Why We Created the Oral Health Equity in America Survey — and What We Found

How is America’s oral health?

It’s a challenging question, especially when you consider all the potential sources of information. Is the best answer based on behaviors and experiences in dental offices and communities across the country? Or is it better to look at knowledge, like how much a person understands about the connection between their oral health and overall health? Or perhaps perception would provide the best insight — the value of oral health in one’s life or confidence in a particular smile.

The best answer is probably all of the above, which is exactly why CareQuest Institute for Oral Health created a nationally representative survey of 5,682 adults earlier this year. The survey — what we call the State of Oral Health Equity in America survey — is a follow-up to a similar survey we created in 2021. (NORC at the University of Chicago collects the responses.)

This year’s survey yielded dozens of novel and compelling insights on the landscape of oral health, many of which the CareQuest Institute research team is examining and comparing as you read this. As a companion to the many reports, articles, and educational programs the Institute will release in the coming weeks and months, here are some additional insights from our research team on why we conduct the survey, some early findings, and areas within oral health that are ripe for change.

What is the State of Oral Health Equity in America survey?

The State of Oral Health Equity in America survey is the largest nationally representative survey focused exclusively on adults’ knowledge, attitudes, experiences, and behaviors related to oral health. In addition to gathering information on individuals’ oral health experiences, this survey also collected information on how insurance coverage, oral health literacy, and how access to a trusted provider can improve oral health opportunities and affect outcomes.

Who completed the survey?

NORC at the University of Chicago collected survey results in January–February 2022 (and in 2021) on adults 18 and older on the AmeriSpeak panel. The data obtained from more than 5,000 adults from across the United States can be stratified in a variety of ways to gain a better understanding of oral health behaviors, literacy, and other neighborhood, social, and psychosocial factors associated with oral health inequities. Barriers to oral health care have been well recognized in the past, but these data provide new perspectives on inequities related to factors such as food insecurity, housing instability, discrimination experiences, and the social determinants of health.

What were some noteworthy findings from the 2022 survey?

There are far too many to list here, so here are six that stood out:

• 96% of adult Americans know that there is a connection between the health of the mouth and the rest of the body.
• Cost (27%) was the primary reason adults did not go to the dentist in the last two years. COVID-19 (18%) was the second-most-common reason.
• More than two-thirds of adults strongly agree that dental care should be covered by Medicaid (67%) and Medicare (70%).
• Nearly 6 in 10 (59%) of Black adults have lost one or more permanent teeth to decay or gum disease compared to 45% for all adults.
• Nearly a third of adults (29.9%) used a patient portal to access oral health information in 2022, compared to only 16.2% in 2021.
• Approximately 1 in 4 adults (25.2%) rate oral health as more important than physical health.

What one finding was most surprising?

That we have seen substantial increases in American’s knowledge of the interconnection between overall and oral health in just the last year. The time is right to create more medical/dental integration. Americans are asking for it.

Why do we dedicate so much time and effort to this? Why do we believe it’s important?

To our knowledge, there is not another nationally representative survey of this size and high quality completely devoted to oral health. Other major surveillance tracking surveys, generally funded by the federal government, have some oral health questions, but it’s challenging to add new questions to those surveys or to use the information in them to respond to immediate changes in the environment, as the data can be 2–4 years old by the time it’s released. Our survey provides timely and actionable insights into the state of adult attitudes, knowledge, and beliefs — as well as the state of oral health equity — and allows for a deeper understanding among key market segments and historically underserved communities.

What do we hope oral health stakeholders do with this knowledge?

We hope that they use the knowledge we generate with this data to inform advocacy, policy, technology advancement, and clinical endeavors to serve those who can most benefit from increased access to oral health care as we continue our work to transform the oral health care system into one that is more accessible, equitable, and integrated. CareQuest Institute uses the findings to inform our programmatic initiatives and grantmaking efforts, and we think it can be used by others in the industry to react to market trends in a timely way.

What other topics do we plan to explore in dedicated reports and articles?

We’re still examining the data and aligning areas with our strategy — and we’d love to hear any ideas from the field — but we can definitely share a few topics we will be exploring:

• Dental anxiety
• Oral hygiene habits
• Attitudes toward value-based care
• The oral health of specific populations, including veterans, LGBTQIA+ individuals, and members of American Indian and Alaska Native communities
• Emergency department use for dental conditions

How can you call the survey “nationally representative”?

AmeriSpeak is a probability-based panel designed to be representative of the United States’ household population. Randomly selected US households were sampled using area probability and address-based sampling, with a known, non-zero probability of selection from NORC National Sample Frame. Sampled households were contacted by mail, telephone, and field interviewers. A sampling unit of 17,603 was used, with a final sample size of 5,682 and a final weighted cumulative response rate of 4.0%. All data presented account for appropriate sample weights. The margin of error for the survey is 1.75%.

Will we be doing this every year for the foreseeable future?

Yes. We will continue to track trends in existing variables while also expanding and revising to adapt to the changing needs of the oral health care landscape.