Overview and quality assurance for the oral health component of the National Health and Nutrition Examination Survey (NHANES), 2011–2014

Abstract

Background Following implementation in 2009–2010 to the oral health component for the National Health and Nutrition Examination Survey (NHANES), a full-mouth periodontal examination was continued during 2011–2014. Additionally, a comprehensive dental caries assessment was re-introduced in 2011 after a 6-year absence from NHANES. This report provides oral health content information and results of dental examiner reliability statistics for key intraoral assessments conducted by dentists during 2011–2014. Methods During the 2011–2014 NHANES 17,463 persons age 1 and older representing the US civilian, non-institutionalized population received an oral health examination. From this group, 387 individuals underwent a repeat examination conducted by the survey reference examiner. A combination of examiner training and calibration, electronic data capture, and ongoing performance evaluation with statistical monitoring was used to ensure conformance with NHANES protocols and data comparability to prior data collection periods. Results During 2011–2014, the Kappa statistics for the tooth count assessment ranged from 0.96 to 1.00, for untreated dental caries Kappa scores were 0.93 to 1.00. The overall Kappa statistics for identifying combined moderate-severe periodontitis using the CDC/AAP case definition was 0.66 and 0.69 with percent agreement of 83 to 85% during 2011–2014. When evaluating inter-examiner agreement using information collected from 3 periodontal sites for comparability to the NHANES 2003–04 periodontal examination protocols, Kappa scores for combined moderate-severe periodontitis was 0.65 and 0.80 during 2011–2014. For total mean attachment loss and pocket depth across all 6 periodontal sites, the inter-class coefficients (ICCs) ranged from 0.80–0.90 and 0.79–0.86 respectively. Site-specific mean attachment loss ICCs were generally higher for the 4 interproximal measurements compared to the 2 mid-site probing measurements and this observation was similar in 2009–2010. Conclusion During 2011–2014, results overall indicate a high level of data quality and substantial examiner reliability for tooth count and dentition; reliability for periodontal disease, across various assessments, was at least moderate. When comparing the 2011–2014 examiner performance to findings from 2003 to 2004, comparable concordance between the examiners and the reference examiner exists.

Tooth loss among older adults according to poverty status in the United States from 1999 through 2004 and 2009 through 2014

“…Examination techniques and criteria for assessing tooth presence were consistent throughout the entire study period. Overall, data quality and examiner reliability analyses indicated that examiner performance was similar between the two survey periods being compared (1999-2004 and 2009-2014) 28,29,30,31 . Additional information about NHANES can be located at http://www.cdc.gov/nchs/nhanes.htm.…”

Age‐dependent distribution of periodontitis in two countries: Findings from NHANES 2009 to 2014 and SHIP‐TREND 2008 to 2012

“…Dental examinations, including full-mouth periodontal examinations involving participants age 30 and older, were conducted by trained dental examiners on the MEC. Details on NHANES methodology, the oral health component, and related data quality assurance may be found elsewhere (Dye et al, 2014, Dye & Iafolla, 2017). The NHANES 2009-2014 interviewed 30,468 people, of which, 9,667 were edentulous, and 9,393 did not have a periodontal examination and were therefore excluded, resulting in a total of 10,713 participants for analysis in this study (see Fig.…”

Prevalence, Incidence and Risk Factors for Early Childhood Caries Among Young African-American Children in Alabama

“…Worldwide statistics show that a considerable percentage of children younger than age six years suffered from Early Childhood Caries 13 . In the United States, the National Health and Nutrition Examination Survey III (NHANESIII), 1988-1994, showed that 8.4% of the children who were two years old and 40% who were five years old had at least one filled or decayed tooth 14 . Also, the prevalence of ECC was higher among specific risk groups, such as children from low SES families, and those who were from specific racial and ethnic backgrounds, such as Hispanics, Native Americans, and African…”

“…Examination Survey III (NHANES III) data from 1988-1994 showed that about 8.4% of the children who were 2 years old and 40.0% who were 5 years old had at least one decayed or filled tooth 1 . Although the prevalence of dental caries experience among the U.S. population, including children, has decreased drastically in the last fifty years, ECC still presents a serious threat to child welfare 2 .…”