HP2020 Objective OH-16 calls for all 50 states and DC to have an oral health surveillance system by the year 2020. The current operational definition of this objective, originally developed for HP2010, defines a state oral health surveillance system in terms of having data for at least six of the nine surveillance data sources listed. Since the development of the current operational definition, there have been substantial developments and updates in public health surveillance: release of HP2020 Objectives, 2012 revision of the National Oral Health Surveillance System Indicators, 2012 updated public health surveillance framework, 2013 revision of Chronic Disease Indicators, emerging issues driven by the Affordable Care Act, and other national initiatives such as the oral health strategy for Medicaid children and Centers for Disease Control and Prevention (CDC)’s new Cooperative Agreement with state oral health programs. These new developments introduced new data sources, new information technologies and an expanded view of public health surveillance, and underscore the overarching purpose of public health surveillance — providing actionable information to guide public health policy and programs. To align with the new developments and meet state surveillance needs, an enhanced operational definition of HP2020 OH-16 was proposed through collaborative efforts among the Association of State and Territorial Dental Directors, the Council of State and Territorial Epidemiologists (CSTE), and CDC, and was published in 2013 on the CSTE website (http://c.ymcdn.com/sites/www.cste.org/resource/resmgr/Chronic/StateBasedOralHealthSurveill.pdf). The enhanced operational definition is broad-based, including a core set of surveillance data covering oral diseases and conditions, along with access to dental care and community water fluoridation. In addition, it includes an oral health surveillance plan, data reporting frequency and data dissemination to measure the use of oral health data to guide public health programs and policies in a timely manner.