adults as a key factor for overall health.

Links to the latest volume of A State of Decay and earlier editions can be viewed on