RESEARCH NOTE

Factors Influencing Interstate Variation in Tooth Loss

Joshua Hall

Published online: 24 January 2008# International Atlantic Economic Society 2008

JEL I18

The term for the loss of all natural permanent teeth is edentulism. In 2004, theCenters for Disease Control and Prevention (CDC) released data on the edentulismrate by state (2004 Behavioral Risk Factor Surveillance System Survey). Measuredas a percentage of state residents over 65, the edentulism rate for the average statewas 22.1%. West Virginia had the highest rate of complete tooth loss at 42.8% andConnecticut had the lowest rate at 13.5%.

The high edentulism rate in West Virginia is surprising given that the state hasfluoridation rates well above the national average. According to the CDC, 91.5% ofWest Virginians live in areas with fluoridated water compared to 70% in the averagestate. This suggests that other factors besides access to fluoridated water must becontributing to the high rate of edentulism in West Virginia.

The medical literature points to several possible reasons for tooth loss in additionto water fluoridation. Income, poverty status, limited access to dental care due togeography, poor attitudes towards dental care and smoking have all been linked totooth loss. A review of the literature found no studies examining the determinants ofinterstate variation in edentulism. To better investigate the role of each of thesefactors in determining why some states have high rates of tooth loss and others donot, I regressed the edentulism rate by state against the following variables: thepercentage of adults with a bachelor’s degree or higher, the elderly poverty rate, stateper capita personal income, urban population percentage, percentage of residents thatare everyday smokers, and the percentage of the population with fluoridated water(Data, sources, and results at: http://joshua.c.hall.googlepages.com/papers/).

Int Adv Econ Res (2008) 14:262–263DOI 10.1007/s11294-008-9139-x

J. Hall (*)Beloit College, 700 College St, Beloit, WI 53511, USAe-mail: halljc@beloit.edu

The adjusted r-squared of the regression was 0.66. The most surprising result isthe statistical insignificance of water fluoridation (t-stat=0.09). The two statisticallysignificant variables are the percentage of everyday smokers (t-stat=3.82) which ispositively related to the edentulism rate and the percentage of state residents living inurban areas (t-stat=−2.46) which is negatively related. These results suggest that theprimary reason why edentulism is so prevalent in West Virginia is because of its highrate of everyday smokers (21% according to the 2004 Behavioral Risk FactorSurveillance System Survey) and poor geographic access to dental care because ofits rural nature (only 46.1% urban; 2007 US Statistical Abstract).

International Advances in Economic Research 263