LAUSR

This article reviews trends in dental caries, periodontal disease, and tooth loss for the United States along with population dynamics and risk factors that might influence these trends going forward. Dental caries experience remains high in the primary dentition. Caries severity in permanent teeth of children has declined to historically low levels, and long-standing inequalities in untreated caries appear to be narrowing. Declines in caries severity of children's permanent teeth have stabilized at a low level, but likely will contribute to future reductions in dental caries severity in adults. The prevalence of periodontal disease is high in adults, and only a small percentage have severe forms of the disease. Countervailing trends in determinants would suggest little change in the prevalence of periodontal disease in the future, but the lack of an obvious trend over the last two decades makes projections uncertain. Tooth loss as a consequence of dental disease has declined markedly over the last half century and has been all but eliminated in high-income groups. However, notable exceptions to these favorable trends are evident. Progress in prevention policies and programs that affect disease experience appears slower than progress in meeting population-level caries treatment needs. Clearly, long-standing inequities related to political and social determinants remain for all dental diseases, and income disparities in dental disease are widening for some indicators. Growing inequalities raise ethical and public health concerns that should be prominent in discussions of dental workforce needs and strategies for the next 25 years. This article was written as part of the project "Advancing Dental Education in the 21st Century."