National Oral Health Report: Mouth Health of Older Americans in a State of Decay

Oral Health America Makes the Case for Policy Change

CHICAGO, OCTOBER 1 – A new report examining factors impacting the oral health of older Americans reveals the nation’s oral health is in trouble. Published by Oral Health America (OHA), A State of Decay, Vol. III is a state-by-state report of the oral health of its 65+ population and the success or failure of states to address those needs. OHA found the lowest-performing states are found in the South and highest-performing throughout the East and the West coasts as well as the Midwest. The report underscores the important role policies and practices play in addressing barriers, particularly for vulnerable populations.

“While many Americans face obstacles when it comes to oral health, older adults are at an increased risk due to challenges with accessing care,” said Dr. Dushanka Kleinman, a dentist and associate dean for research and academic affairs at the University of Maryland School of Public Health. “We have to develop solutions at the practice and policy level to address the barriers older Americans experience.”

Older Americans are at risk for adverse oral health for a variety of reasons. Among the most prominent are a general decline in health, less access to oral healthcare and lack of dental benefits. The report serves as a resource for states to address shortfalls in oral health status, dental benefits for low income adults and population-based prevention, all of which affect the oral health of older adults.

A State of Decay gave a rating of “poor,” “fair,” “good,” or “excellent” based on state level data analyzing seven variables impacting older adult oral health: edentulism (loss of teeth), intake of fruit and vegetables, the availability of Medicaid dental benefits, Community Water Fluoridation, the status of the state’s older adult Basic Screening Survey and the existence and extent to which the State Oral Health Plan includes immediate or recent efforts to improve the oral health of older adults.

OHA identified variables for those ratings based on the latest understanding of what contributes to the condition of oral health among older Americans. Each state has been given two scores–an Individual Oral Health Score that measures individual-level factors that address the oral health of older adults such as edentulism and nutritional intake and a Public Policy Score, which measures factors that address what states are doing to address the oral health needs of older adults. These scores have been combined to give a total Composite Score.

The final evaluations for all 50 states revealed that 74 percent, or 37 states, earned a Composite Score of “fair” (30 percent) or “poor” (44 percent). Puerto Rico, Guam and Washington D.C. were rated on some but not all of the variables, therefore not included in the Composite Scores.

All seven variables were combined in the Composite Score to provide an overall ranking. In order, the 10 states with the highest Composite Score are Connecticut, Rhode Island, Virginia, Minnesota, New York,
Colorado, Florida, Maryland, North Dakota and Wisconsin. The states with the lowest Composite Scores are Montana, Pennsylvania, Arkansas, Hawaii, South Carolina, Oklahoma, Louisiana, Tennessee, Alabama while Mississippi’s was least favorable.

The top findings of this report that illicit further scrutiny and action are:

  • Tooth loss remains a signal of suboptimal oral health. Eight states had strikingly high rates of edentulism, with West Virginia notably having an older adult population that is 33.7 percent edentate
  • Poor nutritional intake affects America’s seniors. Forty percent (21 states) have 40 percent or more older adults who do not eat at least one serving of fruit a day. Puerto Rico (51.3 percent), Arkansas (50.5 percent) and Oklahoma (50.4 percent) represent the highest rates with over half of older adults who are not eating at least one serving of fruit a day
  • Communities without fluoridated water create deficiencies in prevention. Eight states (16 percent) still have 50 percent or more residents living in communities unprotected by fluoridated water. Hawaii (89.2 percent) and New Jersey (85.4 percent) have the highest rates of residents living without fluoridated water
  • Inadequate surveillance of the oral health condition of older adults persists. Forty-five percent (23 states) have never completed a Basic Screening Survey (BSS) of older adults and have no plan to do so. An older adult Basic Screening
  • Survey is a surveillance of the oral health conditions of seniors in community and long-term-care settings. The BSS is, recognizes the need for community level oral health status and dental care access data
  • Persistent shortage of oral health coverage. Forty percent of states (20 states) provide either no dental benefit or emergency coverage only through adult Medicaid dental benefits. Eighteen states provide limited coverage and twelve include comprehensive coverage
  • Critical lack of strategic planning to address the oral health of older adults. Seventy percent (35 states) lack a State Oral Health Plan that mentions older adults, with 13 states lacking any type of State Oral Health Plan.

“Access to oral healthcare for older Americans is a matter of social justice, with those living in poverty suffering the most from the lack of publicly funded benefits needed to improve their oral and overall health,” said Dr. Caswell Evans, Associate Dean of Prevention and Public Health Sciences at the University of Illinois at Chicago School of Dentistry.

OHA developed six key practical recommendations to promote healthy aging and independence for this rapidly growing cohort of America’s population.

  • Support the Reauthorization of the Older Americans’ Act, S.192, in the House of Representatives and the implementation of the oral health screenings provision
  • Support caregivers, often responsible for ensuring the oral health of their loved ones, through the passage of the RAISE Family Caregivers Act
  • Advocate for financially viable publicly-funded dental benefits
  • Sustain Community Water Fluoridation as an evidence-based public health practice that positively impacts oral health at the population level
  • Include specific language to ensure inclusion of provisions for older adults in every state’s Oral Health Plan
  • Establish continuous surveillance of older adults’ oral health by requiring states to conduct a Basic Screening Survey

A State of Decay 2015 is the third in a series of reports from OHA surveying the state of oral health for older Americans. It is one of five programmatic strategies of OHA’s Wisdom Tooth Project®, a program designed to meet the oral health challenges of a burgeoning population of older adults with special needs, chronic disease complications and a growing inability to access and pay for dental services.

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

For 60 years, Oral Health America has been the leading national non-profit dedicated to improving the oral health and well-being of Americans throughout the entire spectrum of life. Over the decades, the organization has evolved and adapted to the dynamic nature of our country’s demographics and specific health needs. The Wisdom Tooth Project was born in 2010 due to the current and future implications of an aging population and the need for oral health resources which mean that we must take meaningful action now.

OHA’s mission is to change lives by connecting communities with resources to drive access to care, increase health literacy and advocate for policies that improve overall health through better oral health for all Americans, especially those most vulnerable. Through Smiles Across America®, which serves 460,000 children annually, the Wisdom Tooth Project®, which reaches tens of thousands of older adults, and the Campaigns for Oral Health Equity, which prioritize oral health alongside other chronic diseases, OHA helps Americans of all ages to have a healthy mouth and to understand the importance of oral health for overall health. For more information about Oral Health America, please visit

® Smiles Across America and Wisdom Tooth Project are both registered trademarks of Oral Health America


CONTACT: Jerica Pitts | (312) 233-1393 | or Brittany Wright | (312) 836-9900 |