Alternative methods for the assessment of oral health status in populations.

Abstract

This investigation tested alternative methods for the estimation of epidemiologic indicators of oral health status among children. The alternative methods included a visual screening performed by a dental hygienist and a registered nurse, and a parent-completed questionnaire. The indicators included dichotomous variables measuring dental caries and treatment needs, presence of sealants, injuries in the anterior teeth, and dental fluorosis. All data were collected during two weeks in April 1994, among pre-school and elementary schoolchildren of Washington Park, a rural school located in Jasper County, Georgia. Both screening and questionnaire findings were compared pairwise with visual-tactile examinations carried out by a calibrated dentist. Validity, represented by sensitivity, specificity and predictive values, was assessed for screening by a dental hygienist, a nurse, and the parent-completed questionnaire. All examiners were assessed for intra-examiner reliability using percent agreement and kappa. Screening obtained indicators of caries and treatment needs with high validity ($>$90% for sensitivity, specificity and predictive values in a sample with 30-40 percent prevalence). Less valid data were obtained for fluorosis, injuries, and presence of sealants. Very little difference in validity was observed between the nurse and the dental hygienist. A relatively high percentage of parents did not know if their children needed fillings (a proxy for untreated decay) (34%), or had received sealants (17%). Only presence of restorations showed valid results in the parent-completed questionnaire. It is concluded that screening using dental hygienists and nurses can provide valid data for surveillance of caries and treatment needs. Training for visual assessment of fluorosis and injuries needs to be improved to diminish the proportion of false negatives. Because a high proportion of parents did not know the oral status of their children, a parent-completed questionnaire has less applicability than visual screening as an oral health surveillance tool.