Amir SohailLOS ANGELES, (ZM NEWSWIRE) — Pearl, the global leader in dental AI solutions, today released the Pearl Oral Health Index, unlocking key insights across age, location, gender, and more in the most comprehensive radiographic census of American oral health ever produced. Using its FDA-cleared AI platform to read dental x-rays at scale, Pearl analyzed more than 26 million dental x-rays across 15 million unique patients, and 737 million individual teeth. This represents a dataset so vast it has, for the first time in history, made the collective reality of the American mouth legible. The data both reveals and challenges assumptions about who gets sick, who gets treated, and why.
Until now, dental research has largely relied on small-sample surveys. X-rays, which are the single richest source of oral health information, have been locked away in tens of millions of isolated patient files, impossible to aggregate or compare. Pearl is the first dental AI platform to read, analyze, and measure them at population scale.
“For the first time, we can see what’s actually happening inside the mouths of America, not through a survey, not through a sample, but through the raw radiographic truth of tens of millions of visits,” said Ophir Tanz, founder and CEO, Pearl. “The picture is dramatically different from what the public data has told us for decades. There is more disease, more inequality, and more variability in care than anyone realized. AI didn’t create this problem, but it finally let us measure it.”
Key Findings
The X-Ray Gap: America’s cavity problem is at least 4.5 times worse than federal data suggests
The CDC’s NHANES, the gold-standard U.S. government oral health survey of just 25,000 participants, uses mirrors and probes in mobile clinics and estimates that roughly 21 percent of American adults have untreated decay. Pearl’s AI, reading radiographs of 15 million participants, finds the real figure is at least 4.5 times higher.
- Decayed teeth per patient: Pearl 6.07 vs. NHANES 0.7. This reflects an 8.7x gap in detected decay.
- Missing teeth per patient: Pearl 2.16 vs. NHANES 2.0. This near-perfect match gives credence to Pearl’s methodology, since empty sockets are visible to both a probe and an x-ray.
- Restored teeth per patient: Pearl 7.01 vs. NHANES 6.0. Like missing teeth, restorations are generally visible to the naked eye, so the near-alignment here likewise supports Pearl’s methodology.
X-rays can reveal demineralization at 30–60 percent mineral loss, which is well before a cavity is visible to the eye. The difference is not a methodological quirk; it is the cost of measuring the nation’s oral health with instruments that were state-of-the-art in the 19th century. Of note, everyone in Pearl’s dataset was already in a dental chair, meaning the true spread in the general population is likely even higher.
Young adults have the most neglected mouths; older adults have the most managed
- Ages 18–24: 52 percent or more than half of all dental disease in young adults is untreated. These are the most neglected mouths in the dataset.
- Crossover between ages 35–44: Fillings finally overtake untreated decay. This is when most people evolve from neglect to managing their oral health.
- Ages 75+: The number of teeth showing signs of decay, loss, or restoration rises to 19.14 out of 28 teeth, meaning over two thirds of teeth have had an issue. Only 28 percent of that damage is untreated. By the time a person hits 75 years old, their mouth is not healthier, but it is more managed.
The Geography of the American Mouth
Where a person lives shapes not just whether they get sick, but what happens when they do. A look at the states with the best and worst oral health include:
- Lowest disease burden: Hawaii (9.63 teeth showing signs of decay, loss, or restoration; lowest calculus at 45.0 percent; fewest extractions).
- Highest disease burden: Delaware (14.22 showing signs of decay, loss, or restoration; calculus 62.6 percent).
- Highest tartar buildup: New Jersey (67.7 percent of patients). This is a 23-point spread vs. Hawaii on a single hygiene indicator.
- Highest rate of extraction: Kansas, where nearly 1 in 10 affected teeth was extracted rather than restored.
The Dentist Lottery: A 4x gap in what two offices on the same block may diagnose
Across 282 dental offices each seeing 200+ adult patients, the 10th-percentile practice finds 3.1 affected teeth per patient, while the 90th-percentile practice finds 12.4 — a 4x gap. Within single zip codes, Pearl identified a 9.2 percentage-point average spread in D-Load (the share of decay left untreated) between neighboring offices, with the top 10 percent of zip codes showing spreads of 17.8 points. Pearl’s AI analyzed every x-ray; what varied was how practices responded to what it found. This is not a disease gap, rather it is a training, awareness, and diagnostic consistency gap.
Dental Deserts: Patients in zip codes with zero dentists lose 40 percent more teeth
Pearl matched zip-code data against the National Provider Identifier (NPI) registry of 180,974 U.S. dental practices and 295,509 dentists. In zip codes with zero dentists, 20.8 percent of affected teeth have been extracted. In zip codes with 51+ dentists, only 14.9 percent are extracted, which marks a 40 percent higher rate of tooth loss in so-called dental deserts. Patients in these communities are not going untreated longer; when they finally receive care, they lose the tooth entirely, which often comes down to affordability. In many cases prevention and treatment comes at a higher cost than extraction.
The Access Signal: American women are 28 percent more likely to visit a dentist than men
In the U.S. dataset, women make up 56.2 percent of patients and men 43.8 percent. Under the U.K.’s National Health Service (NHS), the split is exactly 50/50. Once men and women are in the chair, their clinical numbers are remarkably similar (e.g. female’s untreated rate of 31.4 percent vs. male 33.9 percent). The real gap is not in the mouth — though men do have a higher rate of calculus (1.99 vs. 1.67), or teeth with tartar build up, whereas women tend to have more fillings (7.97 vs. 7.37) — it’s in who makes it through the door.
Two Countries, Two Dental Systems, Two Completely Different Mouths
The data shows that when disease is found, Americans restore and the British extract:
- U.S. patients average 2.16 missing teeth. U.K. patients average 6.36 — roughly 3x more.
- In the U.S. the share of affected teeth extracted sits at 14.5 percent whereas in the U.K. that number’s ~31 percent.
U.S. fee-for-service insurance incentivizes restoration; in the U.K., NHS budget constraints make extraction the more accessible option when a tooth is severely compromised. Neither is objectively superior. But the radiographic evidence shows the two systems produce fundamentally different outcomes in peoples’ mouths.
Why This Matters Now
Oral health is among the last corners of American medicine to be digitized, standardized, and studied at scale. The Pearl Oral Health Index closes that gap in a single step. By applying a consistent, FDA-cleared AI detection model to this volume of x-rays, Pearl has produced the first objective, comparable, population-level picture of what is actually happening inside millions of mouths and how various dental systems respond to it.
The Index’s findings have immediate implications for public-health policy, insurer quality metrics, dental-school curricula, and patient expectations. And it establishes a new baseline against which every future change, including new therapies, new policies, and expanded access, can be measured.
About the Data
The Pearl Oral Health Index draws on two complementary datasets, both covering adults 18+, all 51 U.S. states (including D.C.) and the U.K., using a 28-tooth universe (excluding wisdom teeth) across April 2024 to March 2026:
- FMX Series Dataset: 1.49 million patients with complete full-mouth x-ray series analyzed by Pearl. This is the authoritative source for DMF (average 15.24 of 28 teeth affected, composed of 6.07 decayed, 2.16 missing and 7.01 filled). Its missing-teeth figure matches NHANES almost exactly, validating the methodology.
- Expanded Encounters Dataset: 14.8 million patients and 26 million tooth-level dental encounters, powering state-level analyses, gender comparisons, tooth-by-tooth vulnerability timelines, and 4.26 million longitudinal tooth transitions.
You can access the full version of the Pearl Oral Health Index here: https://hellopearl.com/oral-health-index
About Pearl
Pearl is a dental AI company committed to enhancing how patient care is delivered. Founded in 2019 by a team with decades of experience developing successful, enterprise-grade computer vision solutions, Pearl introduced the first-ever FDA-cleared AI capable of reading and instantly identifying diseases in dental x-rays. With regulatory clearance in 120 countries, Pearl’s AI assists dentists in making precise clinical decisions and effectively communicating with patients, thereby transforming the dental care experience worldwide. As dentistry’s global AI leader, Pearl is committed to the ongoing innovation of robust, accessible AI tools that improve patient health outcomes and build greater trust in dental medicine. To request a demo, please visit hellopearl.com/demo
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