Information for Schools

Beginning January 1, 2007, landmark legislation requiring oral health assessments for children entering public school for the first time (at kindergarten or first grade) becomes effective.  The ultimate goal of this program is to establish a regular source of dental care for every child. The program will identify children who need further examination and dental treatment, and will identify barriers to receiving care. 
Schools play a critical role in ensuring the success of this program!

The 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 dental screening, which can be performed by dentists, as well as dental hygienists and registered dental assistants with supervision.

What follows is a Q & A intended to help school personnel understand this law:

- What specifically does this new law require?
- What are the intended impacts of the requirement?
- What is the role of schools?
- What is the role of school nurses?
- Can school nurses complete this assessment?
- Is the data being collected useful at the school level?
- How is the data reported?
- Does the oral health requirement impact students already enrolled in school?
- What opportunities exist to ensure that children’s oral health improves?
- How is this new requirement paid for?
 
What specifically does this new law require?

  • Schools must notify parents or guardians about this new requirement when they register their children for school, 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 (required forms available at www.cde.ca.gov/).
  • Children entering public school for the first time, in kindergarten or first grade, are to have a dental check-up by May 31st of the first school year. The evaluation must be completed by a licensed dental professional. 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 office that takes their child’s insurance, cannot afford to pay for it, 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. All required forms will be provided to schools by the California Department of Education.  These forms are available now by clicking here or visiting the Department’s Web site.

What are the intended impacts of the requirement?

Dental decay is the most common chronic childhood disease, more common than both asthma and obesity, affecting nearly two-thirds of California’s children by the time they reach third grade.  Dental decay is easily preventable. However, it is also a progressive infection that does not heal without treatment. If cavities are not treated, children can develop infections severe enough to require emergency room treatment and their adult teeth may be permanently damaged. Children need their teeth to eat properly, speak properly, smile and feel confident.  Children with cavities eat poorly, stop smiling, are distracted from learning and miss school.  The requirement for children upon initial entry into public school, in kindergarten or first grade, to have their oral health evaluated is intended to:

  • Raise parents’ awareness of the importance of oral health to overall health and readiness to learn
  • Connect children with dental professionals who can care for their oral health
  • Assist in enrolling children in government benefit programs, such as Medi-Cal and Healthy Families
  • Maximize existing systems of care and reimbursement before creating new systems
  • Identify locally specific barriers-to-care to assist communities in responding to their children’s oral health needs
  • Provide data for further advocacy

What is the role of schools?

The law requires schools to distribute the oral health education materials and the assessment-waiver document to parents who are registering their child in public school for the first time, in either kindergarten or first grade.  Schools must collect the assessment-waiver document by May 31 of the school year, and are responsible to aggregate the data contained on the form and report it, by district, to their County Office of Education by December 31of each year. 

The assessment-waiver form collects the following data with the express intention to identify not only the number of children entering school with untreated decay, but to identify specific access-to-dental care barriers.  When data are unavailable, that will also be recorded (item #7).

  1. Number of pupils in the district, by school, who are eligible for the assessment
  2. Number of pupils who present proof of an assessment
  3. Number of pupils who could not complete an assessment due to financial burden
  4. Number of pupils who could not complete an assessment due to lack of access to a licensed dental health professional
  5. Number of pupils who did not complete an assessment because their parents or legal guardians did not consent to the assessment
  6. Number of pupils who are assessed and found to have untreated decay
  7. Number of pupils who did not return the required paperwork to the school

The school has the vital role of communicating the importance of oral health to parents and of being the guardians of the information that is collected and reported.  All reasonable efforts to encourage parents to seek a dental check-up for their child and to return the paperwork, regardless of whether or not the evaluation was completed, are essential to fulfilling the intent of the legislation. The school personnel responsible for data collection and aggregation are not specified by the legislation and will vary from district to district.   Office administrators, office secretaries, health clerks or school nurses may be involved in this process for example.

Beyond the requirements of the law, schools have historically played an important role in ensuring children are healthy and ready to learn.  As barriers to oral health care are identified for your school’s children, sharing the data with school board members, parent-teacher organizations, community organizations, (e.g. Rotary Club), your local dental society and local public health agencies will assist the development of partnerships and strategies to build capacity to meet these needs.  The data can be a valuable asset in further oral health advocacy for your families – we encourage you to share it!

What is the role of school nurses?

School nurses have historically been the ones to receive a child in pain, determine the source of the discomfort, render care as appropriate and make the necessary referral. We have heard from many school nurses that their number 1 problem is untreated dental disease. The role of school nurses will not change with this requirement. 

The requirement is anticipated to identify dental problems earlier, thereby reducing the number of children’s visits to the school nurse for undiagnosed dental disease.  The requirement is also expected to provide added support for the dental referrals nurses make, in that the school nurse cannot “sign off” on a child’s oral health.  By requiring that a dental professional do this assessment, the State is emphasizing to parents that their child’s oral health must be cared for by dental professionals and reinforces the referrals that school nurses make for children with dental disease.
 
Can school nurses complete this assessment?

No, the law states it must be completed by a “dental professional.”  The ultimate goal of this legislation is to connect children with a regular source of dental care. The legislation requires schools to educate parents about the importance of oral health to overall health and readiness for school and encourages parents to locate a source of dental care, be that a private dentist or a community clinic, for this dental evaluation.  Additionally, information to support enrolling children in Medi-Cal/Denti-Cal and Healthy Families is also provided to parents.  This legislation serves as the impetus to make a connection that is ideally not a one-time event, but can become a regular source of care.

An ongoing challenge for school nurses who provide basic assessments (i.e. screenings) for children at school is follow through on referrals made. This legislation provides another tool to back up a recommendation to see a dentist for comprehensive evaluation and care.  What’s more, this legislation also measures the specific barriers encountered when the parent does not follow through on that recommendation.

Is the data being collected useful at the school level?

While much of the data being collected will be forwarded to the County Office of Education and may be useful for advocacy at the state level, there are also data that may be useful at the local level and which school personnel may want to review.  The assessment-waiver forms will identify:

  • Children entering kindergarten who have untreated decay
  • Children entering kindergarten who have an urgent need for care
  • Children who do not have any form of dental insurance and who may benefit from local programs that assist with enrollment in the Medi-Cal and Healthy Families programs

How is the data reported?

While the law determines the data that school districts must report to their County Office of Education, the California Department of Education has not developed a form for this purpose nor prescribed the exact manner in which it is reported. However, the San Joaquin County Office of Education has developed a state-wide web-based reporting system that is sophisticated and, at the same time, very user friendly. It aggregates reports state-wide and will allow an unprecedented opportunity to study and utilize the reported data. Schools, districts or COEs interested in participating should contact Johnny Arguelles of the SJCOE, CEDR department, at 209.468.5924.

This law becomes effective January 1, 2007.
Does the oral health requirement impact students already enrolled in school?

  • Yes, the effect of the law is immediate 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, notices must go home to parents as quickly as feasible, as parents with children in their first year of school will have until May 31 to either get a dental check-up for their child or request the waiver.  That makes this first year different from subsequent years.
  • It’s important to remember that there is no penalty for students who are not able to get a dental check-up or for schools with non-compliant pupils. The “newness” of the requirement and the shorter timeline may impact the success of this first year.  Consider the first year a time to get familiar with the requirement and set up the processes to meet it.

What opportunities exist to ensure that children’s oral health improves?

  • Collaboration: One of the key initial purposes of the legislation is to learn first hand the specific barriers children face to receiving oral health care in their communities.  As difficult as it may be to just collect the data and not immediately respond, it will be most powerful to allow what is actually happening with regard to access-to-dental care to be measured.  Once this data is collected and reviewed, it presents an unparalleled opportunity for school board members, school administrators, school nurses, community leaders and dental professionals to collaborate to build capacity to better meet the oral health needs of the children in their community who continue to experience barriers to care. 
  • Partnering with parents: California Dental Association (CDA) is encouraging member dentists to offer to complete dental screenings in their offices for children, free of charge as a public service, when parents do not choose to schedule comprehensive dental examinations for their child, but instead request the minimum assessment required by law. Involving parents directly in this process opens up the important opportunity for them to become educated about the condition of their child’s oral health, the consequences if disease is not treated and the benefits of ongoing care.  This is the place where a “screening” becomes the opportunity to begin the process of establishing a dental home for their child, so that the restorative and preventive care can be provided that will keep their child healthy.
  • Working to remove barriers: Additionally, it is anticipated that schools and school districts with many families who experience barriers to dental care will work with local dental and dental hygiene component societies and already established school-based programs to ensure all of their new kindergartners or first graders receive at least a minimal evaluation. This is an opportunity to create effective systems of screening, triage, and referral for children whose families continue to experience barriers to dental care.

How is this new requirement paid for?

  • On an individual basis, dental examinations provided to children who have some form of dental coverage, including Denti-Cal, Healthy Families or commercial insurance, will be paid for by those benefit plans – as all include dental examinations as a benefit.  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 to provide a dental screening to the child, free of charge, as described above. 
  • 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 distribution and collection of required forms, and data aggregation, reporting and maintenance.  CDE is charged with determining the allocation procedure for this funding.  ACSA, CSBA and CDA will provide that information as soon as it becomes available.

    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.