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Dental, Oral and Craniofacial
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Oral Health, U.S. 2002 Annual Report

Surveillance systems collect timely, accurate, representative data to track the status of populations. A comprehensive surveillance system allows use of these data to provide early warning of changing conditions. This can alert those involved with public health programs and policy formation and implementation that interventions or programs may be necessary to prevent increased disease levels and associated costs. Surveillance of oral health can be looked upon as occurring in three ways: as part of national overall health surveillance systems, as part of state-based surveillance systems that may focus on total health or other aspects of overall health and include an oral health component, and through national, state, or local data collection efforts focused solely or primarily on oral health.

Oral health is an integral part of overall health. As such, surveillance of oral health is frequently best accomplished as a component of an overall health surveillance system. There are a number of nationally representative surveillance efforts with an oral health component (Table 8.0.1) including:

  • National Health and Nutrition Examination Surveys (NHANES)
  • National Health Interview Survey (NHIS)
  • Medical Expenditure Panel Survey�Household Component (MEPS-HC)
  • Surveillance, Epidemiology, and End Results (SEER)
  • National Natality Survey (NNS)
  • National Hospital Ambulatory Medical Care Survey (NHAMCS)

Data with an emphasis on the ability to produce estimates for state and local levels are particularly important to improving oral health since oral health is often addressed through population-based programs at the state or local level. A number of surveillance efforts implemented at the state level have oral health components (Table 8.0.2). These include:

  • Behavioral Risk Factor Surveillance System (BRFSS)�surveys adults aged 18 and older, included oral health questions in the core in 1999 and again in 2002 (providing nationally representative data collected at the state level), offers an optional module with further oral health questions, and allows state-added oral health questions.
  • National Program of Cancer Registries (NPCR)�tracks oral and pharyngeal cancers among other cancers.
  • National Vital Statistics System (NVSS)�records oral and craniofacial anomalies on birth certificates.
  • Pregnancy Risk Assessment Monitoring System (PRAMS)�states may include questions about dental visits and problems.
  • Water Fluoridation Reporting System (WFRS)�a tool for water fluoridation program management, which provides states with many reports, including an annual report that serves to track fluoridation status.
  • Youth Risk Behavior Surveillance System (YRBSS)�survey of high school students, includes tobacco questions and a question about last dental visit.

A number of states also implement state or local surveys of oral health. Some are based on the Association of State and Territorial Dental Directors (ASTDD) Basic Screening Survey (BSS). States may modify the ASTDD BSS or components of any of the surveys described above in their own surveillance efforts. The ASTDD BSS is a survey with core questions and clinical examination items for three age groups: preschool, school age, and adult. It focuses on caries experience, untreated tooth decay, and sealants, with age-specific questions on early childhood caries and total tooth loss. Additional questions or clinical exam items can be added to meet state information needs. Data are not currently available on the number of states with independent oral health surveillance systems.

Table 8.0.1. Federal, nationally representative surveillance systems with an oral health component

This table lists the survey titles of different federal, nationally representative surveillance systems in the first column, the agency that sponsors that system, the year(s) of the most recently available data, the age ranges of the participants, all oral health-related variables included in the system, and the web address for the system.

Survey Title Agency* Most Recent Data Participant Age Range Oral Health Variables URL
NHANES III NCHS, CDC 1988�1994 2 months + clinical dental exam outcomes, tobacco, oral hygiene, denture ownership and use, edentulism, dental visits, perceived oral health status, medical history
NHIS NCHS, CDC 1999 All ages access to dental care, dental insurance, eating, edentulism, fluoride, frequency of dental visits, missing teeth, oral cancer, orofacial pain, sealants, tobacco  
MEPS-HC AHRQ Depends on file All ages dental care utilization, dental services received, eating, edentulism, medications, orofacial pain, reason for last dental visit, soft tissue lesions, traumatic injuries 
SEER NCI, NIH 1999 All ages oral cancer
NNS NCHS, CDC 1999 New births craniofacial anomalies
NHAMCS NCHS, CDC 1999 All ages emergency room visits including diagnoses, dental services received, types of health care providers seen, satisfaction with care

*NCHS, CDC = National Center for Health Statistics, Centers for Disease Control and Prevention
AHRQ = Agency for Healthcare Research and Quality
NCI, NIH = National Cancer Institute, National Institutes of Health

Table 8.0.2. State-based health surveillance systems with an oral health component

This table lists the survey titles of different state-based oral health surveillance systems in the first column, the source/agency of the system, the year(s) of the most recently available data, the age ranges of the participants, the geographic scope of the system, all oral health-related variables included in the system, and the web address for the system.

Surveillance System Source* Most Recent Data Participant Age Range Geographical Scope Oral Health Variables URL
BRFSS NCCDPHP, CDC 2000 18 years and older The BRFSS consists of core components, optional modules, and state-added questions. The core components are administered in all states. Each state decides whether to include optional modules in its state data collection. States can also add additional questions relevant to their needs.

2001 Oral health optional module: Arizona, Idaho, Iowa, Missouri, Nebraska, New Hampshire, North Carolina, North Dakota, Pennsylvania, Rhode Island, South Carolina, Washington, Wisconsin, Virginia

2001 Oral health state added questions:  Kansas, Massachusetts, Ohio, South Dakota, Utah, Washington
2001 Core (all states): tobacco use Oral health optional module: dental care, dental insurance, edentulism, last dental visit, reason for not visiting a dentist

Note: In the 2002 version, oral health will be included in the core of the questionnaire administered in all states.    
NPCR NCCDPHP, CDC 2001 All ages The District of Columbia, 45 states, and 3 territories, currently receive funding related to participation in the NPCR. Forty-five programs receive funding to enhance current statewide central cancer registries, and four to plan registries. The five remaining states (Connecticut, Hawaii, Iowa, New Mexico, and Utah) are funded through the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program. Oral and pharyngeal cancer
NVSS NCHS, CDC 2000 Natality- new births Nationally representative Oral and craniofacial anomalies
PRAMS NCCDPHP, CDC 1998 Pregnant women 2000 Alabama, Alaska, Arkansas, Colorado, Delaware, Florida, Georgia, Hawaii, Illinois, Louisiana, Maine, Maryland, Michigan, Minnesota, Mississippi, Montana, Nebraska, New Jersey, New Mexico, New York, New York City, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Texas, Rhode Island, South Carolina, Utah, Vermont, Washington, West Virginia   All states: smoking Some states: dental visit, dental problems, dental care education New York City: preventive care, dental problems, visit to a dentist, access to care, dental care education
WFRS NCCDPHP, CDC 2000 Not applicable Nationally representative Fluoridation
YRBSS NCCDPHP, CDC 1999 Grades 9�12 Nationally representative Cigarettes, smokeless tobacco, tobacco, smoking

* NCHS, CDC= National Center for Health Statistics, Centers for Disease Control and Prevention
NCCDPHP, CDC = National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention.



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