NHANES is critical for monitoring oral health status, risk indicators for disease, and access to preventive and treatment services. This component will address public health significance in areas of surveillance, prevention, treatment, dental care utilization, health policy, evaluation of Federal health programs, standardization of new methods, and oral health disparities.
Oral health data from NHANES will be used for:
- Assessing the prevalence of major oral health diseases and conditions including dental caries, periodontal disease, dental trauma, dry mouth, and dental fluorosis
- Assessing prevention and treatment efforts including the prevalence of dental sealants
- Evaluating specific public health programs/new policies and initiatives
- Monitoring the oral health status of minority/underserved populations
- Evaluating Healthy People 2000 and 2010 objectives related to oral health
- Supporting research activities as identified in the 2000 Surgeon General’s Report on Oral Health in the United States
All survey participants 2 years and older were eligible for the basic oral health questions administered during the Home Interview. These questions included topics covering dental care and visits. Additional detailed questions concerning oral health status and perceived needs where asked to participants’ 16 years and older.
Interview Setting and Mode of Administration
The following subcomponents are from the oral health examination component and home interview component with the age groups of interest in parentheses:
- Dry mouth and problems with chewing food (18 years and older)
- Dental health perception, dental visits and dental care utilization (2 years and older)
- Oral health quality of life (16 years and older)
- Perceived dental treatment needs (18 years and older)
- Medical history screening (13 years and older)
- Dental sealant assessment (2 to 34 years of age)
- Tooth count (2 years and older)
- Coronal caries (2 years and older)
- Incisor traumatic injuries (10 to 29 years of age)
- Dental fluorosis assessment (6 to 49 years of age)
- Periodontal pockets, recession, loss of attachment, and bleeding (13 years and older)
- Root caries (18 years and older)
- Dental erosion and tooth wear (13 years and older)
- Functional occlusal contacts (25 years and older)
- Self-assessed dental condition questions (16 years and older)
- Denture use and wear questions (25 years and older)
- Recommendations for dental care (2 years and older)
Survey Staff and Protocol
A trained household interviewer administrated these questions to the survey participant during the household interview. The information was recorded using a computer-assisted personal interview (CAPI) system. Some of the questions in the OHQ section required the use of printed hand cards. When necessary, the household interviewers read the hand card selections to the respondent.
Interview and examination protocols are discussed in detail in the NHANES Oral Health Home Interview and Exam Training Manuals. These manuals are available at the NHANES website.
Quality Assurance & Quality Control
Several types of quality control were implemented to ensure that high quality data were collected during the survey.
Interviewer monitoring was a major responsibility for NCHS and contractor staff. Interviewers were frequently accompanied on interviews and observed to verify that the interview protocol was administered correctly. Interviewers were retrained on survey procedures if necessary.
The interviewers are encouraged to provide comments and other suggestions, based on their field experiences. NCHS has used field staff and interviewer feedback to improve the questionnaires and survey materials. NCHS and contractor staff conduct annual staff debriefing and training sessions jointly. Interviewers are trained on new survey content and protocol changes prior to implementation in the field.
With respect to data collection quality control, the CAPI systems have built-in edit and range checks for most questions. When unusual or unrealistic responses were recorded, the interviewer is alerted immediately and instructed to verify or edit the initial response.
The oral health data is released in the configuration of six “chapters.” The oral health chapters and subcomponents in parentheses are matched as follows:
- Home Interview (ohq_): Dry Mouth, dental visits, quality of life dental health perception and perceived treatment needs.
- Dentition Exam (ohxden_): Tooth count, coronal caries, root caries, dental sealants, incisor trauma, and dental fluorosis.
- Dentition-Addendum Exam (ohxadd_): Tooth wear and functional occlusal contacts.
- Periodontal Exam-Upper (ohxpru_): Maxillary periodontal pockets, recession, loss of attachment, and bleeding.
- Periodontal Exam-Lower (ohxprl_): Mandibular periodontal pockets, recession, loss of attachment, and bleeding.
- Miscellaneous (ohxref_): Medical exclusions, denture questions, care recommendations, and miscellaneous.
The analysis of NHANES 2003-04 oral health data must be conducted with the key survey design and sample. Although these 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 Analytic Guidelines available at: https://wwwn.cdc.gov/nchs/nhanes/analyticguidelines.aspx for further details on the use of sample weights and other analytic issues.
Special Notes on Using the Dataset
Questions OHQ691, OHQ700, OHQ721, OHQ730, OHQ740, and OHQ750 were designed to be asked of participants 16 years and older as a set. However, the built-in edit and range checks malfunctioned in the first two locations of 2003. Some questions were asked of participants 16 years and older and other questions were asked of participants 18 years and older. In order to keep the pattern for the set consistent, the data was revised to only include answers from participants 18 years and older.
Some of the oral health questions in 2003-2004 differ from 1999–2000 and 2001–2002 questions while some of the oral health questions in 2003-2004 are similar to 1999–2000 and 2001–2002 questions. In addition to the oral health questionnaire data, oral health examination data can be found in the oral health section of the NHANES 2003–2004 Exam Files (OHX). These data may be linked using the unique survey participant identifier, SEQN. Please refer to the Oral Health Examination support documentation for additional information related to the oral component and oral health questions administered at the time of the oral health examination.
The 2003-2004 NHANES Oral Health Component is a collaborative effort between the National Institute of Dental and Craniofacial Research (NIDCR), the National Center for Chronic Disease Prevention and Health Promotion, Division of Oral Health (NCCDPHP/DOH), and the National Center for Health Statistics (NCHS).