Table of Contents

Locator Record

Title: Oral Health (Referral) (OHXREF )
Contact Number: 1-866-441-NCHS
Years of Content: 1999 - 2000
First Published: January, 2004
Revised: May, 2006
Access Constraints: None
Use Constraints: None
Geographic Coverage: National
Subject:oral health, referral
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.

Protocol and Procedure

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:

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 - 150 YEARS

OHAEXSTS - Overall Oral Health Exam Status

Variable Name:
OHAEXSTS
SAS Label:
Overall Oral Health Exam Status
English Text:
Overall Oral Health Exam Status
Target:
Both males and females 2 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Completed 6589 6589
2 Partial 1493 8082
3 Not Done 505 8587
. Missing 0 8587

OHASCST5 - Referral Status Code

Variable Name:
OHASCST5
SAS Label:
Referral Status Code
English Text:
Referral Status Code
Target:
Both males and females 2 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Complete 8049 8049
2 Partial 30 8079
3 Not done 508 8587
. Missing 0 8587

OHQ130 - Must take antibiotics?

Variable Name:
OHQ130
SAS Label:
Must take antibiotics?
English Text:
Q1. Has the doctor or dentist ever told you that you must take antibiotics (e.g. penicillin) before you get a dental check up or care?
Target:
Both males and females 12 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 260 260
2 No 6071 6331
7 Refused 0 6331
9 Don't know 7 6338
. Missing 2249 8587

OHQ132 - Had a heart problem?

Variable Name:
OHQ132
SAS Label:
Had a heart problem?
English Text:
Q2. Has a doctor ever told you that you have a heart problem?
English Instructions:
Before we begin, I would like to read you a list of health conditions that some people have. As I read off each condition, please tell me whether or not a doctor has ever told you that you have the condition.
Target:
Both males and females 12 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 482 482
2 No 5589 6071
. Missing 2516 8587

OHQ134 - Had congenital heart murmurs?

Variable Name:
OHQ134
SAS Label:
Had congenital heart murmurs?
English Text:
Q3. Has a doctor ever told you that you have congenital heart murmurs?
English Instructions:
Was the heart problem due to:
Target:
Both males and females 12 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 160 160
2 No 316 476
7 Refused 0 476
9 Don't know 8 484
. Missing 8103 8587

OHQ136 - Had heart valve problem?

Variable Name:
OHQ136
SAS Label:
Had heart valve problem?
English Text:
Q4. Has a doctor ever told you that you have a heart valve problem?
Target:
Both males and females 12 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 44 44
2 No 280 324
7 Refused 0 324
9 Don't know 0 324
. Missing 8263 8587

OHQ138 - Had congenital heart disease?

Variable Name:
OHQ138
SAS Label:
Had congenital heart disease?
English Text:
Q5. Has a doctor ever told you that you have congenital heart disease?
Target:
Both males and females 12 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 13 13
2 No 263 276
7 Refused 0 276
9 Don't know 5 281
. Missing 8306 8587

OHQ140 - Had bacterial endocarditis?

Variable Name:
OHQ140
SAS Label:
Had bacterial endocarditis?
English Text:
Q6. Has a doctor ever told you that you have bacterial endocarditis?
Target:
Both males and females 12 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 2 2
2 No 267 269
7 Refused 0 269
9 Don't know 0 269
. Missing 8318 8587

OHQ142 - Had rheumatic fever?

Variable Name:
OHQ142
SAS Label:
Had rheumatic fever?
English Text:
Q7. Has a doctor ever told you that you had rheumatic fever?
English Instructions:
Has a doctor ever said you have:
Target:
Both males and females 12 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 45 45
2 No 5795 5840
7 Refused 0 5840
9 Don't know 14 5854
. Missing 2733 8587

OHQ144 - Have kidney disease w/ renal dialysis?

Variable Name:
OHQ144
SAS Label:
Have kidney disease w/ renal dialysis?
English Text:
Q8. Has a doctor ever told you that you have kidney disease requiring renal dialysis?
Target:
Both males and females 12 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 14 14
2 No 5799 5813
7 Refused 0 5813
9 Don't know 0 5813
. Missing 2774 8587

OHQ146 - Have other artificial material?

Variable Name:
OHQ146
SAS Label:
Have other artificial material?
English Text:
Q11. Has a doctor ever told you that you have other artificial material in your heart, veins, or arteries?
Target:
Both males and females 12 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 47 47
2 No 5746 5793
7 Refused 0 5793
9 Don't know 0 5793
. Missing 2794 8587

OHQ148 - Have a hip, bone, or joint replacement?

Variable Name:
OHQ148
SAS Label:
Have a hip, bone, or joint replacement?
English Text:
Q12. Has a doctor ever told you that you have a hip, bone, or joint replacement?
Target:
Both males and females 12 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 159 159
2 No 5588 5747
7 Refused 0 5747
9 Don't know 0 5747
. Missing 2840 8587

OHQ160 - Past 30 days / painful tooth?

Variable Name:
OHQ160
SAS Label:
Past 30 days / painful tooth?
English Text:
During the past 30 days have you experienced a toothache or painful tooth, (including pain with biting or chewing, or sensations to hot, cold or sweets)?
English Instructions:
These questions concern conditions of the teeth, mouth, or face. Tell me if you experienced any of these conditions for any reason (including "cavities", injury, or any other reason).
Target:
Both males and females 10 YEARS - 69 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 1404 1404
2 No 4514 5918
. Missing 2669 8587

OHQ170 - How many days / painful tooth?

Variable Name:
OHQ170
SAS Label:
How many days / painful tooth?
English Text:
For how many days in the past 30 days did you have these sensations?
Target:
Both males and females 10 YEARS - 69 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 to 30 Range of Values 1403 1403
77 SP refused 0 1403
99 Don't know 0 1403
. Missing 7184 8587

OHAREC - Overall recommendation for care

Variable Name:
OHAREC
SAS Label:
Overall recommendation for care
English Text:
Overall recommendation for care
Target:
Both males and females 2 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 See a dentist immediately 14 14
2 See a dentist within the next 2 weeks 356 370
3 See a dentist at your earliest convenience 3927 4297
4 Continue your regular routine care 3732 8029
. Missing 558 8587

OHAROCDT - Untreated Caries / Restorative needs

Variable Name:
OHAROCDT
SAS Label:
Untreated Caries / Restorative needs
English Text:
Untreated Caries / Restorative needs
Target:
Both males and females 2 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 2244 2244
. Missing 6343 8587

OHAROCGP - Periodontal needs

Variable Name:
OHAROCGP
SAS Label:
Periodontal needs
English Text:
Periodontal needs
Target:
Both males and females 2 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 1639 1639
. Missing 6948 8587

OHAROCOH - Gingival / OHI needs

Variable Name:
OHAROCOH
SAS Label:
Gingival / OHI needs
English Text:
Gingival / OHI needs
Target:
Both males and females 2 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 2384 2384
. Missing 6203 8587

OHAROCCI - Assessment of soft tissue lesion

Variable Name:
OHAROCCI
SAS Label:
Assessment of soft tissue lesion
English Text:
Clinical impression of soft tissue condition
Target:
Both males and females 2 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 24 24
. Missing 8563 8587

OHAROTH - Some other finding

Variable Name:
OHAROTH
SAS Label:
Some other finding
English Text:
Some other finding
Target:
Both males and females 2 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 472 472
. Missing 8115 8587

OHARNF - No significant needs

Variable Name:
OHARNF
SAS Label:
No significant needs
English Text:
No significant needs
Target:
Both males and females 2 YEARS - 150 YEARS
Code or Value Value Description Count Cumulative Skip to Item
1 Yes 3724 3724
. Missing 4863 8587