Dental Caries: A Global Health Burden and the Cost of Neglect


Dental Caries remain a significant oral health burden globally. According to the World Health Organization (WHO), around 2.3 billion people worldwide suffer from dental caries in permanent teeth, making it one of the most prevalent chronic diseases. In the United States, it is estimated that 91% of adults aged 20-64 years have experienced caries in their permanent teeth. This oral health issue contributes substantially to healthcare expenditures.

The cost of dental caries and dental care

Dental caries (Figure 1) occasionally necessitates emergency dental care, leading to substantial costs. In the U.S., dental emergencies result in over 2 million annual visits to emergency rooms (ERs), costing an estimated $1.6 billion (HCFA 2000b). These costs highlight the strain on healthcare resources due to caries-related complications. Furthermore, dental caries can lead to missed work and school days. In the U.S., employees are estimated to miss more than 164 million hours of work annually due to dental problems. In schools, children lose approximately 51 million school hours each year because of dental issues (Journal of the American Dental Association, 1994;125,136).

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The higher disease burdens

Vulnerable populations, including low-income individuals and those with limited access to dental care, are disproportionately affected by caries. They often face higher disease burdens and more significant barriers to accessing preventive and restorative dental services, exacerbating oral health disparity. These statistics underscore the need for effective public health initiatives and policies to reduce the caries disease burden, particularly among vulnerable populations, to enhance overall oral health and well-being and facilitate health equity (NCHS, 1999, p. 45).

As noted above, socioeconomic status, geographic location, and provider shortages may greatly influence oral health care access. These barriers may lead to disparities in oral health outcomes. Oral health care services may be a challenge for those with lower socioeconomic status (SES). These barriers include but are not limited to lack of dental insurance coverage and lack of extra funds to cover dental care expenses. Additionally, those living in rural areas often have a shortage of dental professionals, which makes it difficult for them to receive regular dental care, which may result in delayed preventative and treatment services. Another issue for those living in rural areas is the distance they may need to travel to the nearest dental provider. Due to shortages of dental providers, some individuals may be discouraged due to wait times and put off seeking routine check-ups and cleanings, which may increase the risk of oral health problems. According to the US Surgeon General’s first-ever report on oral health, dental caries is a silent epidemic and the burden of dental caries and disparities in oral health services has made oral health access a challenging public health issue globally and nationally. These statistics underscore the need for effective public health initiatives and policies to reduce the caries disease burden, particularly among vulnerable populations, to enhance overall oral health and well-being.

Approach to relieve the burden

One way to relieve the burden of access to oral health care is through community water fluoridation. Water Fluoridation has been shown to be an effective public health strategy to expand oral equity. Water fluoridation is the process of regulating the amount of fluoride in drinking water to a level that is recommended to prevent tooth decay. Currently, that level is 0.7mg/L., (Public Health Reports, 2015). Water fluoridation began in 1945, when the city of Grand Rapids, Michigan, was the first to add fluoride to its city water system. Since then, hundreds of U.S. cities have followed suit, and fluoride is supplied to approximately 73% of Americans. Because of its contribution to the dramatic decline in tooth decay over the past 75 years, the CDC named community water fluoridation as one of the ten great public health achievements of the 20th century. It can help alleviate disparities in dental health and care. It has been identified as the most cost-effective method of delivering fluoride, reducing tooth decay by 25% in children and adults.

School children in communities with water fluoridation have, on average, two fewer decayed teeth than children in communities without it. People who consume fluoridated water experience reduced and less severe decay, resulting in a decreased need for treatment and less time taken off from school or work because of dental issues. This lessens the financial burden on society. In 2020, 72.2% of communities in the U.S. had access to fluoridated water. As part of a plan to use public health interventions to reduce or prevent disease among the population, the U.S. Department of Health and Human Services has set a national health objective in Healthy People 2030 that 77.1% of people served by community water (U.S. DHHS, 2023).


Community water fluoridation has been shown to save money, both for families and the health care system. It is recognized as one of the most cost-effective, equitable, and safe actions communities can take to prevent dental caries and improve oral health for all, regardless of age, income, or education. Water fluoridation is an evidence-based, effective, safe population-based intervention. It can reduce oral health disparities, improve oral health equity, and lower the health care expenditure.

Earn an Online Postgraduate Degree in Community Oral Health

Like what you’re learning? Consider enrolling in the Herman Ostrow School of Dentistry of USC’s online, competency-based certificate or master’s program in Community Oral Health.


  • Community water fluoridation (2020). Edelstein, B. L., Chinn, C. H., Vargas, C. M., & Candelaria, D. A. (2018). Children’s access to dental care in Medicaid: The intersection of policy and practice. American Journal of Public Health, 108(10), 1315-1317
  • Grossman, D. C. (2018). Addressing oral health disparities in rural populations: A Commentary. The Journal of Rural Health, 34(1), 4-6.
  • Increase the proportion of people whose water systems have the recommended amount of fluoride — OH‑11 (2023).
  • Journal of the American Dental Association (1994;125,136) and the National Center for Health Statistics (NCHS, 1999, p. 45)
  • Nasseh, K., Vujicic, M., & Glick, M. (2017). The relationship between periodontal Interventions and healthcare costs and utilization. Evidence-Based Dentistry, 18(2), 61-62.
  • Singh, G. K., & Mohn, J. (2017). Oral health-related disparities: An overview. In G.K. Singh (Ed.), Rural Health in the United States (pp. 307-328).
  • U.S. Department of Health and Human Services. (2000). Oral Health in America: A Report of the Surgeon General. Rockville, MD: National Institute of Dental and Craniofacial Research.
  • U.S. recommendations for fluoride concentration in drinking water to prevent dental caries health and Human Services federal panel on community water fluoridation. (2015) Public Health Reports, 130.
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