Monitoring State-Based Oral Health Surveillance Systems: 2014 Synopses of State Dental Public Health Programs *

BACKGROUND: Healthy People (HP) 2020 objective OH-16 is to increase the number of states with an oral health surveillance system. The operational definition for this objective, developed originally for HP2010, is the number of states with surveillance data for at least six of nine possible surveillance databases with oral health information. Since objective OH-16 was developed, however, the public health surveillance framework has been transformed and public health leaders recognize that oral health surveillance should address a variety of conditions, risk factors and external influences; employ a variety of methods and data sources; go beyond basic disease reporting; and provide actionable information to guide public health policy and programs. In 2013, the Council of State and Territorial Epidemiologists (CSTE) proposed a revised operational definition which requires a state to have the following 10 items in order to be classified as having an oral health surveillance system; (1) a written oral health surveillance plan,  (2) oral health data from a representative sample of 3^rd grade children, (3) publicly available and timely data to guide policy such as a burden document or topical reports, (4) data on state oral health program infrastructure, (5) tooth loss data for adults, (6) oral cancer data, (7) fluoridation data, plus dental utilization data for (8) Medicaid children, (9) children 1-17 years, and (10) adults with diabetes. It should be noted that data for items 5-10 are available for all states through existing sources.

METHODS: To obtain a baseline estimate on the number of states with an oral health surveillance system, using the CSTE definition, the Association of State and Territorial Dental Directors (ASTDD) added a series of surveillance questions to their 2014 Annual Synopses of State Dental Public Health Programs.

RESULTS: All 50 states and DC completed the 2014 Synopses questionnaire. Only 28 states (55%) reported having a written oral health surveillance plan while the percent with 3^rd grade data, publicly available data and infrastructure data were 73%, 78% and 100% respectively. Of the six indicators available to all states through existing sources, only 10 states (20%) reported having all six indicators. Overall, only seven states (14%) reported having all 10 items included in the CSTE operational definition.

CONCLUSIONS: These results highlight the need for expanded technical assistance to states by both CSTE and ASTDD. Technical assistance should focus on the development of a written surveillance plan and providing guidance to oral health programs on locating data from external sources.