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.
Participants aged 2 years and older who do not meet any of the exclusion criteria are eligible. A positive response to any of the following medical health-screening questions asked of participants aged 13 years or older will exclude them from the periodontal and root caries assessments. Participants aged 13-15 years must have a health proxy signed by a parent/guardian to participate in the oral health examination.
- Has a doctor or dentist ever told you that you must always take antibiotics (e.g. penicillin) before you get a dental check up or care?
- Do you have a heart problem (specifically congenital heart murmurs, heart valve problems, congenital heart disease, or bacterial endocarditis)?
- Do you have rheumatic fever?
- Kidney disease requiring renal dialysis?
- Pacemaker or automatic defibrillator or artificial material in your heart veins or arteries?
Protocol and Procedure
The following subcomponents are from the oral health examination component and home interview component with the age groups of interest in parentheses:
- 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)
- 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)
Survey Staff and Protocol
The oral health exam is performed by trained dentists who hold a state dental license in an US jurisdiction. One of up to seven trained oral health recorders is paired with a dentist to form a dental examination team. Two teams function independently throughout the data collection period. All oral health exam data is collected in the mobile examination center. Oral health data obtained during the home interview is collected by trained interviewers. 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
The quality of data in this survey is controlled by
- an intense training period for the dental teams with calibration of dental examiners prior to the beginning of the survey,
- periodic monitoring and recalibration of dental examiners, and
- periodic retraining of dental teams.
The reference examiner will visit each team three times per year to observe field operations and to replicate 20 to 25 dental examinations during each visit. The purpose of these “expert replications” is to determine if the field examiners are maintaining the examination standards achieved during training and to measure the degree of deviation, if any, from those standards. If the inter-rater correlation is not within acceptable limits, retraining is conducted on site and future monitoring of the field examiner intensified. An annual retraining session for each dental examiner also is conducted by the reference examiner to reinforce existing protocols and to accommodate protocol updates as needed.
Automated data collection procedures for the survey were introduced in NHANES 1999. In the mobile examination centers (MECs), data for the oral health component are recorded directly onto a computerized data collection form. The system is integrated centrally and it allows for ongoing monitoring of much of the data. As part of an on-going quality control practice, all data are reviewed systematically for logical inconsistencies and examiner error. Internal quality control data review indicates that data quality is acceptable.
The oral health data is released in the configuration of six “chapters.” The oral health chapters and subcomponents in parentheses are matched as follows:
- 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.
- Home Interview (ohq_): Dry Mouth, dental visits, quality of life dental health perception and perceived treatment needs.
A variety of oral health variables can be derived to assist analysts using the oral health exam data. Recommended derivations and a selection of sample code for dental caries status, dental fluorosis, dental sealants, and periodontal status is provided at the Oral Health Data Resource Center (DRC): http://drc.nidcr.nih.gov/. Additional information regarding the NHANES datasets, including quality assurance publications and prevalence reports supported by the federal partners is also available at the DRC.
It is recommended that data users merge relevant 2003-2004 oral health data files with 1999-2000 and 2001-2002 oral health data files to ensure adequate sample size for analyses of many of the oral health outcome measures available in these files. The six-year sample weights can be calculated by data users. Additional analytical details are available at: https://wwwn.cdc.gov/nchs/nhanes/analyticguidelines.aspx.
The analysis of NHANES 2003-2004 oral health data must be conducted with the key survey design and basic demographic variables. The NHANES 2003-2004 Household Questionnaire Data Files contain demographic data, health indicators, and other related information collected during household interviews. They also contain all survey design variables and sample weights for these age groups. Other household questionnaire and oral questionnaire files may be linked to the oral health examination data file using the unique survey participant identifier SEQN. The Oral Health Exam (OHX) and Oral Health Questionnaire (OHQ) data are publicly available at the NHANES website.
New content was added to the 2003-2004 Oral Health Exam and Interview making the NHANES Oral Health Component one of the most comprehensive assessments of oral health in the United States to date. Consequently, many variables are only available for the 2003-2004 survey period, which may significantly impact some data analyses.
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).