Oral health problems are not unique to Texas, but they are generally preventable with proper treatment. Understanding the current state of oral health in Texas can help identify areas for improvement and hopefully create a plan to eliminate preventable oral health issues and improve the overall oral health of Texans.
What is Oral Health?
According to the American Dental Association (ADA), “oral health is a functional, structural, aesthetic, physiological, and psychosocial state of well-being.” It is essential to overall health and an individual’s quality of life.
Other organizations, including the World Dental Federation (FDI) and World Health Organization (WHO) have adopted similar definitions and placed significant weight on the importance of maintaining good oral health.
Key Dental Health Statistics Texas
1. Texas is behind in several dental health metrics, but it also shows positive signs in some areas.
- 37% of young children and 58% of adolescents have cavities
- Almost half of adults over the age of 30, and 70% over 65 have gum disease
- 13.1% of Texas adults have no natural teeth
- 80.6% of Texas children saw a dentist in the past year
- 68.8% of Texans (19.4 million) have access to fluoridated water
2. Rural and border regions of Texas suffer the most in terms of oral health.
- 4 million Texans live in areas without enough dentists
- There are more than 300,000 licensed oral health care professionals in Texas, but the majority of them are employed in dense urban areas.
3. Focusing on general health care limits the opportunity to grow in other areas such as dental health care.
- Approximately 90% of Texas children have some type of health insurance, and pediatric dental care is an essential benefit under the ACA.
- Children access dental care more regularly than adults.
- Access to fluoridated water lessens the chance of dental cavities by 25%.
- Food insecurity is a significant concern, primarily in low income and rural areas.
Dental Caries/Tooth Decay Statistics
Unfortunately for many Americans, including Texans, tooth decay is an issue. Tooth decay, also known as cavities or caries, refers to permanently damaged teeth resulting from erosion due to bacteria.
Tooth decay affects people of all ages, but it’s especially concerning to see significant issues in children. An alarming number of children experience cavities in primary and permanent teeth, which leaves them susceptible to further issues as they get older.
- 37% of Young Children and 58% of Adolescents Have Cavities (U.S.-wide)
More than one-third of children ages 2 to 8 have tooth decay in their baby teeth. Sadly, that number only increases for adolescents, with 58% of those aged 12 to 19 having experienced tooth decay, which means the cavities affect their permanent teeth.
- 14% of Young Children and 15% of Adolescents Have Untreated Tooth Decay (U.S.-wide)
It may not sound like a big deal to put off treating tooth decay in young children (ages 2-8) because they lose those primary teeth. However, the number rises for adolescents (ages 12-19) whose permanent teeth would be impacted.
Further, considering the numbers noted above, a large number of children dealing with dental caries don’t receive treatment. Imagine what happens to those teeth as the children and adolescents age.
- 66.8% of Texas 3rd Graders Have Cavities, 20% of Them Go Untreated
Texas ranks 39th in the nation for the percentage of 3rd graders with cavities. The national average is just over 50%, but more than two-thirds of Texas 3rd graders have cavities.
Sadly, 1 in 5 Texas 3rd graders with cavities don’t receive the treatment they need. This means that Texas ranks 35th, though the 3rd graders fare worse than the national average of 16.2%.
Tooth Decay & Periodontal Disease Statistics in Adults (U.S.-wide)
Tooth decay and gum disease is a national health concern that affects millions of adults. Thankfully, rates have declined over the past several decades, but not across all demographic groups.
What Is Periodontal Disease?
Periodontal disease, more commonly known as gum disease, is an infection of the soft tissues and bone that support your teeth. There are different degrees of periodontal disease, and it is reversible in the early stages.
According to the ADA, gum disease is caused by plaque build-up along the gum line. The plaque causes your gums to pull away from your teeth which allows bacteria to build-up beneath the gum line. Left untreated, gum disease can progress and eventually cause damage to the soft tissues and bone.
- Almost Half of Adults Over the Age of 30, and 70% over 65 Have Gum Disease
Gum disease affects about 65 million adults (30 or older), which equates to 46% of the U.S. adult population. Sadly, some groups struggle with the condition more than others.
- 7/10 Hispanic adults in U.S. have periodontitis
- 6/10 black adults have periodontitis
- 4/10 white adults have periodontitis
The numbers increase with age as 70% of adults over the age of 65 have some degree of periodontitis.
- More Than 90% of Adults Have a History of Tooth Decay By Their 60th Birthday
Tooth decay remains an issue for American adults, with 91% having a history of tooth decay by age 60. The combination of gum disease and tooth decay in adults is troubling, especially as you consider the statistics on tooth loss.
- More Than 1 in 7 Adults Ages 65-74 Have No Natural Teeth
The combination of tooth decay and periodontitis has long-term effects. Looking at the adults over the age of 65 dealing with severe periodontitis, they have an average of 21 of their natural 32 teeth remaining.
Tooth Decay & Periodontal Disease Statistics in Adults (Texas)
Though many of the above statistics aren’t broken down to the state level, there is some information available for Texas in terms of tooth loss due to tooth decay and gum disease.
- 13.1% of Texas Adults Have No Natural Teeth
The national average for edentulous (no natural teeth) adults is 15.2%, Texas comes in more than two percent lower. Further, though more than half of Texans aged 45 to 64 (about 54.1%) have had at least one tooth removed due to tooth decay or gum disease, it falls below the national average of 72%.
Oral Cancer Statistics in Texas
The eighth most-common type of cancer in the world, oral cancer cases are on the rise. Though Texas is below the national average in terms of oral cancer, there are still significant numbers of adults dealing with the disease.
What is Oral Cancer?
The National Cancer Institute (NIH) classifies any cancer that forms in the mouth, throat, or back of the mouth as oral cancer. It can present in different ways depending on where it occurs, but often includes swelling, thickening, white or red patches, and unexplained bleeding.
- Texas Sees 10.8 New Cases of Oral Cancer Per 100,000 People
Though 10.8 new cases is lower than the national average of 11.5 new cases per 100,000 people, it still represents a significant number of people in Texas. Unfortunately, not everyone manages to overcome oral cancer, and the current mortality rate in Texas is about 2.6 cases per 100,000 people.
Oral Health Care Utilization in Texas
Many oral health problems can be prevented with proper care, including regular visits with a dentist. Preventative care visits allow dentists to regularly evaluate oral health and catch potential issues before they evolve into tooth decay and gum disease. Additionally, early identification of oral cancer can improve survival rates and complications.
1. Preventive and Routine Care
- 80.6% of Texas Children Saw a Dentist in the Past Year
Kids should see a dentist for the first time around age 2, so it’s a good thing that more than two-thirds of children and adolescents see a dentist at least once per year. Unfortunately, the number drops to 70% for teens aged 14 to 18.
- 59.4% of Texas Adults Visited a Dentist in the Past Year
Despite the obvious need to see a dentist consistently as you age, adults in Texas have a far lower rate of past year dental visits than children and teens. The trend is especially troubling in one key demographic – pregnant women.
- Only 11.2% of Pregnant Women in Texas Made a Dental Appointment
Given that women are at high risk for developing periodontal disease while pregnant due to hormonal changes, a dental follow-up is as important as OB appointments.
2. Emergency Care
Emergency rooms cannot do much for oral health issues. If you go to a hospital emergency room, they can generally prescribe an anti-inflammatory and antibiotic before sending you on your way. They also refer you to a dentist for follow-up. However, a startling number of people seek treatment in emergency rooms every year.
- Approximately One Person Every 15 Seconds Visits a Hospital ER for a Dental Condition
Despite the inability to properly care for a dental emergency, hospital emergency rooms dealt with approximately 2.18 million total dental emergency visits nationwide in 2012.
- In Texas, 7.2% of Teens Say They Visited an ER for Dental Problems
Teens between the ages of 14 and 18 say they sought treatment for dental issues in hospital emergency rooms. They aren’t alone. In fact, people of all ages sought treatment from ERs for pain management or infection treatment at an alarming rate.
Approximately 80% of the visits could have been handled at a local dental office. This is even more concerning because many offices offer some form of emergency dental care.
Texas Oral Diseases: Major Contributing Factors
Like many health statistics, there are numerous factors contributing to oral health issues. Several of the contributing factors could be mitigated or eliminated by individuals.
1. Consuming Sugary Beverages
From soda to sports drinks, there are dozens of drinks that contain excessive amounts of sugar. They remain a popular option for meals, snacks, and special events.
- 18% of Texas Adolescents Consume Soda at Least Once Per Week
In this area, Texas teens (ages 14 to 18) perform better than the national average of 20.4%. Of note, children who begin drinking large quantities of sugary drinks as young as age 2 tend to experience more cavities by ages 4 to 7 than those who consume less.
What Sugary Drinks Do to Teeth
Sugary drinks matter because the sugar sticks to the exterior of the teeth. The sugar creates a breeding ground for bacteria and stimulates acid production, which ultimately erodes the tooth enamel and leads to cavities.
2. Tobacco Use
Tobacco is known to cause oral health problems ranging from sensitive teeth to oral cancer. Despite the amount of information available about the negative effects of using tobacco, it remains an ongoing issue for many people.
- Almost 20% of Texan Adults (Ages 18 and Older) Use Some Form of Tobacco
Breaking it down into category, 14.3% of Texan adults smoke cigarettes and 4.3% use smokeless tobacco products regularly. Smokeless tobacco products (chewing, dipping, and snuffing tobacco) are leading risk factors for oral cancers.
- 44% of Smokers Feel Good About Their Oral Health Compared to 60% of Non Smokers
This may have something to do with the common side effects of smoking. Smokers are more likely to have sensitive teeth, toothaches, oral pain, bad breath, and social limitations. They also have twice the rate of edentulism (15%) vs non smokers (7%).
What Tobacco Does to Dental Health
The toxic ingredients of cigarette smoke and smokeless tobacco products damage the soft tissues of the mouth, discolors teeth and gums, and increases the chances of developing periodontal disease. Additionally, tobacco use triggers healthy cells to become cancerous.
3. Alcohol Use
Alcohol use is another contributing factor to oral health problems. Alcohol can have excessive amounts of sugar, similar to soda or energy drinks, and trigger the same effects on your teeth and gums. However, there are some additional repercussions of excessive alcohol use.
- In Texas, 19.3% of Adults Consume Excessive Amounts of Alcohol
Drinking excessively can trigger vomiting, which means more acid exposure for your teeth. Additionally, chronic alcohol users are less consistent with brushing and flossing, which means the sugars and acids remain on the teeth longer.
One study shows people with alcohol use disorders showed significantly more damage to teeth. Several studies show people who consume large amounts of alcohol have a small, but significantly higher risk of developing oral cancers.
What Alcohol Does to Dental Health
Alcohol can have a significant impact on oral health. Not only does it include sugars and acids that can harm your teeth and gums, it tends to dry your mouth out. With less saliva, you lose protection against bacteria. Also, many types of alcohol, like dark beers, stain your teeth.
4. Drugs and Substance Use
Aside from tobacco and alcohol, there are many other drugs and substances available (legally and illegally) that affect oral health. People with substance use disorders have higher rates of tooth decay, gum disease, tooth loss, facial traumas, and oral cancers.
Unfortunately, these individuals have worse access to care, and even if they do get dental care, they are less likely to receive restorative oral care they need.
5. Lack of Water Fluoridation
Adding fluoride to the drinking water was one of the top public health achievements of the 20th century. It has been one of the most important (and cost-effective) public health interventions in terms of preventing oral health disease, like tooth decay.
The process is simple, by drinking fluoridated drinking water, small amounts of fluoride are left on the teeth. These fluoride particles re-mineralize the surface of your teeth and counteract the effects of acids.
- 68.8% of Texans (19.4 Million) Have Access to Fluoridated Water
The importance of using fluoridated drinking water cannot be understated. People who drink fluoridated drinking water experience 25% fewer cavities than those who don’t.
- Water Fluoridation Saves Texas’ Medicaid Program $19 in Dental Expenditures Per Child, Per Year
Fluoridated water is cost effective because it costs less than $2 per person annually (installation and maintenance) and saves millions in dental care every year. The Texas Medicaid program saves $70 million per year because of children having access to fluoridated water.
- 44% of Texas’ State Public Water Systems Contain Natural or Added Fluoride
Despite the cost effectiveness, the number of Texans served by fluoridated drinking water has declined 13% since 2014. This may be due to a shift in public opinion about using fluoridated water – even though there is no scientific research to support the skepticism.
6. Lack of Affordable, Nutritious Food
Dubbed “food insecurity,” there is a growing concern about the lack of affordable, nutritious food. There is a strong link between food insecurity and poor oral health.
To work within a budget, caregivers buy as much as they can with what they have. Unfortunately, if you want to get the most bang for your buck, you end up with inexpensive but heavily processed, sugary, starchy foods.
Access to a variety of nutritious foods is equally challenging in some areas where convenience stores and fast food restaurants offer the only food. Deemed food deserts, these areas lack fresh fruits and vegetables, unprocessed proteins, and dairy products.
Erratic Eating Habits
On top of limited finances and access, many people alter their eating habits because they don’t know when they will eat again. This often means eating smaller amounts throughout the day to keep hunger at bay. However, that leaves food and debris on and between the teeth for longer periods. When that food is starchy and sugary, it increases the risk of tooth decay.
- Nearly One in 10 Texans Experiences Food Insecurity
Some of the lower income neighborhoods and rural areas have more than 60% of households facing food insecurity. Even worse, children from these households have significantly higher rates of cavities and related dental pain.
Consequently, children from food-insecure households require more restorative dental services, like tooth extractions. Unfortunately, these same families usually lack the money to afford dental care, or health care at all.
Barriers Between Texans and Proper Oral Health Care
It would be nice if everybody had the resources to access the dental care they need, but that’s not often the case.
1. Insufficient Resources
- 18% of Texans Did Not See a Doctor When Needed Because of Money
In 2016, 18% of Texans skipped medical appointments of some type because they couldn’t afford to go. Sadly, this is nearly 50% above the national average. However, lack of financial resources is one of the main reasons for delaying or avoiding health care, even if somebody has health insurance.
2. Limited Understanding of Basic Health Information
Understanding basic needs in terms of health and dental, known as health literacy, is a significant barrier for some people. When people lack awareness, they can’t make the best health decisions for themselves and may skip necessary appointments.
3. Perceptions, Beliefs and Experiences
Like anything in life, a bad experience can prevent somebody from going back to a healthcare provider. Similarly, attitudes and cultural beliefs can impact an individual’s willingness to seek care. Additionally, dental anxiety or feeling shame about the state of their oral health make some Texans afraid to visit the dentist.
How Texans are Paying for Oral Health Care
Since finances are a significant barrier to getting dental health care, let’s look at all of the ways Texans currently pay for appointments and treatment.
1. Out-of-Pocket Spending
Regardless of health coverage, many people still pay for a large portion of dental costs out of pocket compared to other health care needs. In 2016, 40% of national dental costs were covered by individuals. Fortunately, Jefferson Dental & Orthodontics offers a Dental Savings Plan, which helps reduce out-of-pocket costs by up to 50% annually.
2. Health Insurance
Even though many health insurance plans exclude dental care, you can still use it to indirectly help your oral health. Many insurance plans cover tobacco cessation and chronic health condition treatment. Some even provide access to a nutritionist to learn how to better meet your dietary needs.
3. Dental Insurance
More Americans have dental coverage than ever, and people are more likely to see a dentist if they have dental insurance.
4. Medicaid & CHIP in Texas
- 46% of Texas Children Have Dental Coverage Through Medicaid or CHIP
In Texas, children, teens, and young adults (up to age 21) can get Medicaid dental benefits through Texas Health Steps (THSteps). Between THSteps and CHIP, about 3.6 million Texas children receive dental coverage.
Oral Health Workforce Capacity
Does Texas have enough dental professionals to meet the state’s needs? What does the state need going forward?
1. Current Size and Distribution
- There Are More Than 300,000 Licensed Oral Health Care Professionals In Texas
From dentists to dental hygienists, Texas has a massive workforce that grows larger every day. In fact, no state has added more dentists since 2013. The downside is that the majority of Texas’ dental workforce is employed in dense urban areas.
- 4 Million Texans Live in Areas With Not Enough Dentists
Around 15% of Texans live in rural areas and lack access to dental professionals. These areas have less than one practicing dentist per 5,000 residents, known as DHPSAs (dental health professional shortage areas).
2. Workforce Diversity
Building a diverse community of dental professionals involves cultural and linguistic diversity is critical for improving patient satisfaction. However, America would need to increase the number of black dentists by four times and Hispanic dentists by five times to match the population proportions.
One method attempting to resolve these proportional disparities includes loan repayment incentives, but it’s not enough. Unfortunately, dental professionals of color tend to bear the responsibility of treating underserved communities where they make less even though they tend to owe more in student loan repayment.
3. Resolving Shortages
Two options to resolve shortages in the dental health field in Texas include Telehealth and expanding the scope of practice.
Telehealth options allow urban dental professionals to consult with rural residents via videoconference. In many cases, this method is still in the early phases and there are many bureaucratic issues to resolve.
Scope of practice changes involve expanding the types of procedures mid-level professionals can perform. The argument is that dental hygienists can safely perform anywhere from 50% to 80% of routine dental services at community clinics to serve more people. Again, this is a new concept being researched.
Now that you know the current state of Texas’ oral health, why not book an appointment at your nearest Jefferson Dental & Orthodontics office?