The National Survey of Children’s Health

The Oral Health

of Children: A Portrait

of States andthe Nation

2005

The National Survey of Children’s Health

The Oral Health

of Children:A Portrait

of States and the Nation

2005

Suggested citation: U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. The National Survey of Children’s Health 2003. Rockville, Maryland: U.S. Departmentof Health and Human Services, 2005.

Individual copies of this report are available at no cost from the HRSA Information Center, P.O. Box 2910, Merrifield, VA 22116; 1-888-ASK-HRSA; or ask@hrsa.gov.The publication is also available online at www.mchb.hrsa.gov and www.cdc.gov/nchs/slaits.htm

Technical Appendix 47Endnotes 48

3

The National Survey of Children’s Health

A Portrait of the Nation 7Condition of Children’s Teeth 8Problems with Teeth 11Use of Preventive Dental Care 12Need for Preventive Care 14Receipt of All Needed 15Preventive Dental CareReasons for Not Receiving 16Needed Dental Care

Table of ContentsIntroduction 4

Pennsylvania 39Rhode Island 39South Carolina 40South Dakota 40Tennessee 41Texas 41Utah 42Vermont 42Virginia 43Washington 43West Virginia 44Wisconsin 44Wyoming 45

State Data 19Alabama 20Alaska 20Arizona 21Arkansas 21California 22Colorado 22Connecticut 23Delaware 23District of Columbia 24Florida 24Georgia 25Hawaii 25Idaho 26Illinois 26Indiana 27Iowa 27Kansas 28Kentucky 28Louisiana 29Maine 29Maryland 30Massachusetts 30Michigan 31Minnesota 31Mississippi 32Missouri 32Montana 33Nebraska 33Nevada 34New Hampshire 34New Jersey 35New Mexico 35New York 36North Carolina 36North Dakota 37Ohio 37Oklahoma 38Oregon 38

The National Survey of Children’s Health

Introduction

4

Dear Colleagues:

The Health Resources and Services Administration is pleased to present this chartbook highlighting the major findings of the National Survey of Children’s Health on children’s oralhealth. This survey, the first of its kind, presents national- and state-level information on the health and well-being of children and their use of health services, including oral health and dental care.

The survey includes many positive findings about children’s oral health. It found that most children’s teeth are in excellent or very good condition, and most receive annual preventive dentalcare and do not go without needed dental care. Overall, 90.4 percent of children have teeth that are in excellent, very good, or good condition, according to their parents, and 72 percent had a preventive dental visit in the past year. Moreover, the parents of 92.9 percent of childrenreport that their children had received all the dental care they needed in the past year.

However, some groups of children do not enjoy good oral health and do not receive all the care they need. Younger children are less likely to receive preventive dental health care than areschool-aged children and fewer than one-quarter of 2-year-olds received a preventive dental visit,despite the recommendation that all children see a dentist by age 1. Also of concern is the findingthat the parents of 88.9 percent of children who did not see a dentist in the past year did notbelieve that their children needed a preventive dental visit.

We at HRSA hope that these findings provide useful information on children’s oral health and are helpful in your efforts to promote appropriate dental care among children.

Sincerely,

Elizabeth M. DukeAdministrator

Health Resources and ServicesAdministration

Rockville MD 20857

DEPARTMENT OF HEALTH & HUMAN SERVICES

Introduction

The National Survey of Children’sHealth (NSCH) was designed to measure the health and well-being of children from birth to age 17 inthe United States while taking intoaccount the environment in whichthey grow and develop. Conducted for the first time in 2003, the surveycollected information from parentsabout their children’s health, includingoral, physical and mental health,health care utilization and insurancestatus, and social well-being. Aspectsof the child’s environment that wereassessed in the survey include familystructure, poverty level, parentalhealth and behaviors, and communitysurroundings. The survey was sup-ported and developed by the U.S.Department of Health and HumanServices, Health Resources andServices Administration, Maternal and Child Health Bureau and was conducted by the Centers for DiseaseControl and Prevention, NationalCenter for Health Statistics.

One essential aspect of children’shealth measured in the survey wasoral health. Parents with children 1year of age or older who had naturalteeth that had erupted were askedabout the condition of their child’steeth and their use of and access todental care. Oral health is criticallyimportant to the overall health andwell-being of children. Left untreated,pain and infection caused by toothdecay can lead to problems in eating,speaking, and learning.1 An estimated51 million school hours are lost everyyear due to dental-related illness.Studies suggest that children experi-encing tooth pain do not score aswell on tests as children who are not distracted by pain.2

Despite the established importanceof oral health, it is estimated that

dental caries (tooth decay) is fivetimes more common than asthma and seven times more common thanhay fever in children. In fact, dentalcaries is the most common chronicchildhood disease.3 Even young children can be affected because achild’s teeth are susceptible to decayas soon as they begin to erupt. Thepresence of one or more decayed(non-cavitated or cavitated lesions),missing (due to caries), or filledtooth surfaces in any primary toothin a preschool-age child betweenbirth and 71 months is known asEarly Childhood Caries (ECC).4 Tomaintain oral health, professionalsrecommend brushing infants’ teethwith water as soon as the first tootherupts, usually at around age 6 to 10months, and beginning preventivedental visits within 6 months of theeruption of the first primary tooth,and no later than 12 months of age.5,6

The NSCH found that most parentsreported that their child’s teeth are inexcellent or very good condition, andmost receive annual preventive dentalcare and do not go without neededdental care. Overall, the parents of68.5 percent of children reported thattheir child’s teeth were in excellent or very good condition; the teeth of another 21.9 percent were reportedto be in good condition. This ratevaries by age, with 77.7 percent of young children (ages 1 to 5 years)having teeth reported to be in excel-lent/very good health, compared toonly 61.8 percent of 6- to 11-year-oldsand 67.5 percent of 12- to 17-year-olds.

The survey also addressed children’soral health in relation to their physicalhealth. While children with specialhealth care needs are somewhat lesslikely than children without specialhealth care needs to have teeth that

are in excellent or very good condition,there was a greater difference amongchildren by overall physical healthstatus. Children reported to be inexcellent or very good physical healthwere much more likely to have teethreported to be in excellent or verygood condition than children in good,fair, or poor health (74.4 versus 38.0 percent).

Despite the recommendation thatcaregivers and parents begin preventivedental care visits for children by 12months of age, the NSCH shows thatonly 10.1 percent of 1-year-olds and23.8 percent of 2-year-olds received a preventive dental visit in the pastyear. Preventive dental care in thepast year was most common among 6- to 11-year-olds (83.7 percent).Overall, 28 percent of children didnot receive preventive dental care inthe past year. By race and ethnicity,White children were most likely to receive preventive dental care inthe past year (77.0 percent), andHispanic children were least likely(60.9 percent). Receipt of preventivedental care rises steadily withincreased income: only 58.1 percentof children in families with incomesbelow 100 percent of the Federalpoverty level (FPL) received care in the past year, compared to 82.4percent of children in families withincomes of 400 percent FPL andabove. Children with special healthcare needs were more likely to receivepreventive care than children withoutspecial health care needs (78.4 versus70.6 percent).

In addition to asking parents abouttheir children’s use of preventive dental care, the NSCH explored whetherparents felt that their children hadneeded routine preventive dental careover the past year. Parents of children

Introduction

5

The National Survey of Children’s Health

who had not seen a dentist in thepast year (whether for preventive careor treatment) were asked if there hadbeen a time during that period whentheir children had needed routine pre-ventive dental care. The responses tothis question provide evidence thatmany of these parents are unaware ofthe recommendation regarding preven-tive dental care. Of all children whodid not receive dental care in the pastyear, only 11.1 percent had parentswho responded that the child neededsuch care; therefore, the parents of88.9 percent of children who did notsee a dentist did not believe that thechild needed preventive dental care in the past year.

Finally, if parents reported thattheir children had needed preventivedental care—or if they reported thattheir children had at least one pre-ventive visit in the past year—theywere asked whether their children hadreceived all the care they needed. Theproportion of children whose parentsbelieved that they did not receive allthe care they needed rose steadilywith age, from less than 1 percent of1-year-olds to 20.4 percent of 12- to17-year-olds. Overall, the parents of92.9 percent of children respondedthat the child had received all neededdental care. The most often-cited reasons for children not receiving allneeded care included lack of insurance(30.9 percent), high cost of care(29.3 percent), and difficulty gettingan appointment (16.2 percent).

Overall, while the survey foundthat most children, particularlyschool-aged children and adolescents,are in good dental health and receiveregular dental care, deficits remain in the dental care of younger childrenand in parents’ understanding of theneed for preventive dental care. It is

“The first oral examination should occur within 6 months of the eruption of the first primary tooth,and no later than age 12 months.”

–Bright Futures Project (2003)5

Bright Futures is a national diseaseprevention and health promotion initiative funded by the Maternal andChild Health Bureau.

. . . . . . . . . . .

“An oral health consultation visit within 6 months of the eruption of the firsttooth and no later than 12 months ofage is recommended to educate parentsand provide anticipatory guidance forprevention of dental disease.”

–American Academy of Pediatric Dentistry (2003)6

Child’s First Preventive Visit

hoped that these findings can helppolicymakers, State and local healthofficials, oral health professionals,and families understand and addressthe importance and scope of oralhealth services for children.

The Technical Appendix of thischartbook presents important infor-mation about the survey sample and methodology. For more detailedanalyses of the survey results, theData Resource Center on Child andAdolescent Health (DRC) Web site provides online access to the surveydata. The interactive data query feature allows users to create their

own customized tables and to com-pare survey results at the Nationaland State level, and by relevant sub-groups such as age, race and ethnicity,and family income. Sponsored by the Health Resources and ServicesAdministration’s Maternal and ChildHealth Bureau, the Web site for theDRC is: www.nschdata.org

More complex analyses of the datacan be conducted using the public usedata set available from the NationalCenter for Health Statistics at:www.cdc.gov/nchs/about/major/slaits/nsch.htm

The National Survey of Children’s Health

Introduction

6

Periodicity of Preventive Visits

Although the traditionally recognized interval for oral health supervision is every 6 months, the above organizations suggest that children should be seen on an individualized schedule recommended by the dentist, based on each child’s needs and risk factors.

“Every child should begin to receive oral health risk assessments by 6 months of age by a qualified pediatrician or aqualified pediatric health care profes-sional. If an infant is assessed to bewithin 1 of the following risk groups,[he/she] should be referred to a dentistas early as 6 months of age and nolater than 6 months after the firsttooth erupts or 12 months of age(whichever comes first): children withspecial health care needs; children of mothers with a high caries rate; children with demonstrable caries,plaque, demineralization, and/orstaining; children who sleep with a bottle or breastfeed throughout the night; children in families of low socioeconomic status.”

–American Academy of Pediatrics, Section on Pediatric Dentistry (2003)7

The Oral Health of Children: A Portrait of the Nation

7

The National Survey of Children’s Health

Condition of Children’s Teeth

Parents were asked to rate the condition of their children’s teeth as excellent, very good, good, fair, or poor. Overall, the parents of 68.5 percent of children report that their children’s teeth are inexcellent or very good condition.

This proportion varies with children’s age. The parents of 77.7percent of 1- to 5-year-olds rate thecondition of their children’s teeth as excellent or very good, comparedto 61.8 percent of children aged 6-11 and 67.5 percent of adolescentsaged 12-17.

The condition of children’s teethvaries by children’s race and ethnicityas well. Just over three-quarters (76.4 percent) of White children have teeth that are in excellent orvery good condition, as reported by their parents, as do 69.9 percentof multiracial children. The parents of Black and Hispanic children are lesslikely to report that their children’steeth are in excellent or very goodcondition: 61.1 percent of Black children and only 46.7 percent ofHispanic children have teeth that are in excellent or very good condi-tion, as do 67.2 percent of children of other races.

The National Survey of Children’s Health

The Oral Health of Children > Condition of Children’s Teeth

8

0

20

40

60

80

100

12-17 Years6-11 Years1-5 Years

Percent of Children Whose Teeth Arein Excellent or Very Good Condition,

by Age

Per

cent

ofC

hild

ren

67.561.8

77.7

0

20

40

60

80

100

Other*MultiracialHispanicBlackWhite

Percent of Children Whose Teeth Arein Excellent or Very Good Condition,

by Race and Ethnicity

Per

cent

ofC

hild

ren

46.7

61.1

76.4

*Includes Asian/Pacific Islander and American Indian/Alaska Native children.

69.967.2

Conditionof Children’s Teeth

Poor 2.1%

Fair7.5%

Good21.9%

Very Good26.0%

Excellent42.5%

The condition of children’s teethalso varies with family income. Ofchildren with family incomes belowthe Federal poverty level (FPL), fewerthan half (48.8 percent) were reportedto have teeth that were in excellentor very good condition, compared to 60.2 percent of children with family incomes between 100 and199 percent of the FPL, 75 percent of children with family incomesbetween 200 and 399 percent of theFPL, and 82.8 percent of children with family incomes of 400 percent or more of the FPL.

The use of preventive dental care also appears to be associatedwith the condition of children’s teeth. Of children who went to a dentist at least once in the pastyear for preventive care, 70.3 percenthad teeth in excellent or very good condition, compared to 64.0 percentof children who did not receive preventive care in the past year.

The Oral Health of Children > Condition of Children’s Teeth

9

0

20

40

60

80

100

Did Not ReceivePreventive Care

in Past Year

ReceivedPreventive Care

in Past Year

Percent of Children Whose Teeth Arein Excellent or Very Good Condition,by Receipt of Preventive Dental Care

Per

cent

ofC

hild

ren

70.3

64.0

0

20

40

60

80

100

400%FPL+

200-399%FPL

100-199%FPL

0-99%FPL*

Percent of Children Whose Teeth Arein Excellent or Very Good Condition,

by Family Income

Per

cent

ofC

hild

ren

75.0

60.2

48.8

*Federal poverty level, equal to $18,400 for a family of four in 2003.

82.8

The National Survey of Children’s Health

cont’d

Children’s dental health is closelyrelated to their physical health. Forexample, 64.9 percent of children with special health care needs (defined as those who have a chronicphysical, developmental, behavioral, or emotional condition and who alsorequire health and related services of a type or amount beyond thatrequired by children generally8), werereported to have teeth in excellent or very good condition, compared to 69.3 percent of children withoutspecial health care needs.

Of children whose overall physicalhealth was described as excellent orvery good, 74.4 percent had excellentor very good dental health. In con-trast, of children whose overall healthwas rated as good, fair, or poor, only38.0 percent had teeth in excellent or very good condition.

Children whose teeth are in excel-lent or very good condition are lesslikely than other children to missmore than 2 weeks of school due to illness or injury. Of children whomissed 11 days or more of school in the past year, 56.6 percent werereported to have teeth in excellentor very good condition, compared to 65.4 percent of children whomissed 10 days of school or fewer.

The National Survey of Children’s Health

The Oral Health of Children > Condition of Children’s Teeth

10

0

20

40

60

80

100

Good, Fair,or Poor

Physical Health

Excellentor Very Good

Physical Health

Percent of Children Whose Teeth Arein Excellent or Very Good Condition,

by Overall Physical Health

Per

cent

ofC

hild

ren

74.4

38.0

0

20

40

60

80

100

Missed 10or Fewer Days

Missed 11or More Days

Percent of Children Whose Teeth Arein Excellent or Very Good Condition,by Number of Missed School Days

Per

cent

ofC

hild

ren

56.6

65.4

0

20

40

60

80

100

Children withoutSpecial HealthCare Needs

Children withSpecial HealthCare Needs

Percent of Children Whose Teeth Arein Excellent or Very Good Condition,

by CSHCN Status

Per

cent

ofC

hild

ren

64.969.3

cont’d

Problems with Teeth

When they reported that their children’s teeth were in fair or poorcondition, parents were asked whatspecific problems their children hadwith their teeth. More than half of children whose teeth are in fair or poor condition (54.6 percent) were reported to have cavities. Other commonly reported problemsincluded crooked teeth, or teeth that need braces (33.5 percent); a broken front tooth or teeth that need repair (11.8 percent); teethproblems such as grinding, soft teeth, or teeth falling out (6.1 percent); and pain (4.6 percent).

All information in the surveyabout problems with teeth was reported by parents. Parents wereallowed to name more than one problem with their children’s teeth.

The Oral Health of Children > Problems with Teeth

11

Problems with Teeth Among Childrenwith Teeth in Fair or Poor Condition

Percent of Children

0 10 20 30 40 50 60

Other

Nerve Problems

Gum Problems

Enamel Problems

Discoloration

Plaque, Need for Cleaning,Doesn’t Brush Regularly

Pain

Teeth Problems(Grinding, Soft Teeth,

Teeth Falling Out)

Broken Front Tooth orTeeth That Need Repair

Crooked Teeth,or Teeth That Need Braces

Cavities

6.1

11.8

33.5

54.6

3.6

4.6

1.7

3.6

0.8

1.4

3.5

The National Survey of Children’s Health

0

20

40

60

80

100

12-176-1154321

Percent of Children ReceivingPreventive Dental Care in Past Year,

by Age

Per

cent

ofC

hild

ren

79.877.2

50.5

10.1

23.8

68.3

83.7

Receiptof PreventiveDental Care

Did Not Havea Visit

in the Past Year28.0%

Had at LeastOne Visit

in the Past Year72.0%

Use of Preventive Dental Care

Dental caries, or cavities, is the mostcommon chronic disease among childrenin the United States.3 Because of theimportance of early identification ofchildren at risk for caries, and thepotential benefit of early interventionin young children’s oral health, it isrecommended that all children have a dental visit by their first birthday.

The traditional recommendationfor preventive care thereafter is thatchildren visit the dentist every 6months for a checkup, although it isnow recognized that such a scheduleshould be adjusted by the dentist basedon each individual child’s needs andsusceptibility to disease.5,6,9 However,many children, particularly youngchildren, receive care that does noteven meet the traditional standard.Overall, parents of 72.0 percent ofchildren aged 1 or older reported that their children had received atleast one preventive dental visit inthe past year. This rate was highestamong children aged 6 to 11; of these children, 83.7 percent visited a dentist at least once for preventivecare. Among adolescents aged 12-17,79.8 percent received preventive dentalcare in the past year.

The use of preventive dental careamong younger children is much lesscommon. Among preschool children(aged 1 to 5), the proportion who have seen a dentist for preventive care rises with age, from 10.1 percentof 1-year-olds to 77.2 percent of

The National Survey of Children’s Health

The Oral Health of Children > Use of Preventive Dental Care

12

5-year-olds. Not until age 3 are evenhalf of children reported to have had apreventive dental visit in the past year.

The likelihood of receiving annualpreventive dental care appears to varyby demographic factors such as raceand ethnicity and family income. AmongWhite children, 77.0 percent receivedat least one preventive dental visit inthe past year, as did 68.1 percent ofmultiracial children and 66.4 percent of Black children. The lowest rate ofpreventive dental care was seen inHispanic children, of whom 60.9 percentreceived a visit. Among children ofother races, 70.3 percent saw a dentistfor preventive care in the past year.

Children in low-income families areless likely to receive preventive dentalcare than children with higher familyincomes. Among children with familyincomes below the Federal poverty level (FPL), 58.1 percent saw a dentistfor preventive care in the past year,compared with 65.8 percent of childrenwith family incomes between 100 and199 percent of the FPL, 77.0 percent ofchildren with family incomes between200 and 399 percent of FPL, and 82.4percent of children with family incomesof 400 percent of FPL or more.

Children with special health careneeds are more likely to receive preventive dental care than childrenwithout special health care needs (78.4 versus 70.6 percent.)

The Oral Health of Children > Use of Preventive Dental Care

13

0

20

40

60

80

100

400%FPL+

200-399%FPL

100-199%FPL

0-99%FPL*

Percent of Children ReceivingPreventive Dental Care in Past Year,

by Family Income

Per

cent

ofC

hild

ren

77.0

65.8

58.1

*Federal poverty level, equal to $18,400 for a family of four in 2003.

82.4

0

20

40

60

80

100

Children withoutSpecial HealthCare Needs

Children withSpecial HealthCare Needs

Percent of Children ReceivingPreventive Dental Care in Past Year,

by CSHCN Status

Per

cent

ofC

hild

ren

78.4

70.6

0

20

40

60

80

100

Other*MultiracialHispanicBlackWhite

Percent of Children ReceivingPreventive Dental Care in Past Year,

by Race and Ethnicity

Per

cent

ofC

hild

ren 60.9

66.4

77.0

*Includes Asian/Pacific Islander and American Indian/Alaska Native children.

68.1 70.3

The National Survey of Children’s Health

cont’d

Need for Preventive Care

Although most professionals agree on the traditional recommendation thatall children receive semi-annual pre-ventive dental care with the child’sfirst visit occurring before the child’sfirst birthday, it appears that someparents are not aware of this recom-mendation. Parents of children whodid not receive preventive dental carewithin the past year were asked iftheir children had needed preventivecare during this time period. Overall, the parents of only 11.1 percent ofchildren who did not receive dentalcare reported that their children had needed this care.

Again, parents’ perception of theneed for preventive dental care riseswith their children’s age. Of childrenwho did not receive a preventive dental visit, parents of 20.4 percentof adolescents aged 12-17 and 17.4percent of children aged 6-11 reportedthat their children had needed pre-ventive dental care. However, parentsof lower proportions of children aged 5 and under—ranging from 12.1 percent of 5-year-olds to lessthan 1 percent of 1-year-olds—reported a need for preventive dental care.

The National Survey of Children’s Health

The Oral Health of Children > Need for Preventive Care

14

0

5

10

15

20

25

12-176-1154321

Percent of Children Reportedto Have Needed Preventive Dental Care

in Past Year, by Age

Per

cent

ofC

hild

ren

20.4

12.1

4.3

0.92.1

9.7

17.4

Age of Child

Reported Need for Preventive Dental Care in the Past Year*

Did Not Need PreventiveDental Care

88.9%

Needed Preventive Dental Care 11.1%

*Among children who did not receive a preventive visitin the past year.

Receipt of All NeededPreventive Dental Care

Parents were asked whether their children had received all of the preventive dental services they feltthey needed. Those who said “no” had children who had either receivedno preventive dental care (although their parents felt they needed it) orhad seen a dentist in the past year(but the parent felt that the childdid not receive all the care he or she needed).

Overall, parents of the vast majorityof children (92.9 percent) reportedthat their children received all thepreventive dental care they needed inthe past year. This rate is relativelyconsistent across children’s agegroups, although it does rise withfamily income. Of children with family incomes below 100 percent ofthe Federal poverty level (FPL), 86.4percent received all the preventivedental care they needed, according totheir parents, compared to 88.1 per-cent of children with family incomesbetween 100 and 199 percent of FPL,94.6 percent of children with familyincomes between 200 and 399 percentof FPL, and 97.7 percent of childrenwith family incomes of 400 percent of poverty or more.

0

20

40

60

80

100

400%FPL+

200-399%FPL

100-199%FPL

0-99%FPL*

Percent of Children ReceivingAll Needed Preventive Dental Care,

by Family Income

Per

cent

ofC

hild

ren

94.6

88.186.4

*Federal poverty level, equal to $18,400 for a family of four in 2003.

97.7

The Oral Health of Children > Receipt of All Needed Preventive Dental Care

15

Receipt of All NeededPreventive Dental Care

Did Not ReceiveAll Needed Care 7.2%

ReceivedAll Needed Care

92.9%

The National Survey of Children’s Health

Reasons for Not Receiving

Needed Dental Care

Parents whose children did notreceive all the preventive care theyneeded were asked why their childrenhad not received all the dental carethey needed. The most commonlyreported reasons were financial: thechild had no insurance to cover theservices (30.9 percent) or the servicescost too much (29.3 percent).

Other commonly reported reasonswere the inability to get an appoint-ment (16.2 percent), a problem withthe health plan (10.9 percent), andthe inability to find a dentist who takesthe child’s insurance (7.2 percent).Parents could give more than one reason for their children not receivingneeded dental care.

The National Survey of Children’s Health

The Oral Health of Children > Reasons for Not Receiving Needed Dental Care

16

Reasons for Not ReceivingNeeded Dental Care

Percent of Children

0 5 10 15 20 25 30 35

Other

Dissatisfaction with Dentist

Dentist Did Not Know How to Treat or Provide Care

Treatment Is Ongoing (Not Complete)

Not Available in Area/Transportation Problems

Child Refused to Go

Did Not Know Whereto Go for Treatment

Can't Find Dentist Who Takes Child’s Insurance

Health Plan Problem

Could Not Get Appointment

Costs Too Much

No Insurance

10.9

16.2

29.3

30.9

4.5

7.2

3.6

3.8

2.3

3.0

2.2

8.2

###

17

The National Survey of Children’s Health

19

The National Survey of Children’s Health

State-Level DataThe National Survey of Children’s Health provides information on the health and well-being of children in the 50 States and theDistrict of Columbia (D.C.). This section presents the survey findings for each State and D.C., including the percentage of children whose teeth are reported to be in excellent or good condition and the percentage of children who received a preventivedental care visit in the past year. These indicators are also shown by children’s age, family income, race and ethnicity, and sex.These data are presented in comparison with the National statistics detailed in the previous section.

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65.8

77.0

82.4

77.0

66.4

60.9

68.1

70.3

71.3

47.8

82.8

79.0

72.7

48.1

84.5

80.6

Stat

e%

73.1

50.3

82.7

80.8

64.7

65.8

80.1

83.7

76.9

67.4

61.8

69.1

* 73.2

48.1

82.0

82.5

72.9

52.5

83.3

79.1

Nati

onal

%

68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

e%

68.0

79.0

60.8

66.8

54.5

58.3

77.8

84.2

75.4

55.2

53.6

70.4

49.5

67.9

79.5

60.8

66.5

68.2

78.5

60.7

67.2

Nati

onal

%

72.0

48.0

83.7

79.8

58.1

65.8

77.0

82.4

77.0

66.4

60.9

68.1

70.3

71.3

47.8

82.8

79.0

72.7

48.1

84.5

80.6

Stat

e%

74.9

50.5

84.9

83.8

68.4

67.7

78.2

84.9

78.1

59.6

67.4

68.3

74.6

75.6

52.4

85.5

83.7

74.3

48.8

84.1

83.9

Nati

onal

%

68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

e%

71.4

76.4

65.6

72.8

56.0

67.7

77.8

83.8

77.5

72.2

71.7

67.9

57.1

70.4

73.9

63.6

73.7

72.6

79.8

67.8

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Teet

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Tota

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Nati

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72.0

48.0

83.7

79.8

58.1

65.8

77.0

82.4

77.0

66.4

60.9

68.1

70.3

71.3

47.8

82.8

79.0

72.7

48.1

84.5

80.6

Stat

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66.9

47.1

75.1

75.6

53.4

60.1

72.1

85.5

75.4

63.1

55.2

72.9

63.5

65.8

46.6

74.2

73.7

68.0

47.2

76.0

77.5

Nati

onal

%

68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

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62.0

73.0

52.3

62.6

41.0

54.8

70.9

82.9

73.5

68.1

42.7

69.0

70.9

60.1

72.9

48.0

61.6

63.9

73.0

56.7

63.6

Nati

onal

%

72.0

48.0

83.7

79.8

58.1

65.8

77.0

82.4

77.0

66.4

60.9

68.1

70.3

71.3

47.8

82.8

79.0

72.7

48.1

84.5

80.6

Stat

e%

66.7

43.3

79.1

74.0

59.6

61.0

74.5

78.0

68.0

63.6

52.3

65.7 *

63.7

42.7

74.5

71.3

69.8

43.9

83.9

76.6

Nati

onal

%

68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

e%

65.7

78.0

57.9

62.9

55.2

59.6

74.2

81.4

69.4

57.3

37.9

77.2

61.0

63.9

75.8

59.6

58.1

67.5

80.5

56.1

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Teet

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72.0

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58.1

65.8

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82.4

77.0

66.4

60.9

68.1

70.3

71.3

47.8

82.8

79.0

72.7

48.1

84.5

80.6

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70.9

49.7

84.3

75.5

60.2

68.9

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78.8

78.7

64.5

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75.2

74.6

70.3

52.7

80.9

75.5

71.5

46.4

87.4

75.5

Nati

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68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

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59.4

67.0

54.2

58.3

37.1

48.6

71.3

77.7

74.1

71.0

42.2

66.4

71.3

59.2

63.6

56.3

58.3

59.6

70.7

52.1

58.4

Nati

onal

%

72.0

48.0

83.7

79.8

58.1

65.8

77.0

82.4

77.0

66.4

60.9

68.1

70.3

71.3

47.8

82.8

79.0

72.7

48.1

84.5

80.6

Stat

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70.5

45.0

83.0

79.9

51.4

57.4

74.1

82.9

75.2 *

56.1

71.3

65.7

70.2

43.3

82.8

79.9

70.9

46.7

83.1

79.9

Nati

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68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

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70.0

77.7

61.8

71.4

45.6

62.1

74.4

82.7

78.3

62.9

47.5

74.9

67.9

65.5

71.8

56.6

68.8

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83.5

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Age

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Nati

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72.0

48.0

83.7

79.8

58.1

65.8

77.0

82.4

77.0

66.4

60.9

68.1

70.3

71.3

47.8

82.8

79.0

72.7

48.1

84.5

80.6

Stat

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80.2

55.6

89.8

90.0

66.1

72.0

84.3

84.7

83.0

76.5

69.5

69.8

75.3

79.9

51.3

90.3

90.9

80.4

59.7

89.2

89.1

Nati

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68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

e%

76.7

84.2

70.9

76.4

61.4

70.8

74.2

84.8

81.5

70.7

59.1

76.0

67.0

75.1

82.4

71.0

73.8

78.3

85.9

70.9

79.1

Nati

onal

%

72.0

48.0

83.7

79.8

58.1

65.8

77.0

82.4

77.0

66.4

60.9

68.1

70.3

71.3

47.8

82.8

79.0

72.7

48.1

84.5

80.6

Stat

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72.4

44.2

85.9

81.3

58.2

59.7

75.6

81.8

77.9

63.6

49.5

71.7

77.2

72.9

47.4

84.6

82.0

71.9

40.6

87.1

80.5

Nati

onal

%

68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

e%

71.3

82.9

63.1

70.2

51.7

61.3

76.9

82.6

77.5

61.2

53.7

63.6

62.8

70.6

84.1

61.0

69.2

71.9

81.6

65.1

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Teet

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Allst

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Age

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Age

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Tota

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Age

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Age

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Age

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Age

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Tota

lFe

mal

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Age

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Age

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Age

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Nati

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72.0

48.0

83.7

79.8

58.1

65.8

77.0

82.4

77.0

66.4

60.9

68.1

70.3

71.3

47.8

82.8

79.0

72.7

48.1

84.5

80.6

Stat

e%

71.3

51.5

84.0

76.4

65.6

69.1

78.3

75.4

74.7

71.7

65.6

64.3

* 72.2

53.9

83.3

77.2

70.5

49.0

84.8

75.5

Nati

onal

%

68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

e%

66.1

77.7

58.3

63.6

58.1

57.3

72.8

83.3

88.5

64.8

42.0

78.4

* 67.7

80.8

57.2

67.0

64.5

74.7

59.5

60.2

Nati

onal

%

72.0

48.0

83.7

79.8

58.1

65.8

77.0

82.4

77.0

66.4

60.9

68.1

70.3

71.3

47.8

82.8

79.0

72.7

48.1

84.5

80.6

Stat

e%

65.0

38.6

78.0

72.9

41.4

58.7

72.5

81.2

71.5

57.9

54.7

58.4

58.8

66.6

40.9

79.3

73.8

63.2

36.3

76.4

71.9

Nati

onal

%

68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

e%

69.7

79.3

65.1

66.7

51.5

61.6

75.9

85.0

76.6

61.8

57.4

74.1

66.5

68.6

75.9

67.3

64.6

70.7

82.7

62.6

68.9

Teet

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The

Nat

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The

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The

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Age

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Age

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Age

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Tota

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Age

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Age

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Age

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Age

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Nati

onal

%

72.0

48.0

83.7

79.8

58.1

65.8

77.0

82.4

77.0

66.4

60.9

68.1

70.3

71.3

47.8

82.8

79.0

72.7

48.1

84.5

80.6

Stat

e%

72.4

47.6

81.8

83.0

54.4

72.5

76.9

83.2

78.4

70.2

45.1

71.0

41.3

72.2

45.3

84.1

83.0

72.5

50.1

79.3

82.8

Nati

onal

%

68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

e%

69.7

79.5

62.8

68.9

55.5

62.5

74.5

85.0

77.0

62.3

46.9

64.7

71.3

67.9

76.7

62.1

66.7

71.7

82.6

63.6

71.4

Nati

onal

%

72.0

48.0

83.7

79.8

58.1

65.8

77.0

82.4

77.0

66.4

60.9

68.1

70.3

71.3

47.8

82.8

79.0

72.7

48.1

84.5

80.6

Stat

e%

78.3

62.1

86.3

83.6

66.4

74.0

80.5

88.2

79.9

75.5

67.9

79.1

81.2

77.3

60.3

85.9

81.8

79.3

63.8

86.6

85.6

Nati

onal

%

68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

e%

70.7

78.1

62.3

72.8

56.2

72.1

72.1

78.9

79.2

72.5

70.5

69.2

68.7

71.3

80.8

59.9

74.9

70.2

75.5

65.3

70.3

Teet

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perc

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teet

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Age

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Tota

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72.0

48.0

83.7

79.8

58.1

65.8

77.0

82.4

77.0

66.4

60.9

68.1

70.3

71.3

47.8

82.8

79.0

72.7

48.1

84.5

80.6

Stat

e%

71.7

49.1

79.7

82.8

52.4

64.6

78.7

86.7

74.4

* 48.9

75.2

70.1

71.5

47.6

78.0

84.7

71.9

50.6

81.7

80.7

Nati

onal

%

68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

e%

69.8

76.9

61.2

72.0

56.4

62.2

75.4

85.1

72.9

* 47.0

67.4

64.8

68.5

79.5

56.7

70.9

71.1

74.3

66.2

73.1

Nati

onal

%

72.0

48.0

83.7

79.8

58.1

65.8

77.0

82.4

77.0

66.4

60.9

68.1

70.3

71.3

47.8

82.8

79.0

72.7

48.1

84.5

80.6

Stat

e%

72.0

49.9

83.2

79.4

56.9

67.0

76.6

82.5

77.6

70.6

58.1

63.4

59.6

70.3

51.4

79.4

77.1

73.8

48.3

87.0

81.7

Nati

onal

%

68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

e%

67.7

78.5

61.3

65.1

42.9

51.2

77.8

82.0

78.7

53.9

43.3

65.2

74.9

64.4

77.9

58.0

59.6

71.1

79.1

64.8

70.8

Teet

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perc

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The

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Tota

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Nati

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72.0

48.0

83.7

79.8

58.1

65.8

77.0

82.4

77.0

66.4

60.9

68.1

70.3

71.3

47.8

82.8

79.0

72.7

48.1

84.5

80.6

Stat

e%

74.8

51.4

87.1

81.6

64.1

61.1

80.9

84.3

78.1

61.8

49.9

73.5

50.1

73.1

48.1

83.7

80.3

76.5

53.8

90.7

83.0

Nati

onal

%

68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

e%

73.2

83.6

66.3

71.8

63.0

67.6

74.6

84.0

76.3

62.8

46.9

73.6

* 71.2

79.6

67.1

69.6

75.2

86.9

65.6

74.3

Nati

onal

%

72.0

48.0

83.7

79.8

58.1

65.8

77.0

82.4

77.0

66.4

60.9

68.1

70.3

71.3

47.8

82.8

79.0

72.7

48.1

84.5

80.6

Stat

e%

78.2

51.0

86.7

90.1

67.9

72.2

82.0

85.4

80.3 *

49.6

66.2 *

76.7

51.0

84.7

88.1

79.9

51.0

88.8

92.1

Nati

onal

%

68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

e%

73.6

81.5

64.7

75.7

65.7

64.4

76.1

83.3

76.1

48.0

42.1 * *

72.7

78.9

65.5

74.5

74.4

84.3

63.9

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Teet

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Age

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Nati

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72.0

48.0

83.7

79.8

58.1

65.8

77.0

82.4

77.0

66.4

60.9

68.1

70.3

71.3

47.8

82.8

79.0

72.7

48.1

84.5

80.6

Stat

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73.5

46.3

85.2

83.1

55.3

66.0

79.5

84.9

76.6

67.7

53.0

70.0

65.4

74.1

45.9

87.3

82.9

72.9

46.8

83.0

83.4

Nati

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68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

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72.5

78.8

66.5

73.3

57.0

68.7

76.3

82.5

77.0

66.0

43.1

75.8

53.4

72.9

79.2

67.3

73.4

72.0

78.4

65.8

73.2

Nati

onal

%

72.0

48.0

83.7

79.8

58.1

65.8

77.0

82.4

77.0

66.4

60.9

68.1

70.3

71.3

47.8

82.8

79.0

72.7

48.1

84.5

80.6

Stat

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73.2

49.5

85.2

80.2

64.6

66.9

73.8

86.1

74.9

63.1

52.3

66.1 *

72.4

48.6

86.7

76.6

74.1

50.4

84.0

83.3

Nati

onal

%

68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

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71.6

86.5

63.7

67.4

51.7

69.5

78.6

81.5

74.2

51.0

49.2

66.5 *

70.0

85.4

64.5

63.3

73.2

87.6

62.5

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82.4

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66.4

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68.1

70.3

71.3

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48.1

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67.3

47.9

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53.1

64.9

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83.2

74.3

57.5

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59.3

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48.8

80.8

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67.7

46.8

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68.5

77.7

61.8

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48.8

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82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

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68.4

80.4

59.8

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55.7

63.9

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56.7

63.6

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Nati

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65.8

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84.7

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45.4

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79.3

49.5

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68.5

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67.5

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46.7

69.9

67.2

67.6

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79.1

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Nati

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72.0

48.0

83.7

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58.1

65.8

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82.4

77.0

66.4

60.9

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70.3

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72.7

48.1

84.5

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73.9

43.8

84.9

86.1

52.6

64.3

73.4

83.2

79.9

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73.3

41.9

85.6

85.9

74.5

46.0

84.0

86.2

Nati

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68.5

77.7

61.8

67.5

48.8

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76.4

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46.7

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67.2

67.6

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61.9

68.8

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74.8

87.2

68.5

71.5

63.4

61.8

74.8

83.2

81.7

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58.7

76.6

71.4

73.4

86.0

69.5

67.0

76.3

88.6

67.5

76.1

Nati

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72.0

48.0

83.7

79.8

58.1

65.8

77.0

82.4

77.0

66.4

60.9

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70.3

71.3

47.8

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79.0

72.7

48.1

84.5

80.6

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79.1

48.4

92.0

89.8

67.4

70.7

81.8

84.7

82.6

68.9

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65.9

78.8

44.9

93.1

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79.5

51.8

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Nati

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68.5

77.7

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67.5

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76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

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79.1

61.9

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73.5

83.5

65.6

73.9

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83.1

80.2

62.3

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83.7

79.8

58.1

65.8

77.0

82.4

77.0

66.4

60.9

68.1

70.3

71.3

47.8

82.8

79.0

72.7

48.1

84.5

80.6

Stat

e%

75.9

47.3

89.4

83.5

61.0

65.1

79.8

84.2

78.6

69.0

62.8

64.7

* 75.0

43.6

89.2

83.6

76.8

51.0

89.7

83.5

Nati

onal

%

68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

e%

71.8

80.6

64.8

71.9

57.3

62.9

74.2

84.2

76.1

58.5

53.3

63.9

70.0

70.1

78.0

63.0

71.1

73.4

83.2

66.7

72.7

Nati

onal

%

72.0

48.0

83.7

79.8

58.1

65.8

77.0

82.4

77.0

66.4

60.9

68.1

70.3

71.3

47.8

82.8

79.0

72.7

48.1

84.5

80.6

Stat

e%

77.6

50.9

87.1

87.9

61.9

73.4

79.4

84.1

81.0

58.5

52.8

78.1

72.4

77.9

52.9

86.2

88.8

77.3

48.6

88.1

86.9

Nati

onal

%

68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

e%

74.4

86.1

64.2

75.5

51.3

60.0

80.0

83.1

78.9

51.6

46.9

74.1

51.6

75.1

87.8

62.0

77.9

73.6

84.1

66.5

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Teet

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Nati

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72.0

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58.1

65.8

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82.4

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66.4

60.9

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70.3

71.3

47.8

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72.7

48.1

84.5

80.6

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67.1

52.4

75.6

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62.6

62.5

72.8

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52.8

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* 65.8

49.9

75.1

69.5

68.4

54.7

76.2

72.6

Nati

onal

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68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

e%

61.2

67.4

51.2

65.5

49.8

56.3

72.4

81.0

71.0

50.8

63.5

67.9

29.9

62.0

69.6

56.3

61.5

60.4

65.3

45.5

69.6

Nati

onal

%

72.0

48.0

83.7

79.8

58.1

65.8

77.0

82.4

77.0

66.4

60.9

68.1

70.3

71.3

47.8

82.8

79.0

72.7

48.1

84.5

80.6

Stat

e%

69.3

39.8

81.1

80.1

43.4

63.9

74.9

83.5

71.8

59.4

69.4

45.3 *

67.2

35.8

81.3

77.8

71.4

44.0

80.7

82.7

Nati

onal

%

68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

e%

72.0

82.0

64.5

71.6

55.0

64.6

75.0

84.1

75.3

59.4

53.2

62.5 *

68.2

76.0

62.6

67.5

75.9

88.5

66.3

75.7

Teet

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68.8

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83.1

75.2

72.8

43.3

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68.5

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61.8

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48.8

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82.8

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61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

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71.6

77.5

66.2

72.2

56.6

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76.1

84.7

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* 67.3

60.8

53.5

70.4

78.4

63.8

70.3

72.9

76.5

68.4

74.3

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65.8

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60.9

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70.3

71.3

47.8

82.8

79.0

72.7

48.1

84.5

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76.1

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70.4

68.5

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85.3

78.6 *

56.5

72.9 *

75.6

44.5

89.3

85.1

76.6

47.5

87.2

89.1

Nati

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68.5

77.7

61.8

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48.8

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82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

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69.3

79.1

61.9

68.8

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74.0

81.2

68.8

73.7

62.9

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78.1

85.4

77.2

65.8

48.4 * *

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71.8

73.9

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66.4

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70.3

71.3

47.8

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72.7

48.1

84.5

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64.2

36.8

74.6

76.3

39.8

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71.9

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38.8

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34.6

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Nati

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68.5

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61.8

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48.8

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67.6

76.4

61.8

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79.1

61.9

68.8

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60.1

69.9

50.9

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31.5

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54.6

40.1

54.0

56.5

58.7

71.4

46.0

60.7

61.6

68.3

55.7

62.6

Nati

onal

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72.0

48.0

83.7

79.8

58.1

65.8

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82.4

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60.9

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47.8

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79.0

72.7

48.1

84.5

80.6

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80.3

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62.9

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89.0

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51.1

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79.5

50.8

89.4

89.8

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51.8

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Nati

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68.5

77.7

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48.8

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61.1

46.7

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67.6

76.4

61.8

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79.1

61.9

68.8

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78.6

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71.9

78.4

70.8

77.0

77.6

83.6

79.1 *

54.6

76.7 *

75.7

85.0

67.4

76.6

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Teet

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34

The

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67.6

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61.8

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71.7

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69.0

72.4

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56.8

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82.5

79.5

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56.1

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56.8

74.2

78.3

68.8

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68.9

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67.9

Nati

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83.7

79.8

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65.8

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77.0

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71.3

47.8

82.8

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48.1

84.5

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70.2

46.4

82.7

75.9

60.6

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74.7

84.9

74.4 *

67.4 *

65.6

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49.9

83.0

77.1

68.6

42.8

82.5

74.6

Nati

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68.5

77.7

61.8

67.5

48.8

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82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

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69.3

79.1

61.9

68.8

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63.7

73.8

55.0

64.2

47.9

58.6

73.0

81.5

77.6 *

55.8 *

59.9

62.5

72.6

54.7

62.2

64.9

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55.2

66.5

Teet

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79.1

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69.5

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45.3

66.8

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82.2

74.8

69.8

53.8

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85.8

64.6

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67.6

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Nati

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83.7

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70.3

71.3

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72.7

48.1

84.5

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86.2

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50.5

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61.1

46.7

69.9

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67.6

76.4

61.8

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79.1

61.9

68.8

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70.4

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70.5

51.2

61.7

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85.8

76.7

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76.6

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69.7

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80.7

76.4

72.9

48.0

80.7

82.7

Nati

onal

%

68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

e%

69.4

82.0

62.9

66.3

52.4

59.0

73.8

84.9

73.5 *

43.7

70.8

71.8

66.7

80.6

60.6

62.1

72.3

83.6

65.6

70.7

Teet

hCo

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perc

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good

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38

The

Nat

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The

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72.0

48.0

83.7

79.8

58.1

65.8

77.0

82.4

77.0

66.4

60.9

68.1

70.3

71.3

47.8

82.8

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72.7

48.1

84.5

80.6

Stat

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76.9

46.9

89.9

84.8

65.0

70.5

80.4

84.1

78.8

75.5

53.9

75.8

61.4

74.9

43.8

89.7

81.3

78.8

50.0

90.0

88.2

Nati

onal

%

68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

e%

72.8

82.2

67.9

71.2

55.4

68.1

75.7

83.6

75.4

64.4

60.2

74.7

54.6

72.1

80.4

69.5

69.0

73.6

84.0

66.0

73.2

Nati

onal

%

72.0

48.0

83.7

79.8

58.1

65.8

77.0

82.4

77.0

66.4

60.9

68.1

70.3

71.3

47.8

82.8

79.0

72.7

48.1

84.5

80.6

Stat

e%

78.5

49.2

90.0

89.5

60.2

76.5

81.9

85.7

82.5

68.7

59.2

79.3 *

77.0

46.0

90.2

88.5

80.2

52.8

89.9

90.6

Nati

onal

%

68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

e%

71.9

78.3

67.1

72.0

45.5

55.5

78.1

85.0

77.6

69.7

43.4

73.4

61.3

71.3

79.7

66.7

69.4

72.6

76.8

67.6

74.9

Teet

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39

The

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Nati

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68.5

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46.7

69.9

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67.6

76.4

61.8

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69.3

79.1

61.9

68.8

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68.7

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65.2

63.7

53.5

65.8

72.5

85.3

76.5

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44.0

75.4

58.7

66.0

80.2

60.4

60.8

71.4

78.9

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66.4

Nati

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72.0

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83.7

79.8

58.1

65.8

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77.0

66.4

60.9

68.1

70.3

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47.8

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79.0

72.7

48.1

84.5

80.6

Stat

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70.5

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58.1

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74.5

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64.2

50.0

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36.2

84.4

77.2

71.9

44.7

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82.8

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68.5

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48.8

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76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

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79.1

61.9

68.8

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75.4

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48.1

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71.5

52.0

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75.1

66.0

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55.6

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74.9

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85.8

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Nati

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68.5

77.7

61.8

67.5

48.8

60.2

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82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

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79.1

61.9

68.8

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81.5

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* 67.5

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60.7

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Nati

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83.7

79.8

58.1

65.8

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82.4

77.0

66.4

60.9

68.1

70.3

71.3

47.8

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79.0

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65.6

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75.2

69.8

59.2

56.1

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78.4

72.4

67.1

58.9

52.7

67.1

64.4

48.6

73.4

69.0

66.8

51.0

77.2

70.5

Nati

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68.5

77.7

61.8

67.5

48.8

60.2

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76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

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69.3

79.1

61.9

68.8

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61.3

72.6

51.0

61.7

43.1

52.5

69.7

83.8

78.9

56.1

44.0

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52.5

59.9

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50.8

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62.8

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The

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86.1

73.3

50.5

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86.8

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68.5

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48.8

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82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

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e%

70.4

75.3

62.0

74.2

52.4

65.1

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82.1

72.6

* 51.2

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73.8

56.8

72.8

73.6

77.0

68.4

75.4

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onal

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83.7

79.8

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77.0

82.4

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60.9

68.1

70.3

71.3

47.8

82.8

79.0

72.7

48.1

84.5

80.6

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e%

85.7

58.9

94.6

92.9

86.6

80.3

86.7

89.8

86.2 *

73.0

78.4 *

85.0

59.0

93.8

92.1

86.4

58.8

95.5

93.8

Nati

onal

%

68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

e%

79.2

85.9

74.2

79.8

55.9

70.3

84.0

86.2

79.0 * *

81.6 *

76.3

81.9

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77.8

82.4

90.4

77.8

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42

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72.0

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83.7

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65.8

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82.4

77.0

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70.3

71.3

47.8

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72.7

48.1

84.5

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Stat

e%

73.6

48.4

82.6

84.9

69.7

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76.7

81.8

78.5

68.0

57.1

70.4

54.4

71.6

45.1

82.8

82.7

75.8

52.0

82.4

87.2

Nati

onal

%

68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

e%

75.9

87.7

69.2

73.0

63.8

67.3

78.0

84.9

81.1

65.7

64.9

78.3

69.2

75.2

88.9

69.0

70.1

76.6

86.3

69.5

76.0

Nati

onal

%

72.0

48.0

83.7

79.8

58.1

65.8

77.0

82.4

77.0

66.4

60.9

68.1

70.3

71.3

47.8

82.8

79.0

72.7

48.1

84.5

80.6

Stat

e%

76.5

54.8

86.5

83.6

60.0

71.6

80.6

83.9

78.7

78.1

64.1

77.4

75.5

75.2

55.4

86.7

79.9

77.7

54.2

86.2

87.3

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onal

%

68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

e%

71.5

79.1

67.1

69.8

50.9

62.2

76.2

82.2

75.4

74.6

48.4

67.7

74.4

69.3

79.9

61.9

67.8

73.6

78.3

72.1

71.6

Teet

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70.3

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72.7

48.1

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74.8

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85.7

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* 63.0

77.8

78.4

72.3

44.7

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79.1

77.4

56.4

85.4

86.4

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%

68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

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69.3

79.1

61.9

68.8

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e%

73.5

84.1

67.3

71.4

59.2

70.7

82.6

82.6

73.7

59.2

74.3

76.9

* 72.2

87.1

64.3

69.0

75.0

81.1

70.8

74.0

Nati

onal

%

72.0

48.0

83.7

79.8

58.1

65.8

77.0

82.4

77.0

66.4

60.9

68.1

70.3

71.3

47.8

82.8

79.0

72.7

48.1

84.5

80.6

Stat

e%

79.3

55.9

89.9

86.7

58.0

75.4

83.6

87.4

82.8

61.6

53.4 * *

79.1

57.4

89.4

85.8

79.6

54.5

90.4

87.5

Nati

onal

%

68.5

77.7

61.8

67.5

48.8

60.2

75.0

82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

66.2

69.3

79.1

61.9

68.8

Stat

e%

74.9

81.1

68.2

76.5

55.7

67.9

78.5

82.4

78.9

57.2

49.3 *

60.2

74.9

79.2

71.6

74.8

74.8

83.5

64.8

78.2

Teet

hCo

ndit

ion

perc

ent

ofch

ildre

nw

ith

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good

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ion

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itio

n

Prev

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44

The

Nat

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ofCh

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Age

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68.5

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61.8

67.5

48.8

60.2

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82.8

76.4

61.1

46.7

69.9

67.2

67.6

76.4

61.8

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69.3

79.1

61.9

68.8

Stat

e%

69.7

78.6

58.6

73.7

58.5

61.5

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79.4

70.3

* 62.0

* 53.0

67.3

79.1

59.5

66.8

72.2

78.2

57.6

81.0

Teet

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ith

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45

Nati

onal

%

72.0

48.0

83.7

79.8

58.1

65.8

77.0

82.4

77.0

66.4

60.9

68.1

70.3

71.3

47.8

82.8

79.0

72.7

48.1

84.5

80.6

Stat

e%

76.9

48.1

87.7

86.0

68.7

71.4

79.3

85.1

77.6

* 70.8

63.9

88.6

74.2

42.6

86.5

82.8

79.6

53.4

88.8

89.3

Prev

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2005

About the Survey

The National Survey of Children’sHealth (NSCH) was fielded using theState and Local Area IntegratedTelephone Survey (SLAITS) mechanism.SLAITS is conducted by the U.S.Department of Health and HumanServices, Centers for Disease Controland Prevention (CDC), National Centerfor Health Statistics (NCHS). It usesthe same large-scale random-digit-dial sampling frame as the CDC’s NationalImmunization Survey.10

Approximately 1.9 million telephonenumbers were randomly generated for inclusion in the NSCH. After eliminating numbers that weredetermined to be nonresidential ornonworking, the remaining numberswere called to identify householdswith children less than 18 years of age. From each household withchildren, one was randomly selectedto be the focus of the interview.

The respondent was the parent orguardian in the household who wasmost knowledgeable about the healthand health care of the children under18 years of age. For 79 percent of thechildren, the respondent was themother. Respondents for the remainingchildren were fathers (17 percent),grandparents (3 percent), or otherrelatives or guardians (1 percent).Surveys were conducted in Englishand Spanish. Overall, 5.9 percent of the interviews were completed in Spanish.

Data Collection

Data collection began on January 29,2003 and ended on July 1, 2004, withinterviews conducted from telephonecenters in Chicago, Illinois; Las Vegas,Nevada; and Amherst, Massachusetts.A computer-assisted telephone inter-viewing system was used to collectthe data. A total of 102,353 interviewswere completed for the NSCH, with 87percent of the interviews completedin 2003. The number of completedinterviews varied by State, rangingfrom 1,848 in New Mexico to 2,241 in Louisiana and Ohio, with oneexception: Only 1,483 interviews were completed in Utah. More than2,000 interviews were completed in 25 States.

The cooperation rate, which is theproportion of interviews completedafter a household was determined to include a child under age 18, was68.8 percent. The national weightedresponse rate, which includes thecooperation rate as well as the resolu-tion rate (the proportion of telephonenumbers identified as residential ornonresidential) and the screeningcompletion rate (the proportion ofhouseholds successfully screened for children), was 55.3 percent.

Overall response rates ranged from49.6 percent in New Jersey to 64.4percent in South Dakota. Severalefforts were made to increaseresponse rates, including sending letters to households in advance tointroduce the survey, toll-free num-bers left on potential respondents’answering machines to allow them to call back, and small monetaryincentives for those households with children who initially declinedto participate.

Data Analysis

In order to produce the population-based estimates in this report, thedata records for each interview wereassigned a sampling weight. Theseweights are based on the probabilityof selection of each household tele-phone number within each State,with adjustments that compensate for households that have multipletelephone numbers, for householdswithout telephones, and for nonresponse.

With data from the U.S. Bureau of the Census, the weights were alsoadjusted by age, sex, race, ethnicity,household size, and educationalattainment of the most educatedhousehold member to provide adataset that was more representativeof each State’s population of non-institutionalized children less than 18 years of age. Analyses were conducted using statistical softwarethat accounts for the weights and thecomplex survey design. Responses of“don’t know” and “refuse to answer”were counted as missing data.

Racial and ethnic groups aremutually exclusive; that is, datareported for White, Black, multiracialand children of other races do notinclude Hispanics, who may be of any race.

Introduction

47

The National Survey of Children’s Health

Technical Appendix

Endnotes

1 U.S. General Accounting Office. Oral Health: DentalDisease is a Chronic Problem Among Low-Incomeand Vulnerable Populations. Washington, DC: U.S. General Accounting Office, 2000.

2 National Maternal and Child Health Oral HealthResources Center, Georgetown University. Oral health and learning: when children’s health suffers,so does their ability to learn. 2003. Available from:www.mchoralhealth.org

3 U.S. Department of Health and Human Services. Oral health in America: a report of the SurgeonGeneral. Rockville, MD: National Institute of Dentaland Craniofacial Research, 2000.

4 American Dental Association. ADA Statement on Early Childhood Caries. Chicago, IL: The Association 2000.

5 Casamassimo P, Holt K. Bright Futures in Practice:Oral Health—Pocket Guide. Washington, DC:National Maternal and Child Oral Health ResourceCenter; 2004.

6 American Academy of Pediatric Dentistry. Policy on early childhood caries (ECC): classifications, consequences, and preventive strategies. Chicago,IL: The Academy; 2004-2005.

7 American Academy of Pediatrics. Oral health riskassessment timing and establishment of the dentalhome. Pediatrics 2003 May; 111(5): 1113-6.

8 McPherson M, Arango P, Fox H, Lauver C, McManus M, Newacheck P, Perrin J, Shonkoff J, Strickland B. A new definition of children with special health care needs. Pediatrics1998;102(1): 137-140.

9 Casamassimo P. Bright Futures in Practice: Oral Health. Arlington, VA: National Center forEducation in Maternal and Child Health, 1996.

10 Zell ER, Ezzati-Rice TM, Battaglia MP, Wright RA. National immunization survey: the methodology of a vaccination surveillance system. Public HealthReports 115:65-77. 2000.

11 Blumberg SJ, Olson L, Frankel M, et al. Design and Operation of the National Survey of Children’sHealth, 2003. National Center for Health Statistics.Vital Health Stat 1(43). 2005.

Accuracy of the Results

The data from the NSCH are subjectto the usual variability associated with sample surveys. Small differencesbetween survey estimates may be dueto random survey error and not totrue differences among children oracross States.

The precision of the survey esti-mates is based on the sample size andthe measure of interest. Estimates atthe national level will be more precisethan estimates at the State level.Estimates for all children will be moreprecise than estimates for subgroupsof children (for example, children 0-5 years of age or children withinthe same race). For national estimates of the health and health care for allchildren, the maximum margin of erroris 0.6 percent. For the State-levelindicators for all children, the maxi-mum margin of error is 3.0 percent.

Availability of the Data

Except for data suppressed to protectthe confidentiality of the survey subjects, all data collected in theNSCH are available to the public onthe NCHS and Maternal and ChildHealth Bureau Web sites. Data docu-mentation and additional details on the methodology11 are availablefrom the NCHS:www.cdc.gov/nchs/slaits.htm

Interactive data queries are possiblethrough the Data Resource Center on Child and Adolescent Health (DRC)for the NSCH: www.nschdata.org

The DRC provides immediate access tothe survey data, as well as resourcesand assistance for interpreting andreporting findings.

The National Survey of Children’s Health

Introduction

48

The National Survey of Children’s Health

Maternal and Child Health Bureau5600 Fishers Lane, Room 18-05Rockville, MD 20857301-443-2170www.mchb.hrsa.gov