Table of Contents

Locator Record

Title: Oral Health (OHQ )
Contact Number: 1-866-441-NCHS
Years of Content: 1999 - 2000
First Published: January, 2004
Revised: NA
Access Constraints: None
Use Constraints: None
Geographic Coverage: National
Subject:Oral Health
Record Source: NHANES 1999 - 2000
Survey Methodology: NHANES 1999 - 2000 is a stratified multistage probability sample of the civilian non-institutionalized population of the U.S.
Medium: NHANES Web site; SAS transport files

Component Description

NHANES is critical for monitoring oral health status, risk indicators for disease, and access to preventive and treatment services. This component will address public health significance in areas of surveillance, prevention, treatment, dental care utilization, health policy, evaluation of Federal health programs, standardization of new methods, and oral health disparities.

Oral health data from NHANES will be used for:

Eligible Sample

Eligible Sample Inclusion Criteria

Participants aged 2 years and older who do not meet any of the exclusion criteria

Exclusion Criteria

A positive response to any of the following medical health screening questions asked of participants aged 13 years or older will exclude them from the periodontal and root caries assessments. Participants aged 13 to 15 years must have a health proxy signed by a parent/guardian to participate in the oral health examination.

Interview Setting and Mode of Administration

Data Collection Methods

For oral health data collected in the mobile examination center, detailed information and instructions are discussed in the NHANES 2000 Oral Health Training Manual. For oral health data collected during the home interview, detailed information and instructions are described in the NHANES 2000 Home Interview Training Manual.

Examination and Interview Protocol

The following subcomponents are from the oral health examination component and home interview component with the age groups of interest in parentheses:

Survey Staff

One of up to seven trained oral health recorders is paired with a licensed dentist to form a dental examination team. Two teams function independently throughout the data collection period. During the home interview, oral health data are collected by trained interviewers.

Data Collection Forms

Detailed placement and reading instructions are discussed in the NHANES Oral Health Training and Home Interview Training Manuals. Each chapter specifies procedures to be used for each of the oral health subcomponents.

Quality Assurance & Quality Control

The quality of data in this survey is controlled by

  1. an intense training period for the dental teams with calibration of dental examiners prior to the beginning of the survey,
  2. periodic monitoring and recalibration of dental examiners, and
  3. periodic retraining of dental teams.

The gold standard examiner will visit each team three times per year to observe field operations and to replicate 20 to 25 dental examinations during each visit. The purpose of these "expert replications" is to determine if the field examiners are maintaining the examination standards achieved during training, and to measure the degree of deviation, if any, from those standards. If the inter-rater correlation is not within acceptable limits, retraining will be conducted on site and future monitoring of the field examiner intensified. Approximately 10% of examined participants are asked to return for a replicate exam. The purpose of these "repeat exams" is to monitor internal consistency within examiners regarding the data collection process. There will be an annual retraining session for each dental examiner, also conducted by the gold standard examiner.

Data Processing and Editing

Automated data collection procedures for the survey were introduced in NHANES 1999. In the mobile examination centers (MECs), data for the oral health component are recorded directly onto a computerized data collection form. The system is centrally integrated and it allows for ongoing monitoring of much of the data.

Analytic Notes

The oral health exam data will be released in the configuration of four "chapters." These chapters are: Dentition, Periodontal, Miscellaneous, and the Home Interview chapter. The oral health chapters and subcomponents in parentheses are matched as follows:

Special Notes on Using the Dataset

The analysis of NHANES 1999-2000 oral health data must be conducted with the key survey design and basic demographic variables. The NHANES 1999-2000 Household Questionnaire Data Files contain demographic data, health indicators, and other related information collected during household interviews. They also contain all survey design variables and sample weights for these age groups. Other household questionnaire and oral questionnaire files may be linked to the oral health examination data file using the unique survey participant identifier SEQN.

Circumstantial factors have produced reasonable doubt as to the examined validity of assessing some anterior teeth for caries experience and incisor trauma. Consequently, a very few observations (3) have had the affected variables set to missing. Moreover, two dental sealant observations were change to a "9" (can not assess) during data preparation for public release because of inconsistency in the recorded data field.

The 1999-2000 dental examiner procedural manual lists a "C" as an acceptable call by the examiner for a crowned tooth, but "C’ is not an allowable value. "C" was immediately converted to an acceptable surface code for restorations (e.g., "5689" for anterior teeth and "56789" for posterior teeth) by the direct data automated entry system at the time of data collection. Thus, a "C" is not listed as a possible code in the codebook. The examiner manual does refer to "C" as a "short call" for allowable restored surface codes.

NHANES 1999-2000 collected tooth-specific data on enamel fluorosis (EF) using Dean’s Index, developed by H.T. Dean in the 1930s and 1940s. The examiner determines which of six ordinal categories (normal, questionable, very mild, mild, moderate and severe) best describes each tooth and assigns a corresponding score of 0, 0.5, 1, 2, 3 or 4, respectively. A tooth is scored as questionable (0.5) if:

The enamel discloses slight aberrations from the translucency of normal enamel, ranging from a few white flecks to occasional white spots. This classification is used in those instances where a definite diagnosis of the mildest form of fluorosis is not warranted and a classification of "normal" is not justified. (Burt and Eklund. 1999. Dentistry, Dental Practice and the Community, 5th Edition.) Included in this category are teeth that show no more than 1-2 mm of white opacity at the cusp tips of posterior teeth or incisal edges of anterior teeth.

If a person level score is to be determined, it should be based on the two teeth most affected by fluorosis. If the two teeth are not equally affected, the classification given is that of the less severely involved tooth. Following Dean’s definition, a person would have a whole-mouth Dean’s Index score of 0.5 (questionable) if two or more teeth have questionable signs and there are not two or more teeth with higher EF severity. This working definition of questionable allows many possible clinical presentations depending on the number of teeth with questionable signs of EF (from 2-28). In addition, Dean’s definition allows a person with one tooth having very mild or higher EF to be classified as having questionable enamel fluorosis, if that tooth is the only tooth with higher than questionable clinical signs. When Dean’s data for populations exposed to 0.9 and 1.2 ppm F in the drinking water are plotted, a dose-response is observed from "No" EF (highest proportion) to "Severe" EF (smallest proportion). In estimating prevalence, Dean did not include children with "questionable" EF.

In the NHANES 1999-2000 data, the distribution of EF severity appears bimodal, with peaks at "Normal" EF and "Very Mild" EF. It appears that examiners often assigned codes of either "Normal" or "Very Mild" EF, rather than use the "Questionable" category. It should be kept in mind that examiners assigned codes to individual teeth and not to the person; therefore, it is plausible that the bimodal presentation may reflect a shift in the application of Dean’s diagnostic criteria. At this time, staffs of the Division of Oral Health (DOH), CDC, and the National Institute of Dental and Craniofacial Research (NIDCR), in coordination with NCHS, are analyzing these data. Point estimators as well as potential limitations of these data will be published during 2004. Furthermore, the future release of NHANES data for 2001-2002 will allow further analysis of these issues.

Although the current NHANES was designed to produce a nationally representative sample for each 2-year data collection interval, the sampling frame was designed to produce reliable estimates using 6-years of data for analyses using lower prevalent conditions. For some low prevalent conditions, which may also have geographical variation (such as EF produced by natural fluoride levels in the drinking water), reliable and precise analyses may not be possible with only two years of data.

For these reasons, the interpretation of age-specific estimates of EF prevalence and severity (in the lowest categories) using the 1999-2000 dataset should be made with caution. Comparisons with the previous national survey of enamel fluorosis (National Institute of Dental Research, 1986-1987) should take into account, in addition to the information noted here, the different protocols and sampling designs. Researchers are encouraged to review the descriptive documentation for each of these surveys before reaching epidemiological conclusions regarding possible trends.

 

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 2 YEARS - 120 YEARS

OHQ010 - General condition of mouth and teeth

Variable Name:
OHQ010
SAS Label:
General condition of mouth and teeth
English Text:
Now I have some questions about {your/SP's} mouth and teeth. How would you describe the condition of {your/SP’s} mouth and teeth? Would you say . . .
English Instructions:
INCLUDE FALSE TEETH AND DENTURES
Target:
Both males and females 2 YEARS - 120 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Very good, 2618 2618
2 Good, 3591 6209
3 Fair, or 2105 8314
4 Poor ? 903 9217
7 Refused 4 9221
9 Don't know 3 9224
. Missing 6 9230

OHQ020 - Limit foods because of teeth problems

Variable Name:
OHQ020
SAS Label:
Limit foods because of teeth problems
English Text:
How often {do you/does SP} limit the kinds or amounts of food {you/s/he} eat{s} because of problems with {your/his/her} teeth or dentures? Would you say . . .
Target:
Both males and females 18 YEARS - 120 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Always, 108 108
2 Very often, 97 205
3 Often, 146 351
4 Sometimes, 535 886
5 Seldom, or 552 1438
6 Never? 3998 5436
77 Refused 5 5441
99 Don't know 2 5443
. Missing 3787 9230

OHQ030 - When did you last visit a dentist

Variable Name:
OHQ030
SAS Label:
When did you last visit a dentist
English Text:
About how long has it been since {you/SP} last visited a dentist? Include all types of dentists, such as, orthodontists, oral surgeons, and all other dental specialists, as well as dental hygienists.
Target:
Both males and females 2 YEARS - 120 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 6 months or less 3520 3520
2 More than 6 months, but not more than 1 year ago 1626 5146
3 More than 1 year, but not more than 2 years ago 1168 6314
4 More than 2 years, but not more than 3 years ago 587 6901
5 More than 3 years, but not more than 5 years ago 526 7427
6 More than 5 years ago 952 8379
7 Never have been 804 9183 End of Section
77 Refused 5 9188
99 Don't know 36 9224
. Missing 6 9230

OHQ033 - Main reason for last dental visit

Variable Name:
OHQ033
SAS Label:
Main reason for last dental visit
English Text:
What was the main reason {you/SP} last visited the dentist?
Target:
Both males and females 2 YEARS - 120 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Went in on own for check-up, examination, or cleaning 4738 4738
2 Was called in by the dentist for check-up, examination, or cleaning 353 5091
3 Something was wrong, bothering or hurting {me/SP} 2546 7637
4 Went for treatment of a condition that dentist discovered at earlier checkup or examination 377 8014
5 Other 362 8376
7 Refused 5 8381
9 Don't know 39 8420
. Missing 810 9230

OHQ035 - CHECK ITEM

Variable Name:
OHQ035
English Instructions:
CHECK ITEM OHQ.035: IF OHQ.030 = 5 OR 6, GO TO OHQ.060. OTHERWISE, CONTINUE.
Target:
Both males and females 2 YEARS - 120 YEARS

OHQ037 - CHECK ITEM

Variable Name:
OHQ037
English Instructions:
CHECK ITEM OHQ.037: IF OHQ.033 = 1 OR 2, GO TO OHQ.050. OTHERWISE, CONTINUE.
Target:
Both males and females 2 YEARS - 120 YEARS

OHQ040 - Routine checkups over past 3 yrs

Variable Name:
OHQ040
SAS Label:
Routine checkups over past 3 yrs
English Text:
During the past 3 years, {have/has} {you/SP} been to the dentist for routine check-ups or cleanings?
Target:
Both males and females 2 YEARS - 120 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 1163 1163
2 No 1155 2318 OHQ060
7 Refused 5 2323 OHQ060
9 Don't know 9 2332 OHQ060
. Missing 6898 9230

OHQ050 - Routine checkups frequency past 3 yrs

Variable Name:
OHQ050
SAS Label:
Routine checkups frequency past 3 yrs
English Text:
During the past 3 years, how often {have you/has SP} gone to the dentist for routine check-ups or cleanings?
English Instructions:
HAND CARD OHQ1
Target:
Both males and females 2 YEARS - 120 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 2 or more times a year 2685 2685
2 Once a year 1684 4369
3 Less than once a year 502 4871
4 Whenever needed, no regular schedule 894 5765
7 Refused 1 5766
9 Don't know 7 5773
. Missing 3457 9230

OHQ060 - Regular dentist/lab you visit for care

Variable Name:
OHQ060
SAS Label:
Regular dentist/lab you visit for care
English Text:
Is there a particular dentist or dental clinic that {you/SP} usually {go/goes} to if {you/he/she} need{s} dental care or dental advice?
Target:
Both males and females 2 YEARS - 120 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 5273 5273
2 No 3137 8410 OHQ075
7 Refused 5 8415 OHQ075
9 Don't know 5 8420 OHQ075
. Missing 810 9230

OHQ070Q - How long use this dentist/lab as regular

Variable Name:
OHQ070Q
SAS Label:
How long use this dentist/lab as regular
English Text:
For how long has this been {your/SP’s} regular source of dental care?
English Instructions:
ENTER NUMBER (OF DAYS, WEEKS, MONTHS OR YEARS)
Target:
Both males and females 2 YEARS - 120 YEARS
Hard Edits:
1 to 99
Code or Value Value Description Count Cumulative Skip to Item
1 to 60 Range of Values 5233 5233
77777 Refused 0 5233
99999 Don't know 40 5273
. Missing 3957 9230

OHQ070U - Unit of measure (days/wks/mos/yrs)

Variable Name:
OHQ070U
SAS Label:
Unit of measure (days/wks/mos/yrs)
English Text:
UNIT OF MEASURE
English Instructions:
ENTER UNIT
Target:
Both males and females 2 YEARS - 120 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Days 22 22
2 Weeks 34 56
3 Months 579 635
4 Years 4598 5233
7 Refused 0 5233
9 Don't know 0 5233
. Missing 3997 9230

OHQ075 - CHECK ITEM

Variable Name:
OHQ075
English Instructions:
CHECK ITEM OHQ.075: IF SP AGE >= 40, CONTINUE. OTHERWISE, GO TO END OF SECTION.
Target:
Both males and females 2 YEARS - 120 YEARS

OHQ080 - Sip liquids to aid swallowing foods

Variable Name:
OHQ080
SAS Label:
Sip liquids to aid swallowing foods
English Text:
{Do you/Does SP} sip liquids to aid in swallowing any foods?
Target:
Both males and females 40 YEARS - 120 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 147 147
2 No 1718 1865
7 Refused 0 1865
9 Don't know 1 1866
. Missing 7364 9230

OHQ090 - Amount of saliva in mouth

Variable Name:
OHQ090
SAS Label:
Amount of saliva in mouth
English Text:
Does the amount of saliva in {your/SP's} mouth seem to be too little, too much, or {do you/does s/he} not notice it?
Target:
Both males and females 40 YEARS - 120 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Too little 113 113
2 Too much 89 202
3 Doesn't notice it 1657 1859
7 Refused 0 1859
9 Don't know 7 1866
. Missing 7364 9230

OHQ100 - Difficulties swallowing foods

Variable Name:
OHQ100
SAS Label:
Difficulties swallowing foods
English Text:
{Do you/Does SP} have difficulties swallowing any foods?
Target:
Both males and females 40 YEARS - 120 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 128 128
2 No 1738 1866
7 Refused 0 1866
9 Don't know 0 1866
. Missing 7364 9230

OHQ110 - Mouth feel dry when eating meal

Variable Name:
OHQ110
SAS Label:
Mouth feel dry when eating meal
English Text:
Does {your/SP's} mouth feel dry when {you/s/he} eat{s} a meal?
Target:
Both males and females 40 YEARS - 120 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 95 95
2 No 1765 1860
7 Refused 0 1860
9 Don't know 6 1866
. Missing 7364 9230