# 21 {#section .Chapter-# .unnumbered}

# Oral Health

21-1 Dental caries experience

21-1a Children aged 2 to 4 years

21-1b Children aged 6 to 8 years

21-1c Adolescents aged 15 years

21-2 Untreated dental decay

21-2a Children aged 2 to 4 years

21-2b Children aged 6 to 8 years

21-2c Adolescents aged 15 years

21-2d Adults aged 35 to 44 years

21-3 No permanent tooth loss

21-4 Complete tooth loss

21-5 Periodontal diseases

21-5a Gingivitis

21-5b Destructive periodontal disease

21-6 Early detection of oral and pharyngeal cancers

21-7 Annual examinations for oral and pharyngeal cancers

21-8 Dental sealants

21-8a Children aged 8 years

21-8b Adolescents aged 14 years

21-9 Community water fluoridation

21-10 Use of oral health care system

21-11 Use of oral health care system by residents in long-term care
facilities

21-12 Dental services for low-income children

21-13 School-based health centers with oral health component

21-14 Health centers with oral health service component

21-15 Referral for cleft lip or palate

21-16 Oral and craniofacial State-based surveillance system

21-17 Tribal, State, and local dental programs

21-1. Reduce the proportion of children and adolescents who have dental
caries experience in their primary or permanent teeth.

  ---------------------- ------------------------------------------------
  21-1a. Reduce the      
  proportion of young    
  children with dental   
  caries experience in   
  their primary teeth.   

  **National Data        National Health and Nutrition Examination Survey
  Source**               (NHANES), CDC, NCHS.

  **State Data Source**  Not identified.

  **Healthy People 2000  Adapted from 13.1 (Oral Health).
  Objective**            

  **Measure**            Percent.

  **Baseline**           18 (1988--94).

  **Numerator**          Number of children aged 2 to 4 years with a
                         clinical diagnosis of dental caries, presence of
                         fillings in at least one primary tooth, or
                         evidence of a missing tooth due to caries.

  **Denominator**        Number of children aged 2 to 4 years.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual, beginning with 1999 data.
  Periodicity**          

  **Comments**           Although this objective uses the same
                         measurement protocol as the comparable Healthy
                         People 2000 objective 13.1, the tracking of
                         young children aged 2 to 4 years is new to
                         Healthy People 2010.

                         A description of the clinical protocol used to
                         diagnose caries experience for Healthy People
                         2000 has been published by NCHS.**^1^**

                         See Part C for a description of NHANES.

                         Baseline data for the American Indian/Alaska
                         Native population are from the 1999 Oral Health
                         Survey of Native Americans. IHS collects data
                         approximately every 10 years on the American
                         Indian/Alaska Native population. Data are
                         collected on clinic users to assess the oral
                         health status and treatment needs of the IHS
                         service area population. The data reflect a
                         weighted sample.

                         Baseline data for the Asian population are from
                         the 1993--94 California Oral Health Needs
                         Assessment of Children. This data set was used
                         because it had the largest representative sample
                         of Asian children in which clinical oral health
                         status indicators were assessed. Data were
                         collected from a representative sample of
                         California children in schools by trained
                         examiners.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  21-1b. Reduce the      
  proportion of children 
  with dental caries     
  experience in primary  
  and permanent teeth.   

  **National Data        National Health and Nutrition Examination Survey
  Source**               (NHANES), CDC, NCHS.

  **State Data Source**  Not identified.

  **Healthy People 2000  13.1 (Oral Health).
  Objective**            

  **Measure**            Percent.

  **Baseline**           52 (1988--94).

  **Numerator**          Number of children aged 6 to 8 years with a
                         clinical diagnosis of dental caries, presence of
                         fillings in at least one primary or permanent
                         tooth, or evidence of a missing tooth due to
                         caries.

  **Denominator**        Number of children aged 6 to 8 years.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual, beginning with 1999 data.
  Periodicity**          

  **Comments**           This objective uses the same measurement
                         protocol as the comparable Healthy People 2000
                         objective 13.1. A description of the clinical
                         protocol used to diagnose caries experience for
                         Healthy People 2000 has been published by
                         NCHS.**^1^**

                         See Part C for a description of NHANES.

                         Baseline data for the American Indian/Alaska
                         Native population are from the 1999 Oral Health
                         Survey of Native Americans. IHS collects data
                         approximately every 10 years on the American
                         Indian/Alaska Native population. Data are
                         collected on clinic users to assess the oral
                         health status and treatment needs of the IHS
                         service area population. The data reflect a
                         weighted sample.

                         Baseline data for the Asian population are from
                         the 1993--94 California Oral Health Needs
                         Assessment of Children. This data set was used
                         because it had the largest representative sample
                         of Asian children in which clinical oral health
                         status indicators were assessed. Data were
                         collected from a representative sample of
                         California children in schools by trained
                         examiners.

                         Baseline data for the Native Hawaiian and other
                         Pacific Islander population are from the 1999
                         Hawai'i Children's Oral Health Assessment. The
                         Hawaii State Department of Health collects oral
                         health data of school children periodically
                         (previously in 1998). In 1999 25,553 school
                         children aged 5 to 11 years were surveyed. Data
                         were collected by calibrated examiners from a
                         representative sample of Hawaii children
                         attending public schools.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  21-1c. Reduce the      
  proportion of          
  adolescents with       
  dental caries          
  experience in their    
  permanent teeth.       

  **National Data        National Health and Nutrition Examination Survey
  Source**               (NHANES), CDC, NCHS.

  **State Data Source**  Not identified.

  **Healthy People 2000  13.1 (Oral Health).
  Objective**            

  **Measure**            Percent.

  **Baseline**           61 (1988--94).

  **Numerator**          Number of adolescents aged 15 years with a
                         clinical diagnosis of dental caries, presence of
                         fillings in at least one permanent tooth, or
                         evidence of a missing permanent tooth due to
                         caries.

  **Denominator**        Number of adolescents aged 15 years.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual, beginning with 1999 data.
  Periodicity**          

  **Comments**           This objective uses the same measurement
                         protocol as the comparable Healthy People 2000
                         objective 13.1. A description of the clinical
                         protocol used to diagnose caries experience for
                         Healthy People 2000 has been published by
                         NCHS.**^1^**

                         See Part C for a description of NHANES.

                         Baseline data for the American Indian/Alaska
                         Native population are from the 1999 Oral Health
                         Survey of Native Americans. IHS collects data
                         approximately every 10 years on the American
                         Indian/Alaska Native population. Data are
                         collected on clinic users to assess the oral
                         health status and treatment needs of the IHS
                         service area population. The data reflect a
                         weighted sample.

                         Baseline data for the Asian population are from
                         the 1993--94 California Oral Health Needs
                         Assessment of Children. This data set was used
                         because it had the largest representative sample
                         of Asian children for which clinical oral health
                         status indicators were assessed. Data were
                         collected from a representative sample of
                         California children in schools by trained
                         examiners.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

21-2. Reduce the proportion of children, adolescents, and adults with
untreated dental decay.

  ---------------------- ------------------------------------------------
  21-2a. Reduce the      
  proportion of young    
  children with          
  untreated dental decay 
  in their primary       
  teeth.                 

  **National Data        National Health and Nutrition Examination Survey
  Source**               (NHANES), CDC, NCHS.

  **State Data Source**  Not identified.

  **Healthy People 2000  Adapted from 13.2 (Oral Health).
  Objective**            

  **Measure**            Percent.

  **Baseline**           16 (1988--94).

  **Numerator**          Number children aged 2 to 4 years with a
                         clinical diagnosis of dental decay in at least
                         one tooth that has not been restored.

  **Denominator**        Number of children aged 2 to 4 years.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual, beginning with 1999 data.
  Periodicity**          

  **Comments**           Although this objective uses the same
                         measurement protocol as the comparable Healthy
                         People 2000 objective 13.2, the tracking of
                         young children aged 2 to 4 years is new to
                         Healthy People 2010.

                         A description of the clinical protocol used to
                         diagnose dental decay for Healthy People 2000
                         has been published by NCHS.**^1^**

                         See Part C for a description of NHANES.

                         Baseline data for the American Indian/Alaska
                         Native population are from the 1999 Oral Health
                         Survey of Native Americans. IHS collects data
                         approximately every 10 years on the American
                         Indian/Alaska Native population. Data are
                         collected on clinic users to assess the oral
                         health status and treatment needs of the IHS
                         service area population. The data reflect a
                         weighted sample.

                         Baseline data for the Asian population are from
                         the 1993--94 California Oral Health Needs
                         Assessment of Children. This data set was used
                         because it had the largest representative sample
                         of Asian children for which clinical oral health
                         status indicators were assessed. Data were
                         collected from a representative sample of
                         California children in schools by trained
                         examiners.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  21-2b. Reduce the      
  proportion of children 
  with untreated dental  
  decay in their primary 
  teeth and permanent    
  teeth.                 

  **National Data        National Health and Nutrition Examination Survey
  Source**               (NHANES), CDC, NCHS.

  **State Data Source**  Not identified.

  **Healthy People 2000  13.2 (Oral Health).
  Objective**            

  **Measure**            Percent.

  **Baseline**           29 (1988--94).

  **Numerator**          Number of children aged 6 to 8 years with a
                         clinical diagnosis of dental decay in at least
                         one primary or permanent tooth that has not been
                         restored.

  **Denominator**        Number of children aged 6 to 8 years.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual, beginning with 1999 data.
  Periodicity**          

  **Comments**           This objective uses the same measurement
                         protocol as the comparable Healthy People 2000
                         objective 13.2. A description of the clinical
                         protocol used to diagnose dental decay for
                         Healthy People 2000 has been published by
                         NCHS.**^1^**

                         See Part C for a description of NHANES.

                         Baseline data for the American Indian/Alaska
                         Native population are from the 1999 Oral Health
                         Survey of Native Americans. IHS collects data
                         approximately every 10 years on the American
                         Indian/Alaska Native population. Data are
                         collected on clinic users to assess the oral
                         health status and treatment needs of the IHS
                         service area population. The data reflect a
                         weighted sample.

                         Baseline data for the Asian population are from
                         the 1993--94 California Oral Health Needs
                         Assessment of Children. This data set was used
                         because it had the largest representative sample
                         of Asian children in which clinical oral health
                         status indicators were assessed. Data were
                         collected from a representative sample of
                         California children in schools by trained
                         examiners.

                         Baseline data for the Native Hawaiian and other
                         Pacific Islander population are from the 1999
                         Hawai'i Children's Oral Health Assessment. The
                         Hawaii State Department of Health collects oral
                         health data of school children periodically
                         (previously in 1998). In 1999 25,553 school
                         children aged 5 to 11 years were surveyed. Data
                         were collected by calibrated examiners from a
                         representative sample of Hawaii children
                         attending public schools.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  21-2c. Reduce the      
  proportion of          
  adolescents with       
  untreated dental decay 
  in their permanent     
  teeth.                 

  **National Data        National Health and Nutrition Examination Survey
  Source**               (NHANES), CDC, NCHS.

  **State Data Source**  Not identified.

  **Healthy People 2000  13.2 (Oral Health).
  Objective**            

  **Measure**            Percent.

  **Baseline**           20 (1988--94).

  **Numerator**          Number of adolescents aged 15 years with a
                         clinical diagnosis of dental decay in at least
                         one permanent tooth that has not been restored.

  **Denominator**        Number of adolescents aged 15 years.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual, beginning with 1999 data.
  Periodicity**          

  **Comments**           This objective uses the same measurement
                         protocol as the comparable Healthy People 2000
                         objective 13.2. A description of the clinical
                         protocol used to diagnose dental decay for
                         Healthy People 2000 has been published by
                         NCHS.**^1^**

                         See Part C for a description of NHANES.

                         Baseline data for the American Indian/Alaska
                         Native population are from the 1999 Oral Health
                         Survey of Native Americans. IHS collects data
                         approximately every 10 years on the American
                         Indian/Alaska Native population. Data are
                         collected on clinic users to assess the oral
                         health status and treatment needs of the IHS
                         service area population. The data reflect a
                         weighted sample.

                         Baseline data for the Asian population are from
                         the 1993--94 California Oral Health Needs
                         Assessment of Children. This data set was used
                         because it had the largest representative sample
                         of Asian children in which clinical oral health
                         status indicators were assessed. Data were
                         collected from a representative sample of
                         California schoolchildren in schools by trained
                         examiners.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  21-2d. Reduce the      
  proportion of adults   
  with untreated dental  
  decay.                 

  **National Data        National Health and Nutrition Examination Survey
  Source**               (NHANES), CDC, NCHS.

  **State Data Source**  Not identified.

  **Healthy People 2000  Adapted from 13.2 (Oral Health).
  Objective**            

  **Measure**            Percent.

  **Baseline**           27 (1988--94).

  **Numerator**          Number of adults aged 35 to 44 years with a
                         clinical diagnosis of dental decay in at least
                         tooth that has not been restored.

  **Denominator**        Number of adults aged 35 to 44 years.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual, beginning with 1999 data.
  Periodicity**          

  **Comments**           Although this objective uses the same
                         measurement protocol as the comparable Healthy
                         People 2000 objective 13.2, the tracking of
                         adults aged 35 to 44 years is new to Healthy
                         People 2010.

                         A description of the clinical protocol used to
                         diagnose dental decay for Healthy People 2000
                         has been published by NCHS.**^1^**

                         See Part C for a description of NHANES.

                         Baseline data for the American Indian/Alaska
                         Native population are from the 1999 Oral Health
                         Survey of Native Americans. IHS collects data
                         approximately every 10 years on the American
                         Indian/Alaska Native population. Data are
                         collected on clinic users to assess the oral
                         health status and treatment needs of the IHS
                         service area population. The data reflect a
                         weighted sample.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  21-3. Increase the     
  proportion of adults   
  who have never had a   
  permanent tooth        
  extracted because of   
  dental caries or       
  periodontal disease.   

  **National Data        National Health and Nutrition Examination Survey
  Source**               (NHANES), CDC, NCHS.

  **State Data Source**  Not identified.

  **Healthy People 2000  13.3 (Oral Health).
  Objective**            

  **Measure**            Percent.

  **Baseline**           31 (1988--94).

  **Numerator**          Number of adults aged 35 to 44 with a clinical
                         confirmation of at least 28 natural teeth,
                         exclusive of third molars.

  **Denominator**        Number of adults aged 35 to 44 years.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual, beginning with 1999 data.
  Periodicity**          

  **Comments**           Case definition is "no teeth lost due to caries
                         or periodontal diseases"; however, because cause
                         of tooth loss is not feasible to identify, the
                         presence of 28 natural teeth (excluding third
                         molars) is used as a proxy.

                         See Part C for a description of NHANES.

                         Baseline data for the American Indian/Alaska
                         Native population are from the 1999 Oral Health
                         Survey of Native Americans. The Indian Health
                         Service (IHS) collects data approximately every
                         10 years on the American Indian/Alaska Native
                         population. Data are collected on clinic users
                         to assess the oral health status and treatment
                         needs of the IHS service area population. The
                         data reflect a weighted sample.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

+---------------------+------------------------------------------------+
| 21-4. Reduce the    |                                                |
| proportion of older |                                                |
| adults who have had |                                                |
| all their natural   |                                                |
| teeth extracted.    |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 13.4 (Oral Health).               |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 26 (1997).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of older adults aged 65 to 74 years who |
|                     | report having lost all their natural teeth.    |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of adults aged 65 to 74 years.          |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1997 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Have you lost all of your upper natural    |
|                     |     (permanent) teeth?                         |
|                     |                                                |
|                     | -   Have you lost all of your lower natural    |
|                     |     (permanent) teeth?                         |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | A person is defined as having lost all their   |
|                     | natural teeth if they answered "yes" to both   |
|                     | of the preceding questions.                    |
+---------------------+------------------------------------------------+
|                     | Although the same measurement is used to track |
|                     | this objective and the comparable Healthy      |
|                     | People 2000 objective 13.4, data for the       |
|                     | Healthy People 2010 objective are restricted   |
|                     | to older adults aged 65 to 74 years while the  |
|                     | Healthy People 2000 data cover all older       |
|                     | adults aged 65 years and older.                |
+---------------------+------------------------------------------------+
|                     | A description of the comparable Healthy People |
|                     | 2000 objective 13.4 has been published by      |
|                     | NCHS.**^1^**                                   |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS.          |
+---------------------+------------------------------------------------+
|                     | Baseline data for the American Indian/Alaska   |
|                     | Native population are from the 1999 Oral       |
|                     | Health Survey of Native Americans. The Indian  |
|                     | Health Service (IHS) collects data             |
|                     | approximately every 10 years on the American   |
|                     | Indian/Alaska Native population. Data are      |
|                     | collected on clinic users to assess the oral   |
|                     | health status and treatment needs of the IHS   |
|                     | service area population. The data reflect a    |
|                     | weighted sample.                               |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  

21-5. Reduce periodontal disease.

  ---------------------- ------------------------------------------------
  21-5a. Gingivitis.     

  **National Data        National Health and Nutrition Examination Survey
  Source**               (NHANES), CDC, NCHS.

  **State Data Source**  Not identified.

  **Healthy People 2000  Adapted from 13.5 (Oral Health).
  Objective**            

  **Measure**            Percent.

  **Baseline**           48 (1988--94).

  **Numerator**          Number of adults aged 35 to 44 years with a
                         clinical confirmation of gingivitis.

  **Denominator**        Number of adults aged 35 to 44 years.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual, beginning with 1999 data.
  Periodicity**          

  **Comments**           Gingivitis is gingival bleeding in one or more
                         sites after gently probing the gingival sulcus.

                         A description of the comparable Healthy People
                         2000 objective 13.5, which included the clinical
                         protocol used to diagnose gingivitis has been
                         published by NCHS.**^1^**

                         The same measurement is used to track this
                         objective and the comparable Healthy People 2000
                         objective 13.5. However, published data for the
                         Healthy People 2000 objective were restricted to
                         employed adults while the Healthy People 2010
                         data covers all noninstitutionalized individuals
                         aged 35 to 44 years.

                         See Part C for a description of NHANES.

                         Baseline data for the American Indian/Alaska
                         Native population are from the 1999 Oral Health
                         Survey of Native Americans. The Indian Health
                         Service (IHS) collects data approximately every
                         10 years on the American Indian/Alaska Native
                         population. Data are collected on clinic users
                         to assess the oral health status and treatment
                         needs of the IHS service area population. The
                         data reflect a weighted sample.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  21-5b. Destructive     
  periodontal disease.   

  **National Data        National Health and Nutrition Examination Survey
  Source**               (NHANES), CDC, NCHS.

  **State Data Source**  Not identified.

  **Healthy People 2000  Adapted from 13.6 (Oral Health).
  Objective**            

  **Measure**            Percent.

  **Baseline**           22 (1988--94).

  **Numerator**          Number of adults aged 35 to 44 years with a
                         clinical diagnosis of destructive periodontal
                         disease.

  **Denominator**        Number of adults aged 35 to 44 years.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual, beginning with 1999 data.
  Periodicity**          

  **Comments**           Destructive periodontal disease is the loss of
                         attachment greater than or equal to 4mm in two
                         sites on at least one tooth---as measured at the
                         mid-facial and mesial facial line angles for two
                         quadrants. These two quadrants include one
                         randomly selected quadrant in the maxillary arch
                         and one quadrant in the mandibular arch.

                         Although a similar measurement is used to track
                         the comparable Healthy People 2000 objective
                         13.6, published data for the Healthy People 2000
                         objective were restricted to employed adults,
                         while the Healthy People 2010 data covers all
                         noninstitutionalized adults aged 35 to 44 years.

                         A description of the clinical protocol used to
                         diagnose destructive periodontal disease in
                         Healthy People 2000 has been published by
                         NCHS.**^1^**

                         See Part C for a description of NHANES.

                         Baseline data for the American Indian/Alaska
                         Native population are from the 1999 Oral Health
                         Survey of Native Americans. The Indian Health
                         Service (IHS) collects data approximately every
                         10 years on the American Indian/Alaska Native
                         population. Data are collected on clinic users
                         to assess the oral health status and treatment
                         needs of the IHS service area population. The
                         data reflect a weighted sample.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  21-6. Increase the     
  proportion of oral and 
  pharyngeal cancers     
  detected at the        
  earliest stage.        

  **National Data        Surveillance, Epidemiology, and End Results
  Source**               Program (SEER), NIH, NCI.

  **State Data Source**  State cancer registries.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Percent.

  **Baseline**           35 (1990--95) (selected areas---see Comments).

  **Numerator**          Number of diagnosed incidents of cancer cases in
                         stage 1 (localized) of the oral cavity and
                         pharynx (ICD-9 codes 140-149).

  **Denominator**        Number of diagnosed incidents of all cancer
                         cases of the oral cavity and pharynx (ICD-9
                         codes 140-149).

  **Population           Resident population (selected areas---see
  Targeted**             Comments).

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           SEER data are based on data from
                         population-based registries in Connecticut; New
                         Mexico; Utah; Iowa; Hawaii; Atlanta, GA;
                         Detroit, MI; Seattle-Puget Sound, WA; and San
                         Francisco-Oakland, CA.

                         A description of the SEER program has been
                         published by NCI.**^2^**

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

+---------------------+------------------------------------------------+
| 21-7. Increase the  |                                                |
| proportion of       |                                                |
| adults who, in the  |                                                |
| past 12 months,     |                                                |
| report having had   |                                                |
| an examination to   |                                                |
| detect oral and     |                                                |
| pharyngeal cancers. |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 13 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of adults aged 40 years and older who   |
|                     | report having had an examination to detect     |
|                     | oral and pharyngeal cancer in the past 12      |
|                     | months.                                        |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of adults aged 40 years and older.      |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Have you ever had a test for oral cancer   |
|                     |     in which the doctor or dentist pulls on    |
|                     |     your tongue, sometimes with gauze wrapped  |
|                     |     around it, and feels under the tongue and  |
|                     |     inside the cheeks?                         |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   When did you have your most recent oral    |
|                     |     cancer exam? Was it a year ago or less,    |
|                     |     more than 1 year but not more than 2       |
|                     |     years, more than 2 years but not more than |
|                     |     3 years, more than 3 years but not more    |
|                     |     than 5 years, or over 5 years ago?         |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | A person is defined as having had an oral and  |
|                     | pharyngeal cancer test in the past 12 months   |
|                     | if he/she responded "yes" to the first         |
|                     | question and "a year ago or less" to the       |
|                     | second question listed above.                  |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion of age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and       |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  

21-8. Increase the proportion of children who have received dental
sealants on their molar teeth.

  ---------------------- ------------------------------------------------
  21-8a. Children aged 8 
  years.                 

  **National Data        National Health and Nutrition Examination Survey
  Source**               (NHANES), CDC, NCHS.

  **State Data Source**  Not identified.

  **Healthy People 2000  13.8 (Oral Health).
  Objective**            

  **Measure**            Percent.

  **Baseline**           23 (1988--94).

  **Numerator**          Number of children aged 8 years with a clinical
                         confirmation of dental sealants applied to one
                         or more permanent molars.

  **Denominator**        Number of children aged 8 years.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual, beginning with 1999 data.
  Periodicity**          

  **Comments**           A description of the clinical protocol used to
                         confirm evidence of protective dental sealants
                         has been published by NCHS.**^1^**

                         See Part C for a description of NHANES.

                         Baseline data for the Native Hawaiian and other
                         Pacific Islander population are from the 1999
                         Hawai'i Children's Oral Health Assessment. The
                         Hawaii State Department of Health collects oral
                         health data of school children periodically
                         (previously in 1998). In 1999 25,553 school
                         children aged 5 to 11 years were surveyed. Data
                         were collected by calibrated examiners from a
                         representative sample of Hawaii children
                         attending public schools.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  21-8b. Adolescents     
  aged 14 years.         

  **National Data        National Health and Nutrition Examination Survey
  Source**               (NHANES), CDC, NCHS.

  **State Data Source**  Not identified.

  **Healthy People 2000  Adapted from 13.8 (Oral Health).
  Objective**            

  **Measure**            Percent.

  **Baseline**           15 (1988--94).

  **Numerator**          Number of adolescents aged 14 years with a
                         clinical confirmation of dental sealants applied
                         to one or more first and second permanent
                         molars.

  **Denominator**        Number of adolescents aged 14 years with at
                         least one permanent first molar and one
                         permanent second molar.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual, beginning with 1999 data.
  Periodicity**          

  **Comments**           A description of the clinical protocol used to
                         confirm evidence of protective dental sealants
                         has been published by NCHS.**^1^**

                         Although the same measurement is used to track
                         this objective and the comparable Healthy People
                         2000 objective 13.8, the Healthy People 2010
                         data are limited to protective sealant data on
                         one or more permanent first and second molars,
                         while data for the Healthy People 2000 objective
                         did not distinguish between first and second
                         permanent molars.

                         See Part C for a description of NHANES and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  21-9. Increase the     
  proportion of the U.S. 
  population served by   
  community water        
  systems with optimally 
  fluoridated water.     

  **National Data        CDC Fluoridation Census, CDC, NCCDPHP.
  Source**               

  **State Data Source**  CDC Fluoridation Census, CDC, NCCDPHP.

  **Healthy People 2000  13.9 (Oral Health).
  Objective**            

  **Measure**            Percent.

  **Baseline**           62 (1992).

  **Numerator**          Number of persons receiving optimally
                         fluoridated water from public systems.

  **Denominator**        Number of persons served by public water
                         systems.

  **Population           U.S. resident population served by public water
  Targeted**             systems.

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual, beginning with year 2000 data.
  Periodicity**          

  **Comments**           Optimal water concentration of fluoride is
                         specific for geographic areas, based on their
                         mean daily temperature.

                         A description of the protocol used to
                         characterize a community as optimally
                         fluoridated has been published by NCHS.**^1^**

                         Beginning with year 2000 data, the source of
                         data will be an interactive Web-based
                         surveillance system called the Water
                         Fluoridation Reporting System. This voluntary
                         reporting system obtains information from the
                         local water system on the number of people
                         served by the fluoridated water system, the
                         number of counties and cities served by the
                         fluoridated water system, and the quality of the
                         fluoridated water system. These quality measures
                         will include the number of months the system is
                         operating with optimal fluoride concentration.
                         CDC will produce an annual report from the
                         database.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  21-10. Increase the    
  proportion of children 
  and adults who use the 
  oral health care       
  system each year.      

  **National Data        Medical Expenditure Panel Survey (MEPS), AHRQ
  Source**               (formerly AHCPR).

  **State Data Source**  Not identified.

  **Healthy People 2000  Adapted from 13.14 (Oral Health).
  Objective**            

  **Measure**            Percent.

  **Baseline**           44 (1996).

  **Numerator**          Number of persons aged 2 years and older who
                         report having had a dental visit in the past 12
                         months.

  **Denominator**        Number of persons aged 2 years and older.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    From the 1996 Medical Expenditure Panel Survey.
  Obtain the National    See http://www.meps.ahrq.gov/survey.htm for more
  Data**                 information.

  **Expected             Periodic.
  Periodicity**          

  **Comments**           MEPS data provide information on the nature of
                         the dental visit as well as dental insurance
                         status of the patient. MEPS data are also used
                         for objective 21-12---preventive dental visits
                         for poor children. MEPS data provide a
                         comprehensive assessment of a previous dental
                         visit. Subjects are interviewed on five
                         different occasions over 15 months, so that they
                         do not need to recall details of dental care
                         received more than 3 months beforehand. In
                         addition, MEPS subjects are also asked for
                         specific information about care received at each
                         visit. Therefore, the numbers of visits during a
                         year are substantiated with additional
                         corroborating evidence. MEPS is used as the
                         database for dental visits in the April 2000
                         Government Accounting Office report to Congress
                         on access to dental care.

                         This objective differs from a similar Healthy
                         People 2000 objective 13.14. The Healthy People
                         2000 objective was tracked by the NHIS and was
                         restricted to adults aged 35 years and older,
                         while the Healthy People 2010 objective covers
                         all noninstitutionalized persons aged 2 years
                         and older. A report on the operational
                         definitions for the Healthy People 2000 oral
                         health objectives has been published by
                         NCHS.**^1^**

                         See Part C for a description of MEPS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

+---------------------+------------------------------------------------+
| 21-11. Increase the |                                                |
| proportion of       |                                                |
| long-term care      |                                                |
| residents who use   |                                                |
| the oral health     |                                                |
| care system each    |                                                |
| year.               |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Nursing Home Survey (NNHS), CDC,      |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 19 (1997).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of nursing home residents who used the  |
|                     | oral health care system.                       |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of nursing home residents.              |
+---------------------+------------------------------------------------+
| **Population        | U.S. resident population.                      |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1997 National Nursing Home Survey:    |
| Obtain the National |                                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | \[In the question below, the phrase "last      |
|                     | month" was used if the resident was admitted   |
|                     | in the previous month or earlier. The phrase   |
|                     | "since admission" was used if the resident was |
|                     | admitted in the current month.\]               |
|                     |                                                |
|                     | -   (Last month/since admission) which of      |
|                     |     these services were received by            |
|                     |     ([Resident]{.underline}), either inside or |
|                     |     outside of this facility?\                 |
|                     |     \[A "hand flashcard" is supplied with a    |
|                     |     check box for "Dental care."\]             |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | A nursing home resident was considered to have |
|                     | used the oral health care system if the        |
|                     | respondent indicated Dental care was provided. |
+---------------------+------------------------------------------------+
|                     | Nursing home data were used as proxy data for  |
|                     | long-term care facilities since there is no    |
|                     | known database that enumerates all long-term   |
|                     | care facilities (nursing homes, chronic        |
|                     | disease hospitals, etc.).                      |
+---------------------+------------------------------------------------+
|                     | A description of the 1997 National Nursing     |
|                     | Home Survey has been published by NCHS.**^3^** |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  

  ---------------------- ------------------------------------------------
  21-12. Increase the    
  proportion of          
  low-income children    
  and adolescents who    
  received any           
  preventive dental      
  service during the     
  past year.             

  **National Data        Medical Expenditure Panel Survey (MEPS), AHQR
  Source**               (formerly AHCPR).

  **State Data Source**  Not identified.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Percent.

  **Baseline**           20 (1996).

  **Numerator**          Number of children under age 19 years at or
                         below 200 percent of the Federal poverty level
                         who received a preventive dental visit during
                         the last year.

  **Denominator**        Number of children under age 19 years at or
                         below 200 percent of the Federal poverty level.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    From the 1996 Medical Expenditure Panel Survey.
  Obtain the National    See www.meps.ahrq.gov/survey.htm for more
  Data**                 information.

  **Expected             Periodic.
  Periodicity**          

  **Comments**           A preventive dental visit is defined as
                         receiving a dental sealant, fluoride treatment,
                         or dental prophylaxis.

                         See Comments with objective 21-10 for more
                         information on MEPS. A description of the 1996
                         MEPS has been published by AHRQ (formerly
                         AHCPR).**^4^**

                         See Part C for a description of MEPS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  21-13. (Developmental) 
  Increase the           
  proportion of          
  school-based health    
  centers with an oral   
  health component.      

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         The School Health Policies and Program Study
                         (SHPPS), CDC, NCCDPHP, is a proposed data source
                         since questions addressing oral health have
                         recently been added. Baseline data are
                         anticipated from the 2000 SHPPS.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  21-14. Increase the    
  proportion of local    
  health departments and 
  community-based health 
  centers, including     
  community, migrant,    
  and homeless health    
  centers, that have an  
  oral health component. 

  **National Data        Health Resources and Services Administration
  Source**               (HRSA), Bureau of Primary Health Care (BPHC).

  **State Data Source**  Association of State and Territorial Dental
                         Directors (ASTDD).

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Percent.

  **Baseline**           34 (1997).

  **Numerator**          Number of local health departments and
                         community-based health centers that have an oral
                         health component.

  **Denominator**        Number of local health departments and
                         community-based health centers.

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Comments**           In order to be considered as having an oral
                         health component, a physical office must be
                         identified in which dental services are provided
                         on-site by a dentist. If a center or local
                         health department provides contract dental
                         services, at least 700 people must be served
                         annually.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  21-15. Increase the    
  number of States and   
  the District of        
  Columbia that have a   
  system for recording   
  and referring infants  
  and children with      
  cleft lips, cleft      
  palates, and other     
  craniofacial anomalies 
  to craniofacial        
  anomaly rehabilitative 
  teams.                 

  **Comments**           A complete operational definition was not
                         specified at the time of publication.

                         This objective is adapted from Healthy People
                         objective 13.15 (Oral Health).

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  21-16. Increase the    
  number of States and   
  the District of        
  Columbia that have an  
  oral and craniofacial  
  health surveillance    
  system.                

  **National Data        Association of State and Territorial Dental
  Source**               Directors (ASTDD).

  **State Data Source**  Statewide oral health surveys; Behavioral Risk
                         Factor Surveillance System (BRFSS), CDC,
                         NCCDPHP; Water Fluoridation Reporting System
                         (WFRS),CDC, NCCDPHP; Youth Risk Behavior
                         Surveillance System (YRBSS), CDC, NCCDPHP;
                         Pregnancy risk data; State cancer
                         registries/Surveillance, Epidemiology, and End
                         Results (SEER), NIH, NCI; Orofacial cleft data;
                         Medicaid dental claims data, HCFA; Annual
                         synopsis of State dental programs, Association
                         of State and Territorial Dental Directors
                         (ASTDD).

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Number.

  **Baseline**           0 (1999).

  **Numerator**          Number of States or the District of Columbia
                         with surveillance data for at least six of the
                         nine possible surveillance databases listed
                         above.

  **Denominator**        Not applicable.

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  21-17. (Developmental) 
  Increase the number of 
  Tribal, State          
  (including the         
  District of Columbia), 
  and local health       
  agencies that serve    
  jurisdictions of       
  250,000 or more        
  persons that have in   
  place an effective     
  public dental health   
  program directed by a  
  dental professional    
  with public health     
  training.              

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         Proposed data sources are the Association of
                         State and Territorial Dental Directors; the
                         Annual Synopsis of State Dental Programs
                         (ASTDD); and the Indian Health Service (IHS).

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

## References

1.Vargas, C.; Schober, S.; and Gift, H. Operational definitions for year
2000 objectives: Priority area 13, Oral Health. *Healthy People 2000
Statistical Notes*, No. 12. Hyattsville, MD: National Center for Health
Statistics (NCHS), 1997.

2\. Ries, L.A.G.; Kosary, C.L.; Hankey, B.F.; et al.; eds. *SEER Cancer
Statistics Review, 1973--1996.* Bethesda, MD: National Cancer Institute,
1999.

3\. Gabrel, C.S. An overview of nursing home facilities: Data from the
1997 National Nursing Home Survey. *Advance Data*, No. 311. Hyattsville,
MD: NCHS, 2000.

4\. Krauss, N.A.; Machlin, S.; and Kass, B.L. Use of health care
services, 1996. *MEPS Research Findings*, No. 7. AHCPR Pub. No.99‑0018.
Rockville, MD: Agency for Health Care Policy and Research, 1998.