Pearl AI Study: US Caries Rates Vastly Underreported

Los Angeles-based dental AI company Pearl has released the Pearl Oral Health Index, described as the first large-scale radiographic census of oral health in the US, revealing untreated caries at 4.5 times previous national estimates. Announced on 10 August 2026, the analysis used FDA-cleared AI technology to review radiographs from more than 26 million dental visits, providing the largest population-level radiographic assessment of American oral health completed to date.

The index analysed radiographic data from April 2024 to March 2026, covering approximately 15 million adults and 737 million tooth observations. Untreated caries appears at least 4.5 times more common than the figure reported by the US CDC’s NHANES survey, which relies on visual and tactile examinations, while the average number of decayed teeth per patient identified by Pearl’s AI was 8.7 times the NHANES figure. Notably, missing and restored teeth counts closely matched government estimates, lending credibility to the AI methodology. The discrepancy is consistent with peer-reviewed research showing radiographs reveal proximal caries and hidden lesions that visual and tactile examination frequently miss.

The analysis also identified significant geographical inequalities, with extraction of caries-affected teeth about 40% more common in areas described as “dental deserts” than in better-served regions. A UK comparison suggested that different healthcare funding models influence whether severely damaged teeth are restored or extracted. Pearl positions the data as informing public health policy, dental education, insurance quality measures and future research. The release builds on Pearl’s October 2025 partnership with Dentsply Sirona for AI-assisted radiographic support and its August 2024 $58 million Series C funding round.

The commercial signal is a maturing dental AI diagnostics category increasingly positioned as public health and policy infrastructure rather than just chairside decision support. Pearl’s scale-of-data advantage strengthens its competitive positioning against BeCertain, Overjet, VideaHealth, Diagnocat and Denti.AI. Expect dental insurance payers, DSOs and public health bodies to accelerate procurement of AI radiographic analytics through the rest of 2026 and 2027.

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