NCHS Data Brief ■ No. 336 ■ May 2019

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Regional Variation in Private Dental Coverage

and Care Among Dentate Adults Aged 18–64 in the

United States, 2014–2017

Debra L. Blackwell, Ph.D., Maria A. Villarroel, Ph.D., and Tina Norris, Ph.D.

Key findings

Data from the National 

Health Interview Survey

● Nationally, 50.2% of dentate

adults aged 18–64 with private

health insurance had dental care

coverage throughout the past

12 months.

● Regional percentages of

dental coverage ranged from

45.6% in the East South Central

and South Atlantic regions to

57.1% in New England.

● Nationally, 22.1% of

dentate adults with dental

coverage did not see a dentist

in the past 12 months, with

regional percentages ranging

from 29.4% in the West South

Central region to 14.3% in

New England.

● Unmet dental care needs

due to cost among dentate 

adults with dental coverage 

were lowest in the West 

North Central (2.8%) region 

and highest in the Mountain 

region (7.0%).

Routine dental care can promote oral health (1,2), and those with private 

dental insurance are more likely to visit a dentist than those with other 

types of dental coverage or no coverage (3,4). Geographical variation in 

dental coverage and care among adults under age 65 exists (5,6), as does the 

availability of dental health professionals (7). This report examines regional 

variation in dental coverage among dentate adults (i.e., adults who have not 

lost all permanent teeth) aged 18–64 who had private health insurance in the 

past year, their utilization of dental care, and unmet dental needs due to cost in 

the past year.

Dental coverage was highest in the North Central, Middle 

Atlantic, and New England regions.

NCHS reports can be downloaded from: https://www.cdc.gov/nchs/products/index.htm.

Figure 1. Percentage of dentate adults aged 18–64 who had dental care coverage, by region: 

United States, 2014–2017

NOTES: Significance evaluated at the 0.05 level. Dental coverage includes adults with private health insurance plus dental 

coverage that was part of their health insurance or added as a separate plan. Adults with public insurance are not shown. See 

definitions in this report. Access data table for Figure 1 at: https://www.cdc.gov/nchs/data/databriefs/db336_tables-508.pdf#1. 

SOURCE: NCHS, National Health Interview Survey, 2014–2017.

MS AL

TN

KY

TX LA

AR OK

AK

HI

OR

CA

WA

AZ NM

NV

UT CO

ID

MT

WY

ME NH

MA

CT

RI

VT

OH

WI MI

IL IN

MO

NE

KS

ND

SD

MN

IA NJ

DE

NY

PA

MD

DC

FL

WV VA

NC

SC

GA

East North 

Central 

53.5%

Middle 

Atlantic

55.8% 

New 

England

57.1%

East South 

Central 

45.6%

South

Atlantic

45.6% 

West North 

Central 55.0%

Mountain

48.6%

Pacific 

48.0%

West South 

Central 45.9%

Significantly lower than U.S. average 

Not significantly different from U.S. average

Significantly higher than U.S. average

National average is 50.2% 
NCHS Data Brief ■ No. 336 ■ May 2019

■  2  ■

● Dental coverage among dentate adults was significantly higher than the national average 

(50.2%) in the New England (57.1%), Middle Atlantic (55.8%), West North Central 

(55.0%), and East North Central (53.5%) regions (Figure 1).

● Dental coverage was significantly lower than the national average in the South Atlantic 

(45.6%), East South Central (45.6%), West South Central (45.9%), and Pacific (48.0%) 

regions.

● Dental coverage in the Mountain region (48.6%) was comparable with the national average.

Adults in the East and West South Central regions were most likely to not 

see a dentist in the past 12 months.

● Compared with the national average (22.1%), dentate adults aged 18–64 with dental 

coverage were significantly more likely to go without seeing a dentist in the past 12 months 

in the East South Central (26.9%) and West South Central (29.4%) regions (Figure 2).

● Among dentate adults aged 18–64 with dental coverage, the percentages who did not see a 

dentist in the past 12 months were significantly lower than the national average in the New 

England (14.3%), Middle Atlantic (20.0%), and East North Central (20.6%) regions.

Figure 2. Percentage of dentate adults aged 18–64 with dental care coverage who did not see a dentist in the past 12 

months, by region: United States, 2014–2017

NOTES: Significance evaluated at the 0.05 level. Dental coverage includes adults with private health insurance plus dental coverage that was part of their health 

insurance or added as a separate plan. Adults with public insurance are not shown. See definitions in this report. Access data table for Figure 2 at: 

https://www.cdc.gov/nchs/data/databriefs/db336_tables-508.pdf#2. 

SOURCE: NCHS, National Health Interview Survey, 2014–2017.

East North 

Central 

20.6%

Middle 

Atlantic

20.0%

New England

14.3%

East South 

Central 

 26.9%

South

Atlantic

22.7% 

West North 

Central 22.5%

Mountain

 22.5%

Pacific 

21.1%

West South 

Central 29.4%

Significantly lower than U.S. average 

Not significantly different from U.S. average

Significantly higher than U.S. average

National average is 22.1%

MS AL

TN

KY

TX LA

AR OK

AK

HI

OR

CA

WA

AZ NM

NV

UT

CO

ID

MT

WY

ME

NH MA

CT RI

VT

OH

WI

MI

IL IN

MO

NE

KS

ND

SD

MN

IA NJ

DE

NY

PA

MD

DC

FL

WV VA

NC

SC

GA
NCHS Data Brief ■ No. 336 ■ May 2019

■ 3  ■

● Dentate adults aged 18–64 with dental coverage in the Pacific (21.1%), Mountain (22.5%),

West North Central (22.5%), and South Atlantic (22.7%) regions were as likely as the nation

as a whole to have not seen a dentist in the past 12 months.

Unmet dental care needs due to cost were highest in the Mountain and 

West South Central regions. 

● Among dentate adults aged 18–64 with dental coverage, the Mountain (7.0%) and West

South Central (5.4%) regions had significantly higher percentages of unmet needs due to

cost in the past 12 months compared with the national average (4.4%) (Figure 3).

● Dentate adults with dental coverage in the West North Central (2.8%) and Middle Atlantic

(3.7%) regions had significantly lower percentages of unmet dental care needs due to cost in

the past 12 months compared with the national average.

● Unmet dental care needs among dentate adults with dental care coverage were not

significantly different from the national average in the New England (3.5%), East South

Central (4.1%), East North Central (4.4%), Pacific (4.5%), and South Atlantic (4.7%)

regions.

Figure 3. Percentage of dentate adults aged 18–64 with dental coverage who needed dental care but couldn't afford it in 

the past 12 months, by region: United States, 2014–2017

NOTES: Significance evaluated at the 0.05 level. Dental coverage includes adults with private health insurance plus dental coverage that was part of their health 

insurance or added as a separate plan. Adults with public insurance are not shown. See definitions in this report. Access data table for Figure 3 at: 

https://www.cdc.gov/nchs/data/databriefs/db336_tables-508.pdf#3. 

SOURCE: NCHS, National Health Interview Survey, 2014–2017.

East North 

Central 

4.4%

Middle 

Atlantic

3.7%

New England

3.5%

East South 

Central 

 4.1%

South

Atlantic

4.7% 

West North 

Central 2.8%

Mountain

7.0%

Pacific 

4.5%

West South 

Central 5.4%

Significantly lower than U.S. average 

Not significantly different from U.S. average

Significantly higher than U.S. average

National average is 4.4%

MS AL

TN

KY

TX LA

AR OK

AK

HI

OR

CA

WA

AZ NM

NV

UT

CO

ID

MT

WY

ME

NH MA

CT RI

VT

OH

WI

MI

IL IN

MO

NE

KS

ND

SD

MN

IA NJ

DE

NY

PA

MD

DC

FL

WV VA

NC

SC

GA
NCHS Data Brief ■ No. 336 ■ May 2019

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Summary

About one-half (50.2%) of dentate adults aged 18–64 in the United States had private health 

coverage with dental coverage during 2014–2017. Among those with private health insurance 

and dental coverage, less than one-fourth (22.1%) did not see a dentist in the past 12 months, and 

4.4% had unmet dental needs due to cost in the past 12 months. 

Compared with national averages, dentate adults in the U.S. Middle Atlantic region were more 

likely to have private dental coverage in the past year, less likely to go without seeing a dentist 

in the past year, and less likely to have unmet dental needs due to cost. Similarly, dentate 

adults in the New England, West North Central, and East North Central regions also had higher 

percentages of dental coverage than the national average, lower percentages than the national 

average of dentate adults who did not see a dentist in the past 12 months (New England and East 

North Central regions), and a lower percentage than the national average of having unmet dental 

needs due to cost (West North Central region only). 

In contrast, dentate adults in the West South Central and East South Central regions had lower 

percentages of dental coverage, higher percentages of dentate adults who did not see a dentist 

in the past 12 months, and a higher percentage of unmet dental needs due to cost (West South 

Central region only) compared with national averages. 

Dentate adults in the Pacific and South Atlantic regions had lower percentages of private dental 

coverage than the national average, but among those with coverage, the percentages who did not 

see a dentist or had unmet dental needs due to cost were comparable with the national average. 

Unmet dental care needs due to cost were higher than the national average in the Mountain region 

even though dentate adults in this region were comparable with the United States with respect to 

both percentages of dental coverage and not having seen a dentist in the past 12 months.
NCHS Data Brief ■ No. 336 ■ May 2019

■  5  ■

Definitions

Dental coverage status: Refers to adults aged 18–64 who had any private health insurance 

plan for the 12 months prior to their National Health Interview Survey (NHIS) interview plus 

dental coverage that was either part of that plan or added separately via the purchase of a 

single-service dental plan. A single-service dental plan refers to a private health insurance plan, 

usually purchased separately, that only pays for dental care. Respondents with such plans were 

identified based on a positive response to the following question, “You mentioned that {you have/

person has} a single-service plan—that is, an insurance plan that provides one specific type of 

coverage. What type of service or care does {your/person’s} single service plan or plans pay for? 

... Dental care.” 

Dental care coverage reflects coverage at the time of interview. Also, “adults with private dental 

coverage” does not include publicly insured adults who purchased a single-service dental plan, or 

privately insured adults with dental coverage who had a lapse in private health insurance during 

the past year. 

Dental visit in the past 12 months: Based on the following question, “About how long has it been 

since you last saw a dentist? Include all types of dentists, such as orthodontists, oral surgeons, and 

all other dental specialists, as well as dental hygienists.” Sample adults who responded with “6 

months or less” or “More than 6 months, but not more than 1 year ago” were considered to have 

seen a dentist in the past 12 months. 

Dentate adults: Refers to persons who have not lost all of their permanent or natural teeth (both 

upper and lower), as identified by “no” responses to the question, “Have you lost all of your 

upper and lower natural (permanent) teeth?” During 2014–2017, 96.4% of U.S. adults aged 18–64 

had some or all of their natural teeth.

Regions: Categories were slightly modified from the nine U.S. Census Bureau-designated 

divisions by moving Delaware, the District of Columbia, and Maryland into the Middle Atlantic 

region (8). Divisions include: New England—Connecticut, Maine, Massachusetts, New 

Hampshire, Rhode Island, Vermont; Middle Atlantic—Delaware, District of Columbia, Maryland, 

New Jersey, New York, Pennsylvania; East North Central—Illinois, Indiana, Michigan, Ohio, 

Wisconsin; West North Central—Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, 

South Dakota; South Atlantic—Florida, Georgia, North Carolina, South Carolina, Virginia, West 

Virginia; East South Central—Alabama, Kentucky, Mississippi, Tennessee; West South Central—

Arkansas, Louisiana, Oklahoma, Texas; Mountain—Arizona, Colorado, Idaho, Montana, New 

Mexico, Nevada, Utah, Wyoming; and Pacific—Alaska, California, Hawaii, Oregon, Washington. 

Unmet dental needs due to cost: Based on a positive response to the question, “During the past 12 

months, was there any time when you needed any of the following but didn’t get it because you 

couldn’t afford it? ... Dental care (including check-ups)?” 
NCHS Data Brief ■ No. 336 ■ May 2019

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Data source and methods

Data from the 2014–2017 NHIS were used for this analysis. NHIS data are collected continuously 

throughout the year and include information about the health and health care of the civilian 

noninstitutionalized U.S. population. Interviews are conducted in respondents’ homes, but 

follow-ups to complete interviews may be conducted over the telephone.

Information from the Sample Adult component of the 2014–2017 NHIS was used to determine 

dental visits and unmet dental needs due to cost in the past 12 months for 91,946 adult 

respondents aged 18–64 who had not lost all of their upper and lower teeth. Information on 

private health insurance and dental care coverage was obtained from the 2014–2017 Person files. 

All analyses excluded adults with unknown private insurance status as well as those with private 

insurance and unknown dental coverage; adults with unknown information about dental visits 

in the past 12 months and unmet dental care needs due to cost in the past 12 months were also 

excluded from the analyses shown in Figures 2 and 3, respectively. For more information about 

NHIS, including the questionnaire, visit the NHIS website: https://www.cdc.gov/nchs/nhis.htm.

Sampling weights were used to produce national and regional estimates that were representative 

of the civilian noninstitutionalized U.S. population aged 18–64. Data weighting procedures are 

described in more detail elsewhere (9,10). Point estimates and estimates of their variances were 

calculated using SUDAAN software to account for the complex sampling design of NHIS (11). 

The Taylor series linearization method was chosen for estimation of standard errors. Differences 

between percentages were evaluated using two-sided significance tests at the 0.05 level. The 

estimated standard error of the difference between regional and national estimates accounted for 

nonindependence of regional and national estimates by incorporating their covariance.

About the authors

Debra L. Blackwell, Maria A. Villarroel, and Tina Norris are with the National Center for Health 

Statistics, Division of Health Interview Statistics.
NCHS Data Brief ■ No. 336 ■ May 2019

■  7  ■

References

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communities. A statement from the American Dental Association. 2013. Available from: 

https://www.ada.org/~/media/ADA/Public%20Programs/Files/bringing-disease-prevention-tocommunities_adh.ashx.

2. U.S. Department of Health and Human Services. Oral health. Available from: 

https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Oral-Health.

3. Bloom B, Simile CM, Adams PF, Cohen RA. Oral health status and access to oral health care 

for U.S. adults aged 18–64: National Health Interview Survey, 2008. National Center for Health 

Statistics. Vital Health Stat 10(253). 2012.

4. Hinton E, Paradise J. Access to dental care in Medicaid: Spotlight on nonelderly adults. 

The Kaiser Commission on Medicaid and the Uninsured. Issue Brief. March 2016. Available 

from: http://files.kff.org/attachment/issue-brief-access-to-dental-care-in-medicaid-spotlight-onnonelderly-adults.

5. Cohen RA, Martinez ME, Zammitti EP. Health insurance coverage: Early release of estimates 

from the National Health Interview Survey, 2015. National Center for Health Statistics. May 

2016. Available from: https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201605.pdf.

6. Khan A, Thapa JR, Zhang, D. Preventive dental checkups and their association with access to 

usual source of care among rural and urban adult residents. J Rural Health 33(4):419–26. 2017. 

7. National Center for Health Statistics. Table 86. Active dentists, by state: United States, 

selected years 2001–2016. Health, United States, 2017: With special feature on mortality. 

Hyattsville, MD: National Center for Health Statistics. 2018.

8. Holahan J, Buettgens M, Carroll C, Dorn S. The cost and coverage implications of the ACA 

Medicaid expansion: National and state-by-state analysis. Kaiser Commission on Medicaid and 

the Uninsured. 2012.

9. Parsons VL, Moriarity C, Jonas K, Moore TF, Davis KE, Tompkins L. Design and estimation 

for the National Health Interview Survey, 2006–2015. National Center for Health Statistics. Vital 

Health Stat 2(165). 2014.

10. National Center for Health Statistics. 2017 National Health Interview Survey (NHIS) 

public use data release. Survey description. 2018. Available from: ftp://ftp.cdc.gov/pub/Health_

Statistics/NCHS/Dataset_Documentation/NHIS/2017/srvydesc.pdf. 

11. RTI International. SUDAAN (Release 11.0.0) [computer software]. 2012.
NCHS Data Brief ■ No. 336 ■ May 2019

Keywords: dental visits • unmet dental need • dental care coverage • 

National Health Interview Survey.

Suggested citation

Blackwell DL, Villarroel MA, Norris T. 

Regional variation in private dental coverage 

and care among dentate adults aged 18–64 in 

the United States, 2014–2017. NCHS Data 

Brief, no 336. Hyattsville, MD: National 

Center for Health Statistics. 2019.

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

Jennifer H. Madans, Ph.D., Acting Director

Amy M. Branum, Ph.D., Acting Associate 

Director for Science

Division of Health Interview Statistics

Stephen J. Blumberg, Ph.D., Director

Anjel Vahratian, Ph.D., M.P.H., Associate 

Director for Science

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