North Carolina has one of the country's premier state oral public health programs. The program has been based on epidemiological studies starting in the 1960s. Because of the nature of dental diseases, surveys are conducted about every 15 years. The 1986-87 North Carolina School Oral Health Survey was the last survey conducted. It has been and will continue to be a valuable tool for the planning, evaluation and assessment of North Carolina's state and local dental public health programs until a new survey, conducted during the 2003-2004 school year, is completed. For national research information, see the National Institute of Dental and Craniofacial Research web site.

 

History

The first statewide evaluation of oral health in North Carolina was carried out in 1960, as a door-to-door survey. Findings were used to guide the program planning of the N. C. Dental Health Section through the 1970s. The 1960 survey was repeated in 1976 in order to measure trends in oral health status and provide baseline information for subsequent surveys. In 1986, the Section received funds from the Kate B. Reynolds Health Care Trust and the North Carolina General Assembly in order to follow up the previous studies with the 1986-87 North Carolina School Oral Health Survey (NCSOHS). This series of statewide dental studies is unique in the United States.

Having updated information is crucial because of radical changes in oral health, dental technologies, demographics, dental manpower, financing of dental care, and disparities in oral health status among different population groups. In an environment of rapid change, it is necessary to obtain up-to-date and accurate information to use for planning and carrying out an effective public health program.

 

Why Do a Survey?

When you go to the doctor or dentist with a problem, they will obtain a thorough medical history and do a physical examination, followed by diagnosis, treatment planning, and treatment. The process is much the same for a public health program, where the patient is a community of eight million North Carolinians. The 1986-87 North Carolina School Oral Health Survey was, in effect, a "diagnosis" of the oral health of the population, necessary before "prescribing" an effective and efficient public health preventive treatment program.

The 1986-87 North Carolina School Oral Health Survey objectives were grouped to study the following subjects:

	Current oral health status (including caries, periodontal disease and sealants)
	Treatment needs
	Risk factors

The 1986-87 survey sample was stratified by the following groupings in order to allow targeted assessments and more accurate "treatments." The groupings were age, racial group, parent education, geographic region and degree of urbanism.

 

Results

Dental disease is increasingly affecting a smaller segment of the population. Over 80 percent of tooth decay is now found in approximately 25 percent of the children. The population with severe decay is, in general, of lower socioeconomic status and lives primarily in the rural mountain region of the state.

 

Primary Teeth

In primary teeth, minority (nonwhite) children have a higher incidence of cavities than white children, and more of this decay has been left untreated.

Other factors associated with both higher cavity and higher unmet needs in primary teeth are lower parent education, living in a non-urban area, and living in the Coastal or Mountain regions of North Carolina.

 

Permanent Teeth

	Overall, DMFT (Decayed, Missing, and Filled Teeth) scores indicate a high level of treatment for the decay that has occurred, and that very few teeth are lost due to decay in children.
	Variations in DMFT scores were associated primarily with parent education, and to a lesser degree, with urbanism and geographic region.
	Using the more sensitive DMFS (Decayed, Missing, and Filled Surfaces) index, urbanism was found to have the largest effect on cavity experience, with fewer cavities being found in highly urban areas. The effect of geographic region was almost as great, with a gradient of increasing cavities from coast to mountains.
	Gender and parent education were found to have a moderate effect on scores, with males and those having a parent with a higher educational level having the lowest cavities prevalence.
	Whites and nonwhites were found to have similar levels of cavities experience, but the level of untreated decay is higher in nonwhites.
	Overall, 47 percent of all 5 to 17 year olds have had cavities in their permanent teeth. However this figure increases greatly with age, so that by age 17 over 83 percent have had some decay, with an average of 8.44 DMFS per child. Scores were not evenly distributed among the children with caries. For example, 17 year-old nonwhite females averaged over 11 DMFS.
	Most decay occurs on the chewing surfaces of the teeth, with pit and fissure decay measured at over 81 percent of the total.
	National data collected by the National Institute of Dental Research and DMFS scores for North Carolina are virtually identical.

 

Dental Sealants

	The overall prevalence of children with sealants was 12 percent, with minority (nonwhite) children at about half this level. Geographic region and parent education were also associated with sealant prevalence.
	Overall, the survey revealed that for every tooth surface sealed, approximately three were decayed or filled.
	Minority children had about twice as many decayed or filled surfaces for every sealant as white children. Sealants are severely underutilized in the entire survey population, especially among minorities.

 

Periodontal Disease

The prevalence and severity of periodontal disease among North Carolina's children were very low. Seventy-two percent were assessed as healthy, and another 27 percent had very mild conditions that could be treated by cleaning and oral hygiene instruction. Only one percent required more involved dental treatment for their periodontal condition.

 

Dental Health Trends

DMFT (Decayed, Missing, and Filled Teeth) scores over the course of the 26 years encompassed by the three statewide surveys show large reductions in tooth decay and point to a significant pattern of reduction in the disparity between whites and nonwhite populations. Scores for white children dropped 26 percent between 1960 and 1976, while scores for minority children changed very little. However, between 1976 and 1986 scores for whites dropped another 42 percent while scores for minorities plunged to the same level as that for whites, so that both measured at 0.6 DMFT in 1986. Over this same time period, the percentage of decay that was treated increased, but minority populations still received significantly less treatment for their dental disease than white populations.

Examples of Ways Data Have Been Used

Findings of the North Carolina School Oral Health Survey were published in a special Monograph "North Carolina 1986-87 School Oral Health Survey." Recommendations based on the findings of this Survey included major programmatic modifications in the North Carolina dental public health program.

Organizational changes included:

	Changes in staff distribution. A team approach to providing preventive services was initiated to encourage staff to collaborate with other field staff in order to provide services previously unavailable. One unexpected benefit of the 1986 survey was the "management model" that validated this new way for staff to work together.
	Improved data collection concerning services provided, in order to determine service mix in a timely and accurate manner.
	A validation of the public/private partnership in providing public health dental services. The Section provides the research and informational, technical, and promotional inducements; and the private dental sector furnishes the actual dental services.

Programmatic changes included:

	The targeting of screening to specific grades and high-risk groups.
	Greater emphasis on follow-up of children who are screened and need treatment, to address the phenomenon of the relatively small proportion of children bearing a disproportionate disease burden.
	A change in emphasis of the clinical component of the program from restorative treatment services to preventive services, especially dental sealants. The Oral Health Section discontinued the restorative clinical program and placed their emphasis on prevention and education/promotion programs with a focus on dental sealants.

 

Future Research

As conditions affecting dental health continue to change, the Section will continue to gather dental health data. This will ensure that the Section's programs will remain up-to-date, effective and efficient.

Future research will include:

	The Oral Health Section has secured funding for another statewide epidemiological survey for the school year 2003-2004.
	Every other year surveillance of sealant prevalence and dental decay in kindergarten and 5th grade children. This surveillance will be performed by trained, calibrated public health dental hygienists. The data gathered will enable comparisons of dental health between schools and counties, and in the same school or county over time.