Revision of the National Oral Health Surveillance System

BACKGROUND: The National Oral Health Surveillance System (NOHSS) monitors the burden of oral disease, use of the oral health care system, and the status of community water fluoridation on both national and state levels. NOHSS was developed in 1999 with the collaboration of the Association of State and Territorial Dental Directors (ASTDD), Centers for Disease Control and Prevention (CDC), and Council of State and Territorial Epidemiologists (CSTE) to respond to the lack of state oral health data and track progress towards Healthy People 2010 Objectives. Upon release of the Healthy People 2020 (HP2020) objectives in 2010, the ASTDD Data Committee formed a workgroup partnering with CDC and CSTE to review the indicators and revise to meet surveillance needs for the coming decade.  

METHODS: The workgroup assessed and recommended revisions to NOHSS to (1) align with the HP2020 objectives and their related priority populations, (2) identify state data sources for HP2020 objectives or HP2020-like measures, (3) use newly available data sources and changes to surveillance tools, (4) coordinate with increased state oral health programs’ epidemiology capacity, and (5) plan for implementation of provisions of the Patient Protection and Affordable Care Act.  

RESULTS: Recommendations for revision were completed in early 2012. The recommendations add 24 new indicators to the ten existing NOHSS indicators. The updated indicators expand priority populations to young children (attending Head Start and kindergarten) and older adults (in nursing homes and congregate meal sites) for tooth decay indicators. The additional dental care utilization indicators track more diverse priority populations (e.g., children, Medicaid enrollees, low income populations, and pregnant women) and address cross-cutting areas (e.g., dental care among diabetic population). New data sources were introduced (e.g., National Survey of Children's Health, Centers for Medicare & Medicaid Services Form-416). Most indicators are from existing, publicly available data sources that place no new burden of data collection or reporting on states. Two position statements addressing the recommendations were approved by CSTE in June 2012, and then posted on the CSTE website under the Chronic Disease tab (http://www.cste.org/dnn/AnnualConference/PositionStatements/2012PositionStatements/tabid/584/Default.aspx).   

CONCLUSIONS: The NOHSS revision provides indicators for state oral health programs to monitor progress towards HP2020 Objectives and the impact of intervention programs. The NOHSS revision workgroup will continue its efforts in review and evaluation of NOHSS indicators, improvement of operational definitions, and development of new indicators and data sources to address changes in state oral health surveillance needs.