Regular oral health surveys in a number of countries have revealed important trends in oral health status, especially among children. Since the publication of the fourth edition, WHO has developed new tools for the implementation of oral health surveys. The WHO STEPwise approach to Surveillance (STEPS) facilitates the inclusion of oral health in national surveillance systems for non-communicable chronic diseases.
Aims of the manual
Acknowledgements
Financial support
On-line version
Introduction
For effective surveillance, the WHO suggests that clinical oral health surveys should be carried out regularly every five to six years in the same community or environment. Risk factor analysis is central to the development or adaptation of oral health promotion programs. The oral health effect of risk factors can be estimated by pooling clinical and socio-behavioral data.
Objectives of the manual
Provision of information relevant to planning a survey on oral health status. This includes
Basic questionnaires have been designed for adults and children separately, and can be used to collect information on self-assessment of oral health status, oral health habits, risk behavior, quality of life and social position.
Provision of information relevant to planning a survey on self- assessment of oral health and risk factors
This may include information on general health factors relevant to oral health status, e.g. Oral health monitoring becomes possible when data on oral health status and risk factors are collected systematically and regularly. States may choose to collect data from Step 1 or Step 2, or both, for oral health intervention planning and evaluation.
Structure of this manual
Basic principles of clinical oral health surveys
- Design of an oral health survey
- Special characteristics of oral diseases
- Index ages and age groups
- Sample selection
- Probability selection methods
- Pathfi nder surveys
- Preparing a survey protocol
- Obtaining approval from the authorities
- Budgeting
- Scheduling
- Emergency intervention and referral
- Courtesy reporting
- Reliability and validity of data
- Training and calibrating examiners
- Duplicate examinations
- Estimating reproducibility of recordings
- Implementing the survey
- General preparation
- Personnel and organization
- Instruments and supplies
- Infection control
- Examination area
- Examination position
- Lighting
- Table or platform
- Seating of recording clerk
- Supply of survey forms
- Avoidance of crowding
- Avoidance of noise
- Assessment of oral health status
- Standard forms
- Standard codes
- Oral health assessment form
- Identifi cation and general information sections
- Clinical examination (Boxes 43 and 44)
In other words, a list must be available of the members of the population to be included in the survey. It is important to provide dental professionals and oral health administrators in the area with the details of the examination. Thus, the assessment criteria should be thoroughly discussed as part of the calibration.
This information is useful for assessing the level of education, which is an important factor in the analysis of oral health. In the case of primary teeth, the calculation of the dmft index is similar, i.e.
Oral health self-assessment
- Self-assessment of oral health and risks
- Oral health information system
- Self-assessment of oral health through use of questionnaires
WHO recommends that countries should establish a comprehensive oral health information system for continuous monitoring and evaluation of national oral health programs (8). Comprehensive information about oral health care coverage, care delivery, quality of care, and intermediate and final outcomes of oral health intervention is important to ensure an effective national oral health system. Population data on oral health status and prevalence of risk factors are important for monitoring disease patterns and understanding trends over time; In addition, such information is useful for planning or regulating interventions by health authorities.
Systematic information on the occurrence of risk factors is important for planning community-oriented oral disease prevention and oral health promotion programs. By merging clinical oral health data and risk factor data into a common database, the oral health effects of socio-behavioral factors can be estimated and relevant intervention strategies designed. Consequently, oral health programs can be more effectively planned to meet the needs of specific populations.
In addition to the above, information on self-rated oral health is essential for identifying appropriate approaches to oral health promotion. Participants completing a questionnaire survey should be properly informed about the objectives of the study; each participant must be assured of anonymity and informed that the data will be used for statistical purposes only. When questionnaires involve school pupils, the principal or head teacher of the school and staff involved in the survey should be properly informed of the results.
Self-assessment questionnaires can be prepared either to be completed through an interview or for self-completion.
Oral health information systemsOral health information systems
Oral health risk indicators within the frame of STEPS
This model aims to guide the collection of data by focusing on socio-environmental determinants and modifiable risk factors for oral health such as diet/nutrition, tobacco use and excessive alcohol consumption. In addition, information is required on environmental exposure to fluoride, oral hygiene practices, and use of available oral health services. Quality of life, oral health and systemic health are considered important outcomes of the specified distal and proximal factors.
Thus, the model provides a conceptual and practical basis for relating oral health to the relevant assessment of chronic disease. WHO recommends the use of simplified structured questionnaires for collecting self-reported data on oral health and risk factors in adults (Annex 7) and in children or adolescents (Annex 8). An oral health risk questionnaire (Step 1) can be carried out as a stand-alone activity or in combination with a clinical oral health survey (Step 2).
Because oral health questionnaires include standardized questions, the survey can be administered by non-dental personnel. However, the adult oral health questionnaire included in the standard version of STEPS does not focus on sugar consumption, tobacco and alcohol use, and education, as these items are already part of the general module. For the planning and evaluation of school oral health programmes, a special questionnaire on oral health is available from the WHO.
Finally, special WHO questionnaires on oral health are available for people affected by HIV/AIDS, children with infections and the role of school teachers.
From surveys to surveillance
Public health managers may wish to develop additional health indicators relevant to monitoring community-specific oral health programs, such as periodontal disease indicators (modified CPI) and oral cancer incidence. The STEPS questionnaire defines a specification of indicators to monitor self-rated oral health, experience of oral health problems, self-care practices, quality of life, oral health risk factors such as dietary sugar intake and tobacco use, and use of oral health services. Such indicators are important for countries to evaluate programs that focus on the behavioral dimensions of oral health.
WHO recommends collecting global surveillance data that can provide information on people's experiences of poor quality of life in relation to their oral health, whether primary oral care is available and accessible, and whether healthcare systems are responding to serious oral diseases. However, oral health surveillance can be successfully incorporated into national health surveillance programs as measuring just a few key indicators could provide sufficient information for a valuable assessment of the appropriateness of oral health interventions. This guide advocates strict adherence to standardized approaches to oral health examinations as this will assist WHO in storing consistently comparable, essential data in the Global Oral Health Data Bank.
Obtaining assistance from WHO
- Pre-survey assistance
- Post-survey assistance
Before seeking assistance from WHO, investigators may find it useful to discuss the survey and the proposed survey design with colleagues experienced in the national health or education sector, so that factors of importance and interest are not overlooked or overlooked. Subject to prior agreement, an experienced epidemiologist who has been trained in recommended methods for basic oral health surveys may be assigned to participate in the training and calibration sessions as a trainer and validating examiner. The collected data will be systematically included in the WHO Global Oral Health Data Bank.
DT (number of defective teeth in the permanent dentition) MT (number of missing teeth due to caries in the permanent dentition). FT (number of filled teeth in the permanent dentition) DFT (number of decayed and filled teeth in the permanent dentition). The DFT index can also be calculated for tooth roots, as this data is obtained from each individual tooth; this is especially important in the 65-74 age group.
Percent D/DMFT or d/dmft (percent of decayed teeth within the total caries experience index). Percent M/DMFT or m/dmft (percentage of teeth missing due to caries within the total caries experience index). Percent F/DMFT or f/dmft (percentage of filled teeth within total caries experience index).
The level of caries experience in primary or permanent teeth may correspond to the WHO severity criteria (5).
- Preparation of survey reports
Behavioral indices can be created from these questions by adding the scores of items selected by the respondent (22). Area and Population: This section will include a general description of the geographic region and the sample of people examined. Measures taken to standardize and calibrate examiners and interviewers and to check examiner consistency during the course of the survey should be described.
The text should include a brief description of the main results and summary tables. A comprehensive report of results should include self-explanatory and independent tables with totals at the bottom of the table. The oral health status of the population should be compared with data from previous studies in a similar population, if such data are available.
In addition, it is possible to compare the actual findings with the results of surveys of similar age groups in neighboring settings or countries. Survey weaknesses should describe aspects of the survey that could be done better. The need for intervention of the screened population should be reported along with a brief discussion of the different categories of intervention for the age groups concerned.
Summary or abstract: A short summary of the report is required, of suitable length for use as an abstract (approx. 250 words).
WHO Collaborating Center for Community Oral Health Programs and Research; Organization for Safety and Asepsis Procedures (OSAP); University of Copenhagen, Faculty of Health Sciences, Copenhagen, 2010. Geneva, World Health Organization, 1990 (unpublished document available on request from Oral Health, World Health Organization, 1211 Geneva 27, Switzerland).
Atlas of major oral diseases and conditions
Dentition status
Periodontal status
Enamel fl uorosis
Dental erosion
Traumatic dental injuries
Oral mucosal lesions
Intervention urgency
As a result of the condition of your teeth or mouth, how often have you experienced any of the following problems during the past 12 months. often often times No know. a) Difficulty biting food. Slept so often. i) Took days off work .. j) Difficult to do usual activities. k) Feel less tolerant towards spouse or people who are close. How often do you eat or drink any of the following foods, even in small amounts.
Due to the condition of your teeth and mouth, have you experienced any of the following problems during the past year. How often do you eat or drink any of the following foods, even in small amounts?
Standard tables generated from clinical survey data
General information
Clinical assessment
Standard tables generated from STEPS questionnaire data
Adult questionnaire
Questionnaire for children