• Component Description
• Eligible Sample
• Protocol and Procedure
• Quality Assurance & Quality Control
• Data Processing and Editing
• Analytic Notes
• 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

2015-2016 Data Documentation, Codebook, and Frequencies

Oral Health - Recommendation of Care (OHXREF_I)

Data File: OHXREF_I.xpt

First Published: April 2018

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, 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, coronal caries, root caries, dental sealants, dental fluorosis, and recommendations for dental care. These data are released in multiple data files.

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

• Dentition Exam (OHXDEN_I) – Includes data on tooth count, coronal caries, root caries, and dental sealants.
• Recommendation of Care (OHXREF_I) – Includes data on dental care recommendations and exam position.

In 2015-2016, a dental fluorosis clinical assessment was also conducted as part of the NHANES oral health exam. The fluorosis clinical assessment data are available in a separate dataset: Fluorosis - Clinical (FLXCLN_I). For more information, please refer to the documentation accompanying the data.

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.

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 coronal 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 2015-2016, the tooth count and dental sealants assessments followed the same protocols conducted in 1999-2004, 2011-2012, and 2013-2014.

The 2015-2016 coronal caries assessment was similar to the protocols used in 1999-2004 and 2011-2014, with the following exception: filled surfaces were assessed by restoration type. Please refer to Sections 4.3.3 and 4.3.6 in the NHANES Oral Health Examiners Manual for more details on the Filled Surface assessment.

For survey participants aged 18 years and older, the 2015-2016 examination included a root caries assessment. The dental examiners conducted a “whole mouth” assessment for untreated root caries and dental root restorations. Please refer to Chapter 5 in the NHANES Oral Health Examiners Manual for more details on the dental root caries assessment.

Please refer to the NHANES Oral Health Examiners Manual for additional information regarding data collection protocols for the 2015-2016 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.

Data Processing and Editing

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

OHX##CTC (Coronal caries: tooth condition)
This set of variables indicates the condition identified by the coronal caries assessment for each individual tooth. The fourth and fifth digits in the variable names identify the tooth using American Dental Association’s Universal system. In 2015-2016, two new codes were added to indicate whether the tooth was a primary (code=A) or a permanent tooth (code=F) with a restored surface condition.

OHX##CSC (Coronal caries: surface condition)
This set of variables indicates surface condition identified by the coronal caries assessment for each individual tooth. The fourth and fifth digits in the variable names identify the tooth using American Dental Association’s Universal system. In 2015-2016, the following new codes were used to indicate whether untreated caries, crown, or dental restoration was present and differentiate dental restoration made with amalgams from those with other restorative dental materials:

• 0 = lingual AMALGAM restoration
• 1 = occlusal AMALGAM restoration
• 2 = facial AMALGAM restoration
• 3 = mesial AMALGAM restoration
• 4 = distal AMALGAM restoration
• 5 = lingual OTHER restoration
• 6 = occlusal OTHER restoration
• 7 = facial OTHER restoration
• 8 = mesial OTHER restoration
• 9 = distal OTHER restoration
• -1 = Crown (non-specific full-coverage restoration)
• -4 = Lingual caries
• -5 = Occlusal caries
• -6 = Facial caries
• -7 = Mesial caries
• -8 = Distal caries

Codes -4, -5, -6, -7, and -8 were used for teeth identified as affected with dental caries surface condition (i.e., OHX##CTC = “K” or “Z”). Codes 0-9 and -1 were used for teeth identified as having a restored surface (i.e., OHX##CTC = “A” or “F”). Similar to the codes used in the previous cycles, for this set of variables, these values can be recorded as a string code, for example:"0", "13", "4,6,8", or “-5-8”.

OHXRCAR (Root Caries: whole mouth)
This set of variables indicates the presence or absence of untreated root caries, based on a “whole mouth” assessment. The following codes are used:

• 1 = Root caries detected
• 2 = Root caries not detected
• 9 = Cannot be assessed

OHXRCARO (Other non-carious root lesion: whole mouth)
This set of variables indicates the presence or absence of other non-carious root lesions (erosions/abrasions), based on a “whole mouth” assessment. The following codes are used:

• 1 = Other root lesion detected
• 2 = Other root lesion not detected
• 9 = Cannot be assessed

OHXRRES (Root caries restoration)
This set of variables indicates the presence or absences of root restorations for caries, based upon a “whole mouth” assessment. The following codes are used:

• 1 = Root restoration detected
• 2 = Root restoration not detected
• 9 = Cannot be assessed

OHXRRESO (Other non-carious root restoration)
This set of variables indicates the presence or absences of other root lesions restored for reasons other than caries, based upon a “whole mouth” assessment. The following codes are used:

• 1 = Other root lesions restoration detected
• 2 = Other root lesions restored not detected
• 9 = Cannot be assessed

Analytic Notes

The dentition 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.

Codebook and Frequencies