Oral Health Group

TexasOralHealthSurveillancePlan

Department ofStateHealthServicesFamily andCommunityHealthServicesDivision

OralHealthBranchAugust2012

Introduction

TheTexasOralHealthSurveillanceSystem (TOHSS)defines publichealthsurveillance as anongoingsystematiccollection,analysis,andinterpretationofhealthdataforpurposesofimprovinghealth.Anessentialcomponentofthesystemis thedisseminationand use of surveillancedata toimproveoralhealth.Thisis duetothefactthat toothdecayisthe singlemostcommonchildhooddiseaseaccordingtothe CenterforDiseaseControland Prevention(CDC).1

Theprimaryfocus of TOHSS isto monitortrends inoraldisease,suchasearlychildhoodcaries,loss ofteeth,andoraland pharyngealcancer;effectiveness ofpreventiveservices,suchasdentalsealants,communitywaterfluoridation, andfluoridevarnish;anddentalserviceutilization,throughsuchprogramsas theEarlyand PeriodicScreening,Diagnosis,andTreatment(EPSDT)Programand theChildren’sHealthInsurance Program(CHIP).As an example,inTexas,throughAugust2006,limitedoralevaluationsas partoftheBasicScreeningSurvey(BSS)werecompleted on 17,344schoolchildrenwith5,836 (33percent)ofthosechildrenreceivingdentalsealants.BSS-associatedlimitedoralevaluationswerealsocompleted on 3,698HeadStart(HS)students with97.9 percent ofthosestudentsreceivingfluoride varnish.2ThroughthestatewideBSSconductedduringschoolyear2007–2008,itwasidentifiedthat 34.4 percentofthirdgradechildren inTexashadreceiveddentalsealants.3

Additionally,eachyear,morethan35,000newcasesof cancerofthemouth andthroat (oralcavityandpharynx) arediagnosednationallyand morethan 7,600deaths occur.1Pastsurveillancehasshownthatoral cancerison thedecline inTexas,decreasingfroma rateof 7.1per10,000population in2000to 6.5per 10,000populationin2008.2

Byanalyzingtrends over time,essentialoralhealthinformationis availableforstakeholders andpolicymakers to evaluatecurrentsystems and identifypotentialresourcesneededtoimprove the oralhealthofallTexans inthefuture.IndicatorsthatarenotcurrentlymonitoredbytheTOHSS arelisted inAppendixA forfutureconsideration as resourcesand/orcollaborativeopportunitiesbecomeavailable.

Theopportunitiesavailableto collectobservedin-mouthoralhealthdataaresomewhatlimitedinTexasand compounded bythegeographicsizeofthestate.Datacollectionopportunitiesarefurtherchallengedbythe availabilityof accessto potentialschoolagedcohorts asa resultofrequiredstateeducationalskillstestingpreparationand administrationof theteststhemselves.Access toadultcohortsisalsodifficultandvariousbarriershave beenencounteredoverthecourse ofseveralattempts.

ThecreationofTOHSS allows Texastocollectandrevieworalhealthdatafrom availablestandardizedreportingformats.ItalsoallowsTexastocomparetheoralhealthofitsresidentstothatofnationalstandards,suchastheNationalOralHealthSurveillanceSystem (NOHSS),jointlydevelopedbytheCDCandtheAssociationofStateandTerritorialDentalDirectors(ASTDD),andHealthy People2020(HP2020),whichismaintainedbytheUnitedStates(US)DepartmentofHealthandHumanServices.

Purpose/Goal

ThepurposeorgoaloftheTOHSS istoestablishand maintainongoingmonitoringandtimelycommunicationoffindings;andusethedatatoinitiateandevaluateoralhealthinterventionsandpolicies.

Objectives

AssessmentisakeyobjectiveofTexas’spublichealtheffortsandincludescollection,analysis,interpretation,anddisseminationofdata.Theseactivitiesprovidea mechanismtomonitororaldiseasetrendswithinspecificpopulationsovertime.Thisinformationcanbeusedtoguidetheallocationofresourcesfordiseasepreventionandoralhealthpromotion opportunities, aswellastreatmentservices.Continuedassessmentandevaluationintheseareassupportsthedevelopmentoforalhealth policy.

Thus,theimplementationandmaintenanceofacomprehensiveoralhealthassessmentandsurveillancesystem isacriticalrequirementofanyoralhealthplanningeffort.ObjectivesforTOHSSare:

Assessoralhealthburdenbymonitoringthestatusoforalhealthanddiseaseof Texans.
Incorporatedataonavarietyofnationalandlocalindicatorsthatassessoveralloralhealth.
Identifydataandknowledgegapsbysupporting,enhancing,andexpandingTOHSS.
Measuretheuseoforalhealthservicesavailabletochildren,adolescents,andadultsin Texas.
Monitorpreventiveservices,suchascommunitywaterfluoridationanddentalsealantplacement.

TOHSSComponents

ThefollowingarecomponentsoftheTOHSS:

Oralhealthdatacollectionandsurveillancelogicmodel.
CurrentoralhealthindicatorsinthesurveillanceplaninTexas.
OralhealthresourcesusedintheTOHSS.
DisseminationofTOHSS information.
ConfidentialityofTOHSSdata.
Evaluationofthesurveillancesystem.

TexasOralHealthLogicModel

InputsNeededActivitiesIntermediateOutcomes

Monitortrends inoralhealth in

STAFF

Epidemiologicalsupport

Informationtechnologysupport

Oralhealthpolicyleadership

OHPregional dental teams

Datacollectionanddataentrystaff

DATA SOURCES

Statedatasources

Nationaldatasources

Local-leveldatasources

EQUIPMENT

Hardware andsoftware

OTHER

Funding

Stafftraining

Communitysupport

IMPLEMENT A SURVEILLANCE PLAN

Identifyindicators

Establishobjectivesforsurveillance

Begin to monitorindicatorsby regions,counties, andsubpopulationswhereappropriate andavailable

DATA MANAGEMENT

Acquiredatafromsources

Identifydata gaps

Ensuredatasecurity/confidentiality

Analyze dataandinterpretfindings

Maintain/updatedataregularly

EVALUATION

Engagestakeholders

DescribeTOHSS

Evaluatesurveillanceplan

GathercredibleevidenceregardingtheperformanceofTOHSS

Justifyandstateconclusions,makerecommendations

REPORTING

Ensureuseof evaluationfindings and sharelessonslearned

Texas

Increase evidence-basedprogramplanningand evaluationbased onsurveillancedata

Increase programs for populationsin mostneedasidentifiedbysurveillancedata

DistalOutcomes

Documentchangesin oralhealthindicators

OralHealth IndicatorsunderSurveillancein Texas

State-basedoralhealthsurveillancesystemcontains acoresetofmeasuresthatdescribethestatusofimportantoralhealthconditionsand behaviors.Thesemeasuresserve asbenchmarks forassessingprogressinachievinggood oral health.

To develop amanageableoralhealthsurveillancesystem, itis criticaltoassessthecurrentlyavailableassets,suchas datasourcesthatalreadyincludean oralhealthcomponent,aswellasotherstateresourcesand capacitiesthatcan beusedtoaugmentthose ofthe stateoralhealthprogram.

OralhealthsurveillanceinTexashasbeenshaped tomirrortwoUSstandards,includingthe NOHSS, acollaborativeeffortbetween the CDC DivisionofOralHealth andtheASTDD;andHP2020, acompendiumof indicatorsselectedbythefederalgovernmentto trackthenation’sprogresstowardsyear2020 publichealthobjectives.Table1below containstheoralhealthindicatorsmonitoredbytheTOHSS.TheTexas DepartmentofStateHealthServices(DSHS)OralHealthProgram(OHP),alongwiththeOfficeofProgramDecisionSupportepidemiologistassigned tosupportOHP,workwith theindividualprogramcoordinatorsto obtain andanalyze the oralhealthdatacollectedthroughouttheHealth andHumanServicesEnterprise and DSHS.In 2012, OHP planstobeginaddressingsurveillancedata bysubpopulation;includingrace,gender,andage, to allowthe DSHSOHPto beginreviewingpossiblehealthdisparities andto determinewhichareasmay need furtherattention.

Othernationalindicators,notcurrentlymonitored bytheTOHSS, arelistedin AppendixA forfutureconsiderationas resourcesand/orcollaborativeopportunitiesbecome available.

Table1:TexasOralHealthIndicators
OralHealthIndicatorsMonitoredbyTOHSS
Indicators / Data Set / NationalOralHealthSurveillanceStandard
OralHealthofChildrenand Adolescents(DentalCariesExperience)
Percentof HS childrenwithhistoryof decayintheirprimaryteeth / BSS / HP2020(OH-1.1)
Percentofthirdgradechildrenwithhistoryofdecayintheirprimaryandpermanentteeth / BSS / NOHSS/HP2020(OH-1.2)
Reducethe proportionof childrenwhohavedentalcariesexperienceintheirprimaryorpermanentteeth / BSS / HP2020(OH-1.1-1.3)
OralHealthofChildrenand Adolescents(UntreatedDentalDecay)
PercentofHSchildrenwithuntreateddentaldecayintheirprimaryteeth / BSS / HP2020(OH-2.1)
Percentofthirdgradechildrenwithuntreateddentaldecayintheirprimaryand permanentteeth / BSS / NOHSS/HP2020(OH-2.2)
Reducethe proportionof childrenwithuntreateddentaldecay / BSS / HP2020(OH-2.1-2.3)
OralHealthin Adults(ToothLoss)
Percentofadults≥65 yearswhohavelostallof theirnaturalteethduetotoothdecayorgumdisease / BRFSS / NOHSS/HP2020(OH-4.2)
Percentofadults≥65 yearswhohavelostsixor more teethdueto toothdecayor gumdisease / BRFSS / NOHSS
Percentofadultsaged45-64years who haveeverhad apermanenttoothextractedbecauseof dentalcariesorperiodontal disease / BRFSS / HP2020(OH-4.1)
Reducethe proportionof adultsaged45-64yearswhohaveeverhad apermanenttoothextractedbecauseofdentalcariesorperiodontal disease / BRFSS / HP2020(OH-4.1-4.2)
OralHealthin Adults(Cancerofthe OralCavityand Pharynx)
Age-adjustedmortalityrateper100,000populationcaused bycancer oftheoralcavityor pharynx / TCR / HP2020(OH-6)
Percentoforaland pharyngealcancersdetectedatearlieststage / TCR / HP2020(OH-6)
Increasetheproportionoforaland pharyngealcancersdetectedattheearlieststage / TCR / NOHSS/HP2020(OH-6)
OralHealthIndicatorsMonitoredbyTOHSS (continued)
Indicators / Data Set / NationalOralHealthSurveillanceStandard
AccesstoPreventiveServices
Percentofadolescentswhosawa dentist fora check-up,exam, teeth cleaning, or otherdentalworkin thepastyear, pasttwoyears,more than twoyearsago,never, notsure / Newstatequestionfor2013 YRBS / NOHSS/HP2020(OH-7)
Percentofadultswithdentalvisitsin the pastyear / BRFSS / NOHSS/HP2020(OH-7)
Percentofadults who have had theirteethcleanedin thepastyear / BRFSS / NOHSS/HP2020(OH-7)
Percentofwomen who hadtheirteethcleanedbeforemostrecentpregnancy / PRAMS Phase6 and7 / HP2020(OH-7)
Percentofwomen who hadtheirteethcleanedduringmostrecentpregnancy / PRAMS Phase6 and7 / HP2020(OH-7)
Percentofwoman who wenttoa dentist ordentalclinicaboutaproblemduring mostrecentpregnancy / PRAMS Phase7(potentialaddto 2012PRAMSsurvey) / HP2020 (OH-7)
Percentofwomen who hadtheirteethcleanedaftermostrecentpregnancy / PRAMS Phase7 / HP2020(OH-7)
Increasetheproportionofchildren,adolescents, andadultswhousedthe oralhealthcaresystemin thepastyear / BRFSS(adults),PRAMS (newmothers) / HP2020(OH-7)
Numberof eligiblesreceivinganydentalservices / EPSDT/CHIP / HP2020(OH-8)
Numberof eligiblesreceivingpreventivedentalservices / EPSDT/CHIP / HP2020(OH-8)
Numberof eligiblesreceivingdentaltreatment / EPSDT/CHIP / HP2020(OH-8)
PercentofHSchildrenwithurgentdentalneed / BSS / HP2020(OH-8)
Percentofthirdgradechildrenwithurgentdentalneed / BSS / HP2020(OH-8)
Reducethe proportionof childrenwithanurgentdentalneed / BSS / HP2020(OH-8)
PercentofSBHCswith anoral healthcomponent / SBHC ContractReporting / HP2020(OH-9)
OralHealthIndicatorsMonitoredbyTOHSS (continued)
Indicators / Data Set / NationalOralHealthSurveillanceStandard
AccesstoPreventiveServices(continued)
IncreasetheproportionofSBHCswith anoral healthcomponent(dentalsealants,dentalcare,topicalfluoride) / SBHC ContractReporting / HP2020(OH-9)
Percentofpatients whoreceiveoralhealthservicesathealthcenterseachyear / UDS / HP2020(OH-11)
Increasetheproportionofpatients whoreceiveoralhealthservicesataFederallyQualifiedHealthCenter (FQHC)each year / UDS / HP2020(OH-11)
OralHealthInterventions(DentalSealants)
PercentofHSchildrenwhohavereceiveddentalsealantsin oneor moreoftheirprimarymolarteeth / BSS / HP2020 (OH-12.1)
Percentofthirdgradechildren who havereceiveddentalsealants inone ormoreoftheirpermanentfirstmolarteeth / BSS / NOHSS/HP2020(OH-12.2)
Increasetheproportionofchildrenwhohavereceiveddentalsealants ontheirmolarteeth / BSS / HP2020(OH-12)
OralHealthInterventions(FluoridationStatus)
Percentofpopulation on publicwatersystemsreceivingfluoridatedwater / WFRS / NOHSS/HP2020(OH-13)
Monitoring,SurveillanceSystems(CraniofacialServices)
Numberof babiesbornwith cleftlip/cleftpalate / TBDR / HP2020(OH-15)
Rate ofbabiesbornwithcleftlip/cleftpalateper10,000livebirths / TBDR / HP2020(OH-15)
Increasethenumberofstates andtheDistrictof Columbiathathave asystemfor recordingand referringinfants andchildrenwithcleftlips andcleftpalatesto craniofacialanomalyrehabilitativeteams / TBDR / HP2020(OH-15)

OralHealthDataCollection/Sources

TheTOHSS utilizesdatafrommultiplesources.Table2 providesinformationaboutthedatasources,theagencyin whichtheyarehoused,andthe datacollectiontimeframes.Additionally, a descriptionof eachdatasourceis providedbelow Table2.

Table2:OralHealthData CollectionSources andTime Frames

DataSource / Agency/Division / TimeFrame
BSS / DSHS/FCHS / Every3-5years
YRBS / DSHS/CHS / Every2years
BRFSS / DSHS/CHS / Annual,oral healthrotatingcore every2years
PRAMS / DSHS/FCHS / Annual
TCR / DSHS/PPS / Annual
TBDR / DSHS/PPS / Annual
WFRS / DSHS/PPS / Annual
EPSDT / HHSC/MCD / Annual
CHIP / HHSC/MCD / Annual
SBHC / DSHS/PPS / Annual
UDS / US Department of Health andHumanServices / Annual

BSS – Developed byASTDD in 1999 as aresponseto the needforcommunityleveloralhealth data.TheBSS isastandardsetofsurveysdesigned to collectinformationabouttheobservedoralhealth ofparticipants;self-reportedorobservedinformation onage,gender,andrace/ethnicity;and self-reportedinformationonaccess tocareforpreschool,school-age, and adultpopulations.QuestionsaboutthepersonbeingscreenedinTexasinclude:length oftimesincelastdentalvisit,accessibilityof dentalcare,anddirect oralevaluationofindividualsforcariesand sealants.Measuresusedin theBSS areconsistentwiththe NOHSS,whichallowscomparisonwithotherstates, as wellasthe nation.

BRFSS– Anongoingstate-based datacollectionprogramdesigned to measurebehavioralriskfactorsinthe non-institutionalizedadultpopulation,age 18 yearsor older.Statesselectarandomsample ofadultsfor atelephoneinterview.Thisselectionprocessresultsin arepresentativesamplefor eachstatesothatstatisticalinferencescan be made fromthe informationcollected.The BRFSSsurveys the oral health ofadults onabiennialbasis.Datais currentlyavailableforevenyearsfrom2002 through 2010. Questionsincludelengthoftimesincelastdentalvisit,lengthoftime sincelastdentalcleaning, and the numberofteethremoved due to decay.BRFSS dataisself-reported bytheinterviewedadult.

TBDR – A statewidepopulation-basedbirthdefectsregistryor surveillancesystemthatmonitorsallbirthsinTexasthroughmultiplesources of informationtoidentifycases ofbirthdefects.ChildrenidentifiedthroughTBDR arereferredto appropriatemedicalandcommunityservices.Withregardsto oralhealth,thebirthdefectsregistry collectsthenumberofbabiesborn withcleftlip andcleftpalateto calculatea rateof babiesbornwithcleftlip/cleftpalateper10,000livebirths.Birthdefectdata isgatheredthroughmultiplesources ofinformationinto astatewideregistry and reported bythe EnvironmentalEpidemiologyand DiseaseRegistrySectionwithinthe Texas DSHS.

EPSDT –Thechild-healthcomponentofMedicaidrequired ineverystateanddesigned toimprove thehealthoflow-incomechildren byfinancingappropriateand necessaryhealthcareservices foreligible

individuals,birththrough20yearsof age. Datasourcesincludetheenrollmentandclaimssystems andreportsprepared bytheHHSC.

TCR – A statewidepopulation-basedregistryorsurveillancesystemthatservesasthefoundationformeasuringtheTexascancerburden;comprehensivecancercontrolefforts;healthdisparities;andprogressin prevention,diagnosis,treatment, andsurvivorship.Italsosupports a widevarietyof cancer-relatedresearch.Withregardstooralhealth,theTCR collectsdataon incidence and mortalityratesassociatedwithbothoralandpharynxcancers.Thesedatacan betabulatedbypopulations,allowinga lookathealthdisparitiesinthesecancersforTexas.TCRdataiscollectedbased ondiagnosis throughentitiessuchashospitals,physician’soffices,and/orclinicallabs,andreported bythe EnvironmentalEpidemiologyandDiseaseRegistriesSectionwithintheTexasDSHS.

PRAMS – A CDC-sponsoredinitiative toreduceinfantmortalityandlow birthweightbirths.PRAMSisan ongoingstate-specificpopulation-basedsurveillancesystemdesignedto identifyand monitorselectedmaternalexperiencesbefore,during, and afterpregnancy.Amongquestionsincluded inthissurveyaretwopertainingtothe needfororalhealthcareduringandafterpregnancy.PRAMSdata isself-reported bythewomenparticipatingin thesurvey.

CHIP– A programdesignedspecificallyto assistchildren who lackinsurancecoverage astheirfamiliesearntoo much toqualifyfortheTexasMedicaidProgramand do nothaveprivateinsurance.TheTexasCHIPDentalServicesProgrambecameeffective on April1, 2006,andcoverscertainpreventive andrestorativedentalservices.CHIP data iscollectedfromenrollmentandsubmitteddentalclaims.

WFRS– Atoolforstatestomonitorthe qualityofthewaterfluoridationprograms.Dataprovided bywater systems is used byTexas FluoridationProjectstafftorecognizeexcellentworkin waterfluoridationand toidentifyopportunitiesforcontinuousimprovementin thewaterfluoridationprogram.Forsurveillancepurposes,thisdataprovidesOHPwithinformationregardingthe preventionofdentalcariesatthe communitylevel.Inaddition,the distribution ofdentalcaries bycommunitytype (i.e.,fluoridatedversusnon-fluoridatedcommunities)willallow theOHPmanagementandstafftodeterminewhichareasinTexashavethe greatestneedforpreventivedentalservices.

SBHC – Aninitiativefundedthrough theTitleVMaternalandChildHealthBlockGrant,to providefundingforSBHCsthatdeliverprimaryand preventivehealthservicesto a school-agepopulation,or toexpandservicesto existing SBHCs.One ofthoseexpandedservicesincludesdentalhealthservices.Allcontractedrespondentsmusttracka specifiednumberofstudents,as wellas provideservicesusingevidence-basedpracticesandinterventions andreportclinicalandeducationalprocessandoutcomemeasures.Dataprovidedtothe DSHSSchoolHealthProgramwillbeusedtoreportontheproportionsofSBHCs,withanoralhealthcomponentprovidingservices thatincludedentalsealants,dentalcare, andtopicalfluoridetreatments.

UDS – Acore systemof informationappropriateforreviewingthe operationandperformanceofhealthcenters.UDS isa reportingrequirementforHealthResources andServicesAdministrationgrantees,includingcommunityhealthcenters,migranthealthcenters,healthcareforthehomelessgrantees,and

publichousingprimarycaregrantees.Dataprovided bythe UDSsystemwillbeusedtoreportontheproportionofpatients whoreceiveoralhealthservicesatFQHCsinTexaseachyear.

YRBS– A federally-fundedclassroom-basedpapersurveyconductedbiennially in odd years.The YRBSmonitorspriorityhealth-riskbehaviorsthat contributesubstantiallytotheleadingcauses of death,disability, and socialproblemsamong youthand adultsin theUS.As aprimarysourceforcomprehensivestatewidedataonpreventivehealthpractices andhealthriskbehaviors,YRBS isanimportanttoolfordecision-makingthroughoutDSHS, the TexasEducationAgency, and the publichealthcommunity. Publicand privatehealthauthoritiesatthefederaland statelevelsrelyon YRBS to identifypublichealthproblems,designpolicyandinterventions,setgoals,andmeasureprogresstowardthosegoals.The OHPiscurrentlyproposingonequestionrelatedtoadolescent oral health inthenextYRBS withotherquestions tofollow insubsequentyears,as required. YRBS dataisself-reported byindividualsprovidingresponsestothe survey.

Resources

Resourcesdirectlyrequiredtooperate the TOHSS includefundingsources;personnelrequirements;andotherresourcessuchastravel,training, supplies,computersandotherequipment;andrelatedservices,suchasmail,telephone,computersupport,internetconnections,andhardwareandsoftwaremaintenance.Additionally,estimationofindirectcosts(e.g.,follow-uplaboratorytests)andcostofsecondarydatasources(e.g.,vitalstatisticsorsurveydata)arealsoincludedasavailable/required.ItisdifficulttoascertainandquantifyspecificcostbreakdownsoforalhealthsurveillanceinTexas,sinceoralhealthsurveillancedataareobtainedfrom multipleprogrammaticareas.

Disseminationof TOHSSInformation

DSHSOHP plans toprovideoralhealthinformationtothe publicthrough theprogram’swebsiteandinvariouspublicpresentations.Currentlyavailable datawillbesharedwiththepublic bymeans ofachartbookthatwillcontain asummaryof theresultsfromthe variousindicatorsincorporatedin theTOHSS.Theintentofthechartbookisto helpdisseminatetimelyoralhealthdata sothatresponsibleparties,policymakers, theprofessionalcommunity, and thepublic canreadilyunderstandtheimplicationsoftheinformation.TheTOHSSdata willalsoprovideinformation atthenationallevelto theNOHSS andtheASTDD StateSynopses,asrequiredandavailable.

EvolutionofTOHSS willallowfurtherrefinementoftheindicatorsandcontinuedimprovementintheabilityto communicatedata,includingtrendanalysis.Futureplansincludeexpansion ofindicators toincludesurveillance dataforregions,counties,and subpopulationsbased on pertinentdemographicssuchassex,age, andrace/ethnicity.

Confidentiality ofTOHSS Data

Managementofallhealth-relateddata,bothprimaryand secondary,meetsHealthInsurancePortabilityandAccountabilityActstandardsforpatientprivacy, dataconfidentiality, and dataintegration.Accesstoprotectedhealthinformation(PHI) is limitedtothesurveillancestaffforanalysispurposesonly.Program

staffwillviewPHIonlywhen necessary.NoPHIis releasedto partnersortothepublic.Onlyaggregatedresultswillbereported.

Evaluation

Thepurposeof evaluatingtheTOHSS isto ensurethat problems oforalhealthimportancearebeingmonitoredefficientlyandeffectively.EvaluationoftheTOHSSwilloccurperiodicallytodetermineitsutilityin monitoringoralhealthtrendsovertime,determiningthe effectivenessofinterventions,andplanningfutureprogrammatic and policyinitiatives.The OHPwillengagestakeholdersperiodicallyin anevaluationof TOHSS,followingthe sixtasksproposedin “UpdatedGuidelinesforEvaluatingSurveillanceSystems”(Guidelines)publishedinMorbidityandMortalityWeeklyReport,July27,2001/(50)RR13;1-35:

•Engage Texasstakeholders;

•DescribeTOHSS;

•Evaluatethesurveillanceplan;

•Gathercredibleevidenceregardingtheperformanceof TOHSS;

•Justifyandstateconclusions,makerecommendations;and

•Ensureuseof evaluationfindings andsharelessonslearned.

Theemphasisofthe TOHSSshouldincluderecommendationsforimprovingquality,efficiency, andusefulness.TOHSS shouldalsobe evaluatedtodetermine how wellthesystemoperatesto meetitspurposetoestablishandmaintainongoingmonitoring,timelycommunicationoffindings,andtheuseofdatatoinitiateandevaluateoralhealth interventionsandpolicies.TheTOHSSobjectivesareto:

Assessoralhealthburdenbymonitoringthestatusoforalhealthanddiseaseof Texans;
Incorporatedataonavarietyofnationalandlocalindicators thatassessoveralloralhealth;
Identifydataandknowledgegapsbysupporting,enhancing,andexpandingTOHSS;
Measuretheutilizationoforalhealthservicesavailabletochildren,adolescents,andadultsinTexas;and
Monitorpreventiveservices,suchascommunitywaterfluoridationanddentalsealantplacement.

References:

1OralHealthPreventingCavities, GumDisease,Tooth Loss,and OralCancers: Ata Glance2010.Accessed06/28/2011at

2 OralHealthinTexas2008.Accessed07/08/2011at

3 NationalOralHealthSurveillanceSystem,OralHealthIndicators.Accessed05/18/2012at

AppendixA:OralHealthIndicatorsNOTCurrentlyMonitored byTOHSS

HP2020OralHealthIndicators NOT CurrentlyMonitoredbyTOHSS
OH-3 Untreateddentaldecayin adults
OH-5 Destructiveperiodontaldisease
OH – 10 Healthcenterswithoralhealthcomponent
OH – 14 Preventivedentalscreeningand counseling
OH – 17 Healthagencieswitha dentalprofessionaldirectingtheirdentalpublichealthprogram

AppendixB:TexasOralHealthDataSource Grid

Topic / Source / SFY*2010 / SFY2011 / SFY2012 / SFY2013 / SFY2014 / SFY2015 / SFY2016 / SFY2017 / SFY2018
Pre-SchoolAgeChildren
DecayExperience / BSS / X / X
UntreatedDecay / X / X
SealantPrevalence / X / X
UrgentNeed / X / X
ThirdGradeChildren
DecayExperience / BSS / X / X
UntreatedDecay / X / X
SealantPrevalence / X / X
UrgentNeed / X / X
Adolescents
Lengthoftimesincelastdentalvisit / YRBS / X
Adults
Lengthoftimesincelastdentalvisit / BRFSS / X / X / X / X / X
Lengthoftimesincelastteethcleaning / X / X / X / X / X
Numberofteethremovedduetotoothdecayorgumdisease / X / X / X / X / X
Seniors
Lengthoftimesincelastdentalvisit / BRFSS / X / X
Lengthoftimesincelastteethcleaning / X / X
Numberofteethremovedduetotoothdecayorgumdisease / X / X

*SFY-State FiscalYear(September-August)

Topic / Source / SFY2010 / SFY2011 / SFY2012 / SFY2013 / SFY2014 / SFY2015 / SFY2016 / SFY2017 / SFY2018
MothersofInfants
Percentofwomenwhohadtheirteethcleanedbeforemostrecentpregnancy(Phase6and7) / PRAMS / X / X / X / X / X / X / X / X / X
Percentofwomenwhohadtheirteethcleanedduringmostrecentpregnancy(Phase6and7) / X / X / X / X / X / X / X / X / X
Percentofwomenwho wenttoadentistordentalclinicaboutaproblemduringmostrecentpregnancy(Phase7) / X / X / X / X / X / X / X
Percentofwomenwhohadtheirteethcleanedaftermostrecentpregnancy(Phase7) / X / X / X / X / X / X / X
FluoridationStatus
Percentofpopulationonpublicwatersystemsreceivingfluoridatedwater / WFRS / X / X / X / X / X / X / X / X / X
MalignantOralCavityandPharynxCancerDiagnosed
Age-adjustedmortalityrateper100,000populationcausedbycanceroftheoralcavityorpharynx / TCR / X / X / X / X / X / X / X / X / X
Percentoforalandpharyngealcancersdetectedatearlieststage / X / X / X / X / X / X / X / X / X
Increasetheproportionoforalandpharyngealcancersdetectedattheearlieststage / X / X / X / X / X / X / X / X / X
CleftsandCraniofacialAnomalies
Numberofbabiesbornwithcleftlip/cleftpalate / TBDR / X / X / X / X / X / X / X / X / X
Rateofbabiesbornwithcleftlip/cleftpalateper10,000livebirths / X / X / X / X / X / X / X / X / X
Topic / Source / SFY2010 / SFY2011 / SFY2012 / SFY2013 / SFY2014 / SFY2015 / SFY2016 / SFY2017 / SFY2018
EPSDT
Numberofeligiblesreceivinganydentalservices / TexasMedicaidDentalClaims / X / X / X / X / X / X / X / X / X
Numberofeligiblesreceivingpreventivedentalservices / X / X / X / X / X / X / X / X / X
Numberofeligiblesreceivingdentaltreatment / X / X / X / X / X / X / X / X / X
CHIP
Numberofeligiblesreceivinganydentalservices / TexasCHIPDentalClaims / X / X / X / X / X / X / X / X / X
Numberofeligiblesreceivingpreventivedentalservices / X / X / X / X / X / X / X / X / X
Numberofeligiblesreceivingdentaltreatment / X / X / X / X / X / X / X / X / X