U N I V E R S I T Y O F M I C H I G A N S C H O O L O F D E N T I S T R Y 1 Surveillance

U N I V E R S I T Y O F M I C H I G A N S C H O O L O F D E N T I S T R Y 2 Definition Ongoing systematic collection, analysis, and interpretation of outcome-specific data for use in planning, implementation, and evaluation of public health practice –CDA/Agency for Toxic Substance and Disease Registry

U N I V E R S I T Y O F M I C H I G A N S C H O O L O F D E N T I S T R Y 3 Definition Functional capacity –Data collection –Analysis –Timely dissemination of information derived from the data to persons who can undertake effective prevention and control activities. Surveillance should be tied to health outcomes –It is not just the collection of data

U N I V E R S I T Y O F M I C H I G A N S C H O O L O F D E N T I S T R Y 4 Pre-requisites Organized healthcare system Classification system for diseases Early surveillance systems relied on mortality statistics –Disease specific death counts and rates –Disease patterns

U N I V E R S I T Y O F M I C H I G A N S C H O O L O F D E N T I S T R Y 5 Surveillance and Public Health Uses: –Estimating the burden of diseases –Understanding the natural history –Detecting of epidemics –Facilitating of epidemiologic or laboratory research –Testing hypotheses –Evaluating of control and prevention measures –Monitoring changes in infectious diseases –Monitoring isolation activities –Detection of changes in health practice –Planning

U N I V E R S I T Y O F M I C H I G A N S C H O O L O F D E N T I S T R Y 6 Public Health William Farr ( ) –Founder of surveillance –Vital statistics –Reporting on causes of death to health authorities and public

U N I V E R S I T Y O F M I C H I G A N S C H O O L O F D E N T I S T R Y 7 Surveillance in the US Infectious diseases –Rhode Island in 1741 –Tavern keepers are required to report on contagious diseases –1743: reporting of smallpox, yellow fever, and cholera –1850: mortality statistics based on death registration and the decennial census were first published by the federal government for the entire US –1874: systematic reporting of disease in Massachusetts: State Board of Health instituted a voluntary plan for physicians to provide weekly reports on prevalent diseases using a postcard-size reporting form. –1878: Congress authorized the collecting of morbidity data for use in quarantine measures against such diseases as cholera, smallpox, plague, and yellow fever.

U N I V E R S I T Y O F M I C H I G A N S C H O O L O F D E N T I S T R Y 8 Surveillance in the US In 1925, following the flu pandemic and poliomyelitis –All states participated in a national morbidity reporting system A national health survey was conducted in weekly statistics 1961: CDC responsible for reporting mortality and morbidity reports

U N I V E R S I T Y O F M I C H I G A N S C H O O L O F D E N T I S T R Y 9 Surveillance in the US Council of State and Territorial Epidemiologists decide on what health conditions should be reported about by state to the PHS. In 1955 in the Francis Field Trial of Poliomyelitis, six cases of paralysis associated with polio were reported; and all cases were traced to the vaccine produced by a single manufacturer. Intensive investigation found 141 cases of vaccine- associated paralytic polio, 80 of which represented family contacts with vaccinated individuals.

U N I V E R S I T Y O F M I C H I G A N S C H O O L O F D E N T I S T R Y 10 Steps in Planning a Surveillance System Establish objectives Develop case definitions Determine data sources or data-collection mechanisms (type of system) Develop data-collection instruments Field-test methods Develop and test analytic approach Develop dissemination mechanism Ensure use of analysis and interpretation

U N I V E R S I T Y O F M I C H I G A N S C H O O L O F D E N T I S T R Y 11 National Oral Health Surveillance System (NOHSS) Collaborative effort between CDC's Division of Oral Health and the Association of State and Territorial Dental Directors (ASTDD). Designed to help public health programs monitor the burden of oral disease, use of the oral health care delivery system, and the status of community water fluoridation on both a state and national level. Includes indicators of oral health, information on state dental programs, and links to other important sources of oral health information.

U N I V E R S I T Y O F M I C H I G A N S C H O O L O F D E N T I S T R Y 12 NOHSS Dental Visits. Percentage of people who visited the dentist or dental clinic within the past year. Routine dental visits aid in the prevention, early detection and treatment of tooth decay, oral soft tissue disease, and periodontal diseases. Teeth Cleaning. Percentage of people who had their teeth cleaned in the past year. Having one's teeth cleaned by a dentist or dental hygienist is indicative of preventive behavior.

U N I V E R S I T Y O F M I C H I G A N S C H O O L O F D E N T I S T R Y 13 NOHSS Complete Tooth Loss. Percentage of people aged 65 years and older who have lost all natural permanent teeth. Loss of all natural permanent teeth (complete tooth loss) may substantially reduce quality of life, self-image, and daily functioning. Fluoridation Status. Percentage of people served by public water systems who receive fluoridated water. Water fluoridation plays an important role in reducing tooth decay and tooth loss. Caries Experience. Percentage of 3rd grade students with caries experience, including treated and untreated tooth decay. Dental caries is the single most common chronic disease of childhood, occurring five to eight times as frequently as asthma, the second most common chronic disease in children.

U N I V E R S I T Y O F M I C H I G A N S C H O O L O F D E N T I S T R Y 14 NOHSS Untreated Tooth Decay. Percentage of 3rd grade students with untreated tooth decay. To avoid pain and discomfort, decayed teeth need to be restored (filled). To keep as much of the natural tooth as possible, decayed teeth should be discovered early and repaired promptly so that fillings may be kept small. Dental Sealants. Percentage of 3rd grade students with dental sealants on at least one permanent molar tooth. Plastic coatings applied to decay-susceptible tooth surfaces (the pits and fissures) reduce tooth decay, have been approved for use for many years, and are recommended by professional health associations and public health agencies, particularly for children at high risk for tooth decay. Cancer of the Oral Cavity and Pharynx. Oral and pharyngeal cancer comprises a diversity of malignant tumors that affect the oral cavity and pharynx (mouth and throat). Each year, some 30,000 new cases of oral and pharyngeal cancer are diagnosed and 8,000 people die from the disease. For more information on oral cancer,

U N I V E R S I T Y O F M I C H I G A N S C H O O L O F D E N T I S T R Y 15 Suggested Surveillance Program for Community Health centers Percentage of patients who receive full diagnosis and treatment –Untreated decay –Periodontal diseases –Oral cancer screening and referral, when needed Percentage of patients who are assessed for risk of developing caries, periodontal diseases, and oral cancer Percentage of patients who receive tailored preventive programs Percentage of patients who are recalled Percentage of patients who are recalled based on their risk status