Survey procedures in dentitistry

SURVEY PROCEDURES
IN DENTISTRY
Dr. Aashna Dhingra
Post Graduate Student
Dept. of Public Health Dentistry

Introduction
Definitions
Uses
Types
Methods of data
collection
Scientific Steps
Basic Oral Health
Survey
PathFinder Survey
WHO Oral health
assessment form
Objective:
To understand
what is a survey
and methods
involved in it.

INTRODUCTION
Surveys are a very traditional way of conducting
research.

They are particularly useful for experimental designs
that seek to describe reality.

For instance, to establish prevalence or incidence.

Some issues are best addressed by classical
experimental design where participants are randomised
to either an intervention group or a control group.

It is not always a very practical design.

WHO has a long tradition of epidemiological
survey methodology and surveillance in oral health.

WHO Global Oral Health Data Bank - 1967.

Most of these surveys were initially motivated by
the need for planning of oral health services or
organization of public health intervention
programs.

INTRODUCTION

Deﬁnition:
A survey is an investigation in which information is collected
systematically, but in which experimental method is not used.
Surveys are methods for collection of data, analyzing and
evaluating them in order to determine the amount disease
problems in a community and also to identify cases that have
not been identiﬁed.

A survey is an investigation about the characteristics of a given
population by means of collecting data from a sample of that
population and estimating their characteristics through the
systematic use of statistical methodology.
Glossary of StatisticalTerms: Dec 20, 2005
Deﬁnition:

USES OF SURVEY:
1. Monitoring
trends in
oral health
and disease.
2. Policy
development
3. Program
evaluation
4. Assessment
of dental
needs
5. Providing
visibility for
dental issues
- by repeating national surveys periodically.
- WHO’s pathﬁnder survey - assess trends -
are valid enough to support national
policy decisions.
- Scotland - successfully used survey data to
establish oral health strategies.
- American states: focus shift F mouth rinsing to
Sealant programs after statewide surveys
showed high carious lesions in pits and ﬁssures.

USES OF SURVEY:
1. Monitoring
trends in
oral health
and disease.
2. Policy
development
3. Program
evaluation
4. Assessment
of dental
needs
5. Providing
visibility for
dental issues
- to evaluate programs using the cause and
effect principle.
- However a survey is not a RCT, inferences
need to be made with caution.
- Surveys can be used for need assessment.
- However, criteria varies from those applied
to individual patient care.
- The visibility that oral health acquires through
mere existence of data from national surveys -
most important use of all.

ADVANTAGES:
Provides info. on oral health status
Rates and indices can be calculated.
Association and correlation between variables
can be identified.
Reasons for utilization/non utilization of oral
health services.
Reliable, complete and accurate

Types of Surveys
Surveys can take many forms.
A survey of the entire population is called a CENSUS.
However usually surveys are restricted to a
representative sample of the potential group that the
researcher is interested in, for reasons of practicality
and cost-effectiveness.
Most surveys take one of the following forms:

eg: Distribution of a disease in terms of sex and age.
Cross sectional study Longitudinal study
Prevalence Incidence
occurrence of a disease/condition
in a population is expressed at a
given point in time.
the amount of new
disease in a population
over a period of time.

eg: why does the disease occur in a particular set
of persons
Case control study Cohort study
Retrospective Prospective
both exposure and outcome have
occurred before the start of the study.
Uses a control/comparison group to
support an inference.
Cohort: a group of
people with common
characteristics.
Cause to effect.

CROSS-SECTIONAL SURVEYS:
that are carried out at one point in time.
They provide with a snapshot of what is happening in that
group at that particular time.
e.g.: prevalence of depression amongst new mothers.
LONGITUDINAL SURVEYS:
describes a complete picture of events or attitudes over time -
Months orYears.
Cohort surveys- which follow the same group of individuals over time.
Trend surveys- which have repeated samples of different people
each time but always use the same core questions.

1. Health interview survey:
- face-to-face survey
- measuring subjective phenomenon. Such as perceived
morbidity, disability, impairment, opinions, beliefs,
attitudes and behavioral characteristics.
- Limitations:  
not reliable 
Interviewer’s bias

2. Health Examination Survey:
- Carried out by teams consisting of doctors and
auxiliaries.
- more valid than interviews
- expensive and cannot be carried out on extensive scale.
- requires consideration of providing treatment to people
found suffering from certain diseases.

3. Health Records Survey:
- collection of data from health service records.
- most economical method.
Disadvantages:
Data obtained is not population based.
Reliability is questionable.
Lack of uniform procedures and standardization.

4. Questionnaire Survey:
- Standard method of data collection.
- in clinical, epidemiological, psychosocial and demographic
research.
- Used for measuring subjective phenomenon
- Recorded either in fixed protocol or as open-ended interview.
sending a cover letter
and questionnaire to a
specific person.
High rate of non-response.
Easy in Urban areas
Little use for
developing countries.
Commonest in
community surveys
and clinical research.

- ADVANTAGES:
- Simple
- Economical
- Standardization - written instructions reduce biases
- Anonymity - encourages honest responses.
DISADVANTAGES
- a certain level of education and skill is expected from
respondents.
- High rate of non-response.

For anthropological
and social enquiries.
Require special coding
- lengthy analysis.
Greater uniformity and
simpliﬁed analysis.
Focused, easy to
administer, precoded
for analysis.

Eg: How many cigarettes do you smoke?
_____________
Eg: How many cigarettes do you smoke?
1. Upto 10
2. 10 - 20
3. 20 - 30
4. More than 30
Likert Scale: (Summative)
Quantify attitudes and behavior
Select response that best
represents their degree of answer. 
Guttman Scale: (Scalogram) 
Respondent is asked to agree/
disagree with each statement.

SCIENTIFIC METHOD IN CONDUCTING A SURVEY
1. Establishing the objective
2. Designing the
investigation
3. Selecting a sample
4. Conducting the
examination
5. Analysis of data
6. Drawing conclusions
7. Publishing the result/
report

1. ESTABLISHING THE OBJECTIVE
 
Investigator must be absolutely clear about the objective of
the investigation before considering its design.
- Hypothesis to be tested
- describing what is to be measured.
NULL HYPOTHESIS

1. ESTABLISHING THE OBJECTIVE
e.g.: There is NO diﬀerence in
periodontal status of males and
females aged 35-44 years in Central
India.
e.g.: To determine the prevalence of
dental caries among 12 year old
school children in Central India.

2. DESIGNING THE INVESTIGATION
It is important to prepare a written protocol
for the survey :
• Main objective and purpose of the survey
• Description of the type of information to be collected
and methods to be used.
• Sampling methods to be used.
• Personnel and physical arrangement.
• Statistical methods to be employed.
• A provisional budget.
• A provisional time-table of main activities.

2. DESIGNING THE INVESTIGATION
Prevalence
Incidence
Case Control
Cohort
CONTROLS: A parallel group not exposed must also
be studied in the same way.
- to avoid argument
- imply cause & effect relationship
SURVEY
DESCRIPTIVE
ANALYTICAL

3. SELECTING THE SAMPLE
The process of choosing some representative members
from the target population.
“reference” or
“parent”
population

SIMPLE RANDOM SAMPLING
Population Sample
- every item in the population has an equal chance of being
included.
- when population is small, homogeneous and readily available.
- does not ensure randomness.

SIMPLE RANDOM SAMPLING
Lottery
Method
Table of
random
numbers
- various units of population
are numbered on small and
identical slips or papers,
folded and mixed thoroughly.
- A blindfold selection is then
made to constitute the
desired sample size.
- select at random any
page, & pick up any row
& column at random.
- Random tables:  
Tippets (1927) 
Fisher and Yates (1938) 
Rand Corporation (1953)

STRATIFIED RANDOM SAMPLING
- when population is composed of diverse segments.
- population under study is 1st divided into homogeneous
groups ‘strata’
- Sample is drawn from each stratum using simple random
method.

- Examples:
- Workers: skilled, unskilled, clerical, non clerical groups.
- Sociological (religion): Hindus, Muslims, Christians, Sikhs,
Buddhists, Jains etc.
- Age-group wise etc.

SYSTEMATIC RANDOM SAMPLING
- when a complete list of population from which sample has
to be drawn is available.
- Here we take every ‘K’ th house or item from the
sampling frame.

MULTISTAGE SAMPLING
- Random selection is made of of primary, intermediate and
ﬁnal units from a given population.
- The area under investigation is scientiﬁcally restricted to a
small number of ultimate units, that are representative of
the whole.
- e.g.:
Nutritional
status of
India

MULTIPHASE SAMPLING
- Part of info. is collected from the whole sample, and
part is from the sub-sample.
- eg: Tuberculosis Survey.
1. Mantoux test (simple and cheap) - done to all cases.
2. Chest X ray (for positive cases)
3. Sputum examination (concentrate technique)

CLUSTER SAMPLING
- ‘Cluster’: smallest units in which
the population can be described.
- e.g.: villages, wards, slums of
towns, factories, school children
etc.
- Used in National surveys.
- Clusters are internally
heterogeneous, whereas strata
are homogeneous.
- Usually 30 clusters - randomly
selected - entire population in
cluster is studied.

QUOTA SAMPLING
- Stratiﬁed random sampling minus randomization.
- the researcher decides in advance on some key
characteristics that will deﬁne the strata.
- The respondents may be selected just because they are
accessible to the examiner.

CONVENIENCE SAMPLING
- when selection is made from available resources, like
telephone directory, automobile registers etc.
- an acceptable approach while using a qualitative
design.

VOLUNTEER SAMPLING

SNOWBALL SAMPLING
- Researcher selects a few participants, who then
suggest others who may be willing to participate.

4. CONDUCTING THE EXAMINATION
An orderly
schedule -
for data
collection.
include all the
resources
required to
carry out
survey
Local, regional
or national
authority

Length of time to examine a subject
depends on extend of detail and
inclination of the examiner.
Basic oral health examination :
• 5 - 10 minutes • 15 - 20 minutes

• 30 mouth mirrors
• 30 periodontal
probes
• pairs of tweezers
• conc. sterilizing
solution
• wash basin
• cloth/paper hand
towels
• gauze

• Current national recommendations and
standards should be followed for
• Infection control
• Waste disposal
• Disposable masks, gloves, protective eyewear
recommended.

CHAIR: preferable with a head rest.  
Most comfortable situation is for the subject
to be on a table/bench, and examiner to sit
behind the subject’s head.
ILLUMINATION:  
a separate unit 
lamp attached to head of the examiner 
fibre optic light source
EXAMINATION AREA

CLEANING: some method to remove loose
debris where necessary.
ASSESSMENT FORMS: adequate supply.  
Avoidance of crowding and noise around the
examiner.
RECORDER: live or tape for receiving
information called by the examiner.
ORGANIZING CLERK: to maintain constant flow
f subjects and to enter general descriptive info.
on forms.
EXAMINATION AREA

TYPE 1: Complete examination using mouth mirror &
explorer, good illumination, full mouth radiographs,
& additional diagnostic methods (pulp testing, study
models, transillumination etc.)
TYPE 2: Limited examination, using mirror and
explorer, bitewing radiographs. PA radiographs if
indicated.
TYPE 3: Inspection using mouth mirror & explorer,
good illumination.
TYPE 4: Screening procedure - tongue depressor,
available illumination.
American Dental Association.A dental health program for schools. Chicago (IL):The
American Dental Association; 1954. 16.

For an epidemiological study of dental
conditions:
Examination method
Diagnostic aid
Data recording
Training and calibration
Consent

Examination method
WHO - manual ‘Oral Health Surveys- basic
method’ to standardize survey methods.
For comparison of ﬁndings at national and
international levels.

Diagnostic aid
Basic requirement : a chair, a
source of illumination and some
means to clean debris off teeth.
Diagnostic criteria
Classiﬁcation for diagnosis must be well deﬁned.
Diagnostic method should be
Valid (ability to measure what it is intended to
measure)
Reliable (ability to give same results if repeated)

Data recording
Recording method should be decided in
advance.
• Record sheet
• tape recorder/camera

Training and Calibration
Each examiner should diagnose the condition in the
same way on every occasion.
Intra-examiner variability: ‘reproducibility test’
Helps the examiner to check their ability to produce
same diagnosis of same condition at different
occasions.
Inter-examiner variability: if more than one examiner.
undergo ‘training and calibration exercises’

5. ANALYZING DATA
Once the examination is complete, the work of assembling
the material and interpreting it begins.
ANALYSIS: “computation of certain measures along with
searching for speciﬁc pattern of relationships that exist
among data groups”.
2 components
• Data processing (statistical analysis)
• Interpretation of the results

5. ANALYZING DATA
Depending on measurement and sampling procedures, the
analysis of collected data can be
• Statistical (inferential)
• Non-statistical (descriptive)
TYPE OF MEASUREMENT TYPE OF TEST
Nominal
Nonparametric tests
Ordinal
Interval
Parametric tests
Ratio

5. ANALYZING DATA
• Homogeneity of
variance
• Variables - true
numerical
“distribution
free tests”

5. ANALYZING DATA
Depending on number of variables:
• one variable - unidimensional analysis
• two variables - bivariate analysis
• more than two - multivariate analysis
Depending on type of analysis to be done
- Requires estimating a parameter
• Point estimate (measures of Central tendency)
• Interval estimate (measures of dispersion)
- Testing of hypothesis
Z test, t test, chi square test, ANOVA.

6. Drawing the conclusion
Conclusions should be speciﬁcally related to the
investigation that has been carried out.
Construction of a report with or without a set of
recommendations.
Clearness and simplicity should be sought.

7. PUBLISHING THE RESULTS
INTRODUCTION
• Reasons for conducting the survey
• Review of literature
• Objectives of investigation
• Hypothesis to be tested
MATERIALS AND METHODS
• Selection & description of sample
• Methods used for diagnosis
• Diagnostic criteria
• Technique of investigation
RESULTS
• Appropriate tabulation & illustration
DISCUSSION & CONCLUSION

The WHO outline for a formal written report:
1. Statement of the purposes of the survey.
2. Material and methods.
• Description of area and population served.
• Types of information collected
• Methods of collecting data
• Sampling method
• Examiner personnel and equipment
• Statistical analysis
• Cost analysis
• Reliability & reproducibility of results
3. Results: tabulated & illustrated properly
4. Discussion & conclusions: investigations, its ﬁndings & its
conclusion to be discussed.
5. Summary

LIMITATIONS OF SURVEY APPROACH
1. Surveys are dependent on the chosen sampling frame.  
The representativeness of a survey is entirely dependent
upon the accuracy of the sampling frame used. Sometimes it
is not possible to identify an accurate or up-to-date sampling
frame.
2. Interview surveys are only as good as the interviewers
asking the questions. 
The outcome of a survey may be inﬂuenced by interviewer
error and bias. It is important that all interviewers receive
proper training for each project.
3. Surveys are not so good at explaining why people think
or act as they do.

Coming up next . . .
Basic oral health survey
Pathﬁnder survey
WHO Oral Health Assessment Form
62

Surveys to collect the basic formation about oral
disease status and treatment needs that is
needed for planning or monitoring changes in
disease levels and oral healthcare programs.
BASIC ORAL HEALTH SURVEYS

OBJECTIVES
Initially
Subsequently
to provide a full picture of oral health
status & needs of a population
to monitor changes in disease
levels or patterns

• The extent to which existing oral health
services are coping with the current need for
oral care.
• The nature and extent of required preventive,
curative, and restorative oral health services.
• The resources needed to establish, maintain,
expand or reduce an oral health care program.
USES
They can be used to determine . . . .

Special characteristics of oral diseases . . .
• strongly age-related . .increase in severity &
prevalence with increased age.
• exist in all populations, varying only in severity
and prevalence.
• Dental caries - irreversible, and so information on
current status provides data not only on the amount
of disease present, but also on previous disease
experience.
• Variations across population groups, with different
socioeconomic levels and environmental conditions.

• The special factors associated with the most
common oral diseases & the extensive experience
gaining in oral epidemiology over the past 25
years have enabled a practical economic survey
sampling method to be defined, called the
pathfinder method.
• Method: Stratified cluster sampling.
• It proposes that population subgroups differ in
disease levels.
• Also proposes appropriate numbers of subject in
specific index - age groups.

• WHO came out with pathfinder survey -
• It is economical
• It is practical.
• The results are statistically significant.
• Four specific groups of different ages are
examined: 12yrs, 15yrs, 35-44yrs, 55-74yrs.
• In each group 25-50 subjects should be examined
for each cluster or sampling point depending on the
expected prevalence and severity of oral disease.

5 YEARS
• Wherever practical & feasible, children should be examined b/w
5th - 6th birthdays.
• Caries levels in Primary dentition
• Exhibit changes over a short span of time than in permanent
dentition at other index ages.
• Some countries - 5yrs: the age at which children begin primary
school.

• Children leave primary school.
• Last age at which a reliable sample may be
obtained easily through school system.
• All permanent teeth (except 3rd molars)
are likely to have erupted.
• Chosen as “global indicator age group
for international comparisons and
surveillance of disease trends”
12 YEARS

15 YEARS
• Permanent teeth - exposed to oral environment for 3-9 years.
• Assessment of caries prevalence and periodontal disease in
adolescents. (15-19yrs)
• In countries where it is difficult to obtain a reliable sample of this
age group, it is customary to examine individuals in two-three
areas

• Standard age group for surveillance of oral health conditions in adults.
• Planners & decision-makers can assess the full effect of dental
caries, level of severe periodontal involvement, & general effects of
oral health care provided.
• Samples can be derived from organized groups - office, factory
workers etc.
• Care must be taken to avoid obvious selection bias.
35-44 YEARS

• Has become important with the changes in age distribution of
populations and the worldwide increase in lifespan.
• Estimate the manifestation of oral disease from a life course
perspective.
• Data needed : planning appropriate interventions for older people and
for assessment of the ultimate effect of oral health programmes
• Sampling - care should be taken to sample adequately both house-
bound & active members of this age group.
65-74 YEARS

Number of Subjects
The number of subjects in each index age group to be
examined ranges from minimum 25 to 50 for each
cluster or sampling site, depending on the expected
prevalence and severity of oral disease.

Number of Subjects
If this cluster distribution is applied to four index
ages in the population under study, the total
sample is 4 x 300 = 1200.
permits the identification of differences
- between urban and rural group.
- between socioeconomic groups.
- areas where prevalence is much higher or lower.

Oral Health Surveys: Basic Methods.
5th ed, 2013. Geneva, WHO.
The manual provides:
A description of diagnostic
criteria that can be readily
understood and applied in all
countries.
Information on means of
obtaining practical assistance
for planning and
implementing surveys,
summarizing data and
analyzing results.

AIM of the Manual:
• To provide a systematic approach to the
collection and reporting of data on oral
diseases and conditions.
• To ensure that data collected in a wide range
of environments are comparable.
• To encourage oral health administrators in all
countries to make standard measurements of
oral diseases and conditions as a basis for
planning oral health care services.

Pilot Study
• Test organisation of the survey
• Carry out a calibration and training of personnel
(examiners, organising and recording clerks)
• Estimate the level of disease
• Identify problems
• Adjust the survey design

• It incorporates sufﬁcient examination sites to cover
all important subgroups of th population that may
have differing disease levels or t/t needs.
• Atleast 3 of the age groups or index ages.
• This type of survey design is suitable for the
collection of data for the planning & monitoring of
services in all countries whatever the levels of
disease, availability of resources or complexity of
services in a large country with many
geographical & population subdivisions &
complex surveys in needed.

Guides for estimating levels of disease
Low level

Prevalence = <80%

Moderate level

Prevalence = >80% & <95%

High level

Prevalence = >95%

ASSESSMENT OF ORAL HEALTH
STATUS

STANDARD FORMS • Special forms designed
for this purpose.

STANDARD CODES
• Must be used for all sections of the form(s).
• WHO - will be able to make recommendations for
processing the data and summarizing results.
• Clear writing- to prevent confusion b/w alphabets and
numbers.
• The forms are designed to facilitate computer
processing of the observations. Each box is given an
identification number (the small number in paren-
theses), which represents a location in a computer file.

SECTIONS:
Survey identification information
General information
Extraoral conditions
dentition status (crown, root)
periodontal status
loss of attachment
enamel fluorosis
dental erosion
dental trauma
oral mucosal lesions
denture status (fixed or removable dentures)
intervention urgency and need for referral
notes.

IDENTIFICATION AND
GENERAL INFORMATION
SECTIONS

IDENTIFICATION AND GENERAL INFORMATION SECTIONS
• During planning - a list of examination sites & of
the examiners involved in the study should be made
& a code assigned to each examiner.
• The coding list should also include the numeric
codes to be used for other relevant information
such as the fluoride content of drinking water or
use of fluoride supplements.

Box 1 - 4
WHO code for the country
• Country in which the survey is
carried out.
• Should not be filled by the
investigator.

Box 5 - 10
Essential info.: year, month, date
• Should be recorded at the time of
examination.
• Enables an investigator to refer
back to examinations held on any
particular day which may need to
be reviewed or checked.

Box 11 - 14
Identification number
• Each subject examined should be given an
identification number.
• Should always have the same number of
digits as the total number of subjects.
• e.g.: 1200 subjects . . . first subject -
0001.
• If possible, ID no.s be entered before
commencing the examinations.

Box 15
Original / Duplicate examination
• If the subject will be re-examined to
assess reproducibility, original
examination is scored “1” & any
subsequent examinations are coded
“2”, “3”, “4” etc.
• For all subjects for whom duplicate
examinations are made, data from the
1st examination only are included in
the survey analysis.

Box 16 & 17
Examiner
• If more than one examiner is
participating in the survey.
• Each examiner should be assigned a
specific code.

Name
• in Block letters.
• In some countries, identification of survey
subjects by name is not permitted, in such
case - space should be left blank.
Sex (18)
• Must always be recorded, because it is
not always possible to tell a person’s
sex from the name alone.
• 1 = Male, 2 = Female.

Box 19 - 26
Date of birth (19-24)
• Year, month and day of birth
• For cross-checking purposes.
• age at last birthday.
• 6 years is coded as “06”.
• when age is not known - ‘estimated age’:
eruption status, major life events etc.
• Manner of estimation should be reported.
Age (25 & 26)

Box 27-30
Ethnic group
• In different countries, ethnic groups may be
identified in different ways, by area or
country of origin, race, color, language,
religion or tribal membership.
• local health & education authorities should be
consulted.
• May be obtained from govt. agencies or school
administrative data at the time of sample
selection.
Other Group:
• To identify different subpopulation groups.

Box 31 - 33
Number of years in school
• For assessment of the level of
education.
• In children - may be used for recording
the school grade achieved by a child.
Occupation
• A coding system should be devised
according to local usage to identify
different occupations and appropriate
code entered.

Box 34 & 35
Community - geographical location
• To record the site where examination is
being conducted.
• 01 - 98
• ’99’ entered if this information is not
recorded.
• Community information is useful for
health administrators for planning or
revising programs or strategies.

Box 36
Location type
• General information about the local
environmental conditions &
availability of services at each site.
1 Urban site
2 Periurban area: areas surrounding
major towns with very few health
facilities & limited access.
3 Rural area or small village.

Box 37 - 42
Other data
• use of tobacco, SES, physical
environment, levels of fluoride
etc.
• Frequency of sugar intake.

CLINICAL EXAMINATION
The oral cavity is a part of the orofacial
complex & examiners should record any
evident abnormality of the tissues, nose,
cheek or chin.

Box 43, 44 Extraoral examination

Box 45-108,
45-72
DENTITION STATUS
• Examination for dental caries - plane mouth mirror.

• Use of radiography for detection of proximal caries is
not recommended . .impractical in most ﬁled situations.

• Examiners should adopt a systematic approach.

• Proceed in orderly manner from one tooth to adjacent
tooth or tooth space.

• A tooth should be considered present in the mouth when
any part of it is visible.

• If a permanent & primary tooth occupy the same space,
the status of permanent tooth should be recorded.

Box 45-108,
45-72
DENTITION STATUS
• An entry must be made in every box pertaining to the coronal
& root status of a tooth.

• In children, root status is not assessed, so the corresponding
boxes have been omitted.

DENTITION STATUS
0 (A) Sound crown 
No evidence of treated/untreated caries. Early stages of caries are excluded
because they cannot be reliably identified in field conditions. Following defects can
be coded as sound: 
- white or chalky spots; discolored/rough spots that are not soft to touch.  
- stained enamel pits and fissures that do not have cavitation.  
- dark, shiny, hard, pitted areas of enamel showing signs of fluorosis.

1 (B) Carious crown 
- unmistakable cavity, undermined enamel, or detectably softened floor or wall. 
- temporary filling, or sealed with decay.  
- Where any doubt, caries should not be recorded as present.  
- If carious lesion on root, doesn’t involve crown, it should be recorded as root
caries.

2 (C) Filled crown, with caries 
A crown that has one/more permanent restorations & one/more areas are
decayed.

3 (D) Filled crown with no caries 
A crown that has one/more permanent restorations are present & there is no
caries anywhere.

DENTITION STATUS
4 (E) Missing tooth, due to caries  
Permanent or primary teeth extracted because of caries.  
Recorded under coronal status.

5 (-) Permanent tooth missing due to any other reason 
Absent congenitally, extracted for orthodontic reasons, periodontal
disease, trauma, etc.  
6 (F) Fissure sealant 
A ﬁssure sealant has been placed on occlusal surface. 
7 (G) Fixed dental prosthesis abutment, crown or veneer 
8 (-) Unerupted tooth  
Teeth scored as unerupted are excluded from all calculations
concerning caries. 
9 (-) Not Recorded 
Used for an erupted permanent tooth that cannot be examined
for any reason such as orthodontic bands, severe hypoplasia,
calculus etc.

PERIODONTAL STATUS: CPI modified
Gingival Bleeding Periodontal Pockets
• CPI probe

• 0.5mm ball tip.

• black bands 3.5-5.5 &
rings at 8.5, 11.5.

PERIODONTAL STATUS
Gingival Bleeding
• Carefully inserting
the tip of WHO CPI
probe between
gingiva and the tooth
to assess absence/
presence of bleeding
response.

• Sensing force = 20g
Periodontal Pockets
• Probe tip should be
inserted into gingival
sulcus or pocket and the
full extent of sulcus or
pocket explored.

• Not recorded for
individuals <15 yrs.

• All teeth are probed and
scored in corresponding
box.

PERIODONTAL STATUS
Box 73-100 (children)
Box 109-172

LOSS OF ATTACHMENT
• Estimate of the lifetime accumulated destruction of
periodontal attachment.

• NOT recorded < 15 years.
Box 173-178

ENAMEL FLUOROSIS
• Fluorotic lesions are usually B/L symmetrical.

• Horizontal striated pattern across the tooth.

• Premolars > 2nd molars > Maxillary incisors.

• Criteria: Dean’s Index.
Box 179

ENAMEL FLUOROSIS
0= NORMAL - smooth enamel surface, glossy, pale-creamy white color.
1= QUESTIONABLE - slight aberrations in translucency of enamel, few
white ﬂecks.

2= VERY MILD - small, opaque, paper-white areas scattered
irregularly.

3= MILD - white opacities >25% but <50%.

4= MODERATE - marked wear, brown staining.

5= SEVERE - marked hypoplasia. Pitted or worn areas, widespread
brown stains.

8= EXCLUDED

9= NOT RECORDED

DENTAL EROSION
• Progressive loss of calciﬁed dental
tissue, not associated with
bacterial action.

• Enamel loss - exposure to acids,
intrinsic causes like GERD, heavy
alcohol consumption.

• Severity - recorded according to
the tooth with the highest score
of erosion.
Box 180-182

TRAUMATIC DENTAL INJURIESBox 183 - 185
105-107

ORAL MUCOSAL LESIONS
• Sequence:

1. Labial mucosa & sulci (U & L)

2. Labial part of commissures & buccal mucosa (Rt. & Lt.)

3. Tongue (dorsal, ventral & margins)

4. Floor of mouth

5. Hard & soft palate

6. Alveolar ridges/gingiva (U & L)

• Either 2 plane mouth mirrors or one mirror & handle of
pdl probe can be used to retract tissues.

• Whenever possible - tentative diagnosis be provided.
Box 186-191

ORAL MUCOSAL LESIONSBox 186-191

INTERVENTION URGENCYBox 194
• It is the responsibility of the examiner to ensure
that referral to an appropriate healthcare facility
is made, if needed.

• The need for immediate care if pain, infection or
serious illness is present should be understood.

S.No Feature 1997 2013
1. EXTRAORAL EXAMINATION ( w/o code
interpretation)
2. TMJ ASSESSMENT X
3. ORAL MUCOSAL EXAMINATION
4. ENAMEL OPACITIES X
5. DENTAL EROSION X
6. DENTAL FLUOROSIS
7. CPI X
S.No. FEATURES 1997 2013
8. LOA
9. DENTOFACIAL ANOMALIES DENTALTRAUMA
10. DENTITION STATUS
11. TREATMENT NEEDS X
12. PERIODONTAL STATUS X
13. PROSTHETIC STATUS &
PROSTHETIC NEED
X ( DENTURE
STATUS)
14. NEED FOR IMMEDIATE CARRE &
REFERRAL
X (INTERVENTION
URGENCY)
WHO - 1997 and 2013

FROM SURVEYS TO SURVEILLANCE
Surveillance provides on going - continuous or
periodic - collection, analysis & interpretation of
population health data & the timely dissemination of
such data to users.
It ensures decision makers and public health
administrators have the information they need to
control disease now or plan strategies to prevent
disease & adverse health events in future.
A systematic approach helps countries to observe &
evaluate emerging disease patterns & trends.

Effective oral health surveillance requires well-defined
oral health outcome indicators for use in public
health. It must cover the oral health conditions
relevant to the public health burden of disease in a
way that it is :
- measurable and robust
- easy to understand
- relevant to quality of life
- clearly related to common modifiable risk factors
- instrumental to oral disease prevention & promotion
of oral health through health systems response.
FROM SURVEYS TO SURVEILLANCE

REFERENCES:
1. Peter S. Essential of preventive and community dentistry. 5th ed. Arya Publishing; 2008.
2. Rao T. Research methodology. 2nd ed. Hyderabad: Paras Medical Publisher; 2010.
3. Marya CM. A textbook of public health dentistry. JP Medical Ltd; 2011 Mar 14.
4. Mathers N, Fox N. and Hunn A. Surveys and Questionnaires. The NIHR RDS for the
East Midlands / Yorkshire & the Humber, 2007.
127

REFERENCES:
1. Oral Health Surveys, Basic Methods, 4th Edition ,World Health
Organization , 1997.
2. Oral Health Surveys, Basic Methods, 5th Edition , World
Health Organization, 2013.
3. Peter S. Essentials of Public Health Dentistry, 5th edition.
4. Hiremath SS, Textbook of Public Health Dentistry, 3rd edition.
5. Marya CM. A textbook of public health dentistry. JP Medical
Ltd; 2011 Mar 14.

Survey procedures in dentitistry

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