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:

The 2011-2012 dental fluorosis clinical assessment data were originally released with the 2011-2012 Dentition File, but have been moved into a separate dataset (i.e., FLXCLN_G) to be consistent with the release of the 2013-2014 and 2015-2016 dental fluorosis clinical data. While the variables of these fluorosis data were renamed to reflect the new file name (i.e., the prefix changed from OHX to FCX), no changes were made to the values of any data points. Data documentation describing the dental fluorosis assessment data are available with the data file (FLXCLIN_G).

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 2011-2012, the tooth count, dental caries, and dental sealants assessments followed the same protocols conducted in 1999-2004.

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 in 2011-2012.

Please refer to the NHANES Oral Health Examiners Manual for detailed information regarding data collection protocols for the 2011-2012 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 8073 8073
2 Partial 399 8472
3 Not Done 484 8956
. Missing 0 8956

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 8394 8394
2 Partial 6 8400
3 Not Done 556 8956
. Missing 0 8956

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 1 1
2 See a dentist within the next 2 weeks 201 202
3 See a dentist at your earliest convenience 3187 3389
4 Continue your regular routine care 5007 8396
. Missing 560 8956

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 2047 2047
2 No 27 2074
. Missing 6882 8956

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 1840 1840
2 No 19 1859
. Missing 7097 8956

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 1466 1466
2 No 9 1475
. Missing 7481 8956

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 36 36
2 No 26 62
. Missing 8894 8956

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 531 531
2 No 2 533
. Missing 8423 8956

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 4991 4991
2 No 43 5034
. Missing 3922 8956

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 3 3
2 No 0 3
. Missing 8953 8956

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 6893 6893
2 No 113 7006
. Missing 1950 8956