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
World Health Organization. Oral health surveys: basic methods.
2nd
ed. Geneva: World Health Organization, 1977.
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.
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.
Gruebbel AO. A measurement of dental caries prevalence and
treatment service for deciduous teeth. J Dent Res
1944;23:163-8.
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.
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).
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).
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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