Table of Contents

Component Description

NHANES is critical for monitoring oral health status, risk indicators for disease, and access to preventive and treatment services. Oral health data from NHANES may be used for:

The oral health examination component provides information on a number of oral health topics including tooth count, dental caries, dental sealants, dental fluorosis, periodontal pockets, recession, and loss of attachment, and recommendations for dental care. These data are released in multiple data files.

This data documentation specifically provides information on the following three data files:

In 2013-2014, a dental fluorosis clinical assessment was also conducted as part of the NHANES oral health exam. The fluorosis data are available in separate datasets. Fluorosis clinical assessment data from participants aged 6-19 years are available publically through the NHANES website (i.e., Fluorosis – Clinical, FLXCLN_G). Fluorosis clinical data collected in 2014 for participants aged 20-29 years are available through the NCHS Research Data Center (i.e., Fluorosis - Clinical 20-29 Years, FLXC_H_R), due to disclosure concerns. For more information on the dental fluorosis clinical assessment data, please refer to the documentation accompanying these datasets.

In addition to the oral health examination data, oral health questionnaire data are collected during the household interview. For information on these data please refer to the documentation for the Oral Health Questionnaire (OHQ) section.

Eligible Sample

All survey participants 1 year and older were eligible for the oral health examination.

Participants aged 30 years and older were eligible for the periodontal examination if they had one or more natural teeth and no health condition requiring antibiotic prophylaxis before periodontal probing. Based on the 2008 American Dental Association guidelines, participants who reported that they had a heart transplant, an artificial heart valve, congenital heart disease (not including mitral valve prolapse), or ever had bacterial endocarditis were excluded from the periodontal examination.

Protocol and Procedure

The oral health examination was conducted by dental examiners, who were dentists (D.D.S./D.M.D.) licensed in at least one U.S. state. A health technician assisted in entering all examiner observations directly into a computerized data collection system. All oral health assessments took place in a designated room at the mobile examination center (MEC) that included a portable dental chair, light, and compressed air.

For all survey participants aged 1 and older, the oral health examination began with a tooth count assessment. Next, their teeth were assessed for dental caries, including untreated dental decay and teeth treated or extracted due to caries. For children and adolescents aged 3 to 19 years, eligible teeth were assessed for the presence of dental sealants. In 2013-2014, the tooth count, dental caries, and dental sealants assessments followed the same protocols conducted in 1999-2004 and 2011-2012.

Adults aged 30 years and older were eligible for a full-mouth periodontal examination (FMPE) that included an assessment of gingival recession and pocket depth measures. The FMPE protocol was introduced in NHANES in 2009-2010 and has remained the same through 2013-2014.

Please refer to the NHANES Oral Health Examiners Manual for detailed information regarding data collection protocols for the 2013-2014 oral health component.

Quality Assurance & Quality Control

The specific QA practices for the oral health examination are documented in detail in the NHANES Oral Health Examiners Manual.

All dental examiners received an initial training, which consisted of lecture, model review, practice simulations and standardization sessions. Following successful initial training, examiners received field training at the MEC consisting of more practice simulation, standardization, and calibration sessions.

There are three main activities employed to facilitate the ongoing collection of quality oral health data on NHANES. To reduce data recording errors, all data are directly entered into an electronic data management system and automated data management utilities are used to check for out of range values at the time of entry. NHANES staff periodically conduct observations of the data collection to ensure that protocols are followed. Finally, the reference examiner visits each dental examiner 2-3 times a year and conducts about 20 replicate exams during each visit. Data from these replicate exams were used to produce inter-rater reliability statistics to objectively evaluate examiner agreement. Although dental examiners were aware of the inter-rater evaluations being conducted, examiners are blinded to each other’s observations. Because all inter-rater reliability statistics were calculated after the MEC evaluation visits, the findings were unavailable for real time use. However, all examiners did receive general feedback pertaining to their performance immediately following each evaluation visit by the reference examiner. An annual retraining session was conducted to reinforce existing protocols and to introduce protocol updates, if needed.

Inter-rater reliability statistics including percent agreement, Kappa statistics, and inter-class correlation coefficients for the 2011-2014 oral health data are available elsewhere (Dye et al., 2019).

Data Processing and Editing

Frequency counts were checked and data values were reviewed prior to data release.

Analytic Notes

The dentition, periodontal, and recommendation of care data files can be linked using the unique survey participant identifier, SEQN. In addition to the examination data, self-reported data on oral health related topics are available in the Oral Health questionnaire (OHQ) section collected as part of the household interview. These data can be linked using the SEQN as well. Although the OHQ data were collected as part of the household questionnaire, if they are merged with the MEC exam data, exam sample weights should be used for the analyses. Please refer to the NHANES Analytic Guidelines and the online NHANES Tutorial for further details on the use of sample weights and other analytic issues.

If data from this release are combined with oral health data from previous data cycles for analyses, users should understand that methodological differences (in data collection) may exist among similar, earlier assessments and may bias the analysis conducted.

References

Codebook and Frequencies

SEQN - Respondent sequence number

Variable Name:
SEQN
SAS Label:
Respondent sequence number
English Text:
Respondent sequence number.
Target:
Both males and females 1 YEARS - 150 YEARS

OHDEXSTS - Overall Oral Health Exam Status

Variable Name:
OHDEXSTS
SAS Label:
Overall Oral Health Exam Status
English Text:
Overall Oral Health Exam Status
Target:
Both males and females 1 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Complete 8633 8633
2 Partial 333 8966
3 Not Done 456 9422
. Missing 0 9422

OHDRCSTS - Recommendation Care Status Code

Variable Name:
OHDRCSTS
SAS Label:
Recommendation Care Status Code
English Text:
Recommendation Care Status Code
Target:
Both males and females 1 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Complete 8938 8938
2 Partial 0 8938
3 Not Done 484 9422
. Missing 0 9422

OHAREC - Overall recommendation for care

Variable Name:
OHAREC
SAS Label:
Overall recommendation for care
English Text:
Overall recommendation for care
Target:
Both males and females 1 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 See a dentist immediately 2 2
2 See a dentist within the next 2 weeks 433 435
3 See a dentist at your earliest convenience 3080 3515
4 Continue your regular routine care 5423 8938
. Missing 484 9422

OHAROCDT - Decayed teeth

Variable Name:
OHAROCDT
SAS Label:
Decayed teeth
English Text:
Decayed teeth
Target:
Both males and females 1 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 2312 2312
2 No 13 2325
. Missing 7097 9422

OHAROCGP - Gum disease/problem

Variable Name:
OHAROCGP
SAS Label:
Gum disease/problem
English Text:
Gum disease/problem
Target:
Both males and females 1 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 1868 1868
2 No 12 1880
. Missing 7542 9422

OHAROCOH - Oral hygiene

Variable Name:
OHAROCOH
SAS Label:
Oral hygiene
English Text:
Oral hygiene
Target:
Both males and females 1 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 1764 1764
2 No 3 1767
. Missing 7655 9422

OHAROCCI - Impression of soft tissue condition

Variable Name:
OHAROCCI
SAS Label:
Impression of soft tissue condition
English Text:
Clinical impression of soft tissue condition
Target:
Both males and females 1 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 26 26
2 No 11 37
. Missing 9385 9422

OHAROCDE - Denture/Partial Denture/Plates

Variable Name:
OHAROCDE
SAS Label:
Denture/Partial Denture/Plates
English Text:
Denture/Partial Denture/Plates
Target:
Both males and females 1 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 368 368
2 No 6 374
. Missing 9048 9422

OHARNF - No significant findings

Variable Name:
OHARNF
SAS Label:
No significant findings
English Text:
No significant findings
Target:
Both males and females 1 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 5424 5424
2 No 24 5448
. Missing 3974 9422

OHAROTH - Some other finding (specify w/referral)

Variable Name:
OHAROTH
SAS Label:
Some other finding (specify w/referral)
English Text:
Some other finding (specify w/referral letter)
Target:
Both males and females 1 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 2 2
2 No 0 2
. Missing 9420 9422

OHAPOS - Was participant exam position recumbent

Variable Name:
OHAPOS
SAS Label:
Was participant exam position recumbent
English Text:
Was the SP in a recumbent (laying down) position for all eligible assessments of the oral health exam?
English Instructions:
Was the SP in a recumbent (laying down) position for all eligible assessments of the oral health exam (Oral-facial--Loss of Attachment)?
Target:
Both males and females 1 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 8301 8301
2 No 272 8573
. Missing 849 9422