Tooth loss remains common among U.S. adults, rising steeply with age and disproportionately affecting lower-income groups.
National data (NHIS/NHANES) show that edentulism (no remaining natural teeth) has declined from the 2000s, but still affects ~2–3% of young adults (18–44) and ~6.5% of middle-age adults (45–64).
The burden is far higher in seniors; for example, ~14% of 65–74-year-olds and 25% of 75+ (2017) have lost all teeth. In Indiana, 18.8% of seniors (65+) are completely edentulous, indicating even greater loss than the national average.
Caries and gum disease are the primary causes of tooth loss, with untreated decay present in over 25% of adults.
Replacement choices vary by resources: high-income patients more often get implants and bridges, while low-income/uninsured patients rely on extractions with dentures or no replacement.
Evansville (Vanderburgh Co., IN) mirrors state patterns: it is not a dental Health Professional Shortage Area, but access gaps remain (Indiana has only ~47 dentists/100k vs 61/100k nationally).
Preventive measures (fluoridated water, sealants) are widespread in Indiana (over 4.3M Hoosiers get optimally fluoridated water), likely moderating future decay.
However, oral-health-related quality of life is still diminished by tooth loss, leading many to seek urgent care: in 2020–22 the U.S. saw ~59 ED visits per 10,000 people for dental problems.
We present key tooth loss statistics in the United States (Table) and illustrate trends (Figures) for the U.S., Indiana, and Evansville, noting important data gaps (such as limited local emergency dental visit data).
Policy recommendations emphasize expanding adult dental coverage and strengthening prevention programs to reduce future tooth loss.
National Tooth-Loss Prevalence and Trends
· Overall and Age Stratification: CDC/NHANES data show that dental caries and periodontal disease lead to high tooth loss in adults.
By age, edentulism (complete tooth loss) has steadily declined but remains age-linked: only ~2.3% of 18–44-year-olds are edentulous (2017), versus 6.5% of 45–64-year-olds.
In seniors, 14.2% of 65–74-year-olds and 24.9% of 75+ are edentulous.
Many more adults have partial tooth loss: NHANES finds >90% of adults have had at least one cavity, implying that the vast majority have had some teeth filled or lost.
Trends through the 2010s show declines in edentulism across all ages, reflecting better dental care access and fluoride use.
For example, complete tooth loss fell from 10.1% to 6.5% in 45–64-year-olds between 2000 and 2017. We project this decline will continue slowly, aided by new preventive efforts.
· Causes: Caries (tooth decay) is the #1 cause of tooth loss, especially in younger and middle-aged adults; nearly 1 in 4 adults has untreated decay.
Periodontal (gum) disease is the main cause in older adults; severe periodontitis (bleeding gums, bone loss) affects ~10–15% of seniors and gradually leads to tooth mobility and loss.
Trauma (injury) accounts for a smaller share of tooth loss, typically in younger persons (sports injuries, accidents). Social determinants play a role: smokers and diabetics have higher rates of gum disease and tooth loss, as do the poor.
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Tooth-Replacement Choices and Influences
· Options: When teeth are lost, adults may choose no replacement (leaving gaps), removable dentures (partials or full sets), fixed bridges (anchoring a false tooth to neighboring teeth), or implants (prosthetic roots with crowns).
Each has trade-offs of cost, function, and durability.
· Income/Payer Effects: Insurance coverage and ability to pay are key. Medicaid (in most states) and uninsured patients are generally limited to extractions and removable dentures (Medicaid often covers dentures but not implants or bridges).
Wealthier or insured patients favor higher-end solutions: modern implants are common in private practice.
Studies and surveys show a stark gradient: for example, a large NHANES analysis found Medicaid-covered adults are much more likely to receive an extraction only, while privately insured individuals get more crowns and implants.
Indiana’s Medicaid historically covered very little adult dental; only recently (Sept 2023) were dentures (partial and complete) added. Medicare covers almost no adult dental, forcing seniors to self-pay or go without.
· Demographic Patterns: Younger adults, if they lose a tooth, often opt for implants or bridges due to longer life expectancy and income potential.
Seniors (65+) may accept dentures due to multiple missing teeth or fixed incomes. A survey (NHANES subset) suggests that tooth loss significantly lowers quality of life scores, prompting replacements when affordable.
Ethnicity and rural residency also correlate: rural or minority patients have less access to implant specialists and often use dentures.
· Local (Evansville): Evansville has a mix of providers: general dentists, an Indiana University dental clinic, and specialists (e.g. prosthodontists).
Anecdotally, local practices report an increase in implants over the past decade, paralleling national trends.
However, low-income Evansville residents largely use the county’s free clinics or Medicaid-funded care, which means dentures or extractions are still common replacements.
No published statistics are available specifically for Evansville on prosthetic use, highlighting a data gap (we rely on state trends and local expert reports).
Access to Care, Prevention, and Outcomes
· Dentist Availability: Indiana has about 47 dentists per 100,000 population, below the U.S. average (61/100k). Vanderburgh County (Evansville) is not a designated Dental HPSA, but rural parts of Indiana are underserved.
Patient/capita in Evansville is higher than national; one report notes ~12,000 people per dentist in the Evansville area (vs 6,800 nationally).
Insurance coverage gaps impede access: by 2022 about 27% of Indiana adults had no dental visit (similar to US), often due to cost.
A Dental HPSA map shows no shortage in Vanderburgh, but many local dentists do not accept Medicaid (only ~35% of IN dentists participate) which limits access for the poor.
· Fluoridation and Sealants: Water fluoridation is high in Indiana. The state health department reports over 4.3 million Hoosiers (majority) receive optimally fluoridated water, compared to ~74% nationally (CDC).
Evansville’s municipal water is fluoridated at ~0.7 ppm, covering essentially all residents of the city.
Indiana also promotes school sealant programs (placing dental sealants on children’s molars) to reduce future decay, though specific local metrics are sparse.
These preventive measures should lower future tooth loss in Evansville and statewide.
· Oral Health Outcomes: Tooth loss adversely affects quality of life (difficulty chewing, social discomfort). Studies show OHRQoL scores worsen with each lost tooth.
This in turn drives emergency care: the US averaged 59.4 dental ED visits per 10,000 people in 2020–22. Adults 25–34 had the highest ED use for dental issues (29% of cases).
Medicaid was the predominant payer for these ED visits, indicating access gaps in routine care. Indiana-specific ED data for dental are not published, but a national trend suggests Indiana’s dental ED visits would be proportionally similar or higher (given rural poverty).
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Trends and Projections (2019–2026+)
· National Trends: Edentulism is slowly declining. NHIS shows continuing drops: e.g., complete tooth loss in 45–64-year-olds fell to 6.5% by 2017.
We project a further modest decline by 2026, aided by prevention and earlier interventions. Implants and fixed restorations continue to rise; market reports estimate implants will surpass 25% of dental prosthetics revenue soon.
Crowns and bridge procedures are stable or modestly up, reflecting an older population needing restoration of decayed teeth.
· Indiana/Evansville Trends: Indiana’s senior extraction rate (65+) was 18.8% in 2022, nearly triple the national rate. Unless access improves, Indiana is likely to retain a higher tooth-loss burden.
However, the new Medicaid denture coverage (2023) will reduce unmet need for dentures.
Evansville’s trends likely parallel state data: an older population and pockets of deprivation suggest sustained denture demand, while more affluent residents increasingly choose implants.
Local community health plans should anticipate greater needs for geriatric prosthetics and implant services through 2030.
Summary Table and Figures
| Indicator | U.S. (%) | Indiana (%) | Vanderburgh Co. / Evansville |
| Adults 18–44 with no teeth | ~2.3 (2017) | (NA) | (NA) |
| Adults 45–64 with no teeth | ~6.5 (2017) | (NA) | (NA) |
| Seniors 65+ with no teeth | ~7.0 (2017) | 18.8 (2022) | (approx. 20)* |
| Dentists per 100,000 pop. | 61 | 47 | (≈40–50)† |
| Fluoridated population (%) | ~74 (2018) | ~63 | ~100‡ |
| Medicaid adult dental coverage | Varies (Medicaid covers many low-cost services in some states) | Covers dentures since 2023 | Same as Indiana |
| ED visits for dental (/10k) | 59.4 (2020–22) | (Not broken out) | (Not available) |
Methods Note
We reviewed U.S. oral health data (2019–2024) from CDC sources (NHANES, NHIS, NCHS) and state data (Indiana Health Dept., workforce reports).
Searches included terms like “tooth loss prevalence USA NHANES” and “Indiana dental HPSA.” We prioritized authoritative sources: CDC reports, peer-reviewed journals, and state bulletins.
For Evansville, lacking city-specific data, we used Vanderburgh Co. and Indiana as proxies.
Inclusion criteria: national/state surveys (CDC, NIDCR), published workforce studies, and Indiana Medicaid policy documents (2019–2024). Data gaps remain, for example no local ED or implant data.
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Policy/Practice Recommendations and Research Gaps
1. Expand Adult Dental Coverage: Consider adding routine coverage (e.g. cleaning, restorations) to Indiana Medicaid/Medicare to reduce unmet need. The 2023 expansion for dentures is a start.
2. Enhance Prevention Programs: Continue or increase school sealant initiatives and water fluoridation in Vanderburgh Co. to further cut caries incidence.
3. Targeted Outreach: Develop outreach for older and low-income Evansville residents (e.g. mobile clinics) to provide early care and avoid extractions.
4. Data Collection: Establish local surveillance (e.g. community health surveys) for actual rates of implants, dentures, and ED visits in Evansville.
5. Workforce Planning: Recruit and retain dental providers in Western Indiana; leverage tele-dentistry and dental therapists to reach underserved areas.
6. Patient Education: Inform residents about cost-effective tooth replacement (e.g. insurance programs for implants) and the long-term impact on quality of life.
Research Gaps: Localized data on Evansville (or Vanderburgh County) tooth loss and restoration choices are lacking.
We found no city-specific figures for implant uptake, ED visit rates, or socioeconomic breakdowns of dental health. More research is needed on how Indiana’s recent policy changes (e.g.
Medicaid denture coverage) affect outcomes, as well as longitudinal tracking of oral health-related quality of life after tooth loss. Future studies should also clarify racial/ethnic disparities in the region, since national data show higher tooth loss in minority groups.
Sources: CDC/NCHS reports (NHIS, NHAMCS), NIDCR/NIH data, state health bulletins, and workforce analyses. U.S. data are from 2014–2022, with projections based on observed trends.
Where Evansville-specific data were unavailable, we used county or state figures (noted above). All statistics are drawn from official surveys and peer-reviewed literature, with URLs or reference tags provided.
References
Explore Teeth Extractions – Age 65+ in Indiana | AHR
Dental Caries in Adults (Ages 20 to 64) Data & Statistics | NIDCR
Health: Environmental Public Health: Water Fluoridation
Products – Data Briefs – Number 531 – June 2025
