Section 4

TOOTH LOSS
Oral diseases such as dental caries and periodontal disease are the primary reasons for tooth
loss/extractions (Oliver & Brown, 1993; CDC, 1999). Tooth loss has psychological, social, and physical effects. A persons quality of life is diminished as a result of tooth loss due to a reduction in the
ability to chew and speak and to reduced social interactions (Hollister & Weintraub, 1993; Reisine &
Locker, 1995; Gift & Redford, 1992).
This section examines the following indicators related to tooth loss: loss of no permanent teeth to
disease, characterization of tooth loss (functional dentition), complete loss of all teeth (edentulism),
and denture ownership and use.
REFERENCES
Centers for Disease Control and Prevention. Total tooth loss among persons aged > or = 65 yearsselected states, 1995-1997. MMWR
Morb Mortal Wkly Rep 1999;48(10):206-10.
Gift HC, Redford M. Oral health and quality of life. Clin Geriatr Med 1992;8:673-83.
Hollister MC, Weintraub JA. The association of oral status with systemic health, quality of life, and economic productivity. J Dent Educ
1993;57(12):901-12.
Oliver RC, Brown LJ. Periodontal diseases and tooth loss. Periodontology 2000 1993;2:117-27.
Reisine S, Locker D. Social, psychological, and economic impacts of oral conditions and treatments. In: Cohen LK, Gift HC (eds.). Disease
Prevention and Oral Health Promotion: Socio-Dental Sciences in Action. Copenhagen: Munksgaard and la Federation Dentaire
Internationale, 1995, 33-71.

4. Tooth Loss

Oral Health U.S., 2002

27

4.1

Persons with full dentition

A full dentition in adults is defined as the presence of all natural teeth, not including third molars.
Approximately 30% of the U.S. population aged 18 and older were fully dentate in the Third
National Health and Nutrition Examination Survey (NHANES III) 1988-1994 (Marcus et al., 1996).
SOURCES OF DATA
Analyses reported here are based on the Third National Health and Nutrition Examination Survey (NHANES III) 1988-1994, National
Center for Health Statistics, Centers for Disease Control and Prevention and the 1999 Behavioral Risk Factor Surveillance System
(BRFSS), Centers for Disease Control and Prevention. NHANES III used clinical exams while BRFSS contains self-reported data.

! Demographic differences (Figure 4.1.1)

!

The proportion of persons with full

dentition was lower in the older age
groups.
A greater percentage of non-Hispanic
whites and Mexican Americans had
full dentitions compared to nonHispanic blacks.

! Differences by income (Figure 4.1.3)

!

The percentage of persons with a full

dentition was higher at each successive educational level.

The percentage of persons with full

dentitions was greater at each higher
income level.

Bullets reference data that can be found in Table

4.1.1.
REFERENCES

! Differences by federal poverty level

(Figure 4.1.2)
!

At both poverty levels, a greater percentage of non-Hispanic whites and

Mexican Americans compared to nonHispanic blacks had full dentitions.

Marcus SE, Drury TF, Brown LJ, Zion GR. Tooth retention and
tooth loss in the permanent dentition of adults: United
States, 1988-1991. J Dent Res 1996;75:684-95.

A greater percentage of persons living

at or above the federal poverty level
had full dentitions.

Figure 4.1.1. Percentage of adults aged 18 and older with full dentition by demographic variables*

70

4. Tooth Loss

65.2

60

Percent

50

45.3

40

37.7
32.7

30.1

30
20

19.2

16.8

26.8
20.3

9.7

10
0

30.7

5.9

18-24

25-34

35-44

45-54

55-64

65-74

2.2
75-84

0.3
85 and
Older

NonHispanic
White

NonMexican
Hispanic American
Black

Less Than
12th
Grade

12th
Grade

More Than
12th
Grade

*Age standardized to the year 2000 U.S. population except for age groups.
Data source: The Third National Health and Nutrition Examination Survey (NHANES III) 1988-1994, National Center for Health
Statistics, Centers for Disease Control and Prevention.

Oral Health U.S., 2002

29

Figure 4.1.2. Percentage of adults aged 18 and older with full dentition
by race/ethnicity and federal poverty level (FPL)*

40
33.6

35

Percent

30
25

32.6

27.7
22.1

21.0

20

15.1

15
10
5
0

Below FPL

At or Above FPL

Non-Hispanic White

Non-Hispanic Black

Mexican American

*Age standardized to the year 2000 U.S. population.

Data source: The Third National Health and Nutrition Examination Survey (NHANES III) 1988-1994, National Center for Health
Statistics, Centers for Disease Control and Prevention.

Figure 4.1.3. Percentage of adults aged 18 and older

with full dentition by annual family income*

70
60.3

60

4. Tooth Loss

Percent

50
40

46.1
37.0

51.2

39.5

30
20
10
0

Less Than
$15,000

$15,000-$24,999

$25,000-$34,999

$35,000-$49,999

$50,000
or More

*Age standardized to the year 2000 U.S. population.

Data source: 1999 Behavioral Risk Factor Surveillance System (BRFSS), Centers for Disease Control and Prevention.

30

Oral Health U.S., 2002

4.2

Adults with 21 or more teeth

The presence of 21 or more natural teeth has been used internationally as a marker for a functional dentition, or one which provides the ability to eat, speak, and socialize without active disease, discomfort, or embarrassment without the need for full or partial dentures (Adult Dental
Health Survey, 1998).
Although tooth retention has greatly improved over the past few decades, a significant percentage of older Americans do not have functional dentitions (Burt & Eklund, 1999). Since the
effects of tooth loss increase as more teeth are lost, this indicator gives a broader perspective
than indicators measuring the presence or absence of all teeth.
While the absolute number of teeth is very important, peoples satisfaction with their mouth and
their ability to function also depend on having anterior teeth and opposing (or occluding) pairs of
natural teeth that facilitate chewing, and on the absence of disease (Elias & Sheiham, 1999).
National data on occluding pairs of teeth will be collected starting in 2003.
SOURCES OF DATA
Analyses reported here are based on the Third National Health and Nutrition Examination Survey (NHANES III) 1988-1994, National
Center for Health Statistics, Centers for Disease Control and Prevention.

! Among the U.S. population aged 20 years

and older, 71.7% had 21 or more natural
teeth, compared to 42.4% of those aged 50
years and older.
! Differences by age and race/ethnicity
(Figure 4.2.1)
!

The percentage of people with 21 or

more teeth was progressively lower in
older age groups.

! Demographic differences among

those aged 50 and older
!

The percentage of people with 21 or

more teeth was greatest for those with
more than a 12th grade education, followed by high school graduates and
those with less than a 12th grade education (Figure 4.2.2).

Oral Health U.S., 2002

For both those living below and at or

above the federal poverty level a
higher percentage of Mexican
Americans had 21 or more teeth
(Figure 4.2.3).
A higher percentage of people at or
above the federal poverty level had 21
or more teeth than did people below
the federal poverty level (Figure
4.2.3).

Bullets reference data that can be found in Tables

4.2.1 and 4.2.2.

4. Tooth Loss

At all age groups between ages 30 and

79, a lower percentage of nonHispanic blacks had 21 or more teeth
than either non-Hispanic whites or
Mexican Americans.

REFERENCES
Adult Dental Health Survey: Oral Health in the United Kingdom.
Office for National Statistics. 1998
Burt BA, Eklund SA. Dentistry, dental practice, and the
community. Philadelphia: W.B. Saunders Co., 1999.
Elias AC, Sheiham A. The relationship between satisfaction with
mouth and number, and position of teeth. Journal of Oral
Rehabilitation 1998;25:649-61.

31

Figure 4.2.1. Percentage of adults aged 20 and older with 21 or

more teeth by age and race/ethnicity

100

99.2
96.9 97.9

96.0

91.7
81.5

80

85.2
76.8

Percent

67.8

60

57.5

54.2
46.3

44.1

40

35.0
23.3

20
0

32.2

31.5

32.2

18.4
11.3
2.1

20-29

30-39

40-49

Non-Hispanic White

50-59

60-69

Non-Hispanic Black

70-79

80 and
Older
Mexican American

Data source: The Third National Health and Nutrition Examination Survey (NHANES III) 1988-1994, National Center for Health
Statistics, Centers for Disease Control and Prevention.

Figure 4.2.2. Percentage of adults aged 50 and older with 21 or more teeth by education*

70

62.8

60

4. Tooth Loss

Percent

50

41.8

40
30

25.3

20
10
0

Less than
12th Grade

12th Grade

More than
12th Grade

*Age standardized to the year 2000 U.S. population.

Data source: The Third National Health and Nutrition Examination Survey (NHANES III) 1988-1994, National Center for Health
Statistics, Centers for Disease Control and Prevention.

32

Oral Health U.S., 2002

Figure 4.2.3. Percentage of adults aged 50 and older with 21 or more teeth
by race/ethnicity and federal poverty level (FPL)*

70
57.1

60
47.5

Percent

50

47.9

40
30

24.1

29.9
23.4

20
10
0

Below FPL
Non-Hispanic White

At/Above FPL
Non-Hispanic Black

Mexican American

*Age standardized to the year 2000 U.S. population.

Data source: The Third National Health and Nutrition Examination Survey (NHANES III) 1988-1994, National Center for Health
Statistics, Centers for Disease Control and Prevention.

4. Tooth Loss

Oral Health U.S., 2002

33

4.3

Edentulism

Edentulism, defined as total tooth loss, is more prevalent among persons with less than a high school
education, those without dental insurance, non-Hispanic blacks, and current everyday smokers
(CDC, 1999).
Between the 1950s and the early 1990s the prevalence of edentulism in the United States decreased
from 50% to 42% among people aged 65 and older, from 28% to 11% for 45- to 64-year-olds, and from
5% to 2% for persons 18 to 44 years old (Oliver & Brown, 1993).
Using data from the 1999 Behavioral Risk Factor Surveillance System (BRFSS), Centers for Disease
Control and Prevention, the percentage of the U.S. population who were edentulous varied by state.
Hawaii had the lowest percentage (16%) while Kentucky had the highest (44%).
SOURCES OF DATA
Analyses reported here are based on data from the 1998 National Health Interview Survey, National Center for Health Statistics, and the
1999 Behavioral Risk Factor Surveillance System, Centers for Disease Control and Prevention.

Demographic differences for:

! All age ranges (25 to 74 years)
!

The prevalence of edentulism was

lower among those with more education (Figure 4.3.1).
The prevalence of edentulism was
lower among those with higher
incomes or living at or above the federal poverty level (Figures 4.3.1 and
4.3.2).

! 25- to 44-year-olds
!

Twenty-five percent of this age group

was edentulous.
No significant differences in prevalence were found between racial/ethnic groups (Figure 4.3.1).

Bullets reference data that can be found in Tables

4.3.1, 4.3.2, and 4.3.3.
REFERENCES
Centers for Disease Control and Prevention. Total tooth loss
among persons aged > or = 65 yearsselected states,
1995-1997.
MMWR
Morb
Mortal
Wkly
Rep
1999;48(10):206-10.
Oliver RC, Brown LJ. Periodontal diseases and tooth loss.
Periodontology 2000 1993;2:117-27.

4. Tooth Loss

Two percent of this age group was

edentulous.

! 65- to 74-year-olds

A greater percentage of non-Hispanic

whites than Hispanics were edentulous (Figure 4.3.1).

! 45- to 64-year-olds
!

Ten percent of this age group was

edentulous.
Non-Hispanic whites had the highest
prevalence of edentulism (Figure
4.3.1).

Oral Health U.S., 2002

35

Figure 4.3.1. Prevalence of edentulism by selected demographic characteristics

45
40

39.1

37.3

35

Percent

30

27.7

25

24.9

24.5

20

5
0

25.1

18.7

15
10

25.0

23.2

22.9

20.8

10.3
8.1
2.3

2.0

8.8

6.2
2.1

1.4

NonNonHispanic Hispanic
White
Black

12.8

11.4

9.7

9.6

Hispanic

Male

4.1

2.3

Female

4.8
2.6

1.6

Less
12 years
Greater
than
of
than
12 years of Education 12 years of
Education
Education

25-44 Years

45-64 Years

3.4

2.0

Below
FPL

At/Above
FPL

65-74 Years

Data source: 1998 National Health Interview Survey, National Center for Health Statistics, Centers for Disease Control and
Prevention.

Figure 4.3.2. Prevalence of edentulism by annual family income and age

40

37.1

35

4. Tooth Loss

Percent

30

26.9

25
19.4

20

19.1
16.2

15
10
5
0

13.0

11.1

7.7

7.6
2.6

Less than $15,000

2.2

1.4

$15,000-$24,999

25-44 Years

$25,000-$34,999

45-64 Years

3.6
0.8

$35,000-$49,999

0.6

$50,000 or More

65-74 Years

Data source: 1999 Behavioral Risk Factor Surveillance System, Centers for Disease Control and Prevention.

36

Oral Health U.S., 2002

4.4

Edentulous people who have and use dentures

Despite a trend toward increased tooth retention, millions of Americans have lost some or all of their
teeth. Among totally edentulous people 89.6% wear complete dentures in both arches, 96.8% of persons edentulous in the upper arch only wear an upper denture, and 80.6% of persons edentulous in
the lower arch only wear a lower denture (Redford et al., 1996).
SOURCES OF DATA
Analyses reported here are based on the Third National Health and Nutrition Examination Survey (NHANES III) 1988-1994, National
Center for Health Statistics, Centers for Disease Control and Prevention.

! Differences by race/ethnicity (Figure

4.4.1)
!

! Differences by education (Figure

4.4.1)

Among edentulous persons aged 65

years and older a greater percentage of
non-Hispanic whites had and used
their dentures than either nonHispanic blacks or Mexican
Americans.

Bullets reference data that can be found in Table

4.4.1.

! Differences by federal poverty level

(Figure 4.4.1)
!

A greater percentage of persons with

more than a 12th grade education had
and used their dentures compared to
persons with less than a 12th grade
education.

REFERENCES

Among edentulous persons aged 65

years and older, a greater percentage
of persons living at or above the federal poverty level had and used their
dentures.

Redford M, Drury TF, Kingman A, Brown LJ. Denture use and the
technical quality of dental prostheses among persons 18-74
years of age: United States, 1988-1991. J Dent Res
1996;75(Spec Iss):714-25.

Figure 4.4.1. Prevalence of denture use among edentulous adults by race/ethnicity,

federal poverty level (FPL), and education
98.7
93.9

90.9

90.0
79.8

84.1

83.0

79.8
73.1

Percent

64.7

Non-Hispanic
White

Non-Hispanic
Black

4. Tooth Loss

100
90
80
70
60
50
40
30
20
10
0

88.5

83.6
75.4

78.4

67.8
59.4

Mexican
American

Below
FPL

65-74 Years

At/above
FPL

Less than
12th Grade

12th Grade

More than
12th Grade

75 and Older

Data source: The Third National Health and Nutrition Examination Survey (NHANES III) 1988-1994, National Center for Health
Statistics, Centers for Disease Control and Prevention.

Oral Health U.S., 2002

37