Dispelling the myth that 50 percent of U.S. schoolchildren have never had a cavity.

The erroneous claim that 50 percent of U.S. schoolchildren have never had a cavity has taken on the virtues of truth through frequent and widespread restatement. The 50-percent caries-free statement is an excessively optimistic misrepresentation by the media of the 1986-87 survey of oral health among schoolchildren by the National Institute of Dental Research because it only tells part of the story--it ignores dental disease in the primary dentition. This article documents that numerous public policy papers reflect failure to consider primary tooth caries data. Consequently, a significant disease burden has been overlooked. The article reviews the persistent underreporting of children's caries experience in policy documents and the dental literature, and reviews additional epidemiologic studies of caries reported in U.S. dental literature since 1985. Dental caries remains the single most common disease of childhood that is not self-limiting or amenable to a course of antibiotics. The popular statement that half of U.S. schoolchildren have never experienced tooth decay fails profoundly to reflect the extremity and severity of this still highly prevalent condition of childhood. At a time of extreme pressure on the Medicaid Early and Periodic Screening, Diagnosis, and Treatment budget this uncritically held belief is leading to inappropriate policy and funding decisions that can put the health of children at risk.