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survey in public health dentistry methods objectives types WHO criteria

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Survey in Public Health Dentistry

Definition

A survey in public health dentistry is a systematic, non-experimental investigation in which information about the oral health status, treatment needs, and associated factors of a defined population is collected in a standardized manner. It is the community equivalent of the clinical examination done on an individual patient - it examines an entire community.
  • Park's Textbook of Preventive and Social Medicine describes surveys as data-gathering tools using standardized conditions with quality control.

Objectives of Oral Health Surveys

  1. To provide a complete picture of the oral health status and treatment needs of a population
  2. To monitor changes in disease levels and patterns over time
  3. To assess the appropriateness and effectiveness of services being provided
  4. To plan or modify oral health services and training programmes
  5. To determine the resources needed for an oral health programme
  6. For policy development and programme evaluation

Uses of Surveys

  • Monitoring trends in oral health and disease
  • Policy development at national/regional level
  • Programme evaluation
  • Assessment of dental needs
  • Providing visibility to dental public health issues
  • Identifying associations and correlations between variables
  • Understanding reasons for utilization or non-utilization of dental services

Types of Surveys

By Purpose

TypeDescription
DescriptiveSets out to describe a situation - e.g., distribution of dental caries by age and sex
Analytical (Explanatory)Explains a situation - studies determinative processes, formulates and tests hypotheses

By Time Frame

TypeDescription
Cross-sectional (Prevalence/Instantaneous)Provides information about the oral health status at a single point in time
Longitudinal (Time-span)Provides data about events or changes during a period of time - tracks incidence

Methods of Data Collection

1. Health Interview Survey (Face-to-face)

  • Invaluable for measuring subjective phenomena: perceived morbidity, disability, impairment, economic loss, opinions, beliefs, attitudes
  • Provides population-based data
  • Limitation: morbidity data may not be reliable without clinical verification

2. Health Examination Survey

  • Most valid for measuring actual disease
  • Carried out by teams of doctors, technicians, and interviewers
  • Disadvantage: expensive, cannot be done on a large scale; raises ethical issue of providing treatment to those found diseased

3. Health Records Survey

  • Uses existing health service records
  • Cheapest method
  • Disadvantages: not population-based; reliability questionable; lacks uniformity in data recording

4. Mailed Questionnaire Survey

  • Self-administered; simpler and cheaper
  • Requires literacy and skill from respondents
  • Usually has a high non-response rate

Types of Oral Examinations (WHO Classification)

TypeMethodUse
Type 1Questionnaire onlyNo examination
Type 2Visual inspection under natural light, no instrumentsSimple screening
Type 3Inspection using mouth mirror + explorer + adequate illuminationMost used in public health surveys
Type 4Tongue depressor + available illumination (Screening)Identifies urgent treatment need only; unreliable for most surveys

Scientific Steps in Conducting a Survey

  1. Establishing the objectives - The null hypothesis is the starting point
  2. Designing the investigation - Descriptive or analytical; cross-sectional or longitudinal
  3. Selecting the sample - Sampling method, sample size, sampling frame
  4. Conducting the examinations - Standardized criteria, examiner calibration, quality control
  5. Analyzing the data - Statistical analysis using appropriate tests
  6. Drawing the conclusions - Interpretation of results
  7. Publishing the results - Should include: (a) Statement of purposes, (b) Materials & Methods, (c) Results, (d) Discussion & Conclusions, (e) Summary/Abstract

Sampling

The household is the most common sampling unit unless the target is a special group (school children, occupational group). National samples typically cover 5,000 to 10,000 households for national-level estimates. Sample size depends on:
  • The measurement being taken
  • The degree of precision needed

Basic Oral Health Surveys (WHO)

A Basic Oral Health Survey is defined as a survey to collect basic information about oral disease status and treatment needs, needed for planning or monitoring oral health care programmes.
WHO has published the manual "Oral Health Surveys - Basic Methods" to standardize surveys globally:
  • 1st edition - 1971
  • 2nd edition - 1977
  • 3rd edition - 1987
  • 4th edition - 1997
  • 5th edition - 2013 (current)
The manual ensures internationally comparable data using standardized diagnostic criteria and the FDI tooth numbering system.

Pathfinder Surveys

A Pathfinder survey is a practical and economical survey sampling methodology that uses Stratified Cluster Sampling to include the most important population subgroups likely to have differing disease levels.

Aim

To include the most important population subgroups and to cover differing disease levels with an appropriate number of subjects in specific index age groups.

WHO Index Age Groups

  • 5 years - primary dentition
  • 12 years - permanent dentition (global monitoring age for caries)
  • 15 years - periodontal conditions
  • 35-44 years - adults
  • 65-74 years - elderly

Types of Pathfinder Surveys

TypeDescription
Pilot Survey1-2 index age groups; minimum data to commence planning
National Pathfinder SurveyAll important subgroups included; minimum of 3 age groups; used for national-level planning

WHO Oral Health Assessment Form

The WHO Oral Health Assessment Form is based on the "Basic Oral Health Surveys" (WHO, 1997). Standard codes are used throughout; without them, WHO cannot process or summarize the data.

Sections of the WHO Form:

  1. Survey identification information
  2. General information (age, sex, socioeconomic data)
  3. Extra-oral examination
  4. Temporomandibular joint assessment
  5. Oral mucosa assessment
  6. Enamel opacities/hypoplasia
  7. Dental fluorosis
  8. CPITN (Community Periodontal Index of Treatment Needs)
  9. Loss of attachment
  10. Dentition status and treatment need
  11. Prosthetic status and treatment need

Surveys Conducted in India

Two large-scale oral health surveys have been conducted in India (from Park's Textbook):
  1. National Oral Health Survey & Fluoride Mapping - by Dental Council of India (2003)
  2. Oral Health in India: Multi-centric Survey - by Ministry of Health & Family Welfare with AIIMS (2007)

Burden of Oral Diseases in India (Multi-centric Survey 2007)

DiseasePrevalence
Dental Caries40-45%
Periodontal diseases>90% (advanced in 40%)
Malocclusion30% of children
Cleft lip and palate1.7 per 1000 live births
Oral cancer12.6 per lakh population
Oral submucous fibrosis4 per 1000 adults in rural India
Dental fluorosisEndemic in 230 districts across 19 states
Edentulousness (>65 years)19-32%
Oral lesions due to HIV/AIDS72% of HIV/AIDS patients
(Source: Park's Textbook of Preventive and Social Medicine)
Based on this burden, the National Oral Health Programme was initiated in India in 2014-2015 to provide integrated and comprehensive oral health care.

Reliability and Validity in Surveys

  • Reliability = reproducibility of results; the examiner gets the same result on repeated measurement
  • Validity = the examination measures what it is intended to measure
  • Examiner calibration (inter- and intra-examiner) is essential before conducting a survey
  • A pilot study is always conducted before the main survey to test the methodology and check for errors

Key Risk Factors (Common to Oral and Systemic NCDs)

Most oral diseases share modifiable risk factors with the four leading NCDs (CVD, cancer, chronic respiratory disease, diabetes):
  • Tobacco use
  • Alcohol consumption
  • Unhealthy diets high in free sugars
  • Poor oral hygiene
  • Lack of fluoride exposure
This shared risk factor approach forms the basis for integrating oral health into chronic disease surveillance systems, as recommended in the WHO 5th edition manual.
References used: Park's Textbook of Preventive and Social Medicine (24th ed.) | Subharti Dental College Survey Procedures | WHO Oral Health Surveys - Basic Methods, 5th ed.
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