NHS Dental Epidemiology Programme Oral Health Survey of 12 year old children in England

2008 / 2009
National protocol
Minor modifications 7th January 2009
This protocol has been produced for the 2008/09 school year NHS
Dental Epidemiological Oral Health Survey of 12 year olds. It complies
with the British Association for the Study of Community Dentistry
diagnostic criteria for caries prevalence surveys and guidance on
sampling for surveys of child dental health (1997).

1. Introduction
Primary Care Trusts are charged with the responsibility of gathering information on the health
needs of the population they serve so that they may provide services to meet the identified
need. This imperative is described in the Health and Social Care (Community Health and
Standards) Act 2003, underpinned by Statutory Instrument 2006 number 185, and is also
highlighted in Choosing Health (2004) and Choosing Better Oral Health (2005). In addition,
the Water Act (2003) requires that health is monitored by Strategic Health Authorities on a
four- yearly basis starting in 2007/08.
Strategic Health Authorities require PCTs to take action to achieve targets for improving oral
health set in their oral health strategies. Information collected by the nationally co-ordinated
dental surveys provides valuable information on the progress made towards these targets.
During the school year 2008/09 a survey of 12-year-old children will take place in all Local
Authorities (LAs) and Primary Care Trusts (PCTs) in England. These surveys of caries
severity and prevalence, orthodontic need and demand, and self-perception of enamel
opacities among 12-year-old children are part of the NHS Dental Epidemiology Programme
and provide an insight into the dental health of an important priority group.
The overall responsibility for the collection of population level data by PCT lies with Strategic
Health Authorities, in conjunction with Public Health Observatories, who will performance
manage the process. Responsibility for the planning of the surveys at LA and PCT level lies
with Consultants in Dental Public Health, where they are in post, or other dental lead in each
PCT, in consultation with the SHA Regional Dental Public Health lead. The conduct of the
surveys will be the responsibility of the PCT.
PCTs must ensure that adequate provision is made for examiners to be properly trained and
calibrated according to the methodology specified in the appropriate protocol.
PCTs must make timely communication with the relevant Regional Dental Epidemiology
Coordinator (RDEC) to ensure full knowledge of and compliance with the protocol and in
particular provide the RDEC with a complete dataset of anonymised survey data within the
nationally agreed time frame, in the required format.
2. Aim of the Survey
The aim of the survey is to measure the prevalence and severity of dental caries, the need and
demand for orthodontic intervention and self-perceptions of enamel opacities in 12-year-old
children resident in LAs and PCTs in England, thereby:
2.1 enabling PCTs to undertake health needs assessments to support the local
commissioning of dental services
2.2 providing standardised data to inform Local Authority profiles as requested by
Communities and Local Government Dept.
2.3 providing standardised information for comparison locally, regionally, between countries
of the UK and internationally.
2.4.1 enabling PCTs to contribute to the requirements of the Water Act (2003) with regard to
monitoring dental and general health of the population on a four yearly basis.
3. Objectives
3.1 To examine 12-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 surveys 1996/97 (Pitts et al.,
1997) and using BASCD recommended sampling procedures described 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).
3.2 To measure the clinical and aesthetic need for orthodontic intervention using the
Modified Index of Orthodontic Need (Burden et al, 2001).
3.3 To measure self-perceptions of the prevalence, severity and aesthetic impact of enamel
4. Sample
The primary sampling unit will be Local Authorities and samples also need to be taken to
produce estimates for PCTs. In most cases the Local Authority and PCT will be coterminous
so one sample will suffice. In the minority of cases where the PCT and LA are not
coterminous careful consideration of the geographic boundaries and populations within them
should be undertaken to ensure that sampling produces estimates for both Local Authorities
and for Primary Care Trusts.
4.1 Survey population
The survey population is defined as all those children attending maintained schools within the
Local Authority who have reached the age of twelve, but have not had their thirteenth birthday
on the date of examination (Excluding special schools). In most cases this will involve children
from years 7 and 8.
A minimum sample size of 250 children is required per Local Authority and per PCT, from a
minimum of 20 schools, or all schools where there are fewer than 20. This is unlikely to
produce a sufficiently large sample to facilitate local planning for many PCTs, in which case
larger samples will be required. Where larger samples are drawn the children selected must
be coded to allow weighted estimates of means to be produced where necessary. Details of
these requirements and the need for local stratification will be determined by Consultants in
Dental Public Health or other advisers in dental public health to Primary Care Trusts, in liaison
with dental managers/directors of the agencies undertaking the surveys.
Regional NHS Epidemiological Co-ordinators must be informed of proposed sampling methods
so that they can confirm their validity, before the survey commences.
4.2 Sampling procedure
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. Accessed as a guidance document from the information section via
http://www.bascd.org/docs_info.php). Advice can be requested from Girvan Burnside on
Lists of all state maintained secondary or middle schools within each Local Authority area, and
the numbers of pupils attending each will be required as the first stage in the sampling
process. In most instances this will provide all the schools within the PCT but, where LA and
PCTs are not coterminous the geographical position of schools should be determined to allow
compilation of sampling frames. The school postcode is essential in these cases.
Special schools should not be included in the main sampling frame and results from them not
included in the main LA or PCT estimates.
The number of secondary schools in each LA /PCT area will dictate the sampling method
Where there are 6-20 schools, sample all schools
Where there are 21-40 schools, sample 20 schools
Where there are more than 40 schools, sample 25 schools, or 50% of schools,
whichever is greater
A stratified sampling method which takes school size into account is described in the guidance
for use where there are more than 20 schools in a LA/PCT. The school size bandings and
sampling intensity described is guidance only and it may be necessary to alter this to
accommodate the local situation. For example schools could be divided into those with fewer
than 60 children aged 12, those with 61-100 and those with 101 or more. All of the children in
the smaller school would be sampled, while 1 in 2 or 1 in 3 of the medium size and 1 in 4 of
the larger ones are 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, medium 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 for primary schools. 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 Regional NHS Epidemiological Coordinator for agreement before any schools are contacted and children selected.
4.3 Consent
Positive consent is required following the guidance by the Department of Health (Appendix C).
It is advised that 300 children be randomly selected and consent sought from all if a minimum
sample of 250 is being sought. 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 from the sampled pupils must involve:
• Providing parents or guardians with a letter which gives clear information explaining the
nature and purpose of the dental survey in broad terms and simple language (Example given
in appendix H). This letter should explain that consent will be sought from the children but that
parents may refuse permission for their child to be involved in the survey. It is good practice
for these letters to be posted to parents instead of relying on children to deliver them.
• Provision of a verbal explanation of the nature and purpose of the survey to all sampled
children whose parents have not refused their being involved, using the provided wording
(Appendix I).
• Asking each child if they have understood the explanation given, allowing them to ask
questions and then asking if they are willing to take part.
• Recording on the data collection form which children agree to take part and which refuse,
indicating that each child has heard and understood the information given (Appendix K).
• acceptance of, and respect for, the decision of 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. Even where this includes dental examination
or checks, letters should still be provided for parents prior to the survey which describe the
purpose and nature of the survey (see Appendix H) and consent from pupils confirmed
verbally and recorded.
A questionnaire is provided (Appendix Q) for PCTs to record their experiences while collecting
positive consent from child volunteers. This should be passed to Regional Co-ordinators and
then on to the Dental Observatory when the survey is complete.
4.4 Contingency for non-representative samples
There is potential for consent bias to impact upon the validity of results. However, in cases
where the sample is not sufficiently representative of the Local Authority or PCT population,
population weighted estimates may be calculated. This will be done centrally by the Dental
Observatory and North West Public Health Observatory using the raw data. The process
requires that all children approached for consent are entered into the database along
with their home postcode and consent return status.
While these processes represent an increased workload collecting and entering data about
consent provision it is considered to be essential if maximum information is to be compiled
about the impact of the requirement of positive consent this year.
5. Personnel
5.1 The overall responsibility for the commissioning of the surveys lies with PCTs. Normally
this will be delegated to Consultants in Dental Public Health, where they are in post, or other
dental lead in each PCT. The conduct of the surveys will be the responsibility of the PCT. The
process will be performance managed by Strategic Health Authority Leads, along with
Regional Public Health Observatories.
5.2 The dental examinations will be carried out by dentists who will be trained annually to
national standards by the Regional Trainers, using the approved BASCD training pack, to
ensure that they are familiar with the examination method and criteria. Examiners must also be
calibrated annually following the BASCD guidance on the statistical aspects of training and
calibration of examiners for surveys of child dental health (Pine et al., 1997b) and examiners
who do not conform with the accepted diagnostic standards will need to be retrained and
recalibrated, or replaced.
5.3 The Regional NHS Epidemiological Co-ordinators of dental health surveys have a duty to
ensure, from a Regional perspective, that the appropriate quality standards are maintained.
This will be undertaken in consultation with the SHA Regional Dental Public Health leads and
Consultants in Dental Public Health or other dental public health advisers responsible to
Primary Care Trusts, who may wish to apply their own additional quality standards in line with
local policy.
6. General Conduct of the Survey
6.1 The planning and organisation of the survey will be carried out in liaison between the Local
Authority Education Director or equivalent and/or headteachers and governing bodies of the
schools and the PCT DS Epidemiology Team or other agency appointed by the PCT to
undertake this work. Reference to the Statutory Instrument 2006 No 185 (Appendix A) and the
letter from the Chief Dental Officer (Appendix B) should be made if difficulties are encountered
in gaining access to schools.
6.2 Following the selection of the schools to be included in the survey, the relevant
headteachers will be contacted. The aims and objectives of the survey will be explained and
the co-operation of the headteachers sought. Dates for examination will be set at a mutually
convenient time and date.

6.3 Class lists of all age eligible children to be included in the survey will be obtained prior to
the examination. This will involve class list of Years 7 and 8 in most instances. These lists
should include the following information: name, date of birth and residential postcode.
6.4 Using class lists, children who will be age eligible on the planned day of examination will be
identified (see Appendix G) 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 (see
Appendix M) and the data entered into the main DSP2 database.

6.5 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 giving the parent the
opportunity to withdraw their child.(see Appendix H)
6.6 All sampled children, for whom no notification of withdrawal is received from parents or
guardians, should be given, alone or in groups, an explanation using a standard script (see
Appendix I) and use of that script by the dentist or assistant will be recorded on the survey file
by the recorder.
Each individual pupil will be asked if they have any questions (and this will be recorded on the
survey file) before they are asked if they are willing to participate. The agreement of pupils to
participate will also be recorded on the survey file.
Examiners will only examine those pupils:
• whose parents have not refused permission and
• who have received an explanation of the nature and purpose of the survey using the
standard script and
• who have been given an opportunity to ask questions and
• who have given expressed or implied consent by their words or actions.
The withdrawal by parents and withholding of consent by pupils will be recorded for each child
into the main DSP2 database.
In PCTs/LAs where arrangements are in place to collect core agreement for all health
surveillance, consented parents should also be sent a letter informing them of the nature and
purpose of the forthcoming survey and giving them the opportunity to withdraw their child. The
same process of explanation and recording of expressed consent by the pupils should also be
6.7 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.
6.8 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
there is no intention to provide this information the consent letter (Appendix H) and the script of
explanation (Appendix I) should be modified to explicitly reflect this.
7. Fieldwork
Examinations will take place in the selected schools after training and calibration of examiners
and should be completed by the end of June 2009. This gives sufficient time for entering,
checking and cleaning of data, primary analysis and summary reporting.
Equipment, Instruments and Materials
7.1 A table with mat or suitable fully reclining chair will be used for the examination. If a
reclining chair is used, assessment should be made of the safety of it for both examiner and

To ensure standardisation no mobile surgeries or equivalent should be used.

7.2 An inspection light (Daray X100 with Clamp Number 2 or Brandon Medical MT608BASCD
are suitable if a replacement is needed) yielding approximately 4000 lux at 1 metre will be
used for illumination. This requires that the Daray Versatile is set to the brighter of the two
settings. A spare bulb will be carried in case of failure. Fibre optic light sources will not be
used. (For details see Appendix F)
7.3 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 prior to examination.
7.4 Self perception of enamel opacities will be measured via questions and with the assistance
of standard sets of photographs showing grouped presentations of various types of opacities.
These standard photographs will be provided at the National Training and Calibration Exercise.
Additional sets can be obtained by contacting The Dental Observatory.
7.5 The instrument required for assessing the Dental Health Component of the modified Index
of Orthodontic Treatment Need will be a standard metal ruler with coloured markings at 4 and
6 mm, and a set of the ten IOTN colour photographs will be used to gauge the Aesthetic
7.6 Local PCT 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 subject
7.7 Cotton wool rolls, cotton buds, or pledgets of cotton wool will be used to clear teeth of
debris and moisture where necessary.
7.8 Suitable spectacles will be used to protect the subject’s eyes
7.9 Data may be entered either onto paper record sheets (Appendix K) or directly onto
computer, with safeguards for both methods (see 8.4).
8. The Collection of Data – General Information
8.1 Training and calibration
The collection and recording of both non-clinical and clinical data will be undertaken by trained
and calibrated dentists, assisted by appropriately trained assistants. Evidence of intraexaminer reproducibility is desirable – brief guidance is given in Pine et al (1997b).
8.2 Computer software
Data will be collected and processed using the National Format [12YR2008] (Appendix N) with
the Dental Survey Plus 2 version 2.1 release 3 program. The format will be provided in
electronic format. This contains several free fields for local use at the end. If these are
insufficient for local information requirements it is requested that additional fields are added to
the end of the National format and the revised format labelled to show that it differs from the
National one. No other changes to the National format should be made.
8.3 Confidentiality
PCTs will ensure that all data will be handled with full regard to confidentiality and the Data
Protection Legislation. Access to all data files will be controlled and protected by passwords or
on computers which are password protected. Primary Care Trusts will only retain anonymous
processed data files for purposes of further analysis. For this reason no names, gender or day
of birth will be recorded. 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 Primary Care
Trust will register their data collection and analysis computer systems with their data protection
8.4 Security
Where data is recorded directly onto computers a back-up copy will be made every day and
stored separately from the main database.
If data is collected onto paper sheets in the field, transfer onto computer will occur with the
minimum of delay. 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
8.5 File management
Master and sub- data files should be labelled to indicate the population group to which they
refer, according to guidance which will be produced to assist with data checking and analysis.
It is insufficient simply to label files with the age group and year of survey. The name or code
of the PCT is required.
Survey files should be saved into the ‘Survey’ file of DSP2.
8.6 Ownership of data
PCTs retain ownership of their data arising from the NHS Dental Epidemiology Programme.
However, in the interests of accuracy and the benefits of comparability, results should not be
reported until they have been verified centrally. All PCTs are required to submit their data to
their Regional Coordinators so that they can check these and send them on to NWPHO/TDO
(see Introduction), for checking, secondary analysis and compilation with other sets of data.
9. 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.
9.1 Organisational boundary coding
Each child will be coded to show which Local Authority and Primary Care Trust from which
they are drawn. This is defined by the geographical position of the school within LA and PCT
Coding of the previous primary care organisation is optional but can facilitate investigation of
variation over time. [see appendix F]
Local planning and commissioning requirements may also necessitate the recording of wards,
purchasing hubs or other units. Space for this is provided in the National Format as a spare
optional field.
Current codes for Local Authorities and current PCTs are listed in Appendix F.
9.2 Examiner
A name or code must be used to identify the examiner.
9.3 School name and postcode
The school name and postcode will be recorded.
9.4 Examination date
The date of the examination will be recorded.
9.5 Identity number
A unique identity number will 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 recorded.
The use of identity numbers instead of names improves anonymity of the data.
9.6 Month and Year of Birth
The month and year of birth only will be recorded as this increases anonymity. This should fall
within the widest range of dates of birth October 1995 to July 1997 (Appendix G) helps to
identify the narrower ranges for examination dates in each month).
9.7 Home address postcode
Home postcodes will be recorded for all children approached for consent, whether their
parents withdraw them or not and whether the children give consent or not. This should be
sought from the school or, in the rare instances when this is refused, lists from PCT school
health clerks can be requested. (see Appendix F)
This data will be removed from databases centrally as soon as it has been used for grouping.

N.B. Computer programmes can only read postcodes if they are entered in the correct format
(A = alphabetic N = numeric):

Formats Example

Postcodes should be entered with the first part (Outward code) in the first box and the second
part (Inward code) in the second set of boxes. When entering into DSP2 these should be
typed into the two sets of boxes without any spaces to the left of the box.
The most common data entry faults are the substitution of the letters I and O for the numbers 1
and 0 and vice versa.
9.8 Sub-group
To facilitate the identification of samples which are taken in addition to the minimum
requirement coding is required to assist in the calculation of sub-group means and weighting of
collated sample means where necessary. For example, if an additional sample is required for
an area of particular concern it is essential that children sampled for this purpose are
identifiable to allow weighted means to be calculated to produce valid estimates for the overall
All ‘additional’ samples, if used, should be defined locally and descriptions communicated to
Regional Co-ordinators and The Dental Observatory using the reporting form provided
(Appendix P).
The coding to assist with identification of sample types is as follows:
0 Main survey sample (for coterminous PCT/LAs)
1 Additional sample A
2 Additional sample B
3 Additional sample C
4 Additional sample D
5 Additional sample E
9.9 Consent status
All children approached for consent should be entered onto the database, along with their
postcode and consent status coding.
0 Parent withdrawal of child
1 Child consented to take part – having heard explanation and been given opportunity to ask
2 Child did not agree to take part
3 No parent withdrawal but child absent when consent sought
No further information should be recorded for children whose parents withdraw them,
who were absent or who decline consent for themselves.
9.10 Examination type
The type of examination will be recorded as follows:-
0 Main survey examination
1 Replicate examination – for intra-examiner reliability
2 Training examination
3 No examination as child absent at this stage
4 No examination as child refused at this stage
No further information should be recorded for children who are absent or refused on
the day of examination.
9.11 Sequence of the Examination
The following is the suggested sequence of examination:
Volunteer in an area which ensures privacy, away from other pupils and school staff;
FIRST: Questions about – Self -perception of enamel opacities
Self reporting of dental conditions and impact
Toothbrushing frequency
(Optional : Self classification of ethnic group – optional see section 11.8.1)
Volunteer sitting or standing upright at site of examination;
SECOND: Aesthetic Component of IOTN
Volunteer supine;
THIRD: Dental Health Component of IOTN
FOURTH: Plaque assessment
FIFTH: Caries

10. The Collection of Questionnaire Data
The first stage, which involves the questionnaire, should be completed with the volunteer out
of earshot of other volunteers or members of staff who might cause the respondent to be
embarrassed and so give biased answers.
10.1 Measurement of self perception of enamel opacities
All volunteers should be asked these questions, the first of which have been used in previous
NHS DEP surveys (BASCD Training Pack)
Ask all “Do you have any white marks on your front teeth that won’t brush off?” the possible
responses are Yes / No / Don’t know

For those who say yes: “Does the appearance of these white marks bother you?” the
possible responses are Yes / No / Don’t know

This survey will not include an examination for developmental defects by the examiner which
is replaced by an estimate of self matching of dental appearance in comparison to a set of
photographs which portray different levels of developmental defects as classified by a fluorosis
Ask all: “Thinking about white marks on teeth, do you think your front teeth look more like
those in this group, or the ones in this group, or this group?”
Show the three sets of photographs showing groups of teeth with varying types of appearance
Answer either :
Photograph set N
Photograph set S
Photograph set A
Don’t know
10.2 Self reporting of dental conditions and impact on quality of life
These questions allow measurement and reporting of the impact of diseases and disorders
which are of interest to service commissioners. These questions are based on the Child-OIDP
(Gherunpong, 2004, and Yusuf et al, 2006).
Ask “In the past 3 months have you
had toothache or sensitive teeth
had bleeding or swollen gums
been aware of decay in your teeth or a broken adult tooth
had ulcers or a loose baby tooth
had a problem because of tooth colour, shape, size or position”
The possible answers are Yes / No / Don’t know

If the volunteer replies no to all three of the first three conditions do not ask the next question.
If ‘yes’ is reported to one or more of the first three conditions ask “Have any of these problems
with your teeth and mouth led to difficulties with:
Cleaning your teeth
Relaxing (including sleeping)
Your feelings (for example being more impatient irritable, easily upset)
Smiling or laughing
Doing your schoolwork
Mixing with friends and other people”
The possible answers to each these are : None / a little / moderate / a lot
10.3 Self reporting of toothbrushing frequency
Recording brushing frequency indicates exposure to fluoride and can be related to plaque
Ask all volunteers “How often do you usually brush your teeth?” The possible answers are :
Never / less than once day / once a day / twice a day / more than twice a day
The optional variable of asking volunteers to record their ethnic background could be carried
out after these questionnaire items – see section 12.1
10.4 Orthodontic questions
Ask “Have you got an orthodontic brace or appliance?” the answers that should be recorded
are either Yes – the presence of a brace can be verified/seen
or Yes – but the presence of a brace cannot be verified/not seen
or No
For those who reply ‘yes’ with brace seen or unseen – do not ask any further orthodontic
For those who reply “No” ask the next question,
Ask “Do you think your teeth need straightening?” Record either Yes, No or Don’t know
If “no” or “don’t know” do not ask any further orthodontic questions
For those who reply ‘yes’, ask “Would you be prepared to have treatment and wear a brace if it
were necessary?” Record either Yes / No / Don’t know
11 Clinical examination
11.1 Clinical measurement of orthodontic need using modified Index of Orthodontic
Need – Diagnostic Criteria and Codes
N.B. The subject will not be given an orthodontic examination if they are currently wearing an
orthodontic appliance. This can be indicated on the data collection sheet to assist the
The Index of Orthodontic Treatment Need (IOTN) consists of two separate components:
• The Aesthetic Component – determines the level of need for orthodontic treatment on
aesthetic grounds.
• The Dental Health Component – determines the level of need for orthodontic
treatment on dental health grounds.
Each component is assessed independently. The scores from each component are not added
together. A few subjects may have a definite need for orthodontic treatment on aesthetic
grounds, but no need on dental health grounds. Similarly, some children may have a need for
orthodontic treatment on dental health grounds, but not on aesthetic grounds.
The following sections summarise how the IOTN scores should be recorded. The approach
outlined will enable the examiner to record the IOTN score for the vast majority of
The first step has occurred in the questionnaire section (10.4). If the volunteer replied that
they have an orthodontic appliance / brace and this has been visually verified there is no need
to continue with the orthodontic measurement or other orthodontic questions.
11.1.1 The Aesthetic Component
NOTE: It is recommended that for the assessment of the Aesthetic Component of IOTN,
children are seated upright and the examiner views the teeth from in front of the child.
The anterior teeth should be rated by the examiner on their dental attractiveness as seen.
Stained teeth, enamel fractures and gingival inflammation should be ignored. A set of ten
special colour photographs will be used to gauge the Aesthetic Component. However, when
using the Aesthetic Component scale, a ranking should be awarded for overall dental
attractiveness, rather than specific morphological similarity to the photographs.
Ask the subject to close together on their back teeth. Then retract the lips to expose the
anterior teeth. The dental attractiveness of the subject is then rated against the 10 point
Aesthetic Component scale of attractiveness. Grades 8-10 represent a definite need for
orthodontic treatment on aesthetic grounds. Scores should be reported to the recorder with
due regard to the sensitivity of the nature of the measure and the necessity to maintain the
dignity and privacy of the volunteer.
11.1.2 The Dental Health Component
NOTE: It is recommended that for the assessment of the Dental Health Component of IOTN,
volunteers will be examined lying down on a table or in a suitable chair that reclines to fully
supine. The examiner should be seated behind the volunteer.
The Dental Health Component normally comprises a 5 point scale but Professor Donald
Burden, in conjunction with a BASCD working party on Orthodontics, developed the modified
Dental Health Component of IOTN for use in surveys, such as those undertaken by BASCD. It
has been simplified so that only definite need for treatment is recorded, i.e. IOTN Grades 1 -3
are coded as 0 and Grades 4 and 5 coded as 1.
Grades 1 – 3 (no definite treatment need) Code 0
Grades 4 and 5 (definite treatment need) Code 1
A small metal ruler is used to measure overjets, crowding and open bites.
Examine each subject in a systematic manner for the following 5 occlusal traits:
A. Missing teeth (ectopic canines, congenital absence).
B. Overjet (both increased and reverse overjets).
C. Crossbite
D. Displacement of contact points (crowding).
E. Overbite (both increased overbite and open bite).
The acronym ‘MOCDO’ can be constructed from the first letter of each category. This may be
used to remember the scale of occlusal traits. During the examination, if a malocclusion is
present according to the criteria, a Code 1 is recorded. Once a Code 1 is recorded, the
examination is complete and no further categories need to be examined for on the
MOCDO scale.
Methods and Criteria:
A. Missing teeth
Congenital absence/ traumatic loss
Where there is congenital absence or traumatic loss of one or more teeth the examiner must
first decide if orthodontic treatment is required to either open space for a prosthesis or to close
the space completely. If orthodontic treatment is required then the subject is recorded as being
in the definite need category (Code 1) of the Dental Health Component.
Ectopic teeth
Ectopic upper canines are most often recorded in this section. If an upper canine is not present
in the arch (and there is no history of extraction) the examiner should examine/palpate the
buccal sulcus for normal canine position, i.e. a ‘canine bulge’ should be palpable. If no canine
bulge is palpable, then the canine is assumed to be palatally ectopic and a definite need
(code 1) for orthodontic care is recorded.
Impacted teeth
This category usually applies to impacted canines or second premolars. Third molars are not
included in this assessment. An impacted tooth is recorded in IOTN when there is 4mm or
less space between adjacent erupted teeth = definite need category (code 1).
Partially erupted teeth, tipped or impacted against adjacent teeth, are also included in this
category, irrespective of the space available.
During school surveys radiographs are not usually available, therefore it can sometimes be
difficult to determine if a tooth is congenitally missing or impacted. Congenital absence of
permanent canines is rare. Congenital absence of second premolars is more common. Careful
clinical examination/palpation of the alveolus may help to confirm the presence of an
unerupted second premolar.
B. Overjets
To measure positive overjets
i) Use the end of the metal ruler, which has two lines.
i 6mm
ii) Hold the metal ruler parallel to the occlusal plane.
iii) Measure to the labial aspect of the most prominent incisor. On some occasions, the
lateral incisor may be the most prominent incisor.
iv) A definite need (code 1) for orthodontic treatment is recorded if the overjet extends
beyond the second line i.e. 6 mm., red line.
v) If the overjet falls exactly on the line do not record in the definite need category.
Reverse overjets
i) Use the first line of the metal ruler (4mm., white) to measure reverse overjets.
ii) A reverse overjet is defined as all four upper incisors in lingual occlusion.
iii) Reverse overjet is measured from the buccal margin of the incisal edge of the
lower incisor to the buccal surface of the upper incisors
iv) Unlike positive overjet, if the reverse overjet falls exactly on the 4 mm line, then
record in the definite need (code 1) for treatment category.
v) A definite need (code 1) for orthodontic treatment is also recorded if the subject
has a reverse overjet is greater than 1mm and reports eating or speaking
difficulties associated with this.
C. Crossbites
i) Can be anterior or posterior.
ii) The IOTN Dental Health Component need for treatment depends on the amount
of transverse or antero-posterior displacement that occurs on closure.
Transverse displacement is measured by comparing the relationship between upper and lower
midlines when the mouth is open and when it is closed.
Anterior displacement is measured by observing a fixed point in one buccal segment when
teeth are first brought into contact and noting the displacement of this point in comparison with
its lower partner when full closure occurs.
Definite Need = > 2mm displacement
D. Displacement of contact points (crowding)
i) Measure between the anatomical contact points of the two most crowded teeth.
ii) Using the metal ruler, determine if any of the contact points which should be
adjacent to each other are greater than 4mm apart. The first line (4mm, white) of
the metal ruler is used in this assessment. If contact points of permanent teeth
are further than 4mm apart then a definite need (code 1) for treatment is
iii) Only measure crowding between permanent teeth. Do not measure between
deciduous teeth or between deciduous teeth and permanent teeth.
iv) Rotations of premolar and molar teeth are not included in this section.
v) Hold the ruler parallel to the occlusal plane when making these measurements.
E. Overbite – deep or open
Deep overbite
i) The examiner should note if a deep overbite is present then look for signs of soft
tissue trauma caused by this. A definite need (code 1) for treatment is recorded
if there is evidence of trauma to the gingival margin, either on the palatal aspect
of the upper incisors or the buccal aspect of the lower incisors.
Open bite (anterior or posterior)
ii) Only record ‘true’ open bites, do not include developmental open bites where
continued eruption will close them in the normal way.
iii) Determine if the open bite is greater than the first line (4mm, white) – definite
need (code 1) for treatment. More detail here – how many teeth?
Note: Generalised spacing is not recorded by the Dental Health Component.
For the third, fourth and fifth steps in the examination sequence volunteers will be examined
lying down on a table or in a suitable chair that reclines to fully supine. The examiner will be
seated behind the subject for these sections. The caries examination will be visual, aided by
mouth mirrors and the standardised light source only.
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 (11.3.6).
Radiographic or Fibre-optic transillumination examination will not be undertaken.
Only the permanent teeth will be recorded for the NHS Dental Epidemiological Survey of
twelve-year-old children.
11.2 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 Löe Index (1964) will be used. A probe is not used
for this part of the examination, which involves visual examination of upper canine to upper
canine only. No disclosing should be done. Only easily visible plaque should be considered
and recent debris such as small 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
11.3 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 but adherence to
one system during one survey avoids confusion. 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 – 1996/97. The application of
these criteria will be taught using the BASCD Caries Training 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
11.3.1 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) Caries takes precedence over non-carious defects, e.g. hypoplasia
d) Retained roots following extraction or gross breakdown should be
recorded as Code 3.
e) Discoloured, non-vital incisors, without caries or fractures should be
scored T for trauma on all surfaces
f) Surfaces which are obscured e.g. banded teeth, should be assumed to be
sound and coded ‘-‘ or ‘0’.
11.3.2 Teeth present
Before coding the status of individual surfaces, it may be useful to identify which primary
and/or permanent teeth are present and which are absent. A staged examination is
recommended as follows:-
a) the teeth are described :- mirror only
b) tooth surface examination :- mirror + cotton wool (for drying)
11.3.3 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
Tooth Code 7 – Extracted for Orthodontic Reasons
Surfaces are regarded as extracted for orthodontic reasons if the tooth of which they were part
has, in the opinion of the examiner, been extracted solely for orthodontic reasons. Unless
there is overwhelming evidence to the contrary, after questioning the child, missing first
permanent molars will be recorded as extracted due to caries.
Tooth Code 8 – Unerupted or missing other
This code will be used for teeth that are unerupted, congenitally absent or missing due to
reasons unknown.
11.3.4 Obscured surfaces
All obscured surfaces are assumed sound (surface code 0 – 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.
11.3.5 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 0 – Sound
Criteria – A surface is recorded as “sound” 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
• white or chalky spots
• discoloured or rough spots
• 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
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 or
which have received permanent items of advanced restorative care in the form of a
veneer or a restoration constituting a bridge abutment. This is irrespective of the
materials employed or of the reasons leading to the placement of the
crown/veneer/bridge. (Note: missing teeth replaced by a bridge are coded either 6,7,8,
or all surfaces T.)
NB: Code C also applies to pre-formed and stainless steel crowns.
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.
11.3.6 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, i.e. 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
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.
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
12 Optional variables
12.1 Optional variable for ethnic code
Subjects may be coded for ethnic origin.
Either ask the volunteers to identify their own ethnic group from the list supplied (Appendix J)
and add this in during the questionnaire phase of the survey process (stage 1, see end of item
Or use the ethnicity data that schools collect from parents.
The coding may vary from one LA/PCT to another but they should combine to fall into the
following groups:
A White
B Mixed
C Indian
D Pakistani
E Bangladeshi
F Other Asian
G Black Caribbean
H Black African
I Black Other
J Chinese
K Ethnic other – A
L Ethnic other – B
M Ethnic other – C
The final three groups may be used for local use and should be defined to allow for particular
additional ethnic groups.
Further guidance and descriptions of groupings can be found from
12.2 Optional variable for assessment of treatment need
An optional spare variable may be included using a spare variable in the Survey Plus format to
collect broad information on treatment need. Criteria will be agreed locally, or in consultation
with the Regional NHS Epidemiology Co-ordinator.
12.3 Optional data to identify ward, locality or other unit
It may be helpful in some cases to record the ward, purchasing locality or other unit to enable
local analysis to be carried out. Space is provided for this option as a spare variable in the
standard format. (for information see Appendix G).
If coding for ‘old’ PCT is required space for this is provided in the first section of the data
collection sheet and is in the national format
12.4 Information on children with special needs
Information on dental health status of children with special needs is useful for comparison
purposes and to establish priority areas for action. Special needs schools should not be
included in the main sample but coded separately and saved in a separate file. The
identification of children attending mainstream schools who have special needs may be
facilitated by using School Action Plus classification information which may be collected by
schools. A separate protocol is available for those wishing to survey children attending special
needs schools.
For details about this contact janet.neville@centrallancashire.nhs.uk
12.5 Other optional data
Other measures may be helpful to inform local planning functions and can be coded to suit
needs and incorporated into the National Format within the spare variables section or following
this. The new format should be renamed to distinguish it from the standard format.
13 Reporting of Data
Prior to analysis of data and reporting of summaries each PCT 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 schools and entry of clinical data for children
coded absent. Guidance will follow giving details on how this checking should be carried out.
Once the data has been checked and errors corrected, files can be formed into PCT units
which can then be analysed. Separate files should be formed for each PCT estimate, labelled
to indicate which PCT they refer. Care must be used if weighting of samples is necessary to
produce LA or PCT estimates. Please see the guidance to follow and the help from Girvan in
the form of a presentation and a ready reckoner for calculating weighted means, weighted
proportions and confidence intervals
Analysis at Local Authority level will be undertaken centrally by TDO / NWPHO.
The following will be reported by fieldwork teams:
1) Start and finish dates of the period of examinations (dd/mm/yyyy – dd/mm/yyyy)
2) Number of children in school population aged 12 years
3) Total number of schools with 12-year-old children
4) Total number of schools visited
5) Total sample drawn
6) Explanation of sample sub-group codes if necessary
7) Number of children withdrawn by parents
8) Number of children giving consent and refusing consent
9) Number of children examined and children absent,
10) For complete PCT – Mean DT, standard deviation and 95% confidence limits
11) For complete PCT – Mean MT, standard deviation and 95% confidence limits
12) For complete PCT – Mean FT, standard deviation and 95% confidence limits
13) For complete PCT – Mean DMFT, standard deviation and 95% confidence limits
14) For complete PCT – Mean Sealed Teeth ($T), standard deviation and 95% confidence
15) For complete PCT – Mean number of Sound Teeth including sound and sealed (SS$T),
standard deviation and 95% confidence limits
16) For complete PCT – Number and percentage of children with caries experience (DMFT>0)
17) For complete PCT – Mean DMFT, standard deviation and 95% confidence limits, of
children with caries experience (DMFT>0)
18) For complete PCT – Number and percentage of children with current dentinal decay
19) For complete PCT – Mean DT, standard deviation and 95% confidence limits, of children
with current dentinal decay (DT>0)
The following will be calculated centrally by TDO / NWPHO at PCT level:
1) Mean age and standard deviation
2) Number and percentage of children who consider that their teeth match with enamel
opacity photograph set A.
3) Number and percentage of children reporting one or more self reported conditions
4) Number and percentage of children reporting severe impacts due to treatable conditions
5) Number and percentage of children brushing twice or more daily
6) Number and percentage of children wearing orthodontic appliances
7) Number and percentage of children who think their teeth need straightening
8) Number and percentage of children who would be willing to wear a brace if necessary
9) Number and percentage of children with IOTN aesthetic score of 8, 9 or 10
10) Number and percentage of children with IOTN dental health component score indicative of
orthodontic need
11) Number and percentage of children that are eligible for orthodontic care and are ready and
willing to undergo this
12) Prevalence of visible plaque and associations with other variables
13) All the above variables that are relevant at Local Authority level.
Preliminary analyses will be submitted using the summary reporting forms (Appendix N) which
will be provided electronically as part of a workbook which also undertakes the necessary
All returns, which should be made to the Regional Co-ordinator for checking as soon as
possible after completion of the survey and no later than June 30th 2009 and should include:
i) a disk containing the Survey files labelled to indicate PCT to which they refer
ii) the completed Excel results summary reporting sheet
iii) explanations of sampling methods and intensities
iv) a completed questionnaire reporting local experiences regarding the collection of
Regional Co-ordinators will send in these items for their regions via a web portal to the Dental
Observatory ready for checking, assessment of samples, verification of estimates for PCTs
and LAs and calculation of population weighted estimates by NWPHO.
Primary Care Trusts will also require a copy of the data and format files, together with a report
sheet. These should be sent to the respective Consultant in Dental Public Health or dental
public health adviser after central analysis, verification of LA and PCT means and production
of population weighted estimates by TDO/NWPHO.
References :

Statutory Instrument 2006, No 185 can be printed from :
*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.
*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.
*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.
Burden DJ, Pine CM, Burnside G (2001) Modified IOTN: an orthodontic treatment need
index for use in oral health surveys. Community Dentistry & Oral Epidemiology
Gherunpong S, Tsakos G, Sheiham A. (2004) Developing and evaluating an oral
health-related quality of life index for children; the CHILD-OIDP. Community Dental
Health 21: 161-169.
Yusuf H., Gherunpong S., Sheiham A., Tsakos G. (2006) Validation of an English
version of the Child-OIDP Index, an oral health-related quality of life measure for
children. Health and Quality of Life Outcomes 4: 38.
N. M. Nuttall, J. G. Steele, D. Evans, B. Chadwick, A. J. Morris and K. Hill (2006) The
reported impact of oral condition on children in the United Kingdom, 2003 British Dental
Journal 2006; 200: 551–555
Silness J, Löe H (1964) Periodontal disease in pregnancy. II Correlation between oral
hygiene and periodontal condition. Acta Odontologica Scandinavica 22:121–135
*Available as guidance papers from the information section at http://www.bascd.org/
Table of appendices

Descriptor Page
A Statutory Instrument 2006, No 185 27
B Copy of letter from CDO to headteachers** 29
C Requirement for positive consent 30
D Operational timetable 31
E Diagram of data flow 32
F Sources of information including table of codes for Local
Authorities and Primary Care Trusts and their
G Guide for selection of children by birth dates** 41
H Suggested letter for parents and guardians** 42
I Script of explanation for pupils** 43
J Self description of ethnic group** 44
K Data collection sheet** 45
L Examination day sheet – optional use** 47
M Summary table for figures consenting, examined absent
etc. Optional use**
N Dental Survey Plus 2 Format print out – **electronic
copies will be available – to be amended when protocol
O Summary information sheet – **electronic versions will
be available
P Reporting of process** 54
Q Questionnaire recording experiences of consent
** will be provided as separate attachment
Appendix A Scanned copy of Statutory Instrument 2006, N 185
Appendix B – Letter from CDO to headteachers – fieldwork teams may duplicate this and
send to schools – it will not be sent out centrally
New King’s Beam House
22 Upper Ground
0207 633 4247
From: Barry Cockcroft
Chief Dental Officer for England
July 2008
Dear Head Teacher,
NHS Dental Health Surveys of Children
I am pleased to say that in this country our older children generally have some of the best teeth in
Europe. I want to ensure that this not only remains the case but that we take appropriate steps to
improve dental health even further.
In order to do this and to particularly focus preventive dental care into areas that need more support, it
is essential that the NHS has up to date information on current dental health. The NHS child dental
health surveys, which have been undertaken for over 20 years, are now a legal requirement for Primary
Care Trusts to undertake, providing as they do essential data for service planning. During 2008/09
PCTs are required to carry out surveys of 12 year old children and your school may be selected to take
I know that at times in the busy life of a school, it can seem an encumbrance for you and your staff to
both provide the facilities for these surveys and to take children out of class but my colleagues in the
NHS need your support in undertaking these surveys. I know that they will try to fit in with your school’s
routines as much as possible and complete the survey as soon as they can.
All the information obtained will be held in the strictest confidence and an individual student’s data will
not be disclosed under any circumstances.
I hope that you will be able to help us and on behalf of Ministers, I should like to thank you for your
continued support for this work for which we are most grateful.
Thank you once again for your support,
Yours sincerely,
Barry Cockcroft
Chief Dental Officer (England)
Appendix C – Letter from CDO detailing new requirement for positive consent
Appendix D – Operational timetable
National training and calibration 16th 17th 18th September, 2008,
Regional training and calibration From 19th September onwards
Planned sampling methods sent to Regional
Co-ordinator for verification
After date of Regional training
Preparation of samples, letters to parents
recording of responses September and October 2008
Data collection To start as soon as possible and
completed by end of June 2009
Completion of data entry, checking and
Forwarding of PCT completed summaries and
copies of PCT cleaned data files to Regional
Co-ordinators as soon as possible before
By 30th July 2009
Regional Co-ordinators to upload the completed
summaries and copies of checked and cleaned
PCT data files to The Dental Observatory
To be forwarded as and when they
arrive, completed by 31st August
NWPHO/TDO – Checking of data and
samples, verifying estimates, production of
population weighted estimates for PCTs and
As and when they arrive
Feedback of confirmed results to Regional Coordinators, PHOs, PCTs, SHA, CDPH Starting from October 2009
Inclusion of LA estimates into Health Profiles
Publication of PCT estimates in Community
Dental Health March 2010
Appendix E – Diagram to show flow of data
Guidance re
checking data,
initial analysis
and Excel
summary results
sheet provided
by TDO PCTs undertake
initial analysis for
PCTs but do not
share results until
confirmed by TDO
NWPHO with TDO to
produce population
weighted estimates for LAs
and PCTs
Results for PCTs
sent to Dundee for
inclusion in UK data
PCT and LA estimates
sent to Regional Coordinators
Data files, samples and
estimates checked and
verified by TDO
Regional Co-ordinators check files and upload
items listed above to The Dental Observatory
PCTs send to Regional Coordinators on disk:
• Cleaned data files for PCT
• Summary results file for PCT
• Process questionnaire with details
of additional samples drawn if not
minimum LAs and PCT samples,
• Questionnaire on consent
PCTs check and
entered data and
save into clearly
labelled files for
Core format from
The Dental
Dental Survey
Plus 2
PCTs input
collected data
Results for LAs to
be utilised in wider
PH data sets
Shared with PHOs
and SHAs
Regional Co-ordinators
to send estimates to
PCTDS Epidemiology
Teams, CDPH and
other dental leads
Appendix F – Sources of information
• This National protocol, National SPII format, Excel reporting form are available to download
from www.bascd.org.uk
• sampling guidance and Excel tables to help with calculation of weighted means, proportions
and confidence intervals are also available from:
• Numbers of pupils on roll – from Education Authority planning officers. May be available as
an Excel database
• 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. Telephone 0845 6039
038 to obtain a copy.
Alternatively, use the Royal Mail Postcodes on-line at
• Maps of all new PCTs and by region can be found at http://www.dh.gov.uk/en/News/DH_4135088
• National codes for wards can be found at
• List of old and new PCT codes: from ‘Tables’ worksheet in the workbook which can be
opened from http://www.ic.nhs.uk/statistics-and-data-collections/population-andgeography/pct-mapping-tool.
• Light source if new unit required to replace a Daray Versatile or Daray ME8 (these are no
longer produced)
Either The Daray X100 (~£204 + VAT) with Clamp number 2 which is an improved version of
Pivot D clamp (according to Daray) to allow desk mounting
Contact : Daray Ltd
Tel: 0870 777 2664 Sales.team@daray.co.uk www.Daray.com
Or The MT608BASCD (~£245 + VAT incl clamp and bulb)
Contact Brandon Medical Co. Ltd
Tel: 0113 277 7393 www.brandon-medical.co.uk
A list of codes for Local Authorities and new PCTs follows for 2008/09. This is numbered and
colour-coded to indicate how PCTs and LAs relate. The table directly below describes these
and the sampling method indicated for each circumstance
Relationship between geographies Primary population sampling frame
1 Multiple LAs to 1 PCT Local Authority – weighted mean for PCT
estimate may be necessary
2 1 LA to 1 PCT match Local Authority
3 1 LA to multiple PCTs PCT – weighted means may be necessary
4 LA wholly within non-coterminous PCT Local Authority
5 LA spans multiple PCTs Individual consideration – help of statistician
Ref LA Code PCT Code
2 Wigan 00BW Ashton, Leigh and Wigan 5HG
2 Barking and Dagenham 00AB Barking and Dagenham 5C2
2 Barnet 00AC Barnet 5A9
2 Barnsley 00CC Barnsley 5JE
2 Bassetlaw 37UC Bassetlaw 5ET
2 Bath and North East Somerset 00HA Bath and North East Somerset 5FL
1 Mid Bedfordshire 09UC Bedfordshire 5P2
1 Bedford 09UD Bedfordshire 5P2
1 South Bedfordshire 09UE Bedfordshire 5P2
4 Bracknell Forest 00MA Berkshire East 5QG
4 Slough 00MD Berkshire East 5QG
4 Windsor and Maidenhead 00ME Berkshire East 5QG
5 Runnymede 43UG Berkshire East 5QG
1 West Berkshire 00MB Berkshire West 5QF
1 Reading 00MC Berkshire West 5QF
1 Wokingham 00MF Berkshire West 5QF
2 Bexley 00AD Bexley TAK
3 Birmingham 00CN Birmingham East and North 5PG
2 Blackburn with Darwen 00EX Blackburn with Darwen 5CC
2 Blackpool 00EY Blackpool 5HP
2 Bolton 00BL Bolton 5HQ
1 Bournemouth 00HN Bournemouth and Poole 5QN
1 Poole 00HP Bournemouth and Poole 5QN
2 Bradford 00CX Bradford and Airedale 5NY
2 Brent 00AE Brent Teaching 5K5
2 Brighton and Hove City 00ML Brighton and Hove City 5LQ
2 City of Bristol 00HB Bristol 5QJ
2 Bromley 00AF Bromley 5A7
5 Aylesbury Vale 11UB Buckinghamshire 5QD
4 Chiltern 11UC Buckinghamshire 5QD
4 South Bucks 11UE Buckinghamshire 5QD
4 Wycombe 11UF Buckinghamshire 5QD
5 South Oxfordshire 38UD Buckinghamshire 5QD
2 Bury 00BM Bury 5JX
2 Calderdale 00CY Calderdale 5J6
1 Cambridge 12UB Cambridgeshire 5PP
1 East Cambridgeshire 12UC Cambridgeshire 5PP
1 Fenland 12UD Cambridgeshire 5PP
1 Huntingdonshire 12UE Cambridgeshire 5PP
1 South Cambridgeshire 12UG Cambridgeshire 5PP
2 Camden 00AG Camden 5K7
4 Congleton 13UC Central and Eastern Cheshire 5NP
5 Crewe and Nantwich 13UD Central and Eastern Cheshire 5NP
4 Macclesfield 13UG Central and Eastern Cheshire 5NP
5 Vale Royal 13UH Central and Eastern Cheshire 5NP
1 Chorley 30UE Central Lancashire 5NG
1 Preston 30UK Central Lancashire 5NG
1 South Ribble 30UN Central Lancashire 5NG
1 West Lancashire 30UP Central Lancashire 5NG
1 City and County of the City of London 00AA City and Hackney Teaching 5C3
1 Hackney 00AM City and Hackney Teaching 5C3
1 Caradon 15UB Cornwall and Isles of Scilly 5QP
1 Carrick 15UC Cornwall and Isles of Scilly 5QP
1 Kerrier 15UD Cornwall and Isles of Scilly 5QP
1 North Cornwall 15UE Cornwall and Isles of Scilly 5QP
1 Penwith 15UF Cornwall and Isles of Scilly 5QP
1 Restormel 15UG Cornwall and Isles of Scilly 5QP
Ref LA Code PCT Code
1 Chester-le-Street 20UB County Durham 5ND
1 Derwentside 20UD County Durham 5ND
1 Durham 20UE County Durham 5ND
1 Easington 20UF County Durham 5ND
1 Sedgefield 20UG County Durham 5ND
1 Teesdale 20UH County Durham 5ND
1 Wear Valley 20UJ County Durham 5ND
2 Coventry 00CQ Coventry Teaching 5MD
2 Croydon 00AH Croydon 5K9
1 Allerdale 16UB Cumbria 5NE
1 Barrow-in-Furness 16UC Cumbria 5NE
1 Carlisle 16UD Cumbria 5NE
1 Copeland 16UE Cumbria 5NE
1 Eden 16UF Cumbria 5NE
1 South Lakeland 16UG Cumbria 5NE
2 Darlington 00EH Darlington 5J9
2 City of Derby 00FK Derby City 5N7
4 Amber Valley 17UB Derbyshire County 5N6
4 Bolsover 17UC Derbyshire County 5N6
4 Chesterfield 17UD Derbyshire County 5N6
4 Derbyshire Dales 17UF Derbyshire County 5N6
4 Erewash 17UG Derbyshire County 5N6
5 High Peak 17UH Derbyshire County 5N6
4 North East Derbyshire 17UJ Derbyshire County 5N6
4 South Derbyshire 17UK Derbyshire County 5N6
1 East Devon 18UB Devon 5QQ
1 Exeter 18UC Devon 5QQ
1 Mid Devon 18UD Devon 5QQ
1 North Devon 18UE Devon 5QQ
1 South Hams 18UG Devon 5QQ
1 Teignbridge 18UH Devon 5QQ
1 Torridge 18UK Devon 5QQ
1 West Devon 18UL Devon 5QQ
2 Doncaster 00CE Doncaster 5N5
1 Christchurch 19UC Dorset 5QM
1 East Dorset 19UD Dorset 5QM
1 North Dorset 19UE Dorset 5QM
1 Purbeck 19UG Dorset 5QM
1 West Dorset 19UH Dorset 5QM
1 Weymouth and Portland 19UJ Dorset 5QM
2 Dudley 00CR Dudley 5PE
2 Ealing 00AJ Ealing 5HX
1 Broxbourne 26UB East and North Hertfordshire 5P3
1 East Hertfordshire 26UD East and North Hertfordshire 5P3
1 North Hertfordshire 26UF East and North Hertfordshire 5P3
1 Stevenage 26UH East and North Hertfordshire 5P3
1 Welwyn Hatfield 26UL East and North Hertfordshire 5P3
1 Burnley 30UD East Lancashire 5NH
1 Hyndburn 30UG East Lancashire 5NH
1 Pendle 30UJ East Lancashire 5NH
1 Ribble Valley 30UL East Lancashire 5NH
1 Rossendale 30UM East Lancashire 5NH
2 East Riding of Yorkshire 00FB East Riding of Yorkshire 5NW
4 Eastbourne 21UC East Sussex Downs and Weald 5P7
4 Lewes 21UF East Sussex Downs and Weald 5P7
5 Wealden 21UH East Sussex Downs and Weald 5P7
1 Ashford 29UB Eastern and Coastal Kent 5QA
Ref LA Code PCT Code
1 Canterbury 29UC Eastern and Coastal Kent 5QA
1 Dover 29UE Eastern and Coastal Kent 5QA
1 Shepway 29UL Eastern and Coastal Kent 5QA
1 Swale 29UM Eastern and Coastal Kent 5QA
1 Thanet 29UN Eastern and Coastal Kent 5QA
2 Enfield 00AK Enfield 5C1
2 Gateshead 00CH Gateshead 5KF
1 Cheltenham 23UB Gloucestershire 5QH
1 Cotswold 23UC Gloucestershire 5QH
1 Forest of Dean 23UD Gloucestershire 5QH
1 Gloucester 23UE Gloucestershire 5QH
1 Stroud 23UF Gloucestershire 5QH
1 Tewkesbury 23UG Gloucestershire 5QH
1 Great Yarmouth 33UD Great Yarmouth and Waveney 5PR
1 Waveney 42UH Great Yarmouth and Waveney 5PR
2 Greenwich 00AL Greenwich Teaching 5A8
1 St Helens 00BZ Halton and St Helens 5NM
1 Halton 00ET Halton and St Helens 5NM
2 Hammersmith and Fulham 00AN Hammersmith and Fulham 5H1
1 Basingstoke and Deane 24UB Hampshire 5QC
1 East Hampshire 24UC Hampshire 5QC
1 Eastleigh 24UD Hampshire 5QC
1 Fareham 24UE Hampshire 5QC
1 Gosport 24UF Hampshire 5QC
1 Hart 24UG Hampshire 5QC
1 Havant 24UH Hampshire 5QC
1 New Forest 24UJ Hampshire 5QC
1 Rushmoor 24UL Hampshire 5QC
1 Test Valley 24UN Hampshire 5QC
1 Winchester 24UP Hampshire 5QC
2 Haringey 00AP Haringey Teaching 5C9
2 Harrow 00AQ Harrow 5K6
2 Hartlepool 00EB Hartlepool 5D9
4 Hastings 21UD Hastings and Rother 5P8
4 Rother 21UG Hastings and Rother 5P8
5 Wealden 21UH Hastings and Rother 5P8
2 Havering 00AR Havering 5A4
3 Birmingham 00CN Heart of Birmingham Teaching 5MX
2 County of Herefordshire 00GA Herefordshire 5CN
2 Rochdale 00BQ
Heywood, Middleton and
Rochdale 5NQ
2 Hillingdon 00AS Hillingdon 5AT
2 Hounslow 00AT Hounslow 5HY
2 City of Kingston upon Hull 00FA Hull 5NX
2 Isle of Wight 00MW Isle of Wight NHS 5DG
2 Islington 00AU Islington 5K8
2 Kensington and Chelsea 00AW Kensington and Chelsea 5LA
2 Kingston upon Thames 00AX Kingston 5A5
2 Kirklees 00CZ Kirklees 5N2
2 Knowsley 00BX Knowsley 5J4
2 Lambeth 00AY Lambeth 5LD
2 Leeds 00DA Leeds 5N1
2 Leicester City 00FN Leicester City 5PC
1 Rutland 00FP
Leicestershire County and
Rutland 5PA
1 Blaby 31UB
Leicestershire County and
Rutland 5PA
Ref LA Code PCT Code
1 Charnwood 31UC Leicestershire County and
Rutland 5PA
1 Harborough 31UD Leicestershire County and
Rutland 5PA
1 Hinckley and Bosworth 31UE Leicestershire County and
Rutland 5PA
1 Melton 31UG Leicestershire County and
Rutland 5PA
1 North West Leicestershire 31UH Leicestershire County and
Rutland 5PA
1 Oadby and Wigston 31UJ Leicestershire County and
Rutland 5PA
2 Lewisham 00AZ Lewisham 5LF
5 North Lincolnshire 00FD Lincolnshire 5N9
4 Boston 32UB Lincolnshire 5N9
4 East Lindsey 32UC Lincolnshire 5N9
4 Lincoln 32UD Lincolnshire 5N9
4 North Kesteven 32UE Lincolnshire 5N9
4 South Holland 32UF Lincolnshire 5N9
4 South Kesteven 32UG Lincolnshire 5N9
4 West Lindsey 32UH Lincolnshire 5N9
2 Liverpool 00BY Liverpool 5NL
2 Luton 00KA Luton 5GC
2 Manchester 00BN Manchester 5NT
2 Medway 00LC Medway 5L3
5 Braintree 22UC Mid Essex 5PX
4 Chelmsford 22UF Mid Essex 5PX
4 Maldon 22UK Mid Essex 5PX
2 Middlesbrough 00EC Middlesbrough 5KM
4 Milton Keynes 00MG Milton Keynes 5CQ
5 Aylesbury Vale 11UB Milton Keynes 5CQ
2 Newcastle upon Tyne 00CJ Newcastle 5D7
2 Newham 00BB Newham 5C5
1 Breckland 33UB Norfolk 5PQ
1 Broadland 33UC Norfolk 5PQ
1 King’s Lynn and West Norfolk 33UE Norfolk 5PQ
1 North Norfolk 33UF Norfolk 5PQ
1 Norwich 33UG Norfolk 5PQ
1 South Norfolk 33UH Norfolk 5PQ
1 Colchester 22UG North East Essex 5PW
1 Tendring 22UN North East Essex 5PW
4 North East Lincolnshire 00FC North East Lincolnshire 5AN
5 North Lincolnshire 00FD North East Lincolnshire 5AN
1 Fylde 30UF North Lancashire 5NF
1 Lancaster 30UH North Lancashire 5NF
1 Wyre 30UQ North Lancashire 5NF
5 North Lincolnshire 00FD North Lincolnshire 5EF
2 North Somerset 00HC North Somerset 5M8
4 Newcastle-under-Lyme 41UE North Staffordshire 5PH
5 Staffordshire Moorlands 41UH North Staffordshire 5PH
2 Stockton-on-Tees 00EF North Tees 5E1
2 North Tyneside 00CK North Tyneside 5D8
1 York 00FF North Yorkshire and York 5NV
1 Craven 36UB North Yorkshire and York 5NV
1 Hambleton 36UC North Yorkshire and York 5NV
1 Harrogate 36UD North Yorkshire and York 5NV
1 Richmondshire 36UE North Yorkshire and York 5NV
1 Ryedale 36UF North Yorkshire and York 5NV
1 Scarborough 36UG North Yorkshire and York 5NV
1 Selby 36UH North Yorkshire and York 5NV
1 Corby 34UB Northamptonshire 5PD
1 Daventry 34UC Northamptonshire 5PD
1 East Northamptonshire 34UD Northamptonshire 5PD
1 Kettering 34UE Northamptonshire 5PD
1 Northampton 34UF Northamptonshire 5PD
1 South Northamptonshire 34UG Northamptonshire 5PD
1 Wellingborough 34UH Northamptonshire 5PD
lnwick 35UB Northumberland TAC
1 Berwick-upon-Tweed 35UC Northumberland TAC
1 Blyth Valley 35UD Northumberland TAC
1 Castle Morpeth 35UE Northumberland TAC
1 Tynedale 35UF Northumberland TAC
1 Wansbeck 35UG Northumberland TAC
2 City of Nottingham 00FY Nottingham City 5EM
1 Ashfield 37UB Nottinghamshire County 5N8
1 Broxtowe 37UD Nottinghamshire County 5N8
1 Gedling 37UE Nottinghamshire County 5N8
1 Mansfield 37UF Nottinghamshire County 5N8
1 Newark and Sherwood 37UG Nottinghamshire County 5N8
1 Rushcliffe 37UJ Nottinghamshire County 5N8
2 Oldham 00BP Oldham 5J5
4 Cherwell 38UB Oxfordshire 5QE
4 Oxford 38UC Oxfordshire 5QE
5 South Oxfordshire 38UD Oxfordshire 5QE
5 Vale of White Horse 38UE Oxfordshire 5QE
4 West Oxfordshire 38UF Oxfordshire 5QE
2 City of Peterborough 00JA Peterborough 5PN
2 City of Plymouth 00HG Plymouth Teaching 5F1
2 City of Portsmouth 00MR Portsmouth City Teaching 5FE
2 Redbridge 00BC Redbridge 5NA
2 Redcar and Cleveland 00EE Redcar and Cleveland 5QR
2 Richmond upon Thames 00BD Richmond and Twickenham 5M6
2 Rotherham 00CF Rotherham 5H8
2 Salford 00BR Salford 5F5
2 Sandwell 00CS Sandwell 5PF
2 Sefton 00CA Sefton 5NJ
2 Sheffield 00CG Sheffield 5N4
1 Bridgnorth 39UB Shropshire County 5M2
1 North Shropshire 39UC Shropshire County 5M2
1 Oswestry 39UD Shropshire County 5M2
1 Shrewsbury and Atcham 39UE Shropshire County 5M2
1 South Shropshire 39UF Shropshire County 5M2
2 Solihull 00CT Solihull TAM
1 Mendip 40UB Somerset 5QL
1 Sedgemoor 40UC Somerset 5QL
1 South Somerset 40UD Somerset 5QL
1 Taunton Deane 40UE Somerset 5QL
1 West Somerset 40UF Somerset 5QL
3 Birmingham 00CN South Birmingham 5M1
1 Southend-on-Sea 00KF South East Essex 5P1
1 Castle Point 22UE South East Essex 5P1
1 Rochford 22UL South East Essex 5P1
2 South Gloucestershire 00HD South Gloucestershire 5A3
1 Cannock Chase 41UB South Staffordshire 5PK
1 Eas
t Staffords
hire 41UC South Staffordshire 5PK
1 Lichfield 41UD South Staffordshire 5PK
1 South Staffordshire 41UF South Staffordshire 5PK
1 Stafford 41UG South Staffordshire 5PK
1 Tamworth 41UK South Staffordshire 5PK
2 South Tyneside 00CL South Tyneside 5KG
1 Thurrock 00KG South West Essex 5PY
1 Basildon 22UB South West Essex 5PY
1 Brentwood 22UD South West Essex 5PY
2 City of Southampton 00MS Southampton City 5L1
2 Southwark 00BE Southwark 5LE
2 Stockport 00BS Stockport 5F7
4 City of Stoke-on-Trent 00GL Stoke on Trent 5PJ
5 Staffordshire Moorlands 41UH Stoke on Trent 5PJ
1 Babergh 42UB Suffolk 5PT
1 Forest Heath 42UC Suffolk 5PT
1 Ips
wich 42UD Suffolk 5PT
1 Mid Suffolk 42UE Suffolk 5PT
1 St. Edmundsbury 42UF Suffolk 5PT
1 Suffolk Coastal 42UG Suffolk 5PT
2 Sunderland 00CM Sunderland Teaching 5KL
4 Elmbridge 43UB Surrey 5P5
4 Epsom and Ewell 43UC Surrey 5P5
4 Guildford 43UD Surrey 5P5
4 Mole Valley 43UE Surrey 5P5
4 Reigate and Banstead 43UF Surrey 5P5
5 Runnymede 43UG Surrey 5P5
4 Spelthorne 43UH Surrey 5P5
4 Surrey Heath 43UJ Surrey 5P5
4 Tandridge 43UK Surrey 5P5
4 Wav
erley 43UL Surrey 5P5
4 Woking 43UM Surrey 5P5
1 Merton 00BA Sutton and Merton 5M7
1 Sutton 00BF Sutton and Merton 5M7
4 Swindon 00HX Swindon 5K3
5 Vale of White Horse 38UE Swindon 5K3
4 Tameside 00BT Tameside and Glossop 5LH
5 High Peak 17UH Tameside and Glossop 5LH
2 Telford and Wrekin 00GF Telford and Wrekin 5MK
2 Torbay 00HH Torbay TAL
2 Tower Hamlets 00BG Tower Hamlets 5C4
2 Trafford 00BU Trafford 5NR
2 Wakefield 00DB Wakef
ield District 5N3
2 Walsall 00CU Walsall Teaching 5M3
2 Waltham Forest 00BH Waltham Forest 5NC
2 Wandsworth 00BJ Wandsworth 5LG
2 Warrington 00EU Warrington 5J2
1 North Warwickshire 44UB Warwickshire 5PM
1 Nuneaton and Bedworth 44UC Warwickshire 5PM
1 Rugby 44UD Warwickshire 5PM
1 Stratford-on-Avon 44UE Warwickshire 5PM
1 Warwick 44UF Warwickshire 5PM
5 Braintree 22UC West Essex 5PV
4 Epping Forest 22UH West Essex 5PV
4 Harlow 22UJ West Essex 5PV
4 Uttlesford 22UQ West Essex 5PV
1 Dacorum 26UC West Hertfordshire 5P4
Ref LA Code PCT Code
1 Hertsmere 26UE West Hertfordshire 5P4
1 St. Albans 26UG West Hertfordshire 5P4
1 Three Rivers 26UJ West Hertfordshire 5P4
1 Watford 26UK West Hertfordshire 5P4
1 Dartford 29UD West Kent 5P9
1 Gravesham 29UG West Kent 5P9
1 Maidstone 29UH West Kent 5P9
1 Sevenoaks 29UK West Kent 5P9
1 Tonbridge and Malling 29UP West Kent 5P9
1 Tunbridge Wells 29UQ West Kent 5P9
1 Adur 45UB West Sussex 5P6
1 Arun 45UC West Sussex 5P6
1 Chichester 45UD West Sussex 5P6
1 Crawley 45UE West Sussex 5P6
1 Horsham 45UF West Sussex 5P6
1 Mid Sussex 45UG West Sussex 5P6
1 Worthing 45UH West Sussex 5P6
4 Chester 13UB Western Cheshire 5NN
5 Crewe and Nantwich 13UD Western Cheshire 5NN
4 Ellesmere Port and Neston 13UE Western Cheshire 5NN
5 Vale Royal 13UH Western Cheshire 5NN
2 City of Westminster 00BK Westminster 5LC
1 Kennet 46UB Wiltshire 5QK
1 North Wiltshire 46UC Wiltshire 5QK
1 Salisbury 46UD Wiltshire 5QK
1 West Wiltshire 46UF Wiltshire 5QK
2 Wirral 00CB Wirral 5NK
2 City of Wolverhampton 00CW Wolverhampton City 5MV
1 Bromsgrove 47UB Worcestershire 5PL
1 Malvern Hills 47UC Worcestershire 5PL
1 Redditch 47UD Worcestershire 5PL
1 Worcester 47UE Worcestershire 5PL
1 Wychavon 47UF Worcestershire 5PL
1 Wyre Forest 47UG Worcestershire 5PL
Appendix G – Guide for dates of birth bands for survey of 12-year-olds 2008/09
For this month of
Children born within these ranges will definitely
be 12 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 **
October-08 November 1995 September 1996 October 1995 and 1996*
November-08 December 1995 October 1996 November 1995 and 1996*
December-08 January 1996 November 1996 December 1995 and 1996*
January-09 February 1996 December 1996 January 1996 and 1997**
February-09 March 1996 January 1997 February 1996 and 1997**
March-09 April 1996 February 1997 March 1996 and 1997**
April-09 May 1996 March 1997 April 1996 and 1997**
May-09 June 1996 April 1997 May 1996 and 1997**
June-09 July 1996 May 1997 June 1996 and 1997**
July-09 August 1996 June 1997 July 1996 and 1997**
* If born 1995 birth day should be later than day of exam, if born 1996 birth day should be same day or before day
of exam.
** If born 1996 birth day should be later than day of exam, if born 1997 birth day should be same day or before
day of exam
Appendix H – Consent letter for parents for most PCTs / LAs
Suggested letter of information for parents.
To be added to PCT headed notepaper – minor modifications are acceptable, local details to be
Dear Parent /Guardian,
Dental survey of 12 year-olds
Please will you help us to plan better dental services? To do this we look at the teeth of groups of 12-
year-old pupils every four years. We can then compare dental health in different parts of your Local
Authority area and with other areas in England.
The survey is planned to take place on ……………………..and your child may be asked to take part.
The volunteers taking part will have a simple examination at school when a dentist and assistant, who
are specially trained to do this work, will visit. The dentist will use fresh disposable gloves and
sterilised equipment for each volunteer. The check takes only a few minutes and we will let you know if
we find anything that needs checking further by your own dentist.
The pupils will be asked to give their own consent to take part in this year’s survey. If you do not want
your child to take part, please complete the attached slip and return it to school.
As part of the survey we will be asking the school to share some information they already have, for
example postcodes or ethnic group. The information will be anonymised and stored in a computer
which will be password protected and only dental staff will have access to it. The anonymised results
will be sent to the national centre so that they can be compared with all Local Authorities and PCTs and
with findings from previous years and those collected in the future. The findings for England may be
published in a scientific journal, along with those for Wales and Scotland. No individual will be
identifiable and the analysis and reporting will be carried out on groups.
If you have any questions please contact me on (insert local organiser’s telephone number).
Thank you for your co-operation.
Yours sincerely,
Name and title
School Name …………………………………………………………………………………….
I do not want my child (insert child’s name)…………………………………….Class ……..
to be asked to take part in the National Dental Survey
Signed…………………………………………………. (parent/guardian)
Appendix I –
You have been chosen to take part in a dental survey. The survey will help us plan
dental services.
An assistant will ask you some easy questions then a dentist will look in your mouth
and at your teeth and record what they see and measure. No treatment will be
done and this survey does not replace your regular visits to your dentist. You will
be told if something is wrong, but we cannot arrange treatment for you.
We will look at the information from the survey and will work out the results for
this area and compare it with the rest of the country.
We will not collect your name, so you cannot be identified.
However, if we see something serious that needs urgent follow up, we will write to
tell your parents.
(For Group Use) When it is your turn you will have a chance to ask questions and
we will ask you to take part in the survey. You do not have to take part if you do
not want to.
Please help us by taking part in the dental survey.
Thank you.
(Before proceeding with the survey) Did you understand what you were told about
this survey? Do you have any questions? Are you happy to take part?
Appendix J – List for self identification of ethnic group
Which of these ethnic groups do you think you belong to?
A White British
Any other white background
B Mixed White and Black Caribbean
White and Black African
White and Asian
Any other Mixed background
C Asian or Asian British Indian C
D Pakistani D
E Bangladeshi E
F Any other Asian background F
G Black or Black British Caribbean G
H African H
I Any other Black background I
J Chinese or other
ethnic group
Chinese J
K Other ethnic group K
Appendix K – Data Collection Form
1. LA code |__|__|__|__|__|__| 2. New PCT code |__|__|__|__|__|__| (3.Old PCT code|__|__|__|)
4. Examiner __________________________ 5. School name _________________________________
6. School postcode |__|__|__|__| |__|__|__| 7. Date of examination |__|__|__|__|__|__|
8. Pupil identity number |__|__|__|__|__|__| 9. Month/Year of birth |__|__|__|__|__|__|
10. Home postcode |__|__|__|__| |__|__|__|
11. Sample group code |__| 0 – Main survey sample (coterminous PCT/LA); 1 – Additional sample A; 2 – Additional sample B;
3 – Additional sample C; 4 – Additional sample D; 5 – Additional sample E
12. Consent status |__| 0 – Parent withdrew child; 1 – Pupil consented after explanation and opportunity to ask questions;
2 – Pupil refused consent; 3 – Pupil absent when consent sought
(no further details should recorded for children who refuse or who were absent)

13. Examination type |__| 0 – Main; 1- Repeat; 2 – Training; 3 – Absent at examination; 4 – Refused at examination
(no further details should be recorded for those absent or refused)
Score code “9 – Not answered” if no clear answer given from the child
14. “Do you have any white marks on your front teeth that won’t brush off?” |__| 1-Yes 2- No 3-Don’t
know Go to Q16 Go to Q16
15. IF YES ask : “Does the appearance of these marks bother you?” |__| 1-Yes 2- No 3-Don’t know
16. Ask ALL : “Thinking about white marks on teeth, do you think your front teeth look more like those in this
group, or the ones in this group, or this group ?”
Show the three sets of photographs showing groups of teeth |__| 1 – Set N; 2 – Set S; 3 – Set A; 4-Don’t know
with varying types of appearance

17. Ask ALL : “In the past 3 months have you
had toothache or sensitive teeth |__| 1 – Yes; 2- No; 3 – Don’t know
had bleeding or swollen gums |__| 1 – Yes; 2- No; 3 – Don’t know
been aware of decay in your teeth or a broken adult tooth “ |__| 1 – Yes; 2- No; 3 – Don’t know
Ask ALL : “In the past 3 months have you
had ulcers or a loose baby tooth |__| 1 – Yes; 2- No; 3 – Don’t know
had a problem because of tooth colour, shape, size or position” |__| 1 – Yes; 2- No; 3 – Don’t know
18. IF YES is reported to one or more of the first three conditions ask :
“Have any of these problems with your teeth and mouth led to difficulties with:
Eating |__| 0-None 1 – a little 2- moderate 3 – a lot
Speaking |__| 0-None 1 – a little 2- moderate 3 – a lot
Cleaning your teeth |__| 0-None 1 – a little 2- moderate 3 – a lot
Relaxing (including sleeping) |__| 0-None 1 – a little 2- moderate 3 – a lot
Your feelings (for example being more impatient, |__| 0-None 1 – a little 2- moderate 3 – a lot
irritable, easily upset)
Smiling or laughing |__| 0-None 1 – a little 2- moderate 3 – a lot
Doing your schoolwork |__| 0-None 1 – a little 2- moderate 3 – a lot
Mixing with friends and other people” |__| 0-None 1 – a little 2- moderate 3 – a lot
19. Ask ALL : “How often do you usually brush your teeth?” |__| 0-Never 1 –less than once a day 2- once a day
3-twice a day 4-more than twice a day
20. Optional – Ethnicity |__| A. White E. Bangladeshi I. Black Other K. Ethnic other A
B. Mixed F. Other Asian J. Chinese L. Ethnic other B
C. Indian G. Black Caribbean M. Ethnic other C
D. Pakistani H. Black African
21. Ask ALL : “Are you currently wearing an orthodontic appliance / brace?”
|__| 0 – Yes, seen (go to exam, IOTN exam not needed); 1 –Yes, not seen (go to IOTN exam, Q22 & 23 not required)
2 – No (go to Q22, IOTN exam required)
22. IF NO to Q21 ask : “Do you think your teeth need straightening?”
|__| 1 – Yes (go to Q23); 2 – No (go to IOTN exam); 3- Don’t know (go to IOTN exam)
23. IF YES to Q22 ask : “Would you be prepared to wear a brace if it were necessary?”
|__| 1 – Yes; 2- No; 3 – Don’t know
Clinical examination
24. IOTN Aesthetic Component score |__| 1 – 10 (1-7 no AC need; 8-10 AC need)
25. IOTN Dental Health Component score |__| 0 – no definite need; 1 – definite need
26. Plaque measurement |__| 0 – Teeth appear clean; 1- Little plaque visible;
2 – Substantial amount of plaque visible; 9 – Assessment could not be made
Caries recording
Right UPPER Left
7 6 5 4 3 2 1 1 2 3 4 5 6 7
Right LOWER Left
7 6 5 4 3 2 1 1 2 3 4 5 6 7
Additional optional Measures
27. Spare variable |__| 0 – 1 – 2 – 3 –
28. Spare variable |__| 0 – 1 – 2 – 3 –
29. Spare variable |__| 0 – 1 – 2 – 3 –
Surface Codes continued
Filled………………………………….. 5
Filled, needs replacement…….. R
Obvious sealant rest’n………….. N
Sealed surface ………………….. $
Crown ……………………………… C
Trauma………………………………. T
Surface Codes
Sound…………. Blank, ‘-’ , Or 0
Hard, arrested caries…………… 1
Decayed……………………………… 2
Decay + pulpal involvement….. 3
Roots only remaining………… . 3
Filled and decayed……………….. 4
Tooth Codes
Extracted caries………………….. 6
Extracted ortho ……………… 7
Unerupted or missing other….. 8
Appendix L – Examination sheet – optional use
National dental survey of 12-year-olds
Name of School …………………………………… School postcode ………………………….……… ….
Date of examination _ _ / _ _ / _ _ _ _ Name of school contact………………………….……
This column to be deleted as
soon as possible
Examination status
Pupil name ID Number Date of birth Postcode Examined Absent
Appendix M – Table for recording numbers eligible, sampled, consented and examined or otherwise by school (optional use)
School name Number age
N sampled N Parent withheld
N child refused N child agreed to
N examined N absent
Appendix N – Format for Dental Survey Plus 2 – downloadable from
Appendix O – Summary information sheet – will be available for reporting PCTs as Excel file
from The Dental Observatory
NHS Programme of Caries Prevalence Studies
Survey of 12 Year old Children 2008/09
Primary Care Trust
Name of examiner (s)
Start/finish date of examination (dd/mm/yyyy-dd/mm/yyyy) –
Number of children in school population aged 12 years
Total number of schools with 12-year-old children
Number of schools visited
Total number of children sampled
Number of children (consent) : parent withdrew child
child gave consent
Number of children (examination) : examined
Please give answers rounded to 2 decimal places Standard 95% C.L. of Mean
Mean Deviation Lower Upper
Sealed teeth (code $T)
Sound teeth (including Sound and Sealed – code SS$T)
Standard 95% C.L. of Mean
Number Percentage Mean Deviation Lower Upper
With caries experience (DMFT >0)
With current dentinal decay (DT>0)
I confirm that this data was collected in accordance with the British Association for the Study of Community Dentistry guidelines (1992/93)
Signed _______________________________________ Date : _____________
child absent when
consent sought
absent refused
child refused
Appendix P Questionnaire about Process – will form information item 3a
Reporting on the process of data collection
to be saved with name PCTCode_3a.
Were all mainstream schools containing 12-year-old children
within the PCT included at the start of the sampling process? Yes
Was consent sought according to the National Protocol? Yes
If ‘no’ please explain alternative procedure used:
Were all children selected by random sampling approached for consent?

Were all consented children examined – except for those absent?
Were additional samples taken for local purpose or ‘additional codes’
to comply with sampling guidance Yes
If yes – explanation of additional samples:
Was it necessary for weighting to be applied to calculate PCT estimates?
Appendix Q Experiences of PCT Dental Service Epidemiology Teams when seeking positive
consent to epidemiological surveys among 12 yr old children
Please report your experiences of running the consent process for this survey. This will help
with assessment of the process and future planning.
Name of PCT
Did any schools object to the consent process ?
If yes please give details
Did any parents object to the consent process?
If yes please give details
Approximately how many children asked questions after the standard explanation?
Any other comments or observations about the consent process?
e.g. Did the children listen to the explanation? Did they appear to understand?
Did most agree readily? Did any express concerns after they had been examined?

NHS Dental Epidemiology Programme Oral Health Survey of 12 year old children in England

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