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Community Oral Health Surveillance -- Columbus, Ohio

During 1986, the Columbus Health Department in Columbus, Ohio, conducted a survey to collect data on the oral health status of local schoolchildren. Their purpose was to gather information for program planning. The survey was designed using the World Health Organization's Pathfinder methodology (1). A sample of students from two cohorts (grades one and two and grades six and seven) were given oral examinations. Examination sites were randomly selected from among public schools, which were stratified according to the percentage of children eligible for free and reduced cost meals. Each student's dental status was assessed using the Decayed, Missing, and Filled Surface Index for permanent teeth (2,3) and the decayed and filled surface index for primary teeth (3,4). Portable dental chairs and lights were used in the examinations, and the findings were entered directly into a data management system.

Data from the survey were tabulated according to the percentage of children with dental caries experience and untreated caries, the various degrees of urgency of need for dental treatment, and the presence of pit and fissure sealants. Caries experience in the permanent dentition was classified according to the types of teeth and tooth surfaces affected.

Sixty percent of the 640 children examined had either decayed, missing, or filled teeth (Table 1). Approximately 30% of the children examined had an obvious need for dental treatment, generally for untreated carious lesions. One-third of these had large lesions requiring early treatment, and 1% had pain or infection requiring immediate care. The remaining two-thirds of the children with obvious treatment needs had small carious lesions or needed professional cleanings. Approximately 90% of the children with untreated caries had lesions in up to three teeth.

The caries experience in permanent teeth was evaluated to determine the appropriateness of a pit and fissure dental sealant program. Forty-four percent of the children examined had decayed, missing, or filled permanent teeth. Most caries experience in permanent teeth was on surfaces with pits and fissures rather than on smooth tooth surfaces. Eighty-seven percent of carious permanent tooth surfaces had pit or fissure lesions, while only 4% of children had preventive pit and fissure sealants on one or more teeth. First and second permanent molar teeth accounted for 94% of caries (Table 2). Furthermore, 91% of carious lesions on permanent molars were found on surfaces with pits and fissures (Table 3). Twenty-six percent of first and second graders had decayed, missing, or filled first permanent molar teeth, while 62% of sixth and seventh graders had similar experience. Reported by: M Siegal, DDS, MPH, Columbus Health Dept, R Kuthy, DDS, MPH, Ohio State Univ College of Dentistry, B Martin, RDH, MS, Ohio Dept of Health. S Eklund, DDS, DrPH, Univ of Michigan School of Public Health. Dental Disease Prevention Activity, Office of the Director, Center for Prevention Svcs, CDC. Editorial Note:

Local oral health status data are important for the proper planning and evaluation of local dental programs. National oral health surveys (5-7) provide useful information on trends in the prevalence and distribution of oral diseases. Their sampling methodologies, however, do not permit extrapolation of their findings to specific communities. By thoughtfully selecting purposive samples, local dental programs can collect community-specific data in a timely fashion with limited resources. The cluster sampling technique used in the Columbus survey provided data that were sufficiently precise for planning purposes. Since school programs would be targeted by grade level, grade level rather than age was chosen as a basis for cohort selection.

The Columbus survey of schoolchildren demonstrated that dental caries in permanent teeth were concentrated on the molar tooth surfaces that have pits and fissures. It also revealed that few children were protected by sealants, which have been demonstrated to be an effective means of preventing such carious lesions (8). Columbus has had optimally fluoridated water since 1973. It is, therefore, not surprising that only a small percentage of carious lesions were found on smooth surfaces.

The data from the survey were reported to the local board of health and shared with the local dental society and the media. They were also incorporated into several grant proposals that resulted in the implementation of a school-based sealant program in the Columbus public schools. Some of the findings of the survey were used in planning the sealant program and were incorporated into the long-range plans of the city's dental program. The data will serve as a baseline for evaluation of the school-based sealant program and other efforts of the dental community to increase the use of pit and fissure sealants. Future oral health surveys are planned at 3- to 5-year intervals.

References

  1. World Health Organization. Oral health surveys: basic methods. 2nd ed. Geneva: World Health Organization, 1977.

  2. Klein HP, Palmer CE, Knutson JW. Studies on dental caries: I. dental status and dental needs of school children. Pub Health Rep 1938;53:751-65.

  3. National Institute of Dental Research. DMF and df index: discussion of diagnostic criteria presented at examiner training session by Dr. Swango. In: calibration manual for the national caries prevalence survey 1979. Bethesda, Maryland: National Institute of Dental Research, 1979:V-1 - V-9.

  4. Gruebbel AO. A measurement of dental caries prevalence and treatment service for deciduous teeth. J Dent Res 1944;23:163-8.

  5. National Institute of Dental Research. Prevalence of dental caries in United States children, 1979-80: national dental caries prevalence survey. Bethesda, Maryland: National Institute of Dental Research, 1981; NIH publication no. 82-2245.

  6. National Center for Health Statistics. Decayed, missing, and filled teeth among children, United States. Rockville, Maryland: National Center for Health Statistics, 1971; DHEW publication no. (HSM)72-1003. (Vital and health statistics; series 11; No. 106).

  7. National Center for Health Statistics. Basic data on dental examination findings of persons 1-74 years, United States, 1971-74. Hyattsville, Maryland: National Center for Health Statistics, 1979; DHEW publication no. (PHS)79-1662. (Vital and health statistics; series 11; no. 214).

  8. National Institutes of Health. Consensus development conference statement: dental sealants in the prevention of tooth decay. J Am Dent Assoc 1984;108(2):233-6.



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