Oral Health Information Systems-Towards Measuring Progress in Oral Health Promotion and Disease Prevention
Petersen, Poul Erik, Bourgeois, Denis, Bratthall, Douglas, Ogawa, Hiroshi, Bulletin of the World Health Organization
WHO has a long tradition of epidemiological survey methodology and surveillance in oral health. The so-called WHO Global Oral Health Data Bank was established in 1967; the bank emerged from the gathering of information from surveys on the growing burden of dental caries among children, particularly notable in industrialized countries. Most of the surveys carried out in these countries were initially motivated by the need for planning of oral health services or organization of public health intervention programmes. Over the past decades, WHO has encouraged Member States to report information on disease level for making international comparisons, by use of a standardized methodology (1-4). For comparison between countries, certain indicator age groups are suggested: 5-6 years, 12 years, 15 years, 35-44 years and 65 years or more (or 65-74 years), and a simplified pathfinder sampling methodology (convenience sampling) has been developed for urgent data collection in countries or settings where probability sampling is not possible. To ensure data of high validity and reliability, WHO has designed basic instruments and record forms for use in the collection of clinical data. Standard criteria for recording clinical conditions are recommended, focusing on dentition status, prosthetic status and needs, dental caries and dental treatment needs, developmental anomalies of teeth, periodontal disease and treatment needs, oral mucosal lesions and oral precancer/cancer. Special attempts have been made to obtain high quality data through specification of clearly defined examination procedures, training, and calibration trials for assessment of intra- or inter-examiner variability (5).
Tools for oral epidemiology have been instrumental in the establishment of oral health information systems worldwide. The objectives of the present report are to outline experiences of use of such systems at the global, regional and national levels, and to describe the efforts made in developing expanded systems for the surveillance of oral disease and risk factors within the new WHO STEPwise approach for measuring progress in prevention of chronic disease and promotion of health.
Oral health information systems at the global and regional levels
Data on oral health status for monitoring disease patterns and trends over time represent an essential component of oral health information systems (Fig. 1). In addition to epidemiological information, decision-makers and health planners need information about risk factors to oral health, oral health-related quality of life, service coverage and utilization of oral health services, intervention and care, administrative procedures, and quality of care and services.
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An important public health rationale of the WHO Global Oral Health Data Bank has been to provide for epidemiological analysis of changing oral health status, to highlight how such changes might be related to new risk profiles in countries or regions, and to assess the impact of development or adjustment of oral health systems. In parallel to the continuous update of the Global Data Bank, similar databanks have been developed for the WHO Regional Offices (6, 7) based on common procedures for data collection. Time-series analyses conducted on the basis of the global and regional data available show improved oral health status in children in several industrialized countries, as measured by a decline in the average number of teeth affected by dental caries at the age of 12 years (8). This trend is partly a reflection of the introduction of preventive oral care programmes in these countries. In contrast, information is available on the increasing prevalence of dental caries in developing countries over recent years, due to the increasing consumption of sugars and lack of preventive programmes.
In 1996, WHO established an Internet online oral health database, supported by the WHO Collaborating Centre in oral health at Malmo University, Sweden, and the University of Niigata, Japan. …