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Measuring the Oral Health of Washington’s Children

Challenges and Practical Solutions

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Beth Hines, RDH,MPHWashington State

Department of HealthJune 28, 2000

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Outline

• Challenges and Practical Solutions

• Tools for direct primary data collection

–Smile Survey 1994 and 2000

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• Tools for indirect primary data collection:

–Lead Poisoning Prevalence Survey

–PRAMS

–Disability Survey

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Challenges

• HP 2010 Objectives

• MCH Block Grant Indicator on Sealants

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• Oral Health surveys are:

–time intensive

–staff intensive

–expensive

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Practical Solutions

• Screening versus examination

• Screening models:

–Smile Survey 1994

–BSS and STP 2000

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• Piggybacking on other surveys:

–Lead

–PRAMS

–Disability

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Smile Survey 1994

10 Counties

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Smile Survey 1994

• Random selection of schools in targeted high risk counties w/ urban & rural rep.

• 6,590 children screened

• 6,399 sample analyzed

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• 1,063 Headstart and ECEAP (mean age 4.3)

• 4,635 Elementary School (mean age 6.9)

• 701 High School ( mean age 15.1)

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Headstart Kids% Needing Treatment

0

5

10

15

20

25

30

35

40

Caucasion AfricanAmerican

Hispanic AmericanIndian

Asian All

%Need Tx

%Urgent

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Age 6-8% Needing Treatment

05

1015202530354045

%Need Tx

% Urgent

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0

5

10

15

20

25

Caucasion AfricanAmerican

Hispanic NativeAmerican

Asian All

with Sealants

Percent with Sealants / Ages 6-8

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Smile Survey 2000

Washington State

Assessment of Children’s

Oral Health Status

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Sampling

• Random sample of elementary schools w/ 25 or more in 2nd & 3rd grades

• 7960 children in 56 schools• Convenience sample of 12

Headstart/ECEAP and Early Headstart

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Protocol

• Smile Survey

• ASTDD/CDC

• STP - BSS Basic Screening Survey

• County Based Tools

• Training and Calibration

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Access to Care Questions

• Parent questionnaire

–dental insurance

–time since last dental visit

–reason for last dental visit

–problems accessing dental care

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ESL

• ask elementary school children -

What language does your family

speak at home?

–ask Early/Head Start teacher -

What language does this child’s

family speak at home?

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• School children

–Count number of primary & permanent teeth with cavities

–Range: 0-24

–If a child has 5 cavities

Coding for Untreated Cavities

0 5

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Lead Poisoning Prevalence Survey

And Oral Health Assessment Survey

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Sampling

• Age cohort: age 1-2 years

• Stratified random sample of birth certificates

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• 2 strata by census tract:

–high risk: 9 counties (high Hispanic pop) N:540

–low risk: remaining 30 counties N: 360–oversample Hispanics and children of

farmworkers

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Methodology

• Questionnaire / Demographics , Access, Risk for lead exposure, Injury prevention

• Finger Stick - blood sample

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• Dental Exam / Visible Caries

• Saliva Sample / Strep Mutans Count

• Water Sample / Fluoride Content

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• Statewide estimate of Early Childhood Caries

• Relationship between blood lead levels and caries

Purpose:

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Purpose

• Potential risk factors for caries:

•Strep Mutans levels

•Fluoride exposure

•Feeding patterns

•Variables associated with birth mother

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PRAMS

Pregnancy Risk Assessment Monitoring System

And Oral Health...

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1. This question is about the care of your teeth during your most recent pregnancy.

• I needed to see a dentist for a problem Y/N

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• I went to a dentist or dental clinic Y/N

•A dental or other health care worker talked with me about how to care for my teeth and gums Y/N

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2. How long has it been since you had your teeth cleaned by a dentist or a dental hygienist?

______ Months

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Washington StateDisability Surveillance Survey

And Oral Health….

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• How long has it been since your child with disabilities last visited the dentist or a dental clinic?

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• What is the reason you have taken your child to the dentist in the last year?

• Does your child have untreated tooth decay or gum disease?

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• Do you have any kind of insurance coverage that pays for some or all of your routine dental care, including dental insurance, prepaid plans such as HMOs, or government plans such as Medicaid?

Assessmentmustbea

priority