Tooth Decay in Children

Percentage of children who have experienced tooth decay (treated or untreated).
Healthy people based on low morbidity, high quality of life, and life expectancy.

Oral health is an often overlooked yet vital component of overall health. Tooth decay can cause oral pain and infection that affect eating habits and nutrition. Additionally, tooth decay impacts communication as well as physical appearance. Tooth decay is the single most common chronic disease of childhood, five times more common than asthma. Poor oral health and loss of teeth impacts speech, eating, self-esteem, social interaction, a child’s ability to learn, and emotional state (OR DHS, 2007). Children’s oral health has a direct impact on their ability to learn. Tooth pain prevents concentration and focus while trips to the dentist keep children out of class. Each year 51 million school hours are lost due to dental-related illness. In Multnomah County non-white children are more likely to have experienced tooth decay than are their white peers. A 2007 survey found that 16% of white non-Hispanic six-to-nine year olds had untreated tooth decay, compared to 42% of African American six-to-nine year olds and 39% of Hispanic six-to-nine year olds (Multnomah, 2007).

Data (click image for interactive version): 

Percentage of children who have experienced tooth decay, Oregon, 2002-2012

Source: Oregon DHS
Notes: Data obtained by the SMILE survey cannot be broken down by individual counties

Tooth decay experience of second and third graders in 2005 and in third graders in 2010, Clark County

Source: Clark County Department of Health

Percentage of children who have experienced tooth decay, by household income, Oregon, 2012

Source: Oregon DHS
Note: Income level for this report is determined by whether or not the child participates in the free or reduced lunch program.

Finding & Trends: 

After a worrying increase in tooth decay in 2007, numbers have fallen to their lowest measured point yet. Most significant is a dramatic decrease in the number of untreated cavities (36 percent to 20 percent), which meets the DHS Healthy People 2020 goal of 26 percent. This success is likely due to more widespread dental care and awareness of tooth decay. The 2012 cavity rate (52 percent), however, is still above the Healthy People 2020 goal of 49 percent.

Children in Clark County experience lower levels of rampant and untreated tooth decay than do children in Washington State as a whole, but there is no significant difference between Clark County and Washington State in decay experience (2010). 

Children from lower income families experience much higher rates of tooth decay than those from higher income families. A full quarter of low-income children in Oregon between the ages six and nine have untreated decay, and over 60% have had one or more cavities, whereas the rates for children from high-income families are nearly half those values. 

Medical care
Public health
Using the indicator to drive change: 

Childhood tooth decay is a community-wide issue that cannot be addressed by public health agencies alone. Strategies to address this issue can be implemented in schools and community settings. Through the evaluation of existing programs and the identification of populations with increased need, different sectors can gain a better understanding of what is and is not working and develop policies to drive change. Programs with proven success rates, including community water fluoridation and school-based dental sealants programs, can decrease the incidence of tooth decay.


Oregon: During the 2002-2003 and 2006-2007 school years, first, second, and third-graders in Oregon public schools participated in a statewide oral health survey conducted by the state’s Oral Health Program, an effort of the Office of Family Health. Using national Basic Screening Survey (BSS) criteria recommended by the Centers for Disease Control and Prevention and the Association of State and Territorial Dental Directors, specially trained dental hygienists performed a brief, simple visual screening of each child’s mouth. In addition, parents were invited to complete a questionnaire that included questions about the child’s age, race/ethnicity, participation in the Federal Free or Reduced Lunch (FRL) Program, language spoken at home, gender, medical insurance, dental insurance, and time since last dental visit. Approximately half of the parents returned the questionnaire.

Clark County: In the 2010 Smile Survey, Kindergarten and 3rd grade students at Clark County’s 14 schools with at least 15 children in those grades were screened by trained dental hygienists who collected additional information on age and language spoken at home by asking the children and recorded gender and race by based on observation.  Nine schools used passive consent, screening all children unless a consent form requesting that they not participate was returned.  Two schools used active consent, where a consent form was required to be returned to screen children.  Four schools did not use a consent procedure.

The geography for tooth decay in children is the greater Portland region which includes Clackamas County, OR;  Multnomah County, OR; Washington County, OR; Clark County, WA.  Please note that the geography used varies across different indicators.


This indicator is based on information from credible sources. However, changes in collection methods and statistical procedures that have occurred over time may affect the data presented. Limitations that are acknowledged by the sources are noted above. Nevertheless, caution should be taken when interpreting all available data.
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