Journal Issue: Protecting Children from Abuse and Neglect Volume 8 Number 1 Spring 1998
National Data Sources
National information on children's dental health is generally based on large household surveys. The data presented in this article were collected in five nationwide surveys: the National Health and Nutrition Examination Survey I, 1971–74 (NHANES I), the National Health and Nutrition Examination Survey III, 1988–91 (NHANES III), the National Institute of Dental Research's (NIDR) surveys of oral health in school children in 1979–80 and 1986–87, and the National Health Interview Survey, 1989 (NHIS).
The NHANES were designed to produce nationally representative data on a wide variety of health indicators, including dental health, for the civilian noninstitutionalized U.S. population.10 The NIDR surveys were designed to produce nationally representative data on oral health for all children in grades K–12 enrolled in public or private schools.11 Certain groups were not captured in these two surveys (in the case of the NHANES, homeless persons or migrant workers and their families, and in the case of the NIDR, children who were not enrolled in school—also principally children whose families were homeless or migrant). Because these omitted groups may be more likely than average to experience poor dental health, the rates of dental disease among children as measured by the NHANES and the NIDR may be understated. However, children living in such families represent a small fraction of all children, so any underestimate of overall population measures in data from these surveys is likely to be small. Nonetheless, identification of unmet dental health needs in populations of children not well represented in these surveys is problematic. In addition, because radiographic examinations were not conducted as part of these surveys, some caries occurring in difficult-to-observe locations (between the teeth, for instance) may go undetected, and for this reason, too, the dental caries indicators based on these surveys may represent underestimates of actual caries prevalence.
The NHIS is a nationally representative sample of the civilian noninstitutionalized population, designed to collect data on selected health topics. In addition to oral health, the 1989 NHIS also collected data on a wide range of other topics, including mental health, AIDS awareness, and diabetes. Unlike the NHANES and NIDR, which rely on physical examination of teeth by trained examiners, the NHIS data are collected in personal household interviews. Adults in the surveyed household respond for household members under 19 years of age, but 17- and 18-year-olds are permitted to respond for themselves if they wish. To the extent that survey nonparticipants are less likely than average to receive dental services (because, for instance, they are homeless), the rates of service receipt represented in the NHIS data may be slightly overstated.