The authors examined trends in the utilization of oral health services in the United States from 1997 to 2010, including breakdowns by age and poverty level. They examined trends in one major driver of utilization: insurance coverage. The results suggest that the recent economic downturn did not result in an overall decrease in the utilization of dental services. Rather, the findings suggest an earlier decline from 2003 to 2008. In this article, the authors report that the overall trend masked significant variation by age and poverty level. Among children, there was steady growth in utilization from 1997 to 2010. This appears to have coincided with a shift away from private insurance toward public coverage and a significant drop in the percentage of uninsured children. Among non-elderly adults, however, utilization has been falling steadily since 1997 among all but the wealthiest income group. During the great recession from December 2007 to June 2009, the decline in utilization accelerated among those in the lowest income group. The decrease in adult utilization appears related to a decrease in private insurance coverage and an increase in public coverage and noninsured rates. As a consequence of these trends in coverage, the authors predict a continued decline in the utilization of dental services among non-elderly adults.