Oral health surveillance: past, present, and future challenges.

We reviewed and summarized the efforts in the United States to collect data on oral diseases, conditions, and behaviors implemented at the national and state level. The main characteristics of these efforts were: (1) systematic collection of data from representative samples, mostly at the national level; (2) one-time or sporadic experiences when data are collected at state and local levels; (3) use of visual-tactile protocols implemented at the tooth-surface or tooth-site level for data collection; (4) focus mainly on dental caries and periodontal diseases; and (5) leap-time from data collection to publication of results. Using the definition of surveillance in public health (the ongoing and systematic collection, analysis, and interpretation of outcome-specific data for use in planning, implementing, and evaluating public health practice), we show there is an impending need to develop new techniques to build up surveillance systems for oral diseases, conditions, and behaviors at the national, state, and local levels. In the second part of this review, we presented a number of alternative techniques developed in the last 10 years to collect timely data for oral health. The main characteristics of these efforts include: (1) focusing on data collection at state and local level; (2) integration into existing and ongoing surveillance systems; (3) using visual-only protocols to collect data on oral disease status; (4) focusing on a variety of diseases, conditions, and behaviors; and (5) analyzing the data in a timely matter. Many of these efforts have been integrated into the National Oral Health Surveillance System, which has developed eight indicators in response to national health objectives. Finally, we envision the future of visual-tactile protocols in data collection of representative samples to monitor oral health status at the national level and as a research tool. At the state and local level, however, we envision an integrated system of data collection as a constantly evolving process as new techniques are developed in response to new demands.