© 2025 American Dental Association l 23
Fluoridation Facts
10. Is tooth decay still a serious problem in the United States?
Answer
Yes. Tooth decay, or a cavity in the tooth, is a disease that continues to be a significant oral health
problem for children and adults, with 46% of children ages 2–19 having one or more untreated or
restored cavities. Among adults aged 20 and older, nearly 90% have had at least one cavity.122
Fact
Good oral health is often taken for granted by many people in the United States. However, while
largely preventable, tooth decay, cavities, or dental caries (a term used by health professionals)
remain a common, debilitating, chronic condition for many children and adults.
Tooth decay begins with a weakening and/or breakdown (loss of minerals) of the enamel (the hard
outer layer of teeth) caused by acids produced by bacteria that live in plaque. Dental plaque is a soft,
sticky film that is constantly forming on teeth. Eating foods or drinking beverages that contain sugars
or other refined carbohydrates allows the bacteria in the plaque to produce acids that attack the
enamel. The plaque helps to keep these acids in contact with the tooth surface and demineralization
(loss of mineral) occurs. After repeated acid attacks, the enamel can break down, creating a cavity.
Left unchecked, bacteria and acid can penetrate the dentin (the next, inner layer of teeth) and then
finally the pulp, which contains nerves and blood vessels. Once the bacteria enter the pulp, the tooth
becomes infected (abscessed) and, without treatment, the infection can progress and travel into the
surrounding tissues. The infection can enter the bloodstream and potentially spread the infection to
other parts of the body which, in rare cases, becomes life-threatening.
Additional information on this topic can be found in this Section, Question 2.
Tooth decay can negatively affect an individual’s quality of life and ability to succeed. Tooth decay
can cause pain that can affect how we eat, speak, smile, learn at school, or succeed at work. Children
with cavities often miss more school and receive lower grades than children who are cavity-free.123
More than $6 billion of productivity is lost each year in the United States because people miss
work to get dental care.124
While cavities are often thought of as a problem for children, adults in the United States are keeping
their teeth longer (partly due to exposure to fluoridation), and this increased retention of teeth means
more adults are at risk for cavities—as people age, the gumline recedes and leaves exposed root
surfaces.125,126 Tooth root surfaces are covered with cementum (a softer surface than the enamel) and
so are susceptible to decay. As the baby boomer generation ages, root decay experience is expected
to increase in future years, possibly to the point where older adults experience similar or higher levels
of new cavities than do school children.125
Additional information on this topic can be found in this Section, Question 11
Preventing cavities and remineralizing teeth at the earliest stages of decay are very important,
not only in saving tooth structure but also in reducing the cost for dental care. Community water
fluoridation is an effective public health measure that is a cost-saving and cost-effective approach
to preventing tooth decay.
Additional information on this topic can be found in the Cost Section, Question 68.
Fluoridation Facts
10. Is tooth decay still a serious problem in the United States?
Answer
Yes. Tooth decay, or a cavity in the tooth, is a disease that continues to be a significant oral health
problem for children and adults, with 46% of children ages 2–19 having one or more untreated or
restored cavities. Among adults aged 20 and older, nearly 90% have had at least one cavity.122
Fact
Good oral health is often taken for granted by many people in the United States. However, while
largely preventable, tooth decay, cavities, or dental caries (a term used by health professionals)
remain a common, debilitating, chronic condition for many children and adults.
Tooth decay begins with a weakening and/or breakdown (loss of minerals) of the enamel (the hard
outer layer of teeth) caused by acids produced by bacteria that live in plaque. Dental plaque is a soft,
sticky film that is constantly forming on teeth. Eating foods or drinking beverages that contain sugars
or other refined carbohydrates allows the bacteria in the plaque to produce acids that attack the
enamel. The plaque helps to keep these acids in contact with the tooth surface and demineralization
(loss of mineral) occurs. After repeated acid attacks, the enamel can break down, creating a cavity.
Left unchecked, bacteria and acid can penetrate the dentin (the next, inner layer of teeth) and then
finally the pulp, which contains nerves and blood vessels. Once the bacteria enter the pulp, the tooth
becomes infected (abscessed) and, without treatment, the infection can progress and travel into the
surrounding tissues. The infection can enter the bloodstream and potentially spread the infection to
other parts of the body which, in rare cases, becomes life-threatening.
Additional information on this topic can be found in this Section, Question 2.
Tooth decay can negatively affect an individual’s quality of life and ability to succeed. Tooth decay
can cause pain that can affect how we eat, speak, smile, learn at school, or succeed at work. Children
with cavities often miss more school and receive lower grades than children who are cavity-free.123
More than $6 billion of productivity is lost each year in the United States because people miss
work to get dental care.124
While cavities are often thought of as a problem for children, adults in the United States are keeping
their teeth longer (partly due to exposure to fluoridation), and this increased retention of teeth means
more adults are at risk for cavities—as people age, the gumline recedes and leaves exposed root
surfaces.125,126 Tooth root surfaces are covered with cementum (a softer surface than the enamel) and
so are susceptible to decay. As the baby boomer generation ages, root decay experience is expected
to increase in future years, possibly to the point where older adults experience similar or higher levels
of new cavities than do school children.125
Additional information on this topic can be found in this Section, Question 11
Preventing cavities and remineralizing teeth at the earliest stages of decay are very important,
not only in saving tooth structure but also in reducing the cost for dental care. Community water
fluoridation is an effective public health measure that is a cost-saving and cost-effective approach
to preventing tooth decay.
Additional information on this topic can be found in the Cost Section, Question 68.
