• Component Description
• Eligible Sample
• Protocol and Procedure
• Quality Assurance & Quality Control
• Data Processing and Editing
• Analytic Notes
• References
• Codebook
  • SEQN - Respondent sequence number
  • OHDEXSTS - Overall Oral Health Exam Status
  • OHDRCSTS - Recommendation Care Status Code
  • OHAREC - Overall recommendation for care
  • OHAROCDT - Decayed teeth
  • OHAROCGP - Gum disease/problem
  • OHAROCOH - Oral hygiene
  • OHAROCCI - Impression of soft tissue condition
  • OHAROCDE - Denture/Partial Denture/Plates
  • OHARNF - No significant findings
  • OHAROTH - Some other finding (specify w/referral)
  • OHAPOS - Was participant exam position recumbent

National Health and Nutrition Examination Survey

2013-2014 Data Documentation, Codebook, and Frequencies

Oral Health - Recommendation of Care (OHXREF_H)

Data File: OHXREF_H.xpt

First Published: August 2016

Last Revised: NA

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:

• Assessing the prevalence of major oral health diseases and conditions including dental caries, periodontal disease, and dental fluorosis;
• Assessing prevention and treatment efforts including the prevalence of dental sealants;
• Informing specific public health programs, policies, or initiatives;
• Monitoring the oral health status of minority/underserved populations;
• Evaluating Healthy People objectives related to oral health; and
• Supporting research activities as identified in the 2000 Surgeon General’s Report on Oral Health in the United States.

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:

• Dentition Exam (OHXDEN_H) – Includes data on tooth count, dental caries, and dental sealants.
• Periodontal Exam (OHXPER_H) – Includes data on periodontal pockets, recession, and loss of attachment.
• Recommendation of Care (OHXREF_H) – Includes data on dental care recommendations and exam position.

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

• Dye BA, Afful J, Thornton-Evans G, Iafolla T. Overview and quality assurance for the oral health component of the National Health and Nutrition Examination Survey (NHANES), 2011-2014. BMC Oral Health, in press 2019.

Codebook and Frequencies