NCHS Data Brief ■ No. 191 ■ March 2015

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Dental Caries and Sealant Prevalence in Children and 

Adolescents in the United States, 2011–2012

Bruce A. Dye, D.D.S., M.P.H.; Gina Thornton-Evans, D.D.S, M.P.H.;

Xianfen Li, M.S.; and Timothy J. Iafolla, D.M.D., M.P.H.

Key findings

Data from the National 

Health and Nutrition 

Examination Survey, 

2011–2012

● Approximately 23% of 

children aged 2–5 years had 

dental caries in primary teeth.

● Untreated tooth decay in 

primary teeth among children 

aged 2–8 was twice as high 

for Hispanic and non-Hispanic 

black children compared with 

non-Hispanic white children.

● Among those aged 6–11, 

27% of Hispanic children had 

any dental caries in permanent 

teeth compared with nearly 

18% of non-Hispanic white and 

Asian children.

● About three in five 

adolescents aged 12–19 had 

experienced dental caries in 

permanent teeth, and 15% had 

untreated tooth decay.

● Dental sealants were more 

prevalent for non-Hispanic 

white children (44%) compared 

with non-Hispanic black and 

Asian children (31% each) aged 

6–11.

Although dental caries has been declining in permanent teeth for many 

children since the 1960s, previous findings showed caries in primary teeth 

for preschool children increasing from 24% to 28% between 1988 and 2004. 

Disparities in caries continue to persist for some race and ethnic groups in the 

United States. Prevalence of dental sealants—applied to the tooth chewing 

surfaces to help prevent caries—has also varied among sociodemographic 

groups (1–4). This report describes U.S. youth dental caries and sealant 

prevalence by race and Hispanic origin for 2011–2012.

Keywords: tooth decay • cavities • disparities • National Health and Nutrition 

Examination Survey

How prevalent was any caries in children’s primary teeth?

Approximately 37% of children aged 2–8 years had experienced dental caries 

in primary teeth in 2011–2012 (Figure 1). Dental caries among children aged 

 

Figure 1. Prevalence of dental caries in primary teeth, by age and race and Hispanic origin

among children aged 2–8 years: United States, 2011–2012

 

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NCHS Data Brief ■ No. 191 ■ March 2015

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2–5 was nearly 23% compared with 56% among those aged 6–8. Caries prevalence was higher 

for Hispanic (46%) and non-Hispanic black (44%) children compared with non-Hispanic white 

children (31%) aged 2–8. Non-Hispanic Asian children were less likely to have experienced 

dental caries (36%) compared with Hispanic children (46%) aged 2–8, but were not different 

from non-Hispanic white or non-Hispanic black children. 

In 2011–2012, 14% of children aged 2–8 had untreated tooth decay in primary teeth. Untreated 

caries in primary teeth was twice as high for children aged 6–8 (20%) compared with children 

aged 2–5 (10%). Tooth decay was significantly higher for both non-Hispanic black (21%) and 

Hispanic (19%) children compared with non-Hispanic white children aged 2–8 (10%). The 

prevalence of untreated dental caries in primary teeth in non-Hispanic Asian children did not 

significantly differ from that in any of the other race and Hispanic origin groups.

What percentage of children had any dental caries in permanent teeth?

In 2011–2012, 21% of children aged 6–11 had experienced dental caries in permanent teeth 

(Figure 2). Dental caries among children aged 6–8 was nearly 14% and was twice as high for 

children aged 9–11 (29%). Caries prevalence was higher among Hispanic children aged 6–11 

(27%) compared with non-Hispanic white children (19%) or non-Hispanic Asian children (18%).

 

Figure 2. Prevalence of dental caries in permanent teeth, by age and race and Hispanic origin among children aged

6–11 years: United States, 2011–2012

 

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NCHS Data Brief ■ No. 191 ■ March 2015

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Approximately 6% of children aged 6–11 had untreated tooth decay in permanent teeth. Untreated 

caries in permanent teeth was twice as high for children aged 9–11 (8%) compared with children 

aged 6–8 years (3%). Prevalence of untreated caries was higher for Hispanic children (9%) 

compared with non-Hispanic white children (4%) aged 6–11 years.

Among adolescents, how prevalent was dental caries in permanent teeth? 

Among adolescents aged 12–19, 58% had experienced dental caries in permanent teeth in 

2011–2012 (Figure 3). The prevalence of dental caries experience was higher among adolescents 

aged 16–19 (67%) compared with those aged 12–15 (50%). Overall, the percentage with caries 

experience did not significantly differ by race and Hispanic origin among adolescents.

Fifteen percent of adolescents aged 12–19 had untreated caries in permanent teeth in 2011–2012. 

Untreated tooth decay was higher among adolescents aged 16–19 (19%) compared with those 

aged 12–15 (12%). Untreated caries was higher for non-Hispanic black adolescents (21%) 

compared with non-Hispanic white (13%) or non-Hispanic Asian (12%) adolescents.

 

Figure 3. Prevalence of dental caries in permanent teeth, by age and race and Hispanic origin among adolescents aged

12–19 years: United States, 2011–2012

 

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NCHS Data Brief ■ No. 191 ■ March 2015

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How prevalent were dental sealants among children?

Nearly one-half of children aged 9–11 had at least one dental sealant on a permanent tooth, 

whereas 31% of children aged 6–8 had a dental sealant (Figure 4). Non-Hispanic black and nonHispanic Asian children aged 6–11 (31%) had lower dental sealant prevalence compared with 

non-Hispanic white children (44%). Hispanic children (40%) had higher dental sealant prevalence 

compared with non-Hispanic black children aged 6–11 (31%). 

Figure 4. Prevalence of dental sealants in permanent teeth, by age and race and Hispanic origin among children aged

6–11 years: United States, 2011–2012

 

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NCHS Data Brief ■ No. 191 ■ March 2015

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Among adolescents, how prevalent were dental sealants?

In 2011–2012, 43% of adolescents aged 12–19 had at least one permanent tooth with a dental 

sealant (Figure 5). Dental sealant prevalence was similar among both adolescent age groups 

(43%). Dental sealant prevalence was significantly lower for non-Hispanic black adolescents 

(30%) compared with non-Hispanic white (47%), Hispanic (40%), or non-Hispanic Asian (43%) 

adolescents aged 12–19. 

Figure 5. Prevalence of dental sealants in permanent teeth, by age and race and Hispanic origin among adolescents 

aged 12–19 years: United States, 2011–2012

 

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NCHS Data Brief ■ No. 191 ■ March 2015

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Summary

Overall, disparities persisted in the United States for dental caries and dental sealant prevalence 

in children and adolescents in 2011–2012. In children aged 2–8, Hispanic and non-Hispanic black 

children were more likely to experience any dental caries in primary teeth compared with 

non-Hispanic white children. Non-Hispanic Asian children were less likely to have experienced 

dental caries in primary teeth compared with Hispanic children aged 2–8. Untreated tooth decay 

was nearly twice as high in Hispanic and non-Hispanic black children aged 2–8 compared with 

non-Hispanic white children. Among all children aged 2–5, 23% had experienced dental caries.

In children aged 6–11, one in five children had experienced dental caries in their permanent teeth, 

and approximately 40% had at least one dental sealant present. The prevalence of dental caries 

was higher in Hispanic children compared with non-Hispanic white children or non-Hispanic 

Asian children. Among children aged 6–11, non-Hispanic black and non-Hispanic Asian children 

were less likely to have dental sealants compared with non-Hispanic white children. Hispanic 

children were more likely to have at least one dental sealant on a permanent tooth compared with 

non-Hispanic black children aged 6–11.

Among adolescents aged 12–19, nearly three in five adolescents had experienced dental caries in 

permanent teeth, 15% had untreated tooth decay, and 43% had at least one dental sealant present. 

Dental caries experience was not significantly different among Hispanic and non-Hispanic white, 

black, and Asian adolescents. Among adolescents, the prevalence of untreated tooth decay was 

significantly higher in non-Hispanic black adolescents compared with non-Hispanic white or 

non-Hispanic Asian adolescents. Dental sealant prevalence was significantly lower for 

non-Hispanic black adolescents compared with Hispanic, non-Hispanic white, and Asian 

adolescents. 

Definitions

Untreated dental caries: Dental cavities (tooth decay) that have not received appropriate 

treatment.

Dental caries: Having a tooth appropriately treated for tooth decay or having untreated decay 

present.

Dental sealants: Plastic-like coatings that are applied to the chewing surfaces of back teeth. The 

applied sealant resin bonds into the grooves of teeth to form a protective physical barrier.
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Data source and methods

The National Health and Nutrition Examination Survey (NHANES) is a cross-sectional 

survey designed to monitor the health and nutritional status of the civilian noninstitutionalized 

U.S. population. Survey participants are selected through a complex, multistage process, 

which includes oversampling to obtain reliable estimates of health and nutritional measures 

for population subgroups. In 2011–2012, oversampling included Hispanic, non-Hispanic 

black, and Asian persons. The survey consists of interviews conducted in participants’ homes 

and standardized physical examinations in mobile examination centers (MECs). Additional 

information on NHANES can be found at http://www.cdc.gov/nchs/nhanes.htm.

From 2011 through 2012, the NHANES oral health assessment was conducted in MECs by 

trained dentists. The assessment included a tooth count to identify the presence or absence of 

permanent or primary teeth, including retained dental root tips and dental implants. Each tooth 

was assessed for dental caries, restorations, and sealants. Dental exams were conducted using a 

dental light for illumination, a dental mirror, and an explorer. Overall, preliminary data reliability 

analyses conducted for 2011–2012 indicate that examiner performance was similar to prior survey 

periods using the same dental caries examination methods (1999–2004).

Population estimates and standard errors were calculated in SAS-callable SUDAAN software 

(release 11.0; RTI International, Research Triangle Park, N.C). To account for differing 

probabilities of selection, nonresponse, and noncoverage, exam sample weights were used for 

analysis. The standard errors of the percentages were estimated using Taylor series linearization, 

to take into account the complex sampling design. Differences between groups were evaluated 

using a t statistic at the p < 0.05 significance level. All results presented have a relative standard 

error less than 30% or are marked as ≤ 40% on the figures. All differences discussed are 

statistically significant unless otherwise indicated. Calculated estimates were not age-adjusted and 

no adjustments were made for multiple comparisons.

About the authors

Bruce A. Dye is with NIH’s National Institute of Dental and Craniofacial Research. Gina 

Thornton-Evans is with CDC’s National Center for Chronic Disease Prevention and Health 

Promotion, Division of Oral Health. Xianfen Li is with CDC’s National Center for Health 

Statistics, Office of Analysis and Epidemiology. Timothy J. Iafolla is with NIH’s National 

Institute of Dental and Craniofacial Research.
NCHS Data Brief ■ No. 191 ■ March 2015

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References

1. Dye BA, Arevalo O, Vargas CM. Trends in paediatric caries by poverty 

status in the United States, 1988–1994 and 1999–2004. Int J Paediatr Dent 

20(2):132–43. 2010.

2. Dye BA, Tan S, Smith V, et al. Trends in oral health status: United States, 

1988–1994 and 1999–2004. National Center for Health Statistics. Vital 

Health Stat 11(248). 2007. 

3. Dye BA, Li X, Beltrán-Aguilar ED. Selected oral health indicators in 

the United States, 2005–2008. NCHS data brief, no 96. Hyattsville, MD: 

National Center for Health Statistics. 2012.

4. Dye BA, Li X, Thornton-Evans G. Oral health disparities as determined 

by selected Healthy People 2020 oral health objectives for the United States, 

2009–2010. NCHS data brief, no 104. Hyattsville, MD: National Center for 

Health Statistics. 2012.

Suggested citation

Dye BA, Thornton-Evans G, Li X, Iafolla 

TJ. Dental caries and sealant prevalence in 

children and adolescents in the 

United States, 2011–2012. NCHS data brief, 

no 191. Hyattsville, MD: National Center 

for Health Statistics. 2015.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Nathaniel Schenker, Ph.D., Deputy Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health and Nutrition 

Examination Surveys

Kathryn S. Porter, M.D., M.S., Director