2020’s States with the Best & Worst Dental Health

• Main Findings
• Ask the Experts
• Methodology
• Dental Habits & Care – Total Points: 50
• Oral Health – Total Points: 50

Adam McCann, Financial Writer
Feb 6, 2020

Many people dislike visiting their dentist, especially if they haven’t kept up with their brushing and flossing. Some even have dental anxiety and phobia. But there are other people who wish they could go yet can’t afford it. According to the CDC, 36% of adults have gone over a year without seeing a dentist. The costs of frequent dental checks are worth it, though. A checkup costs $90-$137 on average while a filling can go for $230-$313 and a crown typically sets you back over $1,200. Prevention is cheaper than treatment.

But brushing, flossing and getting an annual checkup aren’t the only things that impact dental health. Where you live can have an effect, too. For example, certain areas of the U.S. have a higher density of dental professionals. And one of the biggest locational factors is the presence of fluoridated water, which can help prevent tooth decay. It’s so important, in fact, that the CDC projects that in 2020 nearly 80% of public water will have this benefit.

In order to determine which places have the healthiest teeth and gums in the U.S., WalletHub compared the 50 states and the District of Columbia across 26 key indicators of dental wellness. Our data set ranges from share of adolescents who visited a dentist in the past year to dental treatment costs to share of adults with low life satisfaction due to oral condition. Read on for our findings, additional insight from dental experts and a full description of our methodology.

Main Findings

States with the Best & Worst Dental Health

Ask the Experts

To help you brush up on the importance and benefits of good dental care, we asked a panel of experts in health and family studies to weigh in. Click on the panelists’ profiles below to read their bios and thoughts on the following key questions:

1. What tips do you have for a person who wants to maintain dental health without breaking the bank?
2. Beyond brushing and flossing, what are the most important habits and behaviors to teach children to ensure they have good dental hygiene?
3. Should cities add fluoride to drinking water to improve dental health? What are the pros and cons?
4. Should school sealant programs be expanded more aggressively, especially in low-income areas, in order to better prevent tooth decay in the school-aged population?
5. How can dental health care become more affordable?
6. Should dental coverage be included with standard health insurance or covered by Medicaid?

Methodology

In order to determine the places with the best dental health in the U.S., WalletHub compared the 50 states and the District of Columbia across two key dimensions, Dental Habits & Health and Oral Health.

We examined those dimensions using 26 relevant metrics, which are listed below with their corresponding weights. Each metric was graded on a 100-point scale, with a score of 100 representing the most favorable conditions for dental health.

We then determined each state and the District’s weighted average across all metrics to calculate its overall score and used the resulting scores to rank-order our sample.

Dental Habits & Care – Total Points: 50

• Share of Adolescents Who Visited a Dentist in the Past Year: Full Weight (~2.63 Points)
• Share of Adults Who Visited a Dentist in the Past Year: Full Weight (~2.63 Points)
• Dental Treatment Costs: Double Weight (~5.26 Points)
  Note: “Dental Treatment” includes cleaning, crowns, root canals and tooth extraction.
• Reduced Dentist Visits Due to Costs: Full Weight (~2.63 Points)
  Note: This metric measures the share of the population who didn’t visit the dentist more frequently due to costs (among those without a visit in the past 12 months).
• Dentists per Capita: Full Weight (~2.63 Points)
• Dental Professionals per Capita: Full Weight (~2.63 Points)
  Note: This metric measures the number of dental hygienists, laboratory technicians and assistants per capita.
• Free or Low-Cost Dental Clinics per Capita: Full Weight (~2.63 Points)
• Share of Population Living in Dental HPSAs (Health Professional Shortage Areas): Full Weight (~2.63 Points)
• Dentists Supply-Demand Ratio by 2025: Full Weight (~2.63 Points)
• Sugar-Sweetened Beverage Consumption Among Adolescents: Full Weight (~2.63 Points)
• Share of Adult Smokers: Full Weight (~2.63 Points)
• Share of People Who Receive Fluoridated Water Through PWSs (Public Water Systems): Full Weight (~2.63 Points)
• Presence of State Oral Health Plan: Full Weight (~2.63 Points)
  Note: This is a binary metric that considers the presence or absence of state oral health plans. According to the Centers for Disease Control and Prevention, “A state oral health plan is a roadmap for accomplishing the goals and objectives that have been developed in collaboration with partners and stakeholders, including the state oral health coalition, and members from the public health, dental and medical communities. A comprehensive state oral health plan should be used to direct skilled personnel and funding decisions to reduce the prevalence of oral disease.”
• Presence of School-Based Dental Sealant Programs: Full Weight (~2.63 Points)
  Note: This is a binary metric that considers the presence or absence of school-based dental sealant programs. According to the Centers for Disease Control and Prevention, “School-based sealant programs provide pit and fissure sealants to children in a school setting. These programs generally target vulnerable populations that may be at greater risk for developing decay and less likely to receive preventive care.”
• Medicaid Dental Benefits for Nonelderly Adults: Full Weight (~2.63 Points)
  Note: This metric measures the number of benefits, if any, provided to adults in the state through Medicaid. According to the Centers for Medicare & Medicaid Services, “States have flexibility to determine what dental benefits are provided to adult Medicaid enrollees. While most states provide at least emergency dental services for adults, less than half of the states currently provide comprehensive dental care. There are no minimum requirements for adult dental coverage.”
• Presence of State Dental Periodicity Schedule: Full Weight (~2.63 Points)
  Note: This is a binary metric that considers the presence or absence of state dental periodicity schedules. According to the Centers for Medicare & Medicaid Services, “Early and periodic screening, diagnostic and treatment (EPSDT) services are required services under the Medicaid program for most individuals under age 21. EPSDT … includes periodic screening, vision, dental, and hearing services and other necessary health services. Schedules specifying the content and periodicity of these services are to be established by each state after consultation with recognized medical organizations involved in child health care (in the case of screening, vision and hearing services) and dental organizations (in the case of dental services).”
• Status of Older Adult Basic Screening Survey: Full Weight (~2.63 Points)
  Note: This metric measures the status of a state’s Older Adult Basic Screening Survey (BSS) administration — more specifically, whether the state has completed (and how long ago) or is planning an Older Adult BSS. According to Oral Health America, a BSS “a surveillance of the oral health conditions of seniors in community and long-term-care settings of older adults.”
• Oral Health Knowledge Index: Full Weight (~2.63 Points)

Oral Health – Total Points: 50

• Poor or Fair Oral Condition: Double Weight (~10.00 Points)
  Note: This metric measures the share of adults whose mouths and teeth are in poor or fair condition.
• Share of Elderly Population with No Natural Teeth: Full Weight (~5.00 Points)
  Note: “Elderly Population” includes the population aged 65 years and older.
• Pain Due to Oral Condition: Double Weight (~10.00 Points)
  Note: This metric measures the share of adults who have experienced very often pain in the past year due to the condition of their mouths and teeth.
• Dry Mouth Due to Oral Condition: Full Weight (~5.00 Points)
  Note: This metric measures the share of adults who have experienced very often dry mouths in the past year due to the condition of their mouths and teeth.
• Sleeping Problems Due to Oral Condition: Full Weight (~5.00 Points)
  Note: This metric measures the share of adults who have experienced very often problems sleeping in the past year due to the condition of their mouths and teeth.
• Reduced Life Satisfaction Due to Oral Condition: Full Weight (~5.00 Points)
  Note: This metric measures the share of adults whose lives in general are less satisfying due to the condition of their mouths and teeth.
• Reduced Social Participation Due to Oral Condition: Full Weight (~5.00 Points)
  Note: This metric measures the share of the population who have experienced very often reduced social participation in the past year due to the condition of their mouths and teeth.
• Work Absence Due to Oral Condition: Full Weight (~5.00 Points)
  Note: This metric measures the share of the population who have taken days off from work very often in the past year due to the condition of their mouths and teeth.

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Sources: Data used to create this ranking were collected from U.S. Census Bureau, Bureau of Labor Statistics, Centers for Disease Control and Prevention, Center for Health Care Strategies, Healthy Grid, American Dental Association, Health Resources & Services Administration, United Health Foundation, Free Dental Care, American Academy of Pediatric Dentistry and Oral Health America.