The average American adult or child visits the dentist twice a year.2 This figure has increased since the 1950s and 1960s when the average was about 1.5 visits. In 1989, some 58 percent of nonelderly adults and 62 percent of children had at least one dental visit. Although the elderly are more likely than other adults to have a medical visit, the percentage of the elderly with at least one dental visit (43 percent) is lower than for other adults (Butt and Eklund, 1992). This contrast presumably reflects the higher rate of edentulism among older people (34 percent for those aged 65 and over versus less than S percent for other adults).
Disparities in the use of dental services are related to both income and race. For example, 4 percent of poor children (family income less than $10,000) have had dental sealants applied compared to more than 17 percent of children from families with income of $35,000 or higher. (A sealant is a plastic film painted onto tooth surfaces to prevent tooth decay.) For poor families, slightly more than 20 percent have not seen a dentist in more than five years; for better-off families, the figure is less than 6 percent (NCHS, 1992a). Sixty percent of whites have seen a dentist in the last year compared with 43 percent of blacks (NCHS, 1992a). In the recent Institute of Medicine report Access to Health Care in America (IOM, 1993a), statistics on dental utilization were highlighted as a frequently neglected indicator of disparities in access to health care.
Differences in dental care utilization are also linked to insurance coverage. In 1989, those with private insurance averaged 2.8 dental visits per year compared to 1.7 for those without. In the same year, 41 percent of the population reported some form of private dental insurance, much of it quite limited. In contrast, over 70 percent of nonelderly Americans have private medical insurance, and virtually all elderly Americans have medical coverage under Medicare, which does not cover dental services. For physician services, consumer out-of-pocket expenses accounted for only 19 percent of spending in 1990; for dental services, the corresponding figure was 53 percent (Burner et al., 1992). For the