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Dental public health epidemiology programme

Oral health survey of five-year-old
children 2014-15
National protocol
Version 2
This protocol aligns with the British Association for the Study of Community Dentistry
(BASCD) diagnostic criteria for caries prevalence surveys and guidance on sampling
for surveys of child dental health.
4,5
Oral health survey of five-year old children, 2014-15. National protocol.
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About Public Health England
Public Health England’s mission is to protect and improve the nation’s health and
to address inequalities through working with national and local government, the
NHS, industry and the voluntary and community sector. PHE is an operationally
autonomous executive agency of the Department of Health.
Public Health England
133-155 Waterloo Road
Wellington House
London SE1 8UG
Tel: 020 7654 8000
www.gov.uk/phe
Twitter: @PHE_uk
Facebook: www.facebook.com/PublicHealthEngland
For queries relating to this document, please contact: Dr Gill Davies,
gill.davies@phe.gov.uk
© Crown copyright 2014
You may re-use this information (excluding logos) free of charge in any format or
medium, under the terms of the Open Government Licence v2.0. To view this
licence, visit OGL or email psi@nationalarchives.gsi.gov.uk. Where we have
identified any third party copyright information you will need to obtain permission
from the copyright holders concerned. Any enquiries regarding this publication
should be sent to [insert email address].
Published July 2014
PHE publications gateway number: 201416
Oral health survey of five-year old children, 2014-15. National protocol.
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Contents
About Public Health England 2
1. Introduction 4
2. Aim of the survey 4
3. Objectives 4
4. Sample 5
5. Consent 6
6. Personnel 8
7. General conduct of the survey 8
8. Fieldwork 10
9. Collection of data – general information 11
10. Collection of non-clinical data 12
11. Collection of clinical data 15
12. Reporting of data 20
13. References 21
14. Table of appendices 23
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1. Introduction
Local authorities have been responsible for gathering information on the health
needs of their local populations since April 2013, following the white paper, Equity
and Excellence; Liberating the NHS.
1
This imperative is described in the Health and
Social Care Act 2012, underpinned by Statutory Instrument 2012 number 3094,
2
and
Choosing Better Oral Health.
3
Leadership and structures supporting the former NHS Dental Epidemiology
Programme transferred into Public Health England (PHE) on 1 April 2013. The
transformation of the programme within PHE is almost complete and some terms
have, of necessity been changed. This protocol has been produced during the
transition phase and best descriptive terms available at that time are used.
It has been agreed that during the academic year 2014-15 the population group for
scrutiny would be five-year olds attending mainstream schools. Surveys of this age
group provide an insight into dental health and associated child rearing practices at a
key life stage. The findings will allow local authorities to monitor this age group, which
has a public health outcomes framework (PHOF) indicator. It will also allow for
longitudinal surveys of children who were examined as three-year olds in 2012-13.
2. Aim of the survey
The aim of the survey is to measure the prevalence and severity of dental caries
among five-year-old children within each lower tier local authority.
This information can be used to:
2.1 Enable local authorities to meet their responsibilities with regard to health
needs assessments.
2.2 Inform part of a health needs assessment, particularly joint strategic needs
assessments.
2.3 Provide comparisons with children of the same age in previous years (2008
and 2012) to permit monitoring of the PHOF measure.
2.4 Inform the local oral health improvement strategy.
2.5 Provide standardised information for comparison locally, regionally, between
countries of the UK and internationally
3. Objectives
To examine five-year old children using caries diagnostic criteria and examination
techniques based on those agreed by the British Association for the Study of
Community Dentistry (BASCD), diagnostic criteria for caries prevalence surveys4
and
using BASCD-recommended sampling procedures described in BASCD guidance on
sampling for surveys of child dental health. A BASCD co-ordinated dental
epidemiology programme quality standard.
5
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4. Sample
The primary sampling unit will be local authority boundaries at unitary, metropolitan
borough or lower tier level, as has been the case in all recent surveys of this
population group.
4.1 Survey population
The survey population is defined as all those children attending state funded primary
schools of all classifications within the local authority who have reached the age of
five, but have not had their sixth birthday on the date of examination (excluding
special schools).
Age eligible children will have dates of birth that fall within the widest range of dates
of birth October 2008 to May 2010 (See appendix K which also helps to identify the
narrower ranges for examination dates in each month).
A minimum sample size of 250 examined children is required per lower-tier local
authority, from a minimum of 20 schools. This is unlikely to produce a sufficiently
large sample to facilitate local planning for many areas, in which case larger samples
will be required. Where larger samples are drawn the children selected may need to
be coded to allow a weighted estimate of local authority mean to be produced where
necessary. Details of these requirements and the need for local stratification will be
determined by local authorities with advice from consultants in dental public health
(CsDPH) in PHE Centres or other advisers in dental public health to local authorities,
in liaison with dental managers/directors of the agencies undertaking the surveys.
PHE dental epidemiology co-ordinators (DECs) must be informed of proposed
sampling methods so that they can confirm their validity, before the survey
commences.
4.2 Sampling procedure
Discussion is required between local authority commissioners and CsDPH in PHE
Centres to establish the size and type of sample that is required to meet local needs,
for example commissioning consortia within an area may each require an enhanced
sample. Once this has been agreed the fieldwork team can undertake the sampling
process.
Detailed guidance on the required stratified sampling procedures is given in British
Association for the Study of Community Dentistry (BASCD) guidance on sampling for
surveys of child dental health. A BASCD co-ordinated dental epidemiology
programme quality standard (Pine et al., 1997a).
5 Advice can also be requested from
the DEC in your area and from Girvan Burnside on g.burnside@liv.ac.uk
Lists of all state maintained primary schools within each local authority area, and the
numbers of pupils attending each, will be required as the first stage in the sampling
process.
Special schools should not be included in the main sampling frame or main local
authority survey file.
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In most local authority areas a two stage sampling procedure will be required for
surveys of five-year-old children as there are normally more than 20 primary schools
covering the local child population.
A stratified sampling method which takes school size into account is described in the
guidance. The school size bandings and sampling intensity described is guidance
only and it may be necessary to alter this to produce larger numbers of children from
whom to seek consent. For example, schools could be divided into those with fewer
than 30 children aged five and those with 30 or more. All of the children in the smaller
school would be sampled while one in two or one in three of the larger ones would be
sampled. Regardless of the selected size bandings and intensities it is still essential
to calculate the correct proportions of children to be selected from small and large
schools in order to ensure the sample is representative of the distribution in the
overall population. This is the normal process for the quota sampling techniques used
previously. Four tables need to be constructed showing how the sample will be
structured and copies of these, together with details of the sampling methodology,
must be sent to the DEC in your area for agreement before any schools are
contacted or children selected.
Efficient methods for sampling to provide ward level estimates are available and in
many cases are far preferable to undertaking all-school, all-children surveys. Details
should be sought from the DEC in your area.
4.3 Sampling for longitudinal surveys
For areas that are planning to undertake the second stage of a longitudinal survey
using children who were examined when they were three years old there are
implications for sampling, consent, choice of examiner, identity numbers, coding of
examination status and analysis. The key principles are provided in appendix P.
5. Consent
Positive consent is required following the guidance by the Department of Health
(appendix D).
It is advised that 300 children be randomly selected and consent sought from all if a
minimum sample of 250 examined is the target. All consented children should then
be examined even though this may mean a sample of less than 250 in some cases.
It is recognised that as the proportion of positive consenters reduces, the
representativeness of the sample also reduces.
The procedure for obtaining positive consent must involve:
 giving parents an invitation letter which gives clear information explaining
the nature and purpose of dental surveys in broad terms and simple
language (example given in appendix C)
 provision of a form which reports parental consent or refusal for the survey,
indicates that parents have read and understood the information letter and
includes a signature and a date of this (attached form given in Appendix L)
 distribution of a second letter with consent form, ideally on differently
coloured paper, to those who do not respond to the first
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 acceptance of, and respect for, the decision of a parent or a child to decline
an examination
In a few instances arrangements exist whereby core consent agreement for all health
surveillance is provided for whole of school life. Where this includes dental
examination or checks, this can be regarded as sufficient consent but letters should
also be provided for parents prior to the survey that describe the purpose and nature
of the survey (see appendix L i).
In an increasing number of schools parents are asked to provide consent for a range
of activities for the forthcoming year or term. It is acceptable for consent for this
survey to be included in this block consent session if an invitation letter is provided.
An additional appendix (L ii) provides suggested wording which can be included in
the school block consent system.
It may help school staff to encourage returns if class lists are provided that show
which children have been sent consent letters and a column for them to record which
ones have returned them (appendix M).
Other strategies may be necessary to maximise the number of consent forms
returned but coercion to provide positive consent should not be used. These include:
 identifying schools where consent return is known to be poor and
providing additional support
 recruiting a named person at a school who can speak with parents
and follow up when forms are not forthcoming. This might be the
school nurse, family liaison worker, pastoral care worker, classroom
assistant or parent volunteer
 giving parents prior warning of the survey and seeking their support
via posters, an insertion in the newsletter, postcards or attendance at
parents’ evening
 posting letters and consents to home addresses with stamped,
addressed envelopes for return
 handing letters and consent forms directly to parents at pick up time
The support of the PHE director of dental public health will be shown in a letter to
directors of public health (appendix B). This can be used to seek the support of
headteachers and expedite co-operation with schools.
Fieldwork teams must keep a record of the number of all children approached, the
numbers with parental consent, parental refusal and no consent (appendix O), so
that the form in appendix Q can be completed and submitted along with data files.
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6. Personnel
6.1 The overall responsibility for planning this survey lies with PHE via the national
lead for dental public health epidemiology and the dental public health epidemiology
team.
Responsibility for ensuring co-ordination and facilitation of the application of quality
standards lies with the DECs.
The commissioning of the surveys will be the responsibility of the local authorities in
partnership with NHS England dental commissioning teams based in NHS England
area teams.
Delivery of the fieldwork to agreed national standards lies with the commissioned
fieldwork teams.
6.2 Fieldwork for the survey will be carried out by community dental service (CDS)
staff. The dental examinations will be carried out by registered dental clinicians who
will be trained to national standards by the regional standard examiners/trainers,
using the approved BASCD training pack, to ensure that they are familiar with the
examination method and criteria. Examiners must be calibrated annually following
BASCD guidance on the statistical aspects of training and calibration of examiners
for surveys of child dental health.
6 Examiners who do not conform to the accepted
diagnostic standards will need to be retrained and recalibrated, or replaced. In this
instance, training and calibration will be provided for five-year olds for all examiners.
6.2.1 Where a therapist or hygienist will be carrying out examinations the
Lead Investigator – Eric Rooney (eric.rooney@phe.gov.uk) should be notified to
ensure correct procedures are implemented.
If a therapist or hygienist is undertaking the examinations, or if there is no
intention to provide information about a child’s clinical status, then the consent letter
(Appendix M) should be modified to reflect this.
6.3 It is good practice for two support workers to accompany the examining dental
clinician. One worker is required to record the codes that the examiner provides and
the other will help support the process by liaising with staff, fetching the children,
assisting with examination and encouraging co-operation.
6.4 For areas that are planning to undertake the second stage of a longitudinal
survey using children who were examined when they were three years old there are
implications for sampling, consent, choice of examiner, identity numbers, coding of
examination status and analysis. The key principles are provided in appendix P.
7. General conduct of the survey
An overview of the survey is shown in plan form in appendix E.
7.1 The planning and organisation of the survey will be carried out by CDS
fieldwork teams who will liaise with local authorities, headteachers and governing
bodies of the schools. Reference to the Statutory Instrument 2012 No 3094
(appendix A) [and the letter from the director of dental public health (appendix B)]
should be made if difficulties are encountered.
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Fieldwork teams will contact the local authority education department to obtain lists of
all state funded primary schools within the area who educate five-year olds, including
community schools, academies, foundation schools and free schools.
7.2 Following random sampling the headteachers of the selected will be
contacted. The aims and objectives of the survey will be explained and the cooperation of the headteachers sought. Dates for examination will be set at a mutually
convenient time and date with relevant staff members at each school.
A summarised explanation is provided at appendix C which may be used as a letter
or a fax to give schools more detail about the purpose and nature of the survey. It
also shows that the request for cooperation comes from a formal, legitimate NHS
source.
7.3 Class lists of all age eligible children to be included in the survey will be
obtained prior to the examination. These lists should include the following
information: name, date of birth, residential postcode and ethnicity.
7.4 Using class lists children who will be age eligible on the planned day of
examination will be identified (see appendix K) and sampling of the appropriate
intensity carried out (see section 4.2). A list of these sampled children, along with
their home postcodes will be formed into a table.
7.5 A letter will then be sent to each selected child’s parent or guardian outlining
the details of the survey and informing them that their child may be included, and
seeking their consent (appendix L).
A second letter will be distributed to those who have not returned a form from the first
drop.
If a therapist or hygienist is undertaking the examinations, or if there is no intention to
provide information about a child’s clinical status, then the consent letter (Appendix M)
should be modified to reflect this.
7.5.1 In local authorities where arrangements are in place to collect core
agreement for all health surveillance, the parents of consented children should only
be sent a letter informing them of the nature and purpose of the forthcoming survey
(see appendices Li to Lii).
7.6 The provision or withholding of consent or non-return of valid consent forms
will be recorded for each child firstly into the sheet for schools suggested in appendix
M and finally entered into the overview table which can be used as an examination
day sheet (appendix O).
7.7 The dental examinations will take place in school in a situation identified as
being suitable for that purpose and convenient for the smooth running of both the
survey and the school.
7.8 It is good practice to double check the examination sheet to identify clearly
those children for whom consent has been provided. Children whose parents have
not returned a consent form or those have ticked the box on the form showing that
they do not want their child included must not be examined.
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7.9 It is good practice to inform parents/guardians if a clinical condition requiring
closer investigation is seen during examination, for example sepsis or caries in
permanent teeth. If detailed feedback is provided for parents it should be couched in
terms that respect any existing patient-clinician relationships. If there is no intention
to provide this information the consent letter (appendix L to Lii) should be modified to
reflect this.
8. Fieldwork
Examinations will take place in the schools, after training and calibration of examiners
and must be completed by the end of June 2015. This gives sufficient time for
checking and cleaning of data, summing of numbers of children identified, those
consented and not consented, numbers examined and reporting of these.
Equipment, instruments and materials
To ensure standardisation, no mobile surgeries or equivalent should be used.
8.1 A table with a mat or suitable fully reclining chair will be used for examination,
with the examiner seated behind the child. If a reclining chair is used an assessment
should be made of the safety of it for both the examiner and the volunteer. Some
chairs can tip backwards as smaller children move upwards in them if there is no
support underneath.
8.2 An inspection light (Daray X100 with Halogen bulb with PivotD desk mount or
Brandon Medical MT608BASCD are suitable if a replacement is needed. DO NOT
use a lamp with an LED bulb) yielding approximately 4000 lux at one metre will be
used for illumination. This requires that the Daray Versatile be set to the brighter of
the two settings. A spare halogen bulb will be carried in case of failure. Daray lamps
must be firmly secured to a rigid surface before use and the attachment mechanism
correctly orientated to ensure it cannot topple over (see appendix G).
8.3 The instruments required for the caries examination will include No.4 plain mouth
mirrors, ball ended CPITN probes or blunt or ball ended probes (0.5mm). Mirror heads will
be replaced when they become scratched or otherwise damaged.
The attachment of the mirror head to the stem and the stem to the handle should be
checked for security.
8.4 Local policies and arrangements will be applied to prevent cross-infection and
avoidance of allergic reactions to latex and glove powder. A fresh set of autoclaved
instruments and a new pair of examination gloves will be used for each volunteer.
8.5 Cotton wool rolls, cotton buds, or pledgets of cotton wool will be used to clear teeth
of debris and moisture.
8.6 Suitable shaded spectacles will be used to protect the volunteer’s eyes from the
light and accidental contact.
8.7 Data may be entered either onto paper record sheets (appendix N) or directly onto
computer, with safeguards for both methods (see 8.4).
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8.8 Criminal Records Bureau or Disclosure and Barring Service certificates may be
requested by schools. All members of the fieldwork teams will need to have up to date
versions of these to hand in such cases.
9. Collection of data – general Information
9.1 Training and calibration
Trained and calibrated dental clinicians, assisted by appropriately trained assistants,
will undertake the collection and recording of non-clinical and clinical data. Evidence
of intra-examiner reproducibility is desirable for local use – brief guidance is given in
Pine et al.
6
9.2 Computer software
Data will be collected and processed using the Dental Public Health Epidemiology
Programme (DPH EP) format [5YR2015] with the Dental SurveyPlus 2 (DSP2)
version 2.1 release 3. The format is available electronically from:
www.nwph.net/dentalhealth under the relevant survey link.
The format contains several free fields for local use at the end. These can be
modified for local use by amending the label, but NOT the field name, using the
DSP2 formatter. If these are insufficient for local information requirements it is
requested that additional fields are added to the end of the national format.
Newer computers and upgraded ones using Windows 7 or later are incompatible with
DSP2 unless a ‘patch’ is applied. A machine with Windows 6 or earlier should be kept
aside to allow data entry and analysis of data in DSP2. The details of the patch are
given at appendix I for IT staff.
9.3 Confidentiality
Fieldwork teams will ensure that all data is handled with full regard to confidentiality
and the data protection legislation. Access to all data files will be controlled and
protected by passwords. Fieldwork teams will only retain anonymous processed data
files for purposes of further analysis. As personal data processed for purposes of
research and statistics falls within the scope of the Act (but may be exempt from
subject access) each provider team will register their data collection according to
local procedures.
9.4 Security
Where data are recorded directly onto computers a back-up copy will be made every
day and stored separately from the main database.
If data are collected onto paper sheets in the field, transfer onto computer will occur
with the minimum of delay. It is good practice for data to be entered on the same day
as examination takes place. Paper copies will be kept securely and distant from the
electronic database when inputting is not occurring. These should be retained and
destroyed according to local protocols.
9.5 File management
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Files should be labelled to indicate the population group to which they refer. It is
insufficient to simply label files with the age group and year of survey. The name of
the local authority is required, according to the guidance.
Survey files should be saved into the ‘Survey’ folder of DSP2.
Data handling guidance instructions on the checking, cleaning and labelling of data
files will be available from: www.nwph.net/dentalhealth
9.6 File transfer
Data files will only be transferred on disk or stick by hand delivery from the fieldwork
team to the DEC or by sending as an e-mail attachment from an nhs.net address to
the DEC’s nhs.net address.
10. Collection of non-clinical data
Non-clinical data may be entered onto paper sheets or DSP2 before going to the
school for the clinical examination.
10.1 Organisational boundary coding
Each child will be coded to show the lower tier local authority within which the school
is sited. This is defined by the geographical position of the school within local
authority boundaries. This should be clear, as the local authority will have provided
lists of the schools they cover. A table of codes for local authorities is provided in
appendix J.
10.2 Examiner
A name or code must be used to identify the examiner.
10.3 Examination date
The date of the examination will be recorded.
10.4 School name and postcode
The school name and postcode will be entered. Care must be taken to record each
school with a single method of spelling and punctuation to avoid erroneously creating
schools which the computer programme recognises as distinct – eg, a single school
recorded as St Mary’s in five records and St. Marys in ten others will appear to be
two schools when the central computer checks entries.
10.5 Child identity number
A unique identity number must be entered for each child, which consists of a prefix
from the school code and a suffix, which numbers participants from class lists. The
list of school prefixes should be locally agreed and may be based on the national
school coding system that the local authority will use. Details of these can be found
from: www.education.gov.uk/edubase/public/
The use of identity numbers instead of names improves anonymity of the data and
should reduce the chance of duplicate data entries.
For areas that are planning to undertake the second stage of a longitudinal survey
using children who were examined when they were three years old there are
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implications for sampling, consent, choice of examiner, identity numbers, coding of
examination status and analysis. The key principles are provided in appendix P.
10.6 Date of birth
Use of just the month and year of birth increases anonymity. However this causes
difficulty when checking ages of examined children in the complete datasets. It has
therefore been agreed that all children will be recorded onto computer as being born
on the 15th of the month. The DSP2 format will then automatically indicate when a
child is possibly too old or too young for inclusion. In these cases a double check
should be run on the actual date of birth to ensure that they are in fact five years old
on the day of examination.
Age eligible children will have dates of birth that fall within the widest range of dates
of birth September 2008 to August 2010 (see appendix K which also helps to identify
the narrower ranges for examination dates in each month).
10.7 Home address postcode
Home postcodes will be recorded for all children for whom parental consent is
provided. This should be sought from the school or, in the rare instances when this is
refused, lists from child health databases can be requested.
Note that computer programmes can only read postcodes if they are entered in the
correct format (A = alphabetic N = numeric):
Formats example:
AN NAA M6 5CQ
ANN NAA M25 7GH
AAN NAA BB3 4RL
AANN NAA SK15 8PY
Postcodes should be entered with the first part (outward code) in the first box and the
second part (inward code) in the second box, no spaces.
The most common data entry faults are the substitution of the letters I and O for the
numbers 1 and 0.
10.8 Sub-group
To facilitate the identification of samples that are taken in addition to the minimum
requirement coding is required to assist in the local calculation of weighted means. For
example, if an additional sample is required for an area of particular concern it is easier if
children sampled for this purpose are identifiable. This allows for deeper local analysis. It
is therefore necessary to code these children
All ‘additional’ samples, if used, should be defined locally and descriptions communicated
to DECs.
The coding to assist with identification of sample types is as follows:
0 Main sample
1 Additional sample A
2 Additional sample B
3 Additional sample C
4 Additional sample D
5 Additional sample E
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10.9 Examination status
The type of examination will be recorded as follows:
0 Examined
1 Repeat examination for intra-examiner reliability
2 Training examination
3 Child absent
4 Child refused examination
10.10 Variable for ethnic code
Subjects will be coded for ethnic origin to ensure the requirements of the Health and Social
Care Act, 2012. This act “…introduced the first specific legal duties on health inequalities,
including duties on the Secretary of State for Health. All staff undertaking NHS and public
health functions on behalf of the Secretary of State are responsible for ensuring
compliance with these duties and this guidance is designed to help you do so.” This would
include a requirement to collect ethnicity data to be able to report any inequalities
measured in dental health.
phenet.phe.gov.uk/Our-Organisation/Directorates/Health-andWellbeing/Documents/Reducing%20health%20inequalities%20and%20equality%20act%2
027%20March.pdf
The easiest method is to use the ethnicity data schools collect from parents.
The coding method should not vary, as there is now a standard method of categorisation
and coding for Education Skills and Children’s Services (ESCS). These are suitable for
alignment into the 2011 Census groupings, which are:
Higher
ethnicity
code
Higher ethnicity
description
Lower ethnicity
code Lower ethnicity description
A White
1 British
2 Irish
3 Gypsy or Irish traveller
4 Roma
5 Any other white background
B Mixed
21 White and black Caribbean
22 White and black African
23 White Asian
24 Any other mixed background
C
Asian or Asian
British
41 Indian
42 Pakistani
43 Bangladeshi
44 Any other Asian background
D
Black or black
British
61 Black Caribbean
62 Black African
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63 Any other black background
E Other ethnic group
81 Chinese
86 Any other ethnic group
F
Other ethnic group
– locally defined
G
Other ethnic group
– locally defined
H
Other ethnic group
– locally defined
I
Information on
ethnic group not
provided
The final three groups may be defined for local use and should allow for particular
additional ethnic groups not listed in the table above.
Further guidance and descriptions of ethnic groupings can be found from
www.education.gov.uk/escs-isb/standardslibrary/a0077051/ethnicity-data-standard
10.11 Child part of longitudinal survey
This variable is to record whether the child is part of the second stage of a longitudinal
survey and for their child identity number from the three-year-old survey to be input.
11. Collection of clinical data
Subjects will be examined lying down on a table with a mat or in a suitable chair that
reclines to fully supine. The examiner will be seated behind the subject. The
examination will be visual, aided by mouth mirrors and the standardised light source
only as described in 7.2.
The teeth will not be brushed, but may be rinsed prior to the dental examination.
Where visibility is obscured, debris or moisture should be removed gently from
individual sites with gauze, cotton wool rolls or cotton wool buds. Compressed air
should not be used, in the interests of comparability and cross-infection.
Probes must only be used for cleaning debris from the tooth surfaces to enable
satisfactory visual examination and for defining fissure sealants as indicated below
(10.8). Radiographic or Fibre-optic transillumination examination will not be
undertaken.
Only the primary teeth will be recorded for this survey of five-year-old children.
11.1 Oral cleanliness: assessment of plaque
It is of interest for local surveys to include a variable about oral cleanliness as this
provides a proxy for toothbrushing activity and likely exposure to fluoride toothpaste.
A simple measure based on a modification of the Silness and Low Index
7 will be
used. A probe is not used for this part of the examination, which involves visual
examination only of upper canine to upper canine. No disclosing should be done.
Only easily visible plaque should be considered and recent debris such as small
Oral health survey of five-year old children, 2014-15. National protocol.
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pieces of crisp found in an otherwise clean mouth immediately after a school
lunchtime or break should be ignored.
The coding to be used is:
0 Teeth appear clean
1 Little plaque visible
2 Substantial amount of plaque visible
9 Assessment cannot be made for upper anterior sextant
11.2 Dentition status
Teeth and surfaces will be examined in a standard order. Either the conventional
nomenclature or the FDI 2 digit tooth numbering system may be employed. The
objective is for the examiner to record the present status of the teeth in terms of
disease and treatment history.
The condition of each tooth surface will be recorded using the BASCD standardised
criteria (BASCD) Diagnostic Criteria for Caries Prevalence Surveys.
5
The application
of these criteria will be taught using the BASCD teaching pack.
Data will be recorded by tooth surface. The boundary between mesial / distal surface
and the adjacent lingual/buccal surface is demarcated by a line running across the
point of maximum curvature.
11.3 Conventions
The following conventions will apply:
a) A tooth is deemed to have erupted when any part of it is visible in the
mouth. Unerupted surfaces of an erupted tooth will be regarded as
sound.
b) The presence of supernumerary teeth will not be recorded. If a tooth
and a supernumerary exactly resemble one another then the distal of
the two will be regarded as the supernumerary.
c) MISSING PRIMARY INCISORS ARE ASSUMED EXFOLIATED AND
ASSIGNED TOOTH CODE 8.
d) Caries takes precedence over non-carious defects, eg, hypoplasia.
e) Retained roots following extraction or gross breakdown should be
recorded as code 3.
f) Discoloured, non-vital incisors, without caries or fractures should be
scored T for trauma on all surfaces.
g) Surfaces which are obscured, eg, banded teeth, should be assumed to
be sound and coded ‘-‘ on paper charts, ‘0’ on DSP2 charts.
Oral health survey of five-year old children, 2014-15. National protocol.
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11.4 Teeth present
Before coding the status of individual surfaces, it may be useful to identify which
teeth are present and which are absent. A staged examination is recommended as
follows:
a) the teeth present or absent are described as such : mirror only.
b) tooth surface examination: mirror + cotton wool (for drying).
11.5 Absent teeth
Tooth code 6 – extracted due to caries
Surfaces are regarded as missing if the tooth of which they were a part, has been
extracted because it was carious. Surfaces, which are absent for any other reason,
are not included in this category.
If there has been an extraction and root remains have been left in place, code 3
should be used.
All missing primary canines and primary molars will be considered to have been
extracted (code 6) unless there is unquestionable evidence that a tooth has been
extracted or lost for other reasons.
Missing primary incisors will not be counted and should be coded as code 8 –
unerupted or missing other.
Tooth code 8 – unerupted or missing other
This code will be used where there are missing primary incisors (see section 10.3 c
and 10.5 above).
11.6 Obscured surfaces
All obscured surfaces are assumed sound (surface code ‘-‘ sound) unless there is
evidence of disease experience on the remaining exposed part of the tooth, in which
case the tooth should be coded according to its classification for those exposed
surfaces.
11.7 Caries diagnostic criteria and codes
The diagnosis of the condition of tooth surfaces will be visual and the diagnostic
criteria and codes will be strictly adhered to. Unless the criteria are fulfilled, caries will
not be recorded as present. A single digit code, the descriptor code, will be used to
describe the state of each surface. These codes, which are mutually exclusive, are
as follows:
Surface code – Sound (code 0 in DSP2)
Criteria – a surface is recorded as ‘sound’ using a dashed mark ‘ – ‘ if it shows no
evidence of treated or untreated clinical caries at the ‘caries into dentine’ threshold.
The early stages of caries, as well as other similar conditions are excluded. Surfaces
with the following defects, in the absence of other positive criteria, should be coded
as present and ‘sound’:
 white or chalky spots
 discoloured or rough spots
Oral health survey of five-year old children, 2014-15. National protocol.
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 stained pits or fissures in the enamel that are not associated with a
carious lesion into dentine
 dark, shiny, hard, pitted areas of enamel in the tooth showing signs of
moderate to severe fluorosis
All questionable lesions should be coded as ‘sound’.
Surface code 1 – arrested dentinal decay
Criteria – surfaces will fall into this category if there is arrested caries into dentine.
This code should only be used for arrested dentinal decay.
Surface code 2 – caries into dentine
Criteria – surfaces are regarded as decayed if after visual inspection there is a
carious lesion into dentine. On incisors where the lesion starts mesially or distally,
buccal / lingual surfaces will normally be involved.
Surface code 3 – decay with pulpal involvement
Criteria – surfaces are regarded as falling into this category if there is a carious lesion
that involves the pulp, whether or not there is a filling in the surface. Retained roots
following extraction or gross breakdown should also be recorded as code 3.
Surface code 4 – filled and decayed
Criteria – a surface that has a filling and a carious lesion fulfilling the criteria for code
2 (whether or not the lesion[s] are in physical association with the restoration[s]) will
fall into this category unless the lesion is so extensive as to be classified as ‘decay
with pulpal involvement’, in which case the filling would be ignored and the surface
classified code 3.
Surface code 5 – filled with no decay
Criteria – surfaces which contain a satisfactory permanent restoration of any material,
will be coded under this category (with the exception of obvious sealant restorations
which are coded separately as code N).
Surface code R – filled, needs replacing (not carious)
Criteria – a filled surface is regarded as falling into this category if the restoration is
chipped or cracked and needs replacing but there is no evidence of caries into
dentine present on the same surface.
Lesions or cavities containing a temporary dressing, or cavities from which a
restoration has been lost will be regarded as ‘filled, needs replacing’ unless there is
also evidence of caries into dentine, in which case they will be coded in the
appropriate category of ‘decayed’.
Note: the number of teeth/surfaces scored R should be separately identified.
However, if categories are to be combined later, code R surfaces are to be
considered as part of the ‘filled’ component as no new caries is evident.
Surface code C – crown
Criteria – this code is used for all surfaces which have been permanently crowned.
This is irrespective of the materials employed or of the reasons leading to the
placement of the crown. Note that code C also applies to pre-formed and stainless
steel crowns.
Oral health survey of five-year old children, 2014-15. National protocol.
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Surface code T – trauma
Criteria – a surface will be recorded as traumatised if, in the opinion of the examiner,
it has been subject to trauma and as a result is fractured so as to expose dentine, or
is discoloured, or has a temporary or permanent restoration (excluding a crown).
Minor trauma, affecting enamel only, will be ignored.
Where a tooth is missing through trauma, all surfaces should be coded T.
Any surface exhibiting caries experience, as defined by the caries criteria, will be
recorded with the appropriate caries experience code (code 1-5), irrespective of the
presence of traumatic damage.
11.8 Sealed surfaces
The ball-ended probe should be used to assist in the detection of sealants. Care
should be taken to differentiate sealed surfaces from those restored with tooth
coloured materials used in prepared cavities which have defined margins and no
evidence of fissure sealant. The latter are regarded as fillings and are allocated the
appropriate code, ie, 4, 5 or R. Sealant codes should only be used if the surface
contains evidence of sealant (including cases with a partial loss of sealant), is
otherwise sound and does not contain an amalgam or conventional tooth coloured
filling.
Surface code $ – sealed surface, type unknown
Criteria – all occlusal, buccal and lingual surfaces containing some type of fissure
sealant but where no evidence of a defined cavity margin can be seen (note: this
category will inevitably include both preventive and therapeutic sealants).
Where a clear sealant is in place and there appears to be a lesion showing through
the material, the surface should still be coded code $ – sealed surface, type
unknown.
Surface code N – obvious sealant restorations
Criteria – all occlusal, buccal and lingual surfaces containing a tooth coloured
restoration where there is evidence of a defined cavity margin and a sealed
unrestored fissure. If doubt exists as to whether a preventive sealant or a sealant
restoration is present, the surface should be regarded as being preventively sealed –
code $.
When doubt exists about the classification of any condition, the lower category
should always be recorded.
11.9 Abscess/sepsis
All children should be examined for the presence or absence of sepsis. Following
examination of the mouth for caries, if, in the opinion of the trained examiner, the
presence of an abscess or sinus has been noted – record code 1 in the appropriate
section on the form. If no abscess or sinus present – code 0.
All sepsis must be recorded regardless of cause. No attempt should be made to
identify the cause of the infection.
Oral health survey of five-year old children, 2014-15. National protocol.
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11.10 Optional spare variables
Optional variable for assessment of treatment need
An optional spare variable may be used in the DSP2 format to collect broad
information on treatment need. Criteria will be agreed locally.
Optional data to identify ward, locality or other unit
Spare variables have been provided, as usual, to allow collection of further data
which may be analysed locally and this should accommodate descriptors of ward,
locality or other unit. If these three are insufficient for local needs then the national
format can be amended to add in additional variables at the end. The new format
should be renamed to distinguish it from the standard format.
Note that if ward level estimates are required then sampling should be undertaken to
ensure there is sufficient representation in each ward to be able to produce robust
estimates. This does not mean that all schools or all children need to be involved as
there are alternative sampling methods which are far more efficient than this.
Assistance is available regarding larger samples from DECs or from Girvan Burnside.
12. Reporting of data
Data should be entered into a secure computer with the DSP2 format for the 2014-15
survey as soon as possible after visiting the school. Data should not be left to be
entered as a batch when all fieldwork is completed.
Prior to sending on data files, each fieldwork team is responsible for checking their
data for inaccuracies. The main areas for error occur with incorrect dates of birth
and/or ages, duplicate entries for children or sites and entry of clinical data for
children coded absent.
Guidance will be provided which will give a step-by-step guide to the whole data
handling process. This will be available from: www.nwph.net/dentalhealth
Once data has been checked and errors corrected, files should be correctly labelled
according to the guidance and sent on to the relevant DEC to upload. Files can be
passed by hand on password protected memory sticks or disks directly to the DEC or
they can be sent as email attachments from an nhs.net address to an nhs.net
address. Separate files should be formed for each local authority, labelled to indicate
the age group and local authority to which they refer.
The following will be reported using appendix Q:
12.1 Start and finish dates of the period of examinations (dd/mm/yyyy–dd/mm/yyyy).
12.2 Total number of schools providing education for five-year olds.
12.3 Number of schools visited providing education for five-year olds.
12.4 Total number of five-year-old children attending listed schools.
12.5 Number of five-year-old children from whom consent was initially sought.
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12.6 Number of five-year-old children with parental consent, parental consent
refused and consent form not returned.
12.7 Number of five-year-old consented children examined, absent and refused
examination.
Data will be submitted as cleaned DSP2 survey files and summary reports submitted
as completed Word documents.
All returns should be made to DECs as soon as possible after completion of the
survey and no later than 31 July 2015. These must only be made by direct handing
over of a password protected memory stick or disc or by e-mail attachments from an
nhs.net address to an nhs.net address and should include:
i) the completed summary reporting sheet for each lower tier local
authority – appendix Q
ii) the DSP2 survey file for each local authority labelled to indicate which
local authority it refers to
DECs will re-check and clean (where possible) the data files received from fieldwork
teams before sending them to the DPH epidemiology team, via the secure web
portal.
Cleaned and verified copies of the data will be sent to DPH colleagues working in
PHE centres, via the four regional dental public health consultants.
The national report and local authority tailored reports will be provided by the DPH
epidemiology team and the NW KIT.
DPH staff in PHE centres will work with their named local authorities and their public
health analysts to make maximum use of their data if further analysis is required for
local use.
13. References
1. Department of Health (2010). Equity and excellence: Liberating the NHS. London, The
Stationery Office.
2. Statutory Instrument 2012 No 3094. National Health Service, England Social Care Fund,
England Public Health, England. The NHS Bodies and Local Authorities (Partnership
Arrangements, Care Trusts, Public Health and Local Health watch) Regulations 2012.
Available at : http://www.legislation.gov.uk/uksi/2012/3094/regulation/35/made
3. Department of Health (2005). Choosing Better Oral Health. London, The Stationery Office.
4. Pitts, N.B., Evans, D.J., Pine, C.M. (1997): British Association for the Study of Community
Dentistry (BASCD) diagnostic criteria for caries prevalence surveys – 1996/97.
Community Dental Health 14: (Supplement 1), 6-9.
5. Pine, C.M., Pitts, N.B., Nugent, Z.J. (1997a): British Association for the Study of
Community Dentistry (BASCD) guidance on sampling for surveys of child dental health. A
BASCD coordinated dental epidemiology programme quality standard. Community Dental
Health 14: (Supplement 1), 10-17.
Oral health survey of five-year old children, 2014-15. National protocol.
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6. Pine, C.M., Pitts, N.B., Nugent, Z.J. (1997b): British Association for the Study of
Community Dentistry (BASCD) guidance on the statistical aspects of training and
calibration of examiners for surveys of child dental health. A BASCD co-ordinated dental
epidemiology programme quality standard. Community Dental Health 14, (Supplement 1),
18-29.
7. Silness, J. and Loe, H. (1964). Periodontal disease in pregnancy. II Correlation between
oral hygiene and periodontal condition. Acta Odontologica Scandinavica 22: 121–135.
Oral health survey of five-year old children, 2014-15. National protocol.
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14. Table of appendices
Page No.
A Statutory Instrument 2012, No. 3094 23
B*
Letter of support from programme lead for dental public health, Public
Health England, to directors of public health 25
C* Information about the purpose and nature of the survey 27
D Requirement for positive consent 28
E Stages to undertake the survey 29
F Operational timetable 30
G Safe use of Daray lights for dental epidemiology fieldwork 31
H Sources of information 33
I
Guidance and adaptation to allow DSP2 to run on new versions of
Microsoft Windows 34
J List of codes for local authorities 35
K Guide for date of birth bands for survey of five-year-olds 2013-14 43
L, Li,
Lii*
Suggested consent letters and forms 44
M*
Tracking list for schools to record which children have returned consent
forms 47
N* Data collection sheet 48
O* Examination day sheet 49
P Considerations for longitudinal surveys 50
Q* Summary information sheet 53
* Documents will be available in Word format from www.nwph.net/dentalhealth
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Appendix A. Statutory Instrument 2012, No. 3094 – extract
_________________________________________________________________________
S T A T U T O R Y I N S T R U M E N T S
_______________________________________________________
2012 No. 3094
NATIONAL HEALTH SERVICE, ENGLAND
SOCIAL CARE FUND, ENGLAND PUBLIC
HEALTH, ENGLAND
The NHS Bodies and Local Authorities (Partnership
Arrangements, Care Trusts, Public Health and
Local Healthwatch) Regulations 2012
Made – – – – 12th December 2012
Laid before Parliament 17th December 2012
Coming into force in accordance with regulation 1(2)
Extract from pages 8, 9, 26 and 27
PART 4
DENTAL PUBLIC HEALTH FUNCTIONS OF LOCAL AUTHORITIES
Interpretation
16. In this Part—
“oral health promotion programme” means a health promotion and disease prevention programme the underlying
purpose of which is to educate and support members of the public about ways in which they may improve their
oral health;
“oral health survey” means a survey to establish the prevalence and incidence of disease or abnormality of the oral
cavity;
“water fluoridation programme” means fluoridation arrangements made under section 87(1) (fluoridation of water
supplies at request of relevant authorities) of the Water Industry Act 1991(g)
1
.
Exercise of functions of local authorities
17.—
(1) Each local authority (h)
2
shall have the following functions in relation to dental public health in England.

1 (g) 1991 c.56. Section 87(1) is substituted by section 58(1) and (2) of the Water Act 2003 (c.37).
2 (h) See section 2B(5) of the 2006 Act for the definition of “local authority”, which is also applied to section 111 by virtue of
section 111(3) of that Act.
Oral health survey of five-year old children, 2014-15. National protocol.
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(2) A local authority shall provide, or shall make arrangements to secure the provision of, the following within its
area—
(a) to the extent that the authority considers appropriate for improving the health of the people in its area,
oral health promotion programmes;
(b) oral health surveys to facilitate—
(i) the assessment and monitoring of oral health needs,
(ii) the planning and evaluation of oral health promotion programmes,
(iii) the planning and evaluation of the arrangements for provision of dental services as part of
the health service, and
(iv) where there are water fluoridation programmes affecting the authority’s area, the monitoring
and reporting of the effect of water fluoridation programmes.
(3) The local authority shall participate in any oral health survey conducted or commissioned by the Secretary of
State under paragraph 13(1) of Schedule 1 to the 2006 Act (powers in relation to research etc)(a)
3
so far as that
survey is conducted within the authority’s area.
Revocations and transitional arrangements
18.—
(1) The Functions of Primary Care Trusts (Dental Public Health) (England) Regulations
2006(b)
4
(“the 2006 Regulations”) are revoked.
(2) This paragraph applies where, in the exercise of its functions under the 2006 Regulations, a
Primary Care Trust—
(a) provided an oral health promotion programme or an oral health survey which was ongoing
immediately prior to section 29 of the 2012 Act coming fully into force, or
(b) participated in an oral health survey required by the Department of Health which was ongoing
immediately prior to section 29 of the 2012 Act coming fully into force.
(3) Where paragraph (2) applies, each local authority whose area fell wholly or partly within the area of the
Primary Care Trust shall continue to carry out the oral health promotion programme or oral health survey, to the
extent that the programme or survey relates to persons in the local authority’s area.
Signed by authority of the Secretary of State for Health.
Anna Soubry
Parliamentary Under-Secretary of State for Health,
Department of Health
12th December 2012
EXPLANATORY NOTE
(This note is not part of the Regulations)
These Regulations make provision in relation to the designation of certain NHS bodies as Care Trusts, the public
health functions of local authorities and Local Healthwatch organisations.
Part 4 specifies the functions to be exercised by local authorities in relation to dental public health in England.
The functions to be exercised by local authorities in relation to dental public health in England as specified in Part
4, relate to the provision of oral health promotion programmes and oral health surveys. In the case of oral health
surveys, local authorities must make their own arrangements for oral health surveys and must also participate in
any such surveys conducted or commissioned by the Secretary of State.

3 (a) Paragraph 13 of Schedule 1 to the 2006 Act is substituted by section 17(2) and (13) of the 2012 Act.
4 (b) S.I. 2006/185.
Oral health survey of five-year old children, 2014-15. National protocol.
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Appendix B. Letter of support from programme lead for dental public health, Public Health
England, to directors of public health
Dental Public Health
Skipton House
80 London Road
London SE1 6LH
T +44 (0)20 7654 8179
www.gov.uk/phe
To: Directors of Public Health
for forwarding to Directors of Children’s Services
10 September 2014
Gateway number: 2014-318
Dear Director of Public Health and Directors of Children’s Services,
Re: Surveys of the oral health of 5 year old children
I am writing to make you aware of this year’s oral health survey which is taking place during the
academic year 2014/15. As you will know, the oral health of five year olds is an indicator in the
public health outcomes framework.
The survey is taking place in England, as part of the national dental epidemiology programme and
will use a sampling frame to allow statistical comparison at local authority level. The information
generated will be used to make comparisons of the oral health of these children with their sameage peers attending mainstream schools.
Currently the only way the clinical needs can be measured is by fieldwork surveys and this method
of measurement produces robust information.
Surveys conducted previously have suggested that there are significant inequalities in oral health
between 5 year old children across the country. It is important that we understand more about the
oral health status of children in order to target prevention and treatment delivery. This is
particularly relevant because of the impacts of dental decay, specifically dental pain and infection,
time off school and provision of treatment which can be challenging.
Public Health England is asking for directors of public health to give support for local involvement.
Dental Epidemiology Regional Coordinators will be working with Directors of Community Dental
Services to ensure fieldwork teams are available in local areas. It would be very helpful if directors
of public health could voice their support to Directors of Children’s services and for them to pass on
their endorsement to head teachers of primary schools. Consultants in Dental Public Health in
your local Public Health England centre are available to advise during the whole process, including
commissioning of these surveys.
The findings will be made widely available and shared with you and colleagues.
Yours sincerely,
Dr Sandra White
Director of Dental Public Health
E Sandra.white@phe.gov.uk
Oral health survey of five-year old children, 2014-15. National protocol.
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Appendix C. Information about the purpose and nature of the survey
Public Health England dental public health epidemiology programme
Oral health survey of five-year-old children 2014-2015
Dental health surveys involving children have been carried out across the UK since
1987. The information arising from them allows NHS England area teams to plan
dental services and health improvement teams to tailor programmes for groups
where oral health is poor. The overall aim is to support actions to improve oral health,
reduce health inequalities and improve the provision of treatment services.
Local fieldwork teams from the Community Dental Service usually carry out these
surveys. As with all NHS employees the teams are covered by the Data Protection
Act and take confidentiality very seriously. National and regional training is provided
to ensure that high standards are kept and all teams work to the same level at all
stages in the survey.
Fieldwork teams will contact randomly sampled primary schools within a local
authority area. They will ask for cooperation from the school and for access to lists of
all children that may be included, showing dates of birth. From these lists they will
identify children who will be the correct age on the day of examination. Positive,
written consent will then be sought via letters home to parents, which the team will
provide. The ethnic classification and home postcode of consented children will be
requested from school information.
On the day of examination the team will set up their mobile equipment at an agreed
location at the school and undertake brief examinations of the consented children’s
teeth. These examinations take no more than a minute and, as the teams are child
friendly, should cause no discomfort or distress.
The information is recorded anonymously; no names, gender or complete dates of
birth are recorded. All data is kept securely and datasets are securely sent to regional
centres for uploading via a secure web portal to the national coordinating centre. This
centre collates data from all over England and produces reports on levels of dental
health for England as a whole and at a variety of local government and health
organisation levels. At no point is any individual identifiable, as the data is
anonymised from the examination stage and only reported or published as grouped
data.
It is hoped that all sites contacted will be able to assist the fieldwork teams in this
national survey which local authorities have a responsibility to procure by law. The
teams try to keep disruption to a minimum and ensure the children involved have a
positive experience with the dental team.
Oral health survey of five-year old children, 2014-15. National protocol.
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Appendix D. Requirement for positive consent

Oral health survey of five-year old children, 2014-15. National protocol.
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Appendix E. Stages for PHE dental public health epidemiology programme teams to
undertake the survey
Letter received by directors of public
health. Support expressed to
children’s services directorate and
headteachers
Consultant in dental public health at
PHE centre to talk with DsPH
regarding sample size and NHS E
area team about commissioning as
required
Fieldwork team
Trained and calibrated
Request list of all mainstream
primary schools from local
authority, with numbers on roll
Using list of schools
undertake agreed sampling
method at school level
Contact sampled schools to
seek co-operation,
agree date of examination,
request class lists, with dates
of birth (with postcodes and
ethnic group if available at
this stage)
Undertake sampling within
schools
Send out letters and consent
forms for all sampled children
Send letters and consent
forms for the second time to
non-responders
Record on list which are
returned
Examine all consented
children. Enter data into DSP2
using correct format
Create examination day list of
consented children
Check and clean data, label
files. Send securely to dental
epidemiology coordinator.
Letter sent from PHE programme lead
for DPH to DsPH
Seek postcodes and ethnic
group of consented children
from school
(if not previously available)
Discussion
with DEC if
nonstandard
sampling is
required
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Appendix F. Operational timetable
Training for dental epidemiology coordinators
(DECs) – National Protocol
30 June and 1 July 2014
National clinical training and calibration for
standard examiners
Local training and calibration for fieldwork
teams
As soon as can be arranged
following national training.
Data collection and ongoing data entry
To start as soon as possible
and completed by 30 June
2015.
Completion of data checking and labelling of
local authority data files.
Secure forwarding of cleaned data files to
DECs as soon as possible before deadline.
By 31 July 2015.
DECs to upload summaries and copies of local
authority data files to the dental public health
epidemiology team (DPHET) via the web
portal
www.nwph.net/dentalhealthupload/login.aspx
To be uploaded as and
when they have been
checked, completed by 31
August 2015.
DPHET – Checking of data, returning errors for
clarification by fieldwork teams via DECs, and
collation of clean, verified data
As and when data files
arrive.
Knowledge and information team north west
(NW KIT)/DPHET – compute estimates for
local authorities
From September 2015.
Publication of results on website
www.nwph.net/dentalhealth
December 2015 or four
months after receipt of last
data set dependent upon
PHE gateway.
Feedback of cleaned – to be advised January 2016 or five months
after receipt of last data set.
Publication of results in Community Dental
Health
June 2016 dependent upon
receipt of last set of data.
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Appendix G. Safe use of Daray lights for dental epidemiology fieldwork
The Daray lamps recommended as standard for dental epidemiology fieldwork are fit for purpose but it is
likely that many dental epidemiology fieldwork teams are using Daray lamps that are now some years old. It
is important that they are used and maintained correctly to ensure they are safe. This advice is provided in
conjunction with Daray Ltd.
These lamps should be PAT tested, as with any electrical equipment, and signs of damage noted and acted
upon.
The clamps should be fitted and used correctly and checked to ensure they are firmly fixed to a work
surface. For this reason it is best practice to establish a set examination site at a venue and avoid moving
around from one room to another.
The Pivot D2 clamp has replaced the Pivot D clamp and can be sourced from Daray Ltd
Tel: 0870 777 2664 Sales.team@daray.co.uk www.Daray.com
The pictures below show how the clamp with a silver clamping bar should be fitted to ensure that the block of
the clamp is in full contact with the base of the desk or table surface (pictures 1 and 2). If the wedge shaped
bar is fitted upside down it will not be stable (pictures 3 and 4).
Examiners should check that the lamp is stable before undertaking examinations.
Pic 1. Correct fitting and use of the clamp
Pic 2. Correct fitting and use of the clamp
Note the surface contact along the length of the clamp
Oral health survey of five-year old children, 2014-15. National protocol.
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Incorrect use of clamp:
Pic 3. Clamping bar being used upside down
Pic 4. Clamping bar being used upside down
The moving arm should be able to move freely within the socket so that the lamp can be turned without
moving the clamping mechanism. This may require the application of a little lubricant to the spigot.
It should be noted that Daray Ltd also manufacture lamps with LED bulbs. These are
unsuitable for dental examination as they are too bright for eye safety and they provide a
level of light that is too intense for diagnosis and recording of caries. Only the dental
survey lamps with halogen bulbs should be used.
Oral health survey of five-year old children, 2014-15. National protocol.
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Appendix H. Sources of information
• This national protocol, DSP2 format, guidance to data input and handling and
feedback forms are all available from the DPHIP website www.nwph.net/dentalhealth
• The site from which to download the DSP2 software has now changed to
http://dacwww.computing.dundee.ac.uk/projects/dsp2/
Once the shareware version software has been downloaded, the licence details
colleagues may already have will still work when entered to change the software into the
full version.
Anyone who requires a new licence or has lost their old one should contact Janet
Neville [janet.neville@phe.gov.uk] who can arrange this with Dundee University.
• If home postcodes cannot be obtained from schools, school nurses, school
health clerks or local child health information services these can be obtained by cross
referencing the volunteer’s address in the relevant Royal Mail Postal Address Book:
www.royalmail.com/address-book
Alternatively, use the Royal Mail Postcodes on-line at:
www.royalmail.com/portal/rm/postcodefinder
• Light source, if new unit required to replace a Daray Versatile (this is no longer
produced):
Either The Daray X100 Halogen with Pivotd2 to allow desk-mounting
Contact Daray Tel: 0333 321 0971
www.daray.co.uk
www.daray.co.uk/docs/X100.html
Or The MT608BASCD
Contact Brandon Medical Co. Ltd
Tel: 01132 777393
www.brandon-medical.com/products/medical-lighting/examinationlights/mt6008-examination-lamps
Oral health survey of five-year old children, 2014-15. National protocol.
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Appendix I. Guidance and adaptation to allow DSP2 to run on new versions of
Microsoft Windows. With thanks to colleagues at Cardiff University
32-bit and 64-bit Windows
The terms 32-bit and 64-bit refer to the way a computer’s processor (also called a CPU),
handles information. The 64-bit version of Windows handles large amounts of random
access memory (RAM) more effectively than a 32-bit system.
Most programs designed for the 32-bit version of Windows will work on the 64-bit version
of Windows. However, this is not true for 16-bit applications like DSP2 as the table below
shows.
Table 1. Tests of installation of both versions of DSP2 on Windows 7 and 8 operating
systems
Windows 7 Windows 8
32-bit Yes Yes
64-bit Yes if use deployment No
To find out if your computer is running 32-bit or 64-bit Windows, do the following:
1. Open System by clicking the Start button , clicking Control Panel,
clicking System and Security, and then clicking System.
2. Under System, you can view the system type.
DSP2 Deployment
As a short-term interim, and somewhat cumbersome measure, DSP2 may be deployed on
64-bit Windows 7 by using Windows XP Mode. This comes as a separate download and
works only with Windows 7 Professional, Ultimate, and Enterprise.
Machines purchased from retail outlets will be running the consumer versions of Windows
7. A Windows Enterprise licence will be required and the Windows operating system will
need to be re-installed. It is recommended that professional IT support is provided for this
process.
Windows XP mode is not present in Windows 8 though it may be possible to deploy this
using Microsoft’s virtualisation technology Hyper-V.
64-bit Windows machines are becoming very common and it is likely that the next version
of Windows will be 64-bit only. Because of this, and the extra support required to deploy
DSP2 on Windows 7 there is a clear need to update or replace DSP2.
Summary
 Existing installations will continue to work. However Microsoft are withdrawing
support for Windows XP. Corporate type environments will be replacing
Windows XP with Windows 7, and in many cases this will be 64-bit Windows 7
(eg, Cardiff University).
 Both versions (1.1 and 2.1) of DSP2 install on 32-bit Windows 7 and 8.
 DSP2 will install on 64-bit Windows 7 but will require IT support to install, and
an enterprise licence of Windows will need to be acquired.
Oral health survey of five-year old children, 2014-15. National protocol.
35
Appendix J. List of codes for local authorities
Upper tier local authority Upper code Lower tier local authority Lower code
Barking and Dagenham E09000002 Barking and Dagenham E09000002
Barnet E09000003 Barnet E09000003
Barnsley E08000016 Barnsley E08000016
Bath and North East Somerset E06000022 Bath and North East Somerset E06000022
Bedford E06000055 Bedford E06000055
Bexley E09000004 Bexley E09000004
Birmingham E08000025 Birmingham E08000025
Blackburn with Darwen E06000008 Blackburn with Darwen E06000008
Blackpool E06000009 Blackpool E06000009
Bolton E08000001 Bolton E08000001
Bournemouth E06000028 Bournemouth E06000028
Bracknell Forest E06000036 Bracknell Forest E06000036
Bradford E08000032 Bradford E08000032
Brent E09000005 Brent E09000005
Brighton and Hove E06000043 Brighton and Hove E06000043
Bristol, City of E06000023 Bristol, City of E06000023
Bromley E09000006 Bromley E09000006
Buckinghamshire E10000002
Aylesbury Vale E07000004
Chiltern E07000005
South Bucks E07000006
Wycombe E07000007
Bury E08000002 Bury E08000002
Calderdale E08000033 Calderdale E08000033
Cambridgeshire E10000003
Cambridge E07000008
East Cambridgeshire E07000009
Fenland E07000010
Huntingdonshire E07000011
South Cambridgeshire E07000012
Camden E09000007 Camden E09000007
Central Bedfordshire E06000056 Central Bedfordshire E06000056
Cheshire East E06000049 Cheshire East E06000049
Cheshire West and Chester E06000050 Cheshire West and Chester E06000050
City of London E09000001 City of London E09000001
Cornwall E06000052 Cornwall E06000052
County Durham E06000047 County Durham E06000047
Coventry E08000026 Coventry E08000026
Croydon E09000008 Croydon E09000008
Cumbria E10000006
Allerdale E07000026
Barrow-in-Furness E07000027
Carlisle E07000028
Copeland E07000029
Eden E07000030
South Lakeland E07000031
Darlington E06000005 Darlington E06000005
Oral health survey of five-year old children, 2014-15. National protocol.
36
Upper tier local authority Upper code Lower tier local authority Lower code
Derby E06000015 Derby E06000015
Derbyshire E10000007
Amber Valley E07000032
Bolsover E07000033
Chesterfield E07000034
Derbyshire Dales E07000035
Erewash E07000036
High Peak E07000037
North East Derbyshire E07000038
South Derbyshire E07000039
Devon E10000008
East Devon E07000040
Exeter E07000041
Mid Devon E07000042
North Devon E07000043
South Hams E07000044
Teignbridge E07000045
Torridge E07000046
West Devon E07000047
Doncaster E08000017 Doncaster E08000017
Dorset E10000009
Christchurch E07000048
East Dorset E07000049
North Dorset E07000050
Purbeck E07000051
West Dorset E07000052
Weymouth and Portland E07000053
Dudley E08000027 Dudley E08000027
Ealing E09000009 Ealing E09000009
East Riding of Yorkshire E06000011 East Riding of Yorkshire E06000011
East Sussex E10000011
Eastbourne E07000061
Hastings E07000062
Lewes E07000063
Rother E07000064
Wealden E07000065
Enfield E09000010 Enfield E09000010
Essex E10000012
Basildon E07000066
Braintree E07000067
Brentwood E07000068
Castle Point E07000069
Chelmsford E07000070
Colchester E07000071
Epping Forest E07000072
Harlow E07000073
Maldon E07000074
Rochford E07000075
Tendring E07000076
Uttlesford E07000077
Oral health survey of five-year old children, 2014-15. National protocol.
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Upper tier local authority Upper code Lower tier local authority Lower code
Gateshead E08000020 Gateshead E08000020
Gloucestershire E10000013
Cheltenham E07000078
Cotswold E07000079
Forest of Dean E07000080
Gloucester E07000081
Stroud E07000082
Tewkesbury E07000083
Greenwich E09000011 Greenwich E09000011
Hackney E09000012 Hackney E09000012
Halton E06000006 Halton E06000006
Hammersmith and Fulham E09000013 Hammersmith and Fulham E09000013
Hampshire E10000014
Basingstoke and Deane E07000084
East Hampshire E07000085
Eastleigh E07000086
Fareham E07000087
Gosport E07000088
Hart E07000089
Havant E07000090
New Forest E07000091
Rushmoor E07000092
Test Valley E07000093
Winchester E07000094
Haringey E09000014 Haringey E09000014
Harrow E09000015 Harrow E09000015
Hartlepool E06000001 Hartlepool E06000001
Havering E09000016 Havering E09000016
Herefordshire, County of E06000019 Herefordshire, County of E06000019
Hertfordshire E10000015
Broxbourne E07000095
Dacorum E07000096
East Hertfordshire E07000097
Hertsmere E07000098
North Hertfordshire E07000099
St Albans E07000240
Stevenage E07000101
Three Rivers E07000102
Watford E07000103
Welwyn Hatfield E07000241
Hillingdon E09000017 Hillingdon E09000017
Hounslow E09000018 Hounslow E09000018
Isle of Wight E06000046 Isle of Wight E06000046
Isles of Scilly E06000053 Isles of Scilly E06000053
Islington E09000019 Islington E09000019
Kensington and Chelsea E09000020 Kensington and Chelsea E09000020
Oral health survey of five-year old children, 2014-15. National protocol.
38
Upper tier local authority Upper code Lower tier local authority Lower code
Kent E10000016
Ashford E07000105
Canterbury E07000106
Dartford E07000107
Dover E07000108
Gravesham E07000109
Maidstone E07000110
Sevenoaks E07000111
Shepway E07000112
Swale E07000113
Thanet E07000114
Tonbridge and Malling E07000115
Tunbridge Wells E07000116
Kingston upon Hull, City of E06000010 Kingston upon Hull, City of E06000010
Kingston upon Thames E09000021 Kingston upon Thames E09000021
Kirklees E08000034 Kirklees E08000034
Knowsley E08000011 Knowsley E08000011
Lambeth E09000022 Lambeth E09000022
Lancashire E10000017
Burnley E07000117
Chorley E07000118
Fylde E07000119
Hyndburn E07000120
Lancaster E07000121
Pendle E07000122
Preston E07000123
Ribble Valley E07000124
Rossendale E07000125
South Ribble E07000126
West Lancashire E07000127
Wyre E07000128
Leeds E08000035 Leeds E08000035
Leicester E06000016 Leicester E06000016
Leicestershire E10000018
Blaby E07000129
Charnwood E07000130
Harborough E07000131
Hinckley and Bosworth E07000132
Melton E07000133
North West Leicestershire E07000134
Oadby and Wigston E07000135
Lewisham E09000023 Lewisham E09000023
Lincolnshire E10000019
Boston E07000136
East Lindsey E07000137
Lincoln E07000138
North Kesteven E07000139
South Holland E07000140
South Kesteven E07000141
West Lindsey E07000142
Oral health survey of five-year old children, 2014-15. National protocol.
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Upper tier local authority Upper code Lower tier local authority Lower code
Liverpool E08000012 Liverpool E08000012
Luton E06000032 Luton E06000032
Manchester E08000003 Manchester E08000003
Medway E06000035 Medway E06000035
Merton E09000024 Merton E09000024
Middlesbrough E06000002 Middlesbrough E06000002
Milton Keynes E06000042 Milton Keynes E06000042
Newcastle upon Tyne E08000021 Newcastle upon Tyne E08000021
Newham E09000025 Newham E09000025
Norfolk E10000020
Breckland E07000143
Broadland E07000144
Great Yarmouth E07000145
King’s Lynn and West Norfolk E07000146
North Norfolk E07000147
Norwich E07000148
South Norfolk E07000149
North East Lincolnshire E06000012 North East Lincolnshire E06000012
North Lincolnshire E06000013 North Lincolnshire E06000013
North Somerset E06000024 North Somerset E06000024
North Tyneside E08000022 North Tyneside E08000022
North Yorkshire E10000023
Craven E07000163
Hambleton E07000164
Harrogate E07000165
Richmondshire E07000166
Ryedale E07000167
Scarborough E07000168
Selby E07000169
Northamptonshire E10000021
Corby E07000150
Daventry E07000151
East Northamptonshire E07000152
Kettering E07000153
Northampton E07000154
South Northamptonshire E07000155
Wellingborough E07000156
Northumberland E06000048 Northumberland E06000048
Nottingham E06000018 Nottingham E06000018
Nottinghamshire E10000024
Ashfield E07000170
Bassetlaw E07000171
Broxtowe E07000172
Gedling E07000173
Mansfield E07000174
Newark and Sherwood E07000175
Rushcliffe E07000176
Oldham E08000004 Oldham E08000004
Oral health survey of five-year old children, 2014-15. National protocol.
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Upper tier local authority Upper code Lower tier local authority Lower code
Oxfordshire E10000025
Cherwell E07000177
Oxford E07000178
South Oxfordshire E07000179
Vale of White Horse E07000180
West Oxfordshire E07000181
Peterborough E06000031 Peterborough E06000031
Plymouth E06000026 Plymouth E06000026
Poole E06000029 Poole E06000029
Portsmouth E06000044 Portsmouth E06000044
Reading E06000038 Reading E06000038
Redbridge E09000026 Redbridge E09000026
Redcar and Cleveland E06000003 Redcar and Cleveland E06000003
Richmond upon Thames E09000027 Richmond upon Thames E09000027
Rochdale E08000005 Rochdale E08000005
Rotherham E08000018 Rotherham E08000018
Rutland E06000017 Rutland E06000017
Salford E08000006 Salford E08000006
Sandwell E08000028 Sandwell E08000028
Sefton E08000014 Sefton E08000014
Sheffield E08000019 Sheffield E08000019
Shropshire E06000051 Shropshire E06000051
Slough E06000039 Slough E06000039
Solihull E08000029 Solihull E08000029
Somerset E10000027
Mendip E07000187
Sedgemoor E07000188
South Somerset E07000189
Taunton Deane E07000190
West Somerset E07000191
South Gloucestershire E06000025 South Gloucestershire E06000025
South Tyneside E08000023 South Tyneside E08000023
Southampton E06000045 Southampton E06000045
Southend-on-Sea E06000033 Southend-on-Sea E06000033
Southwark E09000028 Southwark E09000028
St. Helens E08000013 St. Helens E08000013
Staffordshire E10000028
Cannock Chase E07000192
East Staffordshire E07000193
Lichfield E07000194
Newcastle-under-Lyme E07000195
South Staffordshire E07000196
Stafford E07000197
Staffordshire Moorlands E07000198
Tamworth E07000199
Stockport E08000007 Stockport E08000007
Stockton-on-Tees E06000004 Stockton-on-Tees E06000004
Stoke-on-Trent E06000021 Stoke-on-Trent E06000021
Oral health survey of five-year old children, 2014-15. National protocol.
41
Upper tier local authority Upper code Lower tier local authority Lower code
Suffolk E10000029
Babergh E07000200
Forest Heath E07000201
Ipswich E07000202
Mid Suffolk E07000203
St Edmundsbury E07000204
Suffolk Coastal E07000205
Waveney E07000206
Sunderland E08000024 Sunderland E08000024
Surrey E10000030
Elmbridge E07000207
Epsom and Ewell E07000208
Guildford E07000209
Mole Valley E07000210
Reigate and Banstead E07000211
Runnymede E07000212
Spelthorne E07000213
Surrey Heath E07000214
Tandridge E07000215
Waverley E07000216
Woking E07000217
Sutton E09000029 Sutton E09000029
Swindon E06000030 Swindon E06000030
Tameside E08000008 Tameside E08000008
Telford and Wrekin E06000020 Telford and Wrekin E06000020
Thurrock E06000034 Thurrock E06000034
Torbay E06000027 Torbay E06000027
Tower Hamlets E09000030 Tower Hamlets E09000030
Trafford E08000009 Trafford E08000009
Wakefield E08000036 Wakefield E08000036
Walsall E08000030 Walsall E08000030
Waltham Forest E09000031 Waltham Forest E09000031
Wandsworth E09000032 Wandsworth E09000032
Warrington E06000007 Warrington E06000007
Warwickshire E10000031
North Warwickshire E07000218
Nuneaton and Bedworth E07000219
Rugby E07000220
Stratford-on-Avon E07000221
Warwick E07000222
West Berkshire E06000037 West Berkshire E06000037
West Sussex E10000032
Adur E07000223
Arun E07000224
Chichester E07000225
Crawley E07000226
Horsham E07000227
Mid Sussex E07000228
Worthing E07000229
Oral health survey of five-year old children, 2014-15. National protocol.
42
Upper tier local authority Upper code Lower tier local authority Lower code
Westminster E09000033 Westminster E09000033
Wigan E08000010 Wigan E08000010
Wiltshire E06000054 Wiltshire E06000054
Windsor and Maidenhead E06000040 Windsor and Maidenhead E06000040
Wirral E08000015 Wirral E08000015
Wokingham E06000041 Wokingham E06000041
Wolverhampton E08000031 Wolverhampton E08000031
Worcestershire E10000034
Bromsgrove E07000234
Malvern Hills E07000235
Redditch E07000236
Worcester E07000237
Wychavon E07000238
Wyre Forest E07000239
York E06000014 York E06000014
Source: From ONS Geographical Lookups.
Oral health survey of five-year old children, 2014-15. National protocol.
43
Appendix K. Guide for date of birth bands for survey of five-year olds 2014-15
For this month
of exam
Children born within these ranges will
definitely be five years old
There may also be a few
more in these ranges
Earliest birth
month and year
Latest birth
month and year
Birth month/Year
Check day of birth * and **
September 2014 October 2008 August 2009 September 2008 and 2009*
October 2014 November 2008 September 2009 October 2008 and 2009*
November 2014 December 2008 October 2009 November 2008 and 2009*
December 2014 January 2009 November 2009 December 2008 and 2009*
January 2015 February 2009 December 2009 January 2009 and 2010**
February 2015 March 2009 January 2010 February 2009 and 2010**
March 2015 April 2009 February 2010 March 2009 and 2010**
April 2015 May 2009 March 2010 April 2009 and 2010**
May 2015 June 2009 April 2010 May 2009 and 2010**
June 2015 July 2009 May 2010 June 2009 and 2010**
July 2015 August 2009 June 2010 July 2009 and 2010**
August 2015 September 2009 July 2010 August 2009 and 2010**
September 2015 October 2009 August 2010 September 2009 and 2010**
* If born 2008 birth day should be later than day of exam, if born 2009 birth day should be same day or
before day of exam.
** If born 2009 birth day should be later than day of exam, if born 2010 birth day should be same day or
before day of exam.
Oral health survey of five-year old children, 2014-15. National protocol.
44
Appendix L. Consent letter and form. To be added to headed notepaper – minor
modifications are acceptable, local details to be added
Dear Parent,
Public Health England dental public health epidemiology programme, oral health survey of
five-year-old children, 2014-15.
Please will you help us to plan better dental services? To do this we are preparing to look at the
teeth of groups of five-year-old children attending mainstream schools. We can then compare
dental health between different areas and with results we found from previous surveys.
Please give your consent to your child taking part in this year’s survey by signing the attached form
and returning it to your child’s school. The survey is planned to take place on ……………….. The
children taking part will have a simple examination at their school when a dentist and assistant who
are trained to do this work will visit. The dentist will use fresh disposable gloves and sterilised
mirrors for each child. The check takes only a few minutes and we will let you know if we find
anything wrong. We would be pleased to see you at the school if you would like to be present.
No treatment will be provided, just a quick examination. All children still need to visit their own
dentist for regular check-ups.
As part of the survey we will be asking the school to share some information they already have, for
example home postcode and ethnic group. The information about your child will be anonymised
(neither their name nor full date of birth will be recorded) and then stored in a computer file which
will be password protected and only dental staff and Public Health England staff will have access
to it. The anonymised results will be sent to the national PHE centre so that they can be compared
with all other local authorities in England. The findings may be published in a scientific journal but
no individual will be identifiable and the analysis and reporting will be carried out on groups.
Thank you for reading this information sheet. If you have any questions please contact ……………
Yours sincerely
Clinical Director
——————————————————————————————————————
CONSENT FORM
I have read and understood the information in the invitation letter about the dental survey.
My child’s name is (insert name)………………………………….. Class ………
Please tick appropriate box below:
Yes, I agree to my child taking part in the dental survey
No, I do not want my child to be included
Signed…………………………………………(parent or guardian) Date …………
Name (block capitals) ……………………………………………
Oral health survey of five-year old children, 2014-15. National protocol.
45
Appendix Li. Suggested information letter for local authorities where parents provide core
agreement to whole of school life health surveillance. To be added to headed notepaper –
local details to be added, minor modifications are acceptable
Dear Parent,
Public Health England dental public health epidemiology programme, oral health survey of
five-year-old children, 2014-15.
Please will you help us to plan better dental services? To do this we are preparing to look at the
teeth of groups of five-year-old children attending mainstream schools. We can then compare
dental health between different areas and with results we found from previous surveys.
You gave your agreement for your child to have dental checks in school and this letter tells you
about this year’s dental survey of five-year-olds which is planned to take place on ……..………..
The children taking part will have a simple examination at their school when a dentist and assistant
who are trained to do this work will visit. The dentist will use fresh disposable gloves and sterilised
mirrors for each child. The check takes only a few minutes and we will let you know if we find
anything wrong. We would be pleased to see you at the school if you would like to be present.
No treatment will be provided, just a quick examination. All children still need to visit their own
dentist for regular check-ups.
As part of the survey we will be asking the school to share some information they already have, for
example home postcode and ethnic group. The information about your child will be anonymised
(neither their name nor full date of birth will be recorded) and then stored in a computer file which
will be password protected and only dental staff and Public Health England staff will have access
to it. The anonymised results will be sent to the national PHE centre so that they can be compared
with all other local authorities in England. The findings may be published in a scientific journal but
no individual will be identifiable and the analysis and reporting will be carried out on groups.
Thank you for reading this information sheet. If you have any questions please contact
………………. If you wish to withdraw your child from the survey please contact the school.
Yours sincerely
Clinical Director
Oral health survey of five-year old children, 2014-15. National protocol.
46
Appendix Lii. Statement and consent signing section for use where school based block
signing systems are in place
CONSENT FORM for Public Health England dental public health epidemiology
programme, oral health survey of five-year-old children, 2014-15.
I have had the opportunity to see the information letter about the 2014/2015 oral health
survey of five-year-olds. I am aware that I should continue to take my child for routine
dental care.
My child’s name is (insert name)………………………………….. Class ………
Please tick appropriate box below:
Yes, I agree to my child taking
part in the oral health survey
No, I do not want my
child to be included
Signed…………………………………………(parent or guardian) Date …………
Name (block capitals) ……………………………………………
Oral health survey of five-year old children, 2014-15. National protocol.
47
Appendix M. Tracking list for schools to record which children have returned consent
forms
PHE dental public health epidemiology programme, 2014-15
Return of consent forms – Class …………
Child’s name Tick when form
returned
Notes
Oral health survey of five-year old children, 2014-15. National protocol.
48
Appendix N. Data collection sheet 2014-15 survey of five-year olds
1. Lower tier local authority code |__|__|__|__|__|__|__|__|__| 2. Examiner _____________________
3. School name _________________________________ 4. School Postcode |__|__|__|__| |__|__|__|
5. Date of examination |_d_|_d_|_m_|_m_|_y_|_y_|_y_|_y_|
6. Child identity number |__|__|__|__|__|__|__|__| 7. Date of birth | 1 | 5|_m_|_m_|_y_|_y_|_y_|_y_|
8. Home postcode |__|__|__|__| |__|__|__|

9a. Higher Ethnicity |__| See 10.10 9b. Lower Ethnicity |____| See 10.10
10. Sample group code |__| 0 – Main sample 1 – Additional sample A 2 – Additional sample B
3 – Additional sample C 4 – Additional sample D 5 – Additional sample E
11. Examination status |__| 0 – Examined 1 – Repeat exam 2 – Training
3 – Absent 4 – Child refused
12. Child part of longitudinal survey |__| 0 – No
1 – Yes If yes ID number used at age 3 |__|__|__|__|__|__|__|
13. Plaque measurement |__| 0 – Teeth appear clean 1 – Little plaque visible
2 – Substantial plaque visible 9 – No assessment could be made
Right UPPER Left
E D C B A A B C D E
D D
O O
M M
B B
L L
Right LOWER Left
E D C B A A B C D E
D D
O O
M M
B B
L L
14. Abscess / Sepsis present |__| 0 – Absent 1 – Present
Optional measures
15. Spare variable |__| 0 – 1 – 2 – 3 –
16. Spare variable |__| 0 – 1 – 2 – 3 –
17. Spare variable |__| 0 – 1 – 2 – 3 –
Tooth Codes
Extracted caries………………….. 6
Unerupted or missing other….. 8
Surface Codes
Sound…………. –
Hard, arrested caries…………… 1
Decayed……………………………… 2
Decay + pulpal involvement….. 3
Roots only remaining…………. 3
Filled and decayed……………….. 4
Filled………………………………….. 5
Filled, needs replacement…….. R
Obvious sealant rest’n………….. N
Sealed surface ………………….. $
Crown ……………………………… C
Trauma………………………………. T
Unrecordable………………….. 9
Oral health survey of five- and 12-year old children attending special support schools, 2013/14. National protocol.
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Appendix O. Overview list and examination day sheet
PHE dental public health epidemiology programme, oral health survey of five-year old children, 2014-15
Name of school ……………….…………………………………………………………………….. School postcode ………………….……… ….
Date of examination _ _ / _ _ / _ _ _ _ Name of school contact………………………….……Telephone number………………………….…
This column to be
deleted as soon as
possible
Consent status Examination status of
parental consented children
Child’s name
ID Number
(school code
prefix then
local number)
Date of birth Postcode Ethnic
code
+ve
consent
provided
Form
returned
consent
refused
No form
returned
Examined Child
absent
Child
refused
Oral health survey of five- and twelve-year old children attending special support schools, 2013/14. National protocol.
50
Appendix P. Considerations for longitudinal surveys
Some areas will have planned to undertake longitudinal surveys using the children
who were examined at age three in 2012-13. There are several issues that need to
be considered if these children are to be included in the 2014-15 survey of five-yearolds.
Identification
In order to identify children who are eligible to take part in the longitudinal survey it
will be necessary to retrieve the securely saved examination sheets for the 2012/13
survey. The protocol for that survey stated “….but if longitudinal surveys are intended
it is essential that the examination sheet is used (appendix Q) and kept securely to
allow the child participants to be identified and tracked in subsequent years.”
Once the names, dates of birth and postcodes of the children who were examined at
age three are known then some work will be required to track them down. Where
examinations took place in nursery classes attached to schools this may be relatively
easy for most children. However, for those who were examined in private nurseries,
playgroups or children’s centres and those who have moved schools, more detective
effort is needed.
Sorting the lists alphabetically by surname and first name, by date of birth and by site
at the time of examination may help. Access to local authority datasets of pupils in
schools, sorted by the same variables, could provide a great deal of help to track
children to schools and even help with children who have changed their names or
sites since 2012-13.
An additional option is to use the local Child Health System which is used for
notifying parents when immunisations are due. Again, using lists sorted in a variety of
orders can reveal where the target children are attending primary school.
It may be useful to note that the dates of birth for the same child are occasionally
different on datasets. There are a few reasons for this but it is worth knowing that
several parameters can be used to identify and track a child, date of birth alone is
sometimes insufficient.
Sampling
Once the number of children who have been identified and tracked for the longitudinal
survey is known further decisions about sampling can be made. It is possible that these
children will be spread through a range of primary schools, far higher than the minimum 20
required for BASCD standard sampling5
.
There are several options to consider, each of which depends upon the local aim of a
longitudinal survey:
Aim 1 To provide information of the timing, severity, prevalence, progression and
pattern of spread of caries during the ages of three to five years and identify
characteristics of those most and least at risk –
either for a representative sample of the population
Or for more intense scrutiny of a sub-group
Oral health survey of five- and twelve-year old children attending special support schools, 2013/14. National protocol.
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Aim 2 To assist with evaluation of an intervention by comparing caries levels and
patterns of attack over time among those who have received an intervention and those
who have not.
If the survey has aim 1 the sample of children who have been tracked can simply be used
as part of the overall sample. Once the numbers of these attending each school is known
further sampling of schools or children may need to be undertaken to increase the sample
size to achieve the advised minimum to produce a robust estimate. The standard sampling
method should be carried out to achieve this.
For aim 2 or for more complex sampling requirements it is advised that there is discussion
between the DEC, the local authority and the CDPH who may be involved and the
fieldwork team. The following principles should be considered:
minimum sample size for required sub-groups,
the BASCD standard method,
the order of sampling
the need for coding.
The use of the coding for additional samples in variable 10 (see fig 1 below) will facilitate
local comparisons of sub-groups, where required.
Additional advise can be sought from the DPH epidemiology team via
janet.neville@phe.gov.uk
Contact
It is unwise to make direct contact with parents without first reference through the school
as datasets held elsewhere may not be sufficiently up to date to notify of children who
have left the school listed for them or, for example, be seriously ill.
Consent
It would be sensible to amend the consent letter to indicate that this is a follow on survey
for those children seen at age three.
Examiner
It is preferable to use the same examiner in longitudinal surveys to reduce variability so
that there is maximum consistency between the baseline examination at age three and at
age five.
Coding
The data collection sheet and the DSP2 format will allow for identification of children
involved in a longitudinal survey (see variable 12) and it requires that the ID number of the
child that was used in the 2012-13 survey is provided as this is essential to allow linkage.
Fig 1. Section of data collection sheet to show accommodation of longitudinal survey
10. Sample group code |__| 0 – Main sample 1 – Additional sample A 2 – Additional sample B
3 – Additional sample C 4 – Additional sample D 5 – Additional sample E
11. Examination status |__| 0 – Examined 1 – Repeat exam 2 – Training
3 – Absent 4 – Child refused
12. Child part of longitudinal survey |__| 0 – No
1 – Yes If yes ID number used at age 3 |__|__|__|__|__|__|__|
Oral health survey of five- and twelve-year old children attending special support schools, 2013/14. National protocol.
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Analysis
The DPH epidemiology team will undertake longitudinal analysis and provide results for
those local authorities that have done this. It is important that the same approach and
methodology is used in these analyses.
Oral health survey of five- and twelve-year old children attending special support schools, 2013/14. National protocol.
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Appendix Q. Summary information sheet – one form to be completed per local
authority
Public Health England dental public health epidemiology programme.
Oral health survey of five-year old children 2014-15.
Lower tier local authority name
Name of examiner(s)
Start – finish date of examinations _______________ – __________________
(dd/mm/yyyy – dd/mm/yyyy)
If additional ethnic codes were used to suit local needs please write in below which ethnic
groups were used:
F – Ethnic other …………………………………………………….
G – Ethnic other …………………………………………………….
H – Ethnic other .…………………………………………………….
Total number of state mainstream primary schools listed by local authority:
Number of schools visited:
Total number of five-year-old children attending state,
mainstream primary schools:
Number of children from whom consent sought:
Number of children with parental consent consent form
supplied: refused: not returned:
Number of children with examined: Child Child
parental consent : absent: refused:

Dental public health epidemiology programme

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