Introduction

Approximately 500 million dental visits occur annually in the United States, representing a significant healthcare expenditure. According to a 2023 report;¹ Within the context of overall U.S. health spending, which reached $4.9 trillion in 2023 (a 7.5% increase from $4.56 trillion in 2022), dental care maintains its position as an essential healthcare service with distinct financing patterns. Dental services account for approximately 3-4% of total healthcare expenditures, with dental spending estimated to have increased by 5-6% from 2022 to 2023. The financing structure remains unique, with a higher proportion coming from out-of-pocket spending (40-45%) compared to other healthcare sectors, while private health insurance covers roughly 50% of dental expenses. This represents a slight shift from 2022, when out-of-pocket spending for dental services was closer to 42%. This financial structure highlights the ongoing challenges in dental care accessibility and affordability for many Americans, particularly as overall healthcare costs continue to outpace general inflation.¹

Dental caries, commonly known as tooth decay, is an oral disease in which the acid generated by oral bacteria cause damage to hard tooth structure. Although preventable, it is one of the most common chronic, infectious diseases among American children and adults, and remains one of the most common diseases throughout the world. In spite of major improvements that have been made in the US dental health care system over the past few decades, particularly with regard to the percentages of cavities found in both children and adults, some population groups continue to experience caries at higher rates than others. This is particularly true for populations with lower income and lower education and also for some ethnic and racial groups.²

Clinical Significance Snapshots

What is the practical significance of the epidemiology of Dental Caries?
As a dental practitioner why should this interest me?
Information that reports the amount of any disease in a population is of tremendous importance in planning, funding and delivery of health services so that enough healthcare professionals of the correct skill sets are trained, enough clinical centers are built, and that new and improved materials and clinical techniques are developed through adequately funded research programs. Access to care is a critical issue for oral health – many of the US population are currently unable to receive the dental care they need. Having knowledge of this need for care helps health planners create preventive programs to avoid disease in the first place (e.g., water fluoridation, availability of low sugar foods and beverages) and to ensure that enough dentists are produced to provide services, and that those services are adequately funded through private or public systems.

What is the value of a dental index to me in dental practice?
Recording of a patient’s health status is important, not only to plan any treatment currently needed, but also to assess a patient’s changes in disease status and their response to treatment over time. The dental chart of cavities and restorations is similar to an index, and while it is not quantified numerically, it does allow comparison over time. As early carious lesions are reversible and typically should be treated not by restorative means, but by preventive means such as fluoride agents and dietary modification, the methods of measurement and recording of the lesions is critically important. The DMF Index does not differentiate between early and late stage lesions, but new caries assessment indices having that capability, such as the ICDAS II (International Caries Diagnosis and Assessment System), are being introduced into dental school curricula.

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