Oral health has improved dramatically in the United States between 1970, when fewer than six
million Americans had dental coverage, and today, when more than 161 million Americans are covered.
The National Institute of Dental Research (NIDR), in a joint 1992study with the University of
Connecticut, reported the number of cavities found in children ages 5 to 17 decreased from seven
in the early 1970s to three by 1987. The same study reported significant reductions in tooth loss
among working adults, with increased access to preventive services cited as one of the major
factors for these improvements, along with wider use of fluorides and better oral hygiene
practices.1 These findings echo those of many other studies,
including one by the Institute of Medicine, which found that regular dental care has resulted
in a dramatic reduction in dental diseases, saving patients an estimated $4 billion a
Total dental expenditures climbed from $2 billion in 1960 to an estimated $61 billion by 2000,
according to the U.S. Health Care Financing Administration (HCFA).3 Yet even as utilization of dental services grew over this period, a shift in the kinds of services
provided -- from major restorative to more preventive-oriented services -- bears testament to the
progress made by the dental profession in controlling oral disease, promoting oral hygiene and
encouraging routine, professional dental care. The American Dental Association estimates that
periodic oral exams increased by 12.1 percent just since 1979, while the number of metal fillings
decreased by 51.7 %, plastic restorations by 5.7 %, and simple extractions by 41.2 %.4
The importance of access to dental care to oral health as provided by dental benefits is
further documented in a Rand study, which concluded that Americans in poor oral health are
less likely to have used dental services in the past or to have access to them in the future.
Conversely, the Rand study showed those in good oral health are more likely to have had previous
dental care and good access to future care.5
Having dental coverage is the single greatest factor in determining whether a person sees
a dentist, according to statistics compiled by the Nation Health Center for Statistics. The
Center's National Health Interview Survey revealed that people with dental benefits coverage
are almost twice as likely to visit a dentist in any given year (2.6 vs. 1.7 visits per year),
are far more likely to have multiple dental visits in a year (45% vs. 28%), and are more likely
to have had a checkup during their last visit rather than require treatment for a specific problem
(48% vs. 30%).6
The motivational effect of dental coverage on encouraging utilization of dental services is
most evident when looking at the behavior of older Americans and lower income Americans.
Covered adults over 75, for instance, average 4.3 dental visits annually, while those without
coverage average only 1.4. Similarly, Americans with dental coverage earning under $10,000
annually average 2.9 dental visits a year compared with only 1.2 for those without.
All of these increased dental office visits translate to better oral health for millions
of Americans as they gain access to a host of preventive and basic restorative services.
Dental expenditures paid for by private insurance programs grew from $10 million in 1960
(10% of all expenditures), to $24 billion in 1997 (50%).7
Despite the tremendous growth in dental coverage and insurer-paid dental expenditures,
overall spending on dental services actually declined as a percentage of total healthcare
spending, from 7.4% in 1960 to a projected 4.7% in 2000.8 Many
researchers attribute this to the success of dental benefits in improving oral health.
As more Americans gained access to dental care , a corresponding improvement in oral
health greatly limited the number of expensive, more costly procedures performed on