Institutional members access full text with Ovid®

Share this article on:

The Importance of Substate Surveillance in Detection of Geographic Oral Health Inequalities in a Small State

Anderson, Ludmila MD, MPH; Martin, Nancy R. MSc, RDH; Flynn, Regina T. BS; Knight, Susan MSPH

Journal of Public Health Management & Practice: September/October 2012 - Volume 18 - Issue 5 - p 461–468
doi: 10.1097/PHH.0b013e31825eabbb
Original Articles

Context: Considering that 42% of children and adolescents and 91% of dentate adults experience dental caries, oral disease is a public health problem. Although the population's oral health is improving, certain subgroups remain at increased risk for dental disease.

Objective: To assess the oral health status at the substate level and explore the possibility of geographic oral health inequalities in New Hampshire while building upon existing surveillance data sets.

Design: We used the Third Grade Oral Health and NH Behavioral Risk Factor Surveillance System surveys. We ensured the availability of substate level data and compared county/region specific estimates.

Setting: New Hampshire.

Participants: Adults and third-grade students in public schools.

Main Outcome Measures: The prevalence of dental caries, untreated caries, and dental sealants among children; and the insurance status, utilization of dental services, and edentulism among adults.

Results: Of the 10 counties, the northernmost Coos County had consistently worse outcomes when compared with other counties. Only 64% of adult Coos County residents reported a dental visit in the past year; of these, 66% reported dental cleaning. Among adults 65 years and older, 29% were edentulous. In comparison with the state overall, these estimates were 76%, 77%, and 19%, respectively. Coos County third-grade students had the highest prevalence of dental caries experience (64% compared with 44% in New Hampshire) and untreated caries (31% compared with 12%), and only 24% had dental sealants (state prevalence is 60%).

Conclusions: Overall oral health status in our state is favorable and comparable with the nation, yet significant geographic inequalities exist among children and adults. The oral health status of disparate groups can be improved using tailored interventions such as community water fluoridation or expansion of school-based dental sealant programs. Surveillance at the substate level is an essential part of the planning, targeting, and progress monitoring.

This article discusses the importance of substate surveillance in detection of geographic oral health inequalities in New Hampshire, using the Third Grade Oral Health and NH Behavioral Risk Factor Surveillance System surveys. Surveillance at the substate level is an essential part of the planning, targeting, and progress monitoring.

Division of Public Health Services, New Hampshire Department of Health and Human Services, Concord, New Hampshire (Dr Anderson and Mss Martin, Flynn, and Knight); and Department of Health Management and Policy, University of New Hampshire, Durham, New Hampshire (Dr Anderson).

Correspondence: Ludmila Anderson, MD, MPH, Department of Health and Human Services, 29 Hazen Dr, Concord, NH 03301 (

The authors thank Sherry Burrer, José Montero, Alisa Druzba, and Lisa Bujno for their contribution at the various stages of the 2009 Third Grade Oral Health Survey as well as the Northeast Delta Dental Foundation for financial support of this survey. They also thank Kathy Phipps, who provided technical assistance supported by the Association of State and Territorial Dental Directors through funding from Health Resources and Services Administration cooperative agreement U44MC00177 and Centers for Disease Control and Prevention (CDC) cooperative agreement DP08-81603, and Paul Siegel, for review and comments. Map was provided by Tylor Young.

This report was partially supported by grant nos. 5U58DP001979 and 1U58DP001471 from the CDC. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the CDC.

Disclosure: The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.