The Burden of Oral Disease
How To Use This Reference Tool
A comprehensive state burden document will provide in-state users, the Centers
for Disease Control and Prevention (CDC), and other states and organizations
with data regarding a broad range of indicators relating to national and state
This reference tool provides background information and graphic templates for
building a comprehensive state burden of oral disease document. This tool
provides an outline, example text, references, and national data for developing
a document unique to your state. It is not prescriptive; the text can be freely
edited or supplemented and the methods of data presentation altered. Where
possible, links to online data sources have been provided in the references.
star symbol indicates where state or community-specific information can be
Recommended elements include oral health status indicators consistent with the
National Oral Health Surveillance System (NOHSS), the Water Fluoridation
Reporting System (WFRS), and the Association of State and Territorial Dental
Directors (ASTDD) State Synopsis. This document and tables were prepared using
Microsoft Word 2000™. Graphs were prepared using Excel 2000™. Graphs and tables
are configured to allow easy editing of state values.
Because this tool is intended to help state programs, we value your input and
suggestions as you use it.
Guidelines for Using and Interpreting National Data
The estimates provided in this tool came from several data sources and national
data reports; each has its own release schedule and standards for collecting or
reporting race and ethnicity data.
These notes will help you in—
- Planning for future updates to your burden document and related informational
- Selecting categories of race and ethnicity that are
- Available from national data
- Comparable with your state’s data collection and reporting policies
This tool compiles data from several national and centrally coordinated
state-based surveys and key indicator publications.
Data and summary reports from national surveys such as the National Health and
Nutrition Examination Survey (NHANES) and the National Health Interview Survey
(NHIS) are released about every two years. The Behavioral Risk Factor
Surveillance System (BRFSS) releases data every year but includes oral health on
the core survey only in some years.
The release schedules for these surveys—
- Do not usually coincide
- May not coincide with your state’s oral health surveillance schedule
- May vary from published schedules due to publishing issues
Estimates produced from these large surveys are often presented in key reports,
such as Healthy People 2010, the Morbidity and Mortality Weekly Report
and in peer-reviewed journal articles. These reports serve as credible, easily
retrieved and verified sources for the data included in your burden document.
As new data and reports become available, updates will be made to this tool
incorporating the new estimates and references from which the estimates are
- See Appendix B for a calendar of expected release dates for key data sources
and reports. These dates may aid in planning for updates to informational pieces
that use these data.
- You may wish to time updates to your core burden document and other
informational pieces with these releases or with releases of key surveillance
data from your state surveillance system.
Presenting Race/Ethnicity Data
Collecting and reporting of race and ethnicity data—
- Is not entirely consistent across data sources or time
- Changed in the late 1990s at the federal level
- Changed in some states in the late 1990s and may change in others
- Has implications for privacy and risk of disclosure of participants’
- Requires some thought in putting together the burden document and other
The federal Office of Management and Budget (OMB) issued a directive in 1997
that required federal data systems to allow participants to report multiple
races. Concurrently, increased attention to preventing disclosure of survey or
registry participants' identities or information has led to restrictions on
releasing certain data elements that pose higher risks of disclosure.
Additionally, most surveys have standards limiting presentation of estimates for
groups with few survey participants or with large variance. The combination of
these factors affects the availability of some categories of race/ethnicity data
as well as other commonly used data elements, such as grade in school or
parent's education level. Consequently, certain categories of race and ethnicity
presented in Healthy People 2010 may not be available from some surveys
collected since 1997 or in certain years or data sets that do not include a
sample of adequate size to produce reliable estimates for those categories.
Some state governments have enacted laws or policies governing the collection
and reporting of race and ethnicity data by state entities and these policies
may differ from the new federal standards. Your state—
- May collect more detailed race or ethnicity data for certain groups that are
not reported separately in national data
- May restrict collection of some of the categories reported in national data
In preparing your comprehensive burden document for reference, it is important
- Understand your state’s regulations for race/ethnicity data
- Include the range of ethnicity categories reported by national surveys
- Add race/ethnicity categories for which your state has (or needs) data
- Clearly mark categories for which your state does not have data by using the
following annotations for national data or footnotes where other explanations
- DNA for data not analyzed
- DNC for data not collected
- DSU for data that are statistically unreliable or do not meet the criteria for
confidentiality or data quality
- NA for not applicable
For short informational pieces, presenting multiple versions of race/ethnicity
data can be overwhelming and confusing. For these informational pieces, focus on
the following race/ethnicity categories:
- Those with the most recent data
- Those most relevant to your state population.
References and resources for race/ethnicity classification collection and
reporting are provided below.
Office of Management and Budget (OMB).
Provisional Guidance on the
Implementation of the 1997 Standards for Federal Data on Race and Ethnicity.
Washington, DC; OMB, 2000.
Parker JD, Schenker N, Ingram RD, Week JA, Heck KE, Madans JG. Bridging
between two standards for collecting information on race and ethnicity: An
application to Census 2000 and vital rates. Public Health Reports
2004;119:192–205. Available at:
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Date last reviewed: August 18, 2010
Date last modified: August 18, 2010
Division of Oral Health,
National Center for Chronic Disease Prevention and