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Oral Health Survey of Third Grade Students --- New Hampshire, 2001

Dental caries is one of the most common chronic disease of childhood (1). Despite improvements in oral health in the United States, by late adolescence approximately 80% of children have a history of caries (1). To establish a baseline for monitoring oral disease trends in New Hampshire, the New Hampshire Department of Health and Human Services in cooperation with the New Hampshire Department of Education conducted a statewide assessment of the oral health status of third grade students attending public schools during the 2000--2001 academic year. This report summarizes the findings of the survey, which indicate that approximately one half of third grade students in New Hampshire have experienced dental decay. Increasing access to fluoridated water and dental sealants is needed to prevent childhood caries.

The survey was based on methodology outlined in the Basic Screening Surveys, a set of standardized, cross-sectional oral health surveys that can be used to collect data for monitoring the national health objectives for 2010 (2). Schools were selected with probability proportional to third grade enrollment size. One third grade class in each school was then selected randomly and all students in that class were eligible to participate. Of 273 public schools with 16,685 third grade students, 27 (9.9%) schools were selected. Only students with parental consent were eligible to participate. Each school decided whether consent was active or passive. For schools allowing active consent, parents wanting their child to participate in the screening were required to return a signed consent form. For schools requiring passive consent, all children were screened except those who returned a parental consent form requesting they not participate. Brief noninvasive dental screenings were conducted by five dental hygienists during February--April 2001; one hygienist conducted 85.9% of the screenings. Students (n=70) in five participating schools had been screened in school-based dental programs within 2 months of the start of the survey; data for these students were abstracted from existing records. Data were tabulated according to the percentage of children with dental caries experience, untreated decay, presence of sealants on permanent molars, and urgency of care. The need for early dental care was defined as having untreated dental caries without accompanying signs or symptoms, the presence of spontaneous bleeding of the gum, or suspicious white or red soft tissue areas. Urgent need for dental care included signs or symptoms consistent with pain, infection, swelling, or soft tissue ulceration of >2 weeks duration (2).

Of the 27 schools selected, 26 (96.3%) participated. The participating schools were located in 22 towns representing nine of the 10 counties in the state. Of the 507 eligible students, 410 (80.8%) were screened. The overall response rate was 77.9%. Almost all (98.8%) children screened were aged 8 or 9 years; 50.2% were female. Among children screened, 52.0% (95% confidence interval [CI]=45.5%--58.4%) had a history of dental caries, 21.7% (95% CI=14.3%--29.1%) had untreated decay, and 45.9% (95% CI=37.7%--54.0%) had a dental sealant on at least one permanent molar. Among children screened, 69.8% (95% CI=62.7%--76.8%) had no obvious dental problems, 25.1% (95% CI=19.1%--31.2%) required early care, and 5.1% (95% CI=3.0%--7.3%) required urgent care.

Reported by: H Saltmarsh, Alexander Eastman Foundation, Derry; N Martin, MS, New Hampshire Dept of Health and Human Svcs. A Pelletier, MD, Div of Adult and Community Health, D Malvitz, DrPH, E Beltran, DMD, Div of Oral Health, National Center for Chronic Disease Prevention and Health Promotion; Div of Applied Public Health Training, Epidemiology Program Office; A Williams, MD, EIS Officer, CDC.

Editorial Note:

This survey provided New Hampshire health officials with the first statewide data to assess the oral health status of children. The survey was conducted quickly (i.e., 20 days) and inexpensively (i.e., screening budget=$5,000) by using the Basic Screening Surveys (2), limiting the sample size, and restricting the amount of data collected.

CDC, in collaboration with the Association of State and Territorial Dental Directors, developed the National Oral Health Surveillance System (NOHSS) to help public health programs monitor the burden of oral disease, the use of the oral health care delivery system, and the status of community water fluoridation on both a state and national level (3). NOHSS includes eight oral health surveillance indicators: four for adults (i.e., dental visits, teeth cleaning, tooth loss, and oral cancer), three for children (i.e., caries experience, untreated caries, and dental sealants) and one involving communities (i.e., fluoridation status). This survey provided New Hampshire data for the three indicators in the NOHSS that were specific to children.

The findings of this survey were consistent with a similar survey conducted in Maine in 1999. In the Maine survey involving 1,297 third grade children, 20.4% had untreated decay, 44.7% had a history of decay, and 47.6% had sealants (4). The national health objectives for 2010 regarding oral health include decreasing the proportion of children aged 6--8 years with untreated decay to 21% (objective 21-2), decreasing the proportion of children aged 6--8 years with a history of caries to 42% (objective 21-1), and increasing the proportion of children aged 8 years with sealants to 50% (objective 21-8) (5).

The findings in this report are subject to at least three limitations. First, the survey was restricted to third grade students in public schools. In New Hampshire, 8% of third grade students attend private schools. Second, assessing the presence of interproximal caries, tooth-colored restorations, and clear sealants can be difficult in a noninvasive screening examination; therefore, the results might underestimate the prevalence of both untreated and treated decay and sealants (6). Third, the type of consent process selected by the schools might have resulted in selection bias. Of 298 eligible students, 273 (91.6%) participated in schools requiring passive consent compared with 137 (65.6%) of 209 eligible students in schools requiring active consent.

New Hampshire is approaching the 2010 national targets for two of three oral health objectives; however, only 43% of the state's residents on public water supply receive fluoridated water. Further progress in attaining the oral health objectives will require efforts to promote water fluoridation, expand sealant usage, and improve access to dental care for those without such services.


This report is based on data and logistical support contributed by I Coulon, T Tolman, Manchester Health Dept, Manchester; S Adams, Seacoast Healthy Grins, Portsmouth; G Barunas, Kiwanis School-based Dental Program, Laconia; K Rannie, MSc, New Hampshire Dept of Education.


  1. U.S. Department of Health and Human Services. Oral health in America: report of the Surgeon General. Rockville, Maryland: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000.
  2. Association of State and Territorial Dental Directors. Basic screening survey: an approach to monitoring community oral health. Columbus Ohio: Association of State and Territorial Dental Directors, 1999.
  3. CDC, Association of State and Territorial Dental Directors. National Oral Health Surveillance System. Available at Accessed March 2002.
  4. Feinstein JA, Phipps K, Sawyer JHP. Results of the 1999 Maine state smile survey. Presented at the National Oral Health Conference 2nd Joint Annual meeting; 2001 April; Portland, Oregon.
  5. U.S. Department of Health and Human Services. Healthy people 2010 (conference ed, 2 vols). Washington, DC: US Department of Health and Human Services, 2000.
  6. Beltran ED, Malvitz DM, Eklund SA. Validity of two methods for assessing oral health status of populations. J Public Health Dent 1997;57:206--14.

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