Rhode Island
Oral Health Surveillance System Plan
2016-2020
Rhode Island Department of Health
Oral Health Program
March 2016
Table of Contents
Introduction………………………………………………………………………………………………………..3
Oral Health Surveillance: A Public Health Surveillance
Overview of Rhode Island Oral Health Needs
Goal and Objectives of the Rhode Island Oral Health Surveillance System…………………5
Principal Guidelines for Rhode Island Oral Health Surveillance System………………………6
Oral Health Indicators in RI Oral Health Surveillance System…………………………………..7
RI Oral Health Surveillance Stakeholders and Partners…………………………………………..14
Data Dissemination and Use………………………………………………………………………………..15
Privacy and Confidentiality…………………………………………………………………………………..17
Evaluation………………………………………………………………………………………………………….17
Reference………………………………………………………………………………………………………….18
Tables
Table 1. RI Oral Health Surveillance System Indicators…………………………………………...8
Table 2. RIOHSS Data Sources and Data Collection Timeline…………………………………..11
The plan was produced by the Rhode Island Oral Health Program and funded through
cooperative agreement DP13-1307 between the Rhode Island Department of Health and
the Centers for Disease Control and Prevention.
I.
Introduction
1. Oral Health Surveillance: A Public Health Surveillance
The 1988 Institute of Medicine (IOM) report on the future of public health outlines three core
functions for public health: assessment, policy development, and assurance.1 In that report
(updated in 2003), the IOM recommended that every public health agency carry out an
essential public health function of assessment, through public health surveillance - the
ongoing and systematic collection, analysis, and interpretation of population health data. Public
health surveillance is essential for planning, implementing, and evaluating public health practice
and, is closely integrated with data dissemination to public health decision makers and other
stakeholders.
According to the Centers for Disease Control and Prevention (CDC) Guidelines for Evaluating
Public Health Surveillance Systems, health-related events are considered for surveillance if they
affect many people, require large expenditures of resources, are largely preventable, and are of
public health importance.2 In addition, the Association of State and Territorial Dental Directors
(ASTDD) released a policy statement in April 2015 supporting and strongly recommending that
state health jurisdictions develop an oral health surveillance plan, and implement and maintain
a robust state-based oral health surveillance system.3
Oral diseases or conditions, also referred to as oral health outcomes, are influenced by a variety
of factors, including access to dental care and the cost to individuals to obtain it, individual risk
factors and risk determinants, availability of interventions, workforce issues, public health
infrastructure, and public policies. Oral health surveillance system is needed to identify
population needs, protect and promote population-wide oral health, and monitor the impact of
those efforts.3,4
2. Overview of Rhode Island Oral Health Needs
Although the oral health status of RI residents has improved during recent decades, profound
and consequential oral health disparities still exist, and obtaining oral health care is a
persistently challenging issue for certain RI populations – children and families with low-income,
those of racial and ethnic minorities, pregnant women, individuals with special care needs, and
elders.
Box 1 summarizes selective highlights of the gaps and disparities in oral health and access to
care among Rhode Islanders, based on the findings in the previous RI Oral Health Surveillance
reports or publications.
3
Box 1. Highlights of the gaps and disparities in oral health among Rhode Islanders

Many children in Rhode Island do not receive the dental care they need: One in four children age
3–5 years in Head Start and 26 percent of 3rd graders have untreated dental decay, meaning that
they have not received adequate treatment in a timely manner.5,6

Among 3rd graders, racial/ethnic minority children or children attending schools with more
students eligible for the free and reduced price school meals program are more likely to
experience dental decay and have untreated tooth decay than their counterparts in more
affluent communities.6

Only 40 percent of 3rd grade school children in RI have dental sealants, a well-accepted clinical
intervention to prevent tooth decay on molar teeth, indicating that RI falls far short of national
standards.6

Most of RI children enrolled in Medicaid do not receive any dental service until they reach
school age: Only 13 percent of children 2 years and under, and less than half of children age 3–5
years (46%), received at least one preventive or treatment dental service in 2010.7

Only half of RI women reported they had a dental visit during their pregnancy. In particular,
pregnant women who participated in WIC (Special Supplemental Nutrition Program for Women,
Infants, and Children) or who had prenatal care coverage by Medicaid were less likely to have a
dental visit during their pregnancy. Many RI pregnant women did not receive oral health
counseling from health care professionals during their prenatal care period.8

Because of separation or exclusion of dental benefits from medical insurance, a quarter of RI adults
age 18–64 years, and more than a half of older adults (65 years and older) do not have any dental
coverage.9 RI adults with no dental coverage report a lower utilization of dental services.9 Despite
having health insurance coverage, adults eligible for dental benefits through Medicaid have trouble
obtaining dental care needed to maintain oral health due to the lack of dental providers willing to
accept Medicaid patients. Consequently, only one-quarter of the adults receive services annually
under Medicaid.10

From 2006-2010, 30,911 hospital ED visits in RI were associated with tooth decay, tooth decayoriginated-inflammatory pulp/periapical lesions, or toothache. These preventable oral health
conditions were more frequently reported by Medicaid-enrolled and uninsured adults.11

The Nursing Home Oral Health Assessment conducted by the Wisdom Tooth mobile dental
program in 2010–2012 showed that 33% of nursing home residents surveyed were edentulous and
about a quarter of them did not have dentures.12
4
II. Goal and Objectives of the RI Oral Health Surveillance System
The goal of the State of RI’s Oral Health Surveillance System (RIOHSS) is to plan, design and
implement coordinated, ongoing, and systematic oral health surveillance activities to:


Assess and monitor extent and nature of oral health status and associated risk factors (burden
of oral diseases) of Rhode Islanders and determine state-specific unmet need of oral health
services, particularly in underserved priority populations, and
Disseminate the surveillance findings to State Oral Health Program and key state audiences
to facilitate planning, implementation, and evaluation of public health practices based on datadriven evidence.
Continued assessment and evaluation of Rhode Islander’s oral health needs, and impact of
community-based oral health prevention and promotion efforts, through the implementation of
RIOHSS, are to achieve the following specific objectives:








Estimate the extent and magnitude of oral disease and risk factors in RI
Measure utilization of oral health services in RI
Monitor utilization and effectiveness of community-based and school-based prevention
programs
Identify target populations at high risk or with unmet need
Provide up to date, scientific and reliable data for RI oral heath stakeholders, advocates, and
legislators
Use oral health data to plan, implement, and evaluate the impact of the state’s oral health
programs and policies
Provide evidence-based information for decision-making and public health resource
allocations
Evaluate the State’s strengths and gaps in surveillance measurements and priority
populations, and identify opportunities and resources to improve the RIOHSS
5
III. Principal Guidelines for RI Oral Health Surveillance System
Healthy People 2020 (HP2020) Objective OH-16 – “increase the number of states and the District
of Columbia that have an oral and craniofacial health surveillance system” – deserves special
mention.13 In 2013, CSTE developed an operational definition for HP2020 OH-16.4 According to
the CSTE, a state oral health surveillance system should provide information necessary for public
health decision-making by routinely collecting data on oral health outcomes, access to care, risk
factors, and intervention strategies for the whole population, representative samples of the
population, or priority subpopulations. In addition, a state oral health surveillance system should
consider collecting information on the oral health workforce, infrastructure, financing, and policies
impacting oral health outcomes.
At a minimum, a state-based oral health surveillance system should include the following ten a
core or foundational set of surveillance elements identified by CSTE, with expansion to a wider
variety of indicators based on the needs and resources of the individual state.
1. A written oral health surveillance plan that was developed or updated within the previous
five years.
2. Oral health status data for a representative sample of third grade children, including
prevalence of caries experience, untreated tooth decay, and dental sealants meeting
criteria for inclusion in NOHSS. Data must have been collected within the previous five
years.
3. Permanent tooth loss data for adults obtained within the previous two years.
4. Annual data on oral and pharyngeal cancer incidence and mortality.
5. Annual data on the percent of Medicaid- and CHIP-enrolled children who had a dental visit
within the past year.
6. Data on the percent of children 1-17 years who had a dental visit within the past year,
obtained every four years.
7. Data on the percent of adults (≥18 years) and adults with diabetes who had a dental visit
within the past year, obtained within the previous two years.
8. Data on the fluoridation status of public water systems within the state, updated every two
years.
9. Annual data on state oral health programs and the environment in which they operate,
including workforce and infrastructure indicators.
10. Publicly available, actionable data to guide public health policy and programs
disseminated in a timely manner. This may take the form of an oral disease burden
document, publicly available reports, or a web-based interface providing information on
the oral health of the state’s population developed or updated within the previous five
years.
The RIOHSS Plan outlines state specific oral health indicators, data sets that can measure the
indicators, collection, analysis, interpretation, and dissemination of these data, and collaborating
partners and programs in surveillance activities. Additionally, the Plan describes evaluation of
the quality and usefulness of the RIOHSS.
6
IV. Oral Health Indicators in RI Oral Health Surveillance System
A set of oral health indicators, a centerpiece of the RIOHSS, includes indicators on the burden
of oral disease, the use of the oral health delivery system, and community level interventions.
RIOHSS indicators has been determined primarily by:


HP 2020, a compendium of indicators selected by the federal government to track the nation’s
progress towards year 2020 public health objectives,13 and
The National Oral Health Surveillance System (NOHSS), a collaborative effort among
ASTDD, CDC and CSTE 14
The tables 1 includes the oral health indicators identified by RIOHSS with target population,
data source, and related HP 2020 national oral health objectives.
As summarized in table 2, RIOHSS obtains data from diverse types of public health data
sources, such as health surveys (e.g. Behavioral Risk Factor Surveillance), data collected for
administrative purposes (e.g., Medicaid, hospital discharges), disease registries (e.g. cancer
registry), or oral health screening data using the ASTDD Basic Screening Survey protocol.
7
Table 1. RI Oral Health Surveillance System Indicators
Indicator
Group
Oral health
outcome
Target Population
New-born babies
Children 3-5 years attending
Head Start
Children 3-5 years attending
Head Start in urban cities
(Providence & Pawtucket)
Public elementary school
children in Kindergarten
Public elementary school
children in grade 3
Public & private elementary
school children in grades K & 3
Adolescents in grades 9-12
Adults 18-64 years
Adults ≥65 years
Adults ≥65 years residing in
long-term care or skilled
nursing facilities & attending
Indicator* (related HP 2020 Objective)
Cleft lip with & without cleft palate (OH-15)
Cleft palate (OH-15)
Dental caries experience (OH-1.1)
Untreated dental caries (OH-2.1)
Urgent Dental Treatment Need
Dental caries experience (OH-1.1)
Untreated dental caries (OH-2.1)
Urgent dental treatment need
Dental sealant (OH-12.1)
Dental caries experience (OH-1.2)
Untreated dental caries (OH-2.2)
Urgent Dental Treatment Need
Dental sealants (OH-12.2)
Dental caries experience (OH-1.2)
Untreated dental caries (OH-2.2)
Urgent Dental Treatment Need
Dental sealants (OH-12.2)
Dental treatment need
Urgent dental treatment need
Dental sealant need
Pain/soreness with teeth or mouth
Self-consciousness or embarrassment because
of teeth or mouth
No tooth loss (OH-4.1)
Six or more teeth lost
All teeth lost (OH-4.2)
Untreated dental caries (OH-3.2 & OH-3.3)
Dental treatment need
Teeth retention & denture need
8
Available data elements
Data Source
Births Defects
Program
age, gender, race, ethnicity,
language, dental insurance,
geographic area
Oral health
screening survey
(using BSS protocol)
age, gender, race, ethnicity,
language, dental insurance,
geographic area
Oral health
screening survey –
Urban cities only
age, gender, race, ethnicity,
geographic area, % of free &
reduced school meals eligibility
Oral health
screening survey
(using BSS protocol)
geographic area, % of free &
reduced school meals eligibility
School Dental
Screening Report
age, gender, race, ethnicity,
dental visit, health-risk behaviors
(e.g., tobacco use)
Youth Risk Behavior
Surveillance System
(YRBSS)
age, gender, race, ethnicity,
language, educational
attainment, marital status, home
ownership, employment, dental
visit, dental insurance, chronic
disease (e.g., diabetes), healthrisk behaviors (e.g., tobacco use)
age, gender, race, ethnicity,
language, dental insurance,
dental visit, geographic area
Behavioral Risk
Factor Surveillance
System (BRFSS)
Oral health
screening survey
(using BSS protocol)
senior centers (congregate
meal sites)
All state population
Access to
care
Children 1-17 years
Children 0-17 years
Children 1-20 years enrolled in
Medicaid
Children 6-9 & 10-14 years
enrolled in Medicaid
Adolescents in Grades 9-12
Adults 18-64 & ≥65 years
Adults ≥18 years with diabetes
Pregnant women
Population served at health
centers
Children & adults enrolled in
Medicaid
Dry mouth
Gingival & periodontal status
Self-perceived oral health status
Oral cavity & pharyngeal cancers (incidence &
mortality (C-6))
Oral cavity & pharyngeal cancers detected at
early stages
HPV-associated oropharyngeal cancers
(incidence)
Annual preventive dental visit†
Annual dental visit (OH-7)†
Annual dental visit (OH-7)
Dental insurance coverage (AHS-1.2)
Preventive dental treatment (OH-8)
Any dental treatment
Dental sealant treatment
Annual dental visit (OH-7)
Annual dental visit (OH-7)
Dental insurance coverage (AHS-1.2)
Financial barrier in obtaining dental care
Dental visit (D-8)
Preventive dental visit before pregnancy
Preventive dental visit during pregnancy
Oral health education during pregnancy
Oral health perception during pregnancy
Dental insurance coverage during pregnancy
Barriers in obtaining dental care during
pregnancy
Receiving oral health services (OH-11)
Receiving dental treatment
9
gender, race, ethnicity,
anatomical site
Cancer Registry
age, gender, race, ethnicity,
language, parental socioeconomic
status
National Survey of
Children's Health
(NSCH)
BRFSS
age
CMS-416 Annual
EPSDT Participation
Report
age, gender, race, ethnicity,
dental visit, health-risk behaviors
(e.g., tobacco use)
age, gender, race, ethnicity,
language, educational
attainment, marital status, home
ownership, employment
Youth Risk Behavior
Surveillance System
(YRBSS)
BRFSS
age, race, ethnicity, educational
attainment, marital status,
prenatal care health insurance
coverage, WIC participation,
geographic area
Pregnancy Risk
Assessment
Monitoring System
(PRAMS)
type of dental services,
geographic area
patient demographics (age,
residential location), type of
dental services, frequency,
provider type & location,
eligibility, claim amount
Uniform Data
System (UDS)
Medicaid Claims
(MMIS: Medicaid
Management
Information System)
All state population
Community
intervention
School children
All state population
Infrastructure
All state population
Dental providers who treat children & adults
enrolled in Medicaid
ED visit for non-injury related oral health
conditions
High-risk schools with school-based sealant
programs
Children served by school-based sealant
programs
Molars with sealant placed by school-based
sealant programs
Population served by community water systems
(OH-13)
Public water systems with optimal fluoridation
level for 12 consecutive months
State Oral Health Program staffing, funding &
structure (OH-17)
State oral health surveillance system (OH-16)
State oral health coalition
State oral health plan
Dental workforce
Dental safety net providers (OH-10)
type of dental services,
geographic area, claim amount
age, genders, insurance,
geographic area
age, race, ethnicity, dental
insurance, geographic area, % of
free & reduced school meals
eligibility
geographic area
age, gender, geographic area
patient age & insurance, type of
services, geographic area,
workforce, operatories & hours
Dental Health Professional Shortage Areas
providers, dental service
(DHPSA)
utilization, community
socioeconomic status
* Green-colored indicators: recommended by CSTE for inclusion in a state-based oral health surveillance system4,14
Purple-colored indicators: additional indicators that were added by the RIOHSS needs and resources
† May be modified or deleted based on the redesign of the National Survey of Children’s Health
10
Hospital Discharge
Data
SEAL RI!
Performance Report
Water Fluoridation
Reporting System
(WFRS)
ASTDD State
Synopsis; RI Oral
Health Program data
Licensure Database
Dental Safety Net
Survey; UDS
Primary Care and
Rural Health DHPSA
Designation
Table 2. RIOHSS Data Sources and Data Collection Timeline
Data source
Indicator
group
Indicator & target population
Data collection timeframe
2016
2017
2018
2019
2020
√
√
√
√
√
ASTDD State
Synopsis
Infrastructure




Behavioral Risk
Factor Surveillance
System (BRFSS)
Oral health
outcome
 No tooth loss among adults 18-64 years
 Six or more teeth lost among adults ≥65 years
 All teeth lost among adults ≥65 years
Access to
care






Birth Defects
Program
Oral health
outcome
 Cleft lip with & without cleft palate among new-born babies
 Cleft palate among new-born babies
√
√
√
√
√
Cancer Registries
Oral health
outcome
 Oral Cavity & pharyngeal cancers (incidence & mortality)
 Oral Cavity & pharyngeal cancers detected at early stages
 HPV-associated oropharyngeal cancer (incidence)
√
√
√
√
√
CMS-416 Annual
EPSDT Participation
Report
Access to
care
 Preventive dental treatment for 1-20 years enrolled in Medicaid
 Any dental treatment for 1-20 years enrolled in Medicaid
 Dental sealant treatment for 6-9 & 10-14 years enrolled in Medicaid
√
√
√
√
√
Dental Safety Net
Survey
Infrastructure
 Dental safety net providers
Hospital Discharge
Data
Access to
care
 ED visit for non-injury related oral health conditions
√
Licensure Database
Infrastructure
 Dental workforce
√
Medicaid Claims
(MMIS: Medicaid
Management
Information
System)
Access to
care
 Receiving dental treatment among children & adults enrolled in Medicaid
 Dental providers who treat children & adults enrolled in Medicaid
√
State Oral Health Program staffing, funding & structure
State oral health surveillance system
State oral health coalition
State oral health plan
√
√
√
Annual dental visit among children 1-17 years
Dental insurance coverage among children 0-17 years
Annual dental visit among adults 18-64 & ≥65 years
Dental insurance coverage among adults 18-64 & ≥65 years
Financial barriers in obtaining dental care among adults 18-64 & ≥65 years
Dental visit among adults ≥18 Years with diabetes
√
11
√
√
√
√
√
√
√
√
√
√
√
National Survey of
Children's Health
(NSCH)
Access to
care
 Annual preventive dental visit among children 1-17 years *
 Annual dental visit among children 1-17 years *
√
Oral Health
Screening Surveys
(using BSS
protocols)
Oral health
outcome
Children 3-5 years attending Head Start
 Dental caries experience
 Untreated dental caries
 Urgent dental treatment need
√
Children 3-5 years attending Head Start in urban cities
 Dental caries experience
 Untreated dental caries
 Urgent dental treatment need
 Dental sealant (primary molar)
√
√
√
√
√
√
√
√
√
Public elementary school children in grades K & 3
 Dental caries experience
 Untreated dental caries
 Urgent dental treatment need
 Dental sealant (permanent 1st molar)
Adults






≥65 years residing in long-term care or skilled nursing facilities
Untreated dental caries
Dental treatment need
Teeth retention & denture need
Dry mouth
Gingival & periodontal status
Self-perceived oral health status
Adults






≥65 years attending senior centers (congregate meal sites)
Untreated dental caries
Dental treatment need
Teeth retention & denture need
Dry mouth
Gingival & periodontal status
Self-perceived oral health status
√
√
√
Primary Care and
Rural Health
DHPSA Designation
Infrastructure
 Dental Health Professional Shortage Areas (DHPSA)
√
Pregnancy Risk
Assessment
Access to
care
 Preventive dental visit among women before pregnancy
 Preventive dental visit among women during pregnancy
 Oral health education among women during pregnancy
√
12
√
√
√
√
√
√
 Oral health perception among women during pregnancy
 Dental insurance coverage among women during pregnancy
 Barriers in obtaining dental care among women during pregnancy
Monitoring System
(PRAMS)
School Dental
Screening Report
Oral health
outcome
 Dental treatment need among elementary school children in grades K & 3 √
 Urgent dental treatment need among school children in grades K & 3
 Dental sealant need among elementary school children in grades K & 3
√
√
√
√
SEAL RI!
Performance
Report
Community
intervention
 High-risk schools with school-based sealant programs
 Children served by school-based sealant programs
 Molars with sealant placed by school-based sealant programs
√
√
√
√
√
Uniform Data
System (UDS)
Access to
care
 Population receiving oral health services at health centers
√
√
√
√
√
Infrastructure  Dental safety net providers
Youth Risk
Behavior
Surveillance
System (YRBSS)
Oral health
outcome
 Pain/soreness with teeth or mouth among adolescents in grades 9-12
 Self-consciousness or embarrassment because of teeth or mouth among
adolescents in grades 9-12
Access to
care
 Annual dental visit among adolescents in grades 9-12
Water Fluoridation
Reporting System
(WFRS)
Community
intervention
 Population served by community water fluoridation
√
 Public water systems with optimal fluoridation level for 12 consecutive
months
13
√
√
√
√
√
√
V.
RI Oral Health Surveillance Stakeholders and Partners
Stakeholders and partners are important pillars and support systems to ensure that
RIOHSS serves its purpose and addresses the needs of communities and stakeholders.
The stakeholders and partners helps in the development and implementation of the
surveillance system, and they are instrumental in the evaluation process.
Internal stakeholders/partners include:
 RIOHP staff
 Chronic Disease Program
 Maternal and Child Health Program
 Health Promotion and Wellness Programs
 Drinking Water Quality Program
 Infectious disease program
 Cancer Registry
 Office of Professional Regulations
 Office of Primary Care and Rural Health
 KIDSNET
 Center for Data Analysis
 Center for Public Health Communication
External stakeholders/partners include:
 RI Oral Health Commission
 RI Department of Human Service (Medicaid Agency)
 RI Department of Education
 RI Department of Elderly Affairs
 RI Kids Count
 RI Health Center Association
 SEAL RI! school-based dental sealant programs
 Early Head Start/Head Start Centers
 Wisdom Tooth Program
 United HealthCare Dental
 Blue Cross Blue Shield of RI
 Delta Dental of RI
 Neighborhood Health Plan of RI
 RI Dental Association
 RI Dental Hygienists’ Association
 RI Dental Assistants Association
 Community College of RI
14
VI. Data Dissemination and Use
RIOHSS’s key component is actionable data. The data collected and analyzed needs to
reach out at the local, state and national levels to create actions and policies that lead to
increased awareness and improved oral health. The RIOHSS stakeholders/partners
should continuously discuss various ways for the dissemination of data reports.
Surveillance reports or publications generated by RIOHSS are disseminated through
general mail, email listserv, and the RIDOH website to local, state, and federal partners
and agencies. Information is disseminated through a variety of media, including the
RIOHP webpages, policy briefs and fact sheets.
Listed are reports and publications in the previous 5 years:
PUBLISHED ARTICLE
 Oh, J., Fulton, J., Washburn, T. (2014). Increasing Trend of HPV-Associated Oropharyngeal Cancers
among Males in Rhode Island, 1987-2011. Medicine and Health Rhode Island, 95(5), 47-49. Available
from: http://www.rimed.org/rimedicaljournal/2014/05/2014-05-47-health-oropharyngeal-cancer.pdf
 Jiang, Y., Okoro, CA., Oh, J., Fuller, DL. (2013). Sociodemographic and Health-Related Risk Factors
Associated with Tooth Loss Among Adults in Rhode Island. Prev Chronic Dis, 10:110285. DOI:
http://dx.doi.org/10.5888/ pcd10.110285
 Oh, J., Leonard, L. (2012). Hospital Emergency Department Visits for Non-Traumatic Oral Health
Conditions among Rhode Island Adults Age 21–64 Years, 2006–2010. Medicine and Health Rhode
Island, 95(11), 367-369. Available from: http://www.rimed.org/medhealthri/2012-11/2012-11367.pdf
 Oh, J., Leonard, L., Walsh, E., Fuller, D. (2012). Rhode Island Children’s Hospital Emergency
Department Visits for Oral Health Conditions, 2006-2010. Medicine and Health Rhode Island, 95(7),
224-26. Available from: http://www.rimed.org/medhealthri/2012-07/2012-07-224.pdf
 Oh, J., Gjelsvik. A., Fuller, D., Walsh, E., Paine, V., Leonard, L. (2012). Less Than Optimal Oral Health
Care among Rhode Island Adults with Diabetes: The Need to Assure Oral Health Care for All Adults
with Diabetes. Medicine and Health Rhode Island, 95(3), 91-93. Available from:
http://www.rimed.org/medhealthri/2012-03/2012-03-91.pdf
 McQuade, W., Dellapenna, M., Oh, J., Fuller, D., Leonard, L., Florio, DJ. (2011). Assessing the Impact
of RI’s Managed Oral Health Program (RIte Smiles) on Access and Utilization of Dental Care among
Medicaid Children Ages Ten Years and Younger. Medicine and Health Rhode Island, 94(8), 147-149.
Available from: http://www.rimed.org/medhealthri/2011-08/2011-08-247.pdf
 Oh, J., Leonard, L., Fuller, D., Miller, K. (2011). Less Than Optimal Oral Health Care During
Pregnancy in Rhode Island Women: Oral Health Care as a Part of Prenatal Care. Medicine and Health
Rhode Island, 94(5), 141-143. Available from: http://www.rimed.org/medhealthri/2011-05/2011-05141.pdf
 Oh, J., Fuller, D., Leonard, L., Miller, K. (2011). Primary Care Physicians’ Role in Promoting Children’s
Oral Health. Medicine and Health Rhode Island, 94(1), 20-22. Available from:
http://www.rimed.org/medhealthri/2011-01/2011-01-20.pdf
PUBLISHED REPORT/DOCUMENTATION
 Dental Insurance Coverage for Rhode Island Adults: After Implementation of the Affordable Care Act
(ACA) (2016). Rhode Island Department of Health, Providence, RI. February 2016. Available from:
http://health.ri.gov/publications/databriefs/2014DentalInsuranceCoverageAfterACA.pdf
 Oral Health Access to Dental Care among Rhode Island Children and Adults, 2014 BRFSS (2015).
Rhode Island Department of Health, Providence, RI. October 2015. Available from:
http://health.ri.gov/publications/databriefs/2014AccessToDentalCareAmongRIChildrenAndAdults.pdf
 Oh, J., Yearwood, S., Leonard, L. (2015). The Oral Health of Rhode Island’s Children. Rhode Island
Department of Health, Providence, RI. July 2015. Available from:
http://health.ri.gov/publications/programreports/2015OralHealthOfRIChildren.pdf
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Rhode Island Dental Safety Net Report, 2013 (2014). Rhode Island Department of Health,
Providence, RI. October 2014. Rhode Island Department of Health, Providence, RI. October 2014.
Available from: http://www.health.ri.gov/publications/databriefs/2013DentalSafetyNet.pdf
Oral Health Concerns and Dental Care among Rhode Island Middle and High School Students, 2013
YRBS. (2014). Rhode Island Department of Health, Providence, RI. June 2014. Available from:
http://www.health.ri.gov/publications/databriefs/2013OralHealthConcernsAmongMiddleSchoolAndHig
hSchool.pdf
Oral Health Status and Access to Dental Care among Rhode Island Children and Adults, 2012 BRFSS
(2014). Rhode Island Department of Health, Providence, RI. January 2014. Available from:
http://www.health.state.ri.us/publications/databriefs/2012AccessToDentalCareAmongRhodeIslandChil
drenAndAdults.pdf
Oh, J., Yearwood, S., Fuller, D. (2013). CDC State-Based Oral Disease Prevention Program, 20032013. Final Evaluation Report. Rhode Island Department of Health, Providence, RI. October 2013.
Oh, J., Leonard, L., Fuller, D. (2013). The Oral Health of Rhode Island’s Preschool Children Enrolled
in Head Start. Rhode Island Department of Health, Providence, RI. August 2013. Available from:
http://www.health.state.ri.us/publications/reports/2013OralHealthOfRhodeIslandsPreschoolChildrenE
nrolledInHeadStartPrograms.pdf
Oral Health Status and Access to Dental Care among Rhode Island Children and Adults, 2010 BRFSS
(2012). Rhode Island Department of Health, Providence, RI. November 2012. Available from:
http://www.health.state.ri.us/publications/databriefs/2010OralHealthStatusAndAccessToDentalCareA
mongRhodeIslandChildrenAndAdults.pdf
Rhode Island Oral Health Issue Brief - Rhode Island Hospital Emergency Department Visits for NonInjury Related Oral Health Conditions among Adults Age 21–64, 2006–2010 (2012). Rhode Island
Department of Health, Providence, RI. October 2012. Available from:
http://www.health.state.ri.us/publications/issuebriefs/2012OralHealthIssue2.pdf
Rhode Island Oral Health Issue Brief - HPV and Oropharyngeal Cancers in Rhode Island (2012).
Rhode Island Department of Health, Providence, RI. April 2012. Available from:
http://www.health.state.ri.us/publications/issuebriefs/2012OralHealthissue3.pdf
Oh, J., Fuller, D. (2011). The Oral Health of Rhode Island’s Children. Rhode Island Department of
Health, Providence, RI. August 2011.
Oh, J., Leonard, L. (2011). The Burden of Oral Diseases in Rhode Island, 201. Rhode Island
Department of Health. Providence, Rhode Island. 2011. Available from:
http://www.health.ri.gov/publications/burdendocuments/2011OralHealth.pdf
The Dental Safety Net in Rhode Island, Special Report (2011). Rhode Island KIDS COUNT, Rhode
Island Health Center Association and Rhode Island Department of Health. Providence RI. May 2011.
Available from: http://www.health.ri.gov/publications/reports/2011DentalSafetyNet.pdf
Rhode Island Oral Health Issue Brief - Rhode Island Young Children’s Preventive Dental Visit: The
Need for Primary Care Medical Providers’ Engagement in Children’s Oral Health (2011). Rhode Island
Department of Health, Providence, RI. June 2011. Available from:
http://www.health.state.ri.us/publications/issuebriefs/2011OralHealthIssue1.pdf
Oral Health Status and Access to Dental Care among Rhode Island Children and Adults, 2008 BRFSS
(2010). Rhode Island Department of Health, Providence, RI. November 2010. Available from:
http://www.health.state.ri.us/publications/healthriskreports/adults/2008OralHealth.pdf
PUBLISHED ABSTRACT/PRESENTATION
 Oh, J (2016). Hospital Emergency Department Visits for Oral Health Conditions among Rhode Island
Non-Elderly Adults. Rhode Island Annual Oral Health Summit, Providence, RI. February 2016.
 Oh, J., Leonard, L., Yearwood, S. (2015). Medicaid Expansion and Change in Hospital Emergency
Department Visits for Oral Health Conditions among Rhode Island Adults. National Oral Health
Conference, Kansas City, MO. April 2015.
 Oh, J. (2014). Assessment of Preventive Dental Visit among Children Age 1-Years with Parent’s
Dental Visit, Rhode Island Behavioral Risk Factor Surveillance System (BRFSS). Council of State and
Territorial Epidemiologists Annual Conference, Nashville, TN. June 2014.
 Oh, J., Leonard, L. (2013). Rhode Island Women’s Oral Health Counseling & Care during Pregnancy:
2009-2011 Pregnancy Risk Assessment Monitoring System (PRAMS). Annual American Public Health
Association Meeting, Boston, MA. November 2013.
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Oh, J., Leonard, L., Jones-Bridges, M., Simas, M., Ross, M. (2013). Workforce Survey of Rhode Island
Dental Hygienists. National Oral Health Conference, Huntsville, AL. April 2013.
Oh, J., Fulton, J., Fuller, D., Walsh E. (2012). An Increase of HPV-Associated Oropharyngeal Cancer
Incidence in Rhode Island Males, 1987-2009. National Oral Health Conference, Milwaukee, WI. April
2012.
Oh, J., Leonard, L., Fuller, D., Miller, K. (2011). Hospital Emergency Department Visits for Oral Health
Conditions among Rhode Island Adults Age 18-64, 2005-2009. National Oral Health Conference,
Pittsburgh, PA. April 2011.
VII. Privacy and Confidentiality
The RIOHSS follows HIPAA standards for patient privacy and protected health
information. The system limits identifiers collected to only essential data elements, and
the data are stored on a secure, private, electronic server at the RIDOH. Identifiers can
only be seen by health department oral health staff who have been trained on HIPAA,
data security, and confidentiality. The identifiers will never be released to external
partners and aggregate data is never reported for small counts, according to the RIDOH
reporting guideline.
VIII. Evaluation
To ensure that the oral health indicators are being monitored effectively and efficiently
and to increase the utility and productivity of the RIOHSS, an annual evaluation will be
performed to determine the system’s usefulness in monitoring oral health trends over
time, determining the effectiveness of interventions, and planning future programmatic
and policy initiatives. The RIOHP will evaluate the RIOHSS based on CDC’s framework for
program evaluation including how well the following six steps outlined in Updated
Guidelines for Evaluating Surveillance Systems were implemented.2
•
•
•
•
•
•
Engage Utopia’s stakeholders;
Describe the OHSS;
Focus the evaluation design;
Gather credible evidence regarding the performance of the OHSS;
Justify and state conclusions, make recommendations; and
Ensure use of evaluation findings and share lessons learned.
The evaluation of the OHSS will focus on providing recommendations for improving the
quality, efficiency, and usefulness of the system. OHSS will also be evaluated to determine
the system’s sustainability, the timeliness of analysis of surveillance data, dissemination
and use of the reports by stakeholders, and policy and legislative actions that have been
taken due to surveillance efforts.
17
1
Institute of Medicine (IOM). The Future of Public Health. Washington, DC: National Academy
Press, 1988.
2
German RR, Lee LM, Horan JM, Milstein RL, Pertowski CA, Waller MN; Guidelines Working Group
Centers for Disease Control and Prevention. Updated guidelines for evaluating public health surveillance
systems: recommendations from the Guidelines Working Group. MMWR Recomm Rep 2001;50(RR-13):135.
3
Association of State and Territorial Dental Directors (ASTDD). State-Based Oral Health Surveillance
Systems, April 2015. Available at: www.astdd.org
4
Phipps K, Kuthy R, Marianos D, Isman B. State-Based Oral Health Surveillance Systems: Conceptual
Framework and Operational Definition. Council of State and Territorial Epidemiologists, 2013. Available
at: c.ymcdn.com/sites/www.cste.org/resource/resmgr/Chronic/StateBasedOralHealthSurveill.pdf
5
Oh, J., Leonard, L., Fuller, D. (2013). The Oral Health of Rhode Island’s Preschool Children Enrolled in
Head Start. Rhode Island Department of Health, Providence, RI. August 2013. Available from:
http://www.health.state.ri.us/publications/reports/2013OralHealthOfRhodeIslandsPreschoolChildrenEnroll
edInHeadStartPrograms.pdf
6
Oh, J., Fuller, D. (2012). The Oral Health of Rhode Island’s Children. Rhode Island Department of
Health, Providence, RI. February 2012. Available from:
http://www.health.state.ri.us/publications/reports/2012OralHealthOfRhodeIslandChildren.pdf
7
McQuade, W., Dellapenna, M., Oh, J., Fuller, D., Leonard, L., Florio, DJ. (2011). Assessing the Impact of
RI’s Managed Oral Health Program (RIte Smiles) on Access and Utilization of Dental Care among Medicaid
Children Ages Ten Years and Younger. Medicine and Health Rhode Island, 94(8), 147-149. Available
from: http://www.rimed.org/medhealthri/2011-08/2011-08-247.pdf
8
Oh, J., Leonard, L., Fuller, D., Miller, K. (2011). Less Than Optimal Oral Health Care During Pregnancy
in Rhode Island Women: Oral Health Care as a Part of Prenatal Care. Medicine and Health Rhode Island,
94(5), 141-143. Available from: http://www.rimed.org/medhealthri/2011-05/2011-05-141.pdf
9
Dental Insurance Coverage for Rhode Island Adults: After Implementation of the Affordable Care Act
(ACA) (2016). Rhode Island Department of Health, Providence, RI. February 2016. Available from:
http://health.ri.gov/publications/databriefs/2014DentalInsuranceCoverageAfterACA.pdf
10
An Assessment of the Rhode Island Medicaid Adult Dental Program. RI Executive Office of Health &
Human Services, Cranston, RI. January 2014
11
Oh, J., Leonard, L. (2012). Hospital Emergency Department Visits for Non-Traumatic Oral Health
Conditions among Rhode Island Adults Age 21–64 Years, 2006–2010. Medicine and Health Rhode Island,
95(11), 367-369. Available from: http://www.rimed.org/medhealthri/2012-11/2012-11-367.pdf
12
Summary of Findings for 2010-12 Nursing Home Oral Health Assessment (2013). RI Department of
Health Oral Health Program. August 2013 (Program Internal Document).
13
Healthy People 2020. Topic & Objectives: Oral Health. Available at:
https://www.healthypeople.gov/2020/topics-objectives/topic/oral-health
14
CSTE Chronic Disease/Maternal and Child Health/Oral Health Committee Position Statement (15-CD01): Revision to the National Oral Health Surveillance System (NOHSS) Indicators. Council of State and
Territorial Epidemiologists June 2015. Available at:
http://c.ymcdn.com/sites/www.cste.org/resource/resmgr/2015PS/2015PSFinal/15-CD-01-ALL.pdf
18