Dental Health Report 2025: Cavities, Fluoride, Extractions, Visits and Spending

Regularly visiting the dentist is critical for your health, but many Americans don’t go as often as they should. And with governments across the country moving to ban fluoride in public drinking water, those visits may be more important than ever.

According to a ValuePenguin study, 34.1% of adults didn't go to the dentist in the past year. Meanwhile, access to fluoridated water (which helps decrease cavity rates) varies significantly by state — and, for many, is on the decline.

Here’s a closer look.

Key findings

Child cavity rates are highest in Nevada

Across the U.S., 12.1% of children ages 1 to 17 had cavities or decayed teeth in the past year — as of the time of the 2022-23 surveys. (This doesn't include teeth lost for injury or orthodontics.)

The rate is highest in Nevada, at 15.1%. North Carolina (15.0%) follows, with Alaska and Wyoming tying for third (at 14.9%).

According to the Centers for Disease Control and Prevention (CDC), untreated cavities were almost three times more common in young children living in low-income than in higher-income households. With the exception of Alaska, the five highest-ranking states have poverty rates higher than the national average and median incomes below the national median.

ValuePenguin health insurance expert Divya Sangameshwar says these states’ large rural populations play a role.

"Rural areas experience a disproportionately large shortage of health care professionals (including dentists), making it hard for families to get regular dental health checkups for their children," she says. "Rural residents are also less likely to have dental insurance. Even if they did, their insurance may not cover comprehensive dental services, making dental care harder to afford."

On the other end of the list, Rhode Island (8.3%) has the lowest cavity rates. Connecticut (8.9%) and Virginia (9.4%) follow. All three states have poverty rates below the national average and median incomes above the national median.

Full rankings

States with the highest/lowest rates of cavities and tooth decay among children ages 1-17

72.3% of Americans receive fluoridated water

Research has long shown that fluoridated water can reduce cavity rates, but access varies — and amid states imposing bans on fluoridated water, access may become even further limited. Across the U.S., 72.3% of Americans as of 2022 were on water systems receiving fluoridated water.

Access is highest in the District of Columbia, at 100.0%. That’s followed by Kentucky (99.7%) and Minnesota (98.9%).

Meanwhile, rates are lowest in Hawaii (8.5%), New Jersey (16.2%) and Oregon (26.4%).

Fluoridated water became a political issue after U.S. Health Secretary Robert F. Kennedy Jr. falsely claimed it was linked to cancer, diseases and disorders in November 2024. In March 2025, Utah became the first state to ban it in public drinking water. Previously, 43.6% of Utah residents had been able to access fluoridated water. In May 2025, Florida became the second state to ban it, with the state cutting off access on July 1 to the 78.1% of residents who’ve been receiving it.

Lawmakers in states including Ohio and South Carolina have made proposals to restrict fluoride in water, while similar restrictions were rejected or stalled in New Hampshire, Tennessee, North Dakota and Kentucky.

Full rankings

States with the most/least fluoridated water access

40.3% of adults have had a permanent tooth removal

In total, 40.3% of adults as of 2022 have had at least one permanent tooth removed. That rises to over half in West Virginia (56.5%), Mississippi (51.3%) and Kentucky (51.1%).

On the other hand, the extraction rate is lowest in the District of Columbia (29.5%). Utah (33.3%) and Colorado (33.9%) rank second and third, respectively.

Full rankings

States with the highest/lowest rates of permanent teeth removal among residents

1 in 3 adults didn’t go to the dentist in the past year

Many Americans skip their routine dental visits. Across the U.S., 34.1% of adults didn't go to the dentist in the past year (as of 2022). That rises to 44.4% in Arkansas, making it the highest by state. West Virginia (43.4%) and Texas (42.1%) follow.

"Many Americans skip dental visits due to a combination of factors," Sangameshwar says. "They include high costs, fear of the dentist, a lack of time, a lack of practicing dentists near them and a lack of insurance coverage for dental care. Many also don’t see dental health visits as a priority."

States with the lowest rates of adults who visited the dentist in the past year

On the other hand, Connecticut (26.1%), Massachusetts (26.8%) and Hawaii (28.1%) have the lowest rates of residents missing out on regular dental care.

Dental visits may be tied to access. At the national level, there were 60.4 dentists per 100,000 U.S. residents as of 2023. But by state, the density of dentists varies. Arkansas leads the low rankings again at 41.2 dentists per 100,000 residents, with Alabama (41.7) and Mississippi (43.1) following. West Virginia and Texas also have a lower rate of dentists than the national average.

The District of Columbia has the highest number of dentists per capita, at 109.4 per 100,000 residents, ahead of Massachusetts (80.2) and Alaska (79.5). Connecticut and Hawaii also have higher rates of dentists than the national average.

Full rankings

States with the highest/lowest rates of adults who visited the dentist in the past year

States with the highest/lowest rates of working dentists per 100,000 population

Out-of-pocket costs are significantly high for dental spending

Dental costs are significant. In fact, out-of-pocket costs accounted for 38.9% of dental spending in 2023 — which is almost four times higher than the 10.4% out-of-pocket share of health spending.

Dental service expenditures by year

National dental spending is rising, too. As of 2023, dental spending stands at $173.8 billion, up 6.2% year over year. Out-of-pocket expenses account for $67.6 billion, up 2.9% annually. In total, dental expenditures represent 3.6% of total national health care spending.

At the same time, dental service prices are getting even higher. Dental service prices increased by 2.2% year over year in April 2025, according to Bureau of Labor Statistics (BLS) consumer price index data.

How does that look for consumers? As of 2020, Americans spend an average of $432 a year on dental services, though specifics, again, vary by state. In New Hampshire, that figure is $648 — the highest in the nation. Alaska ($636) and Washington ($582) follow. Texas and Kentucky (both $340) and Mississippi ($341) are at the bottom.

Full rankings

States where residents spend the most/least per capita on dental services

Saving on dental costs: Top expert tips

Sangameshwar says finding dental care on a tight budget can be tough, but doable.

"Nonprofits, dental schools and community health centers often offer free and low-cost dental care for those who need it," she says. "You can also ask your provider about dental discount plans. Prioritize preventative care by practicing good oral hygiene, getting regular teeth cleanings and checkups to prevent a large expense from a preventable dental emergency. It’s best not to skip dental health visits entirely or wait until a problem is significant before seeking care."

If you need to get a major dental procedure and have to pay a large sum out of pocket, Sangameshwar cautions against putting the expense on your credit card. "Ask your provider about payment plans or financing options offered by the dental office or via third-party lenders like CareCredit," she says. "Dental care is also an area where you can use money saved in your health savings account (HSA) or flexible spending account (FSA) to offset costs."