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September 27, 2019 1141

In 2005, 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 identifies children who need further examination and dental treatment, and identifies 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 an extended function registered dental assistant with supervision.

What follows is a Q & A designed to address common questions regarding this requirement.

What does the law require?

Schools notify parents or guardians about the requirement and provide information on the importance of oral health to overall health and school readiness. Schools should also provide enrollment information for Medi-Cal.

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 31 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 collect and aggregate specified data and school districts forward specified data by July 1 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 “additional” 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:

  • The date of the evaluation
  • Visible caries or fillings present? This indicator is determined by the presence of any restoration and/or at least one untreated decayed tooth.
  • 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.”
  • 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 law. Clinics are encouraged to develop a protocol for filling out the required form based on the child’s record from the last exam.

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.