Information for Clinics

This year the California Dental Association sponsored landmark legislation requiring oral health assessments for children entering public school for the first time (at kindergarten or first grade).  The ultimate goal of this program is to establish a dental home for each child. The program will identify children who need further examination and dental treatment, and will identify barriers to receiving care.  Safety net dental clinics serve a large portion of the pediatric oral health needs in California and play an important role in the success of this program!

The required assessment, or evaluation, can be met in many ways.  It can be a complete examination and treatment plan performed by a dentist, or it can be a more basic oral health evaluation, such as a screening, which can be performed by a dentist, hygienist or a registered dental assistant with supervision.

What follows is a Q & A designed to address common questions regarding this requirement. You are urged to visit cda.org for program updates and to download forms and other helpful materials like the office sign (for dental office/clinic use).

- What does this new law require?
- What should our clinic do when a parent calls needing the school required “oral health assessment” for their child?
- If the requirement can be satisfied by a basic dental screening, how do we determine what service we are providing?
- When does this new requirement go into effect?
- How will this new requirement be paid for?

What does this new law require?

  • Beginning January 1, 2007, schools must notify parents or guardians about this new requirement and must provide information on the importance of oral health to overall health and school readiness. It also requires schools to provide enrollment information for government benefit programs such as Medi-Cal and Healthy Families.
  • Children entering public school for the first time, in kindergarten or first grade, are instructed to have their oral health assessed by a dental professional by May 31st of the first school year. Oral health evaluations that occurred within the 12 months prior to school entry also meet this requirement.
  • Parents may obtain a waiver of this requirement if they cannot find a dental professional to do the evaluation, the assessment poses an undue economic burden, or the parent chooses not to have their child’s oral health evaluated.
  • Schools must collect and aggregate specified data and school districts must forward specified data by December 31 of each year to their County Office of Education.

What should our clinic do when a parent calls needing the school required “oral health assessment” for their child?

If the child is an established patient of your clinic, it should be a routine matter to schedule a dental examination for the child. The oral health assessment requirement is not intended to alter established protocols with regard to new or recall child exams. The only “new” part of the visit is completion of the required “assessment form.” The form is simply a data collection tool and requires information on the following 4 items:

  1. The date of the evaluation
  2. Visible caries or fillings present?  This indicator is determined by the presence of any restoration and/or at least one untreated decayed tooth.
  3. Visible caries?  To standardize the responses to this portion of the assessment, if there is a loss of at least ½ mm of enamel (pencil tip) and brown discoloration of the walls of the cavity (either occlusal or smooth surface), respond “yes.”
  4. Determine treatment urgency:
    * “Urgent” is indicated if the child is in pain or experiences pain or swelling, indicating immediate care is needed
    * “Early dental care” is indicated if caries is present, or there are other treatment considerations, such as need for sealants.
    * “No problem” is indicated when the child is visually healthy and in your judgment is only in need of routine examination.

If the child has had an examination within the last 12 months, the results of that exam will satisfy the requirement of the new law.  Clinics are encouraged to develop a protocol for filling out the required form based on the child’s record from the last exam.

For convenience, the assessment form, protocols for filling out the assessment form, and other helpful materials will be posted on the CDA Web site at cda.org as they become available.

If the requirement can be satisfied by a basic dental screening, how do we determine what service we are providing?

  • There is no reason to alter protocols already established and designed to meet the dental needs of the children who visit your clinic.  If families have a means to pay for the care they receive, it makes sense to utilize those systems of reimbursement.  If children are uninsured, whatever your existing process is for meeting their dental needs, continue to use that. 
  • Beyond established systems of care, it is anticipated that schools with many families who experience barriers to dental care will seek to establish school-based screening programs to ensure that all of their new kindergartners or first graders get at least a minimal evaluation. When children receive an assessment outside of a dental facility, it is an important opportunity to create effective systems of triage and referral so that the necessary follow up care can be provided. By their very nature, safety nets render care in a variety of settings and in a variety of ways, and your clinic’s mobile facility or portable equipment may become an important partner in the success of these efforts.

When does this new requirement go into effect?

  • The law becomes effective January 1, 2007 and impacts students already in kindergarten (or first grade if it is their first year in public school). So, just for this first implementation year, parents with children in their first year of school will be notified of the requirement in January, and have until May 31 to either get the assessment for their child or request the waiver.  This is a much shorter timeline than will be true for subsequent years. 
  • Assessments that occur 12 months prior to school entry, as well as assessments that occur before May 31 of the child’s first year of school meet this requirement.  In all except this first year, parents will have nearly two years to obtain an oral health evaluation for their child. Because of this extended timeline, clinics need not feel pressured to fill all available appointment slots with kindergarten dental exams, but should be aware of the extended time frame available to meet the requirement and work with parents to find a mutually agreeable appointment time.
  • It’s important to remember that there is no penalty for students who are not able to get their oral health assessed or for schools with non-compliant pupils. The “newness” of the requirement and the shorter timeline may impact the success of this first year, and as such, the first year should be considered a year of getting to know the requirement and setting up the processes to meet it.

How will this new requirement be paid for?

  • On an individual basis, as mentioned above, dental examinations provided to children that have some form of dental coverage, including Denti-Cal, Healthy Families or commercial insurance, will be paid for by those benefit plans.  In some cases, dental examinations may be paid for directly by the parent.
  • In situations where a child does not have dental coverage and the parent chooses for their child the minimum assessment required by this law, CDA is encouraging dentists in private practices to provide a dental screening to the child, free of charge, as a public service.  A dental screening is not a billable service. 
    The California Dental Association and California Society of Pediatric Dentistry have jointly developed a screening consent and recommendation form for dental screenings that are conducted in private dental offices (school-based screening programs typically use their own forms for this purpose). This form makes it explicit that the child receiving the screening does not become a patient-of- record and will establish the parameters of the free service provided. This consent/recommendation form, as well as other support materials for this requirement, can be downloaded from cda.org.
  • The requirement is also supported in a couple of different ways on a state level.  The 2006-2007 California State budget includes $4.4 million allocated from Proposition 98 to support the administrative portions of the program, including the creation of the required oral health education materials and the assessment form, distribution and collection, and data aggregation, reporting and maintenance.  Further, Denti-Cal and Healthy Families received additional funding in anticipation of increased utilization of these programs, not only for an expected increase in examinations, but also an increase in treatment of identified dental disease.