New life for Kindergarten Oral Health Requirement

Students’ oral health is receiving a big push in Los Angeles schools. The Los Angeles Unified School District Board of Education in January unanimously approved a resolution that seeks to enforce AB 1433, known as the Kindergarten Oral Health Requirement, by recognizing February as Children’s Dental Health Month, among other actions.

“The resolution puts a stronger emphasis on promoting oral health education and preventive care for our kids,” says Frances Walsh, oral health program manager at The L.A. Trust for Children’s Health, which works with California’s largest school district to provide support for school-based health clinics and health partnerships through school-linked programs.

“Tooth decay is the most common chronic disease in children, despite the fact that it is almost entirely preventable,” states the resolution, which goes on to acknowledge the toll that poor oral health takes on student attendance and academic performance, as well as its disproportionate negative effects on disadvantaged and minority children.  

More than 7,000 students across LAUSD have been screened over the past three years and nearly 70 percent were found to have active dental disease. Of those, five percent had immediate needs such as rampant decay and abscessed teeth. In addition, a 2009 study by Children’s Dental Health Project found that district students with untreated dental disease are absent two additional days each school year compared to students without dental disease.

Citing the intent of AB 1433 to reduce the incidence of dental disease in children, the LAUSD Board of Education has resolved, in part, that the superintendent will:

  • work closely with school-site administrators, external organizations and city agencies to promote oral hygiene awareness and education throughout the district;
  • remind, within 30 days, all local district superintendents and school principals of the kindergarten mandate requirements; and
  • develop or have a designee develop, within 60 days, a recommended annual timeline and strategy for school administrators to inform parents of the kindergarten mandate, collect data and report data to the Los Angeles County Office of Education.

Additionally, the board of education will collaborate with The L.A. Trust, community partners, providers and advocates to promote The L.A. Trust Oral Health Initiative.

“There is a huge need here and our kids are fortunate to have a school board that is looking out for them,” Walsh said.

State Dental Director Jayanth Kumar, DDS, credits reporting efforts

AB 1433 was signed into law in 2005 to help parents establish a dental home for their children, thereby ensuring they have access to needed services. As part of this, the law required that all public school students enrolled in kindergarten, or first grade if they did not attend kindergarten, present proof of having received an oral health assessment by May 31 of the school year. Schools or districts would then collect the assessment forms and report the data by Dec. 31 to the county office of education.

Although the Department of Education continues to allocate funds for AB 1433, recent changes to the law governing categorical program funding allow for schools’ discretion in implementing the program. These funds can be used to notify parents and legal guardians of the oral health assessment requirements and support data reporting.

State Dental Director Jayanth Kumar, DDS, in a 2015 interview with CDA said that a state oral health program is considered successful if, among other things, it “has access to current data on oral health status and high-quality oral health surveillance.” He also says that the reporting efforts under AB 1433 work toward this effort.

“Oral health reporting provides a source of data on oral health status, availability of dental care and gaps in services that can be used to inform and educate the community about their needs,” Kumar said. “It is the only source of dental data available at the local level on an annual basis.”

Kumar said that several communities have used the data to develop their community health needs assessments, action plans and interventions — and there have been successes. For example, since 2007, the San Francisco Department of Public Health has organized a dental screening program for approximately 4,000 kindergarten children in the San Francisco Unified School District. According to the California Department of Public Health, this data show that the prevalence of tooth decay declined from 45 percent in 2007 to 32.1 percent in 2014. During the same period, untreated tooth decay declined from 26 percent to 14.5 percent.

The data collected from this assessment was used in the San Francisco Community Health Needs Assessment report, which noted that low-income, Black\African-American, Latino and Asian children continue to be two times more likely to experience dental decay than higher-income and White children. The San Francisco Health Improvement Partnership has used the data to develop a strategic plan and increase utilization of dental services among children ages 0–3 years enrolled in the Denti-Cal program.  

The dentist’s role in providing good, current data

Kumar says that access to data is “critical for describing and monitoring oral health status, guiding actions to address needs and setting priorities for the use of resources and evaluating the outcome of implemented actions.”

“Dental practitioners can be champions for promoting the kindergarten assessment policy in their communities,” Kumar adds. They can help implement a kindergarten assessment program, provide expertise in addressing the underlying causes of oral health problems and accept referrals from schools. 

Under AB 1433, dentists complete four boxes on the required one-page oral health assessment form, which the parent or legal guardian of the child will provide at the appointment. These boxes record: the date of the evaluation; whether the child has experienced caries in his or her lifetime; the child’s needs, such as the presence of visible caries; and urgency of treatment.

The state-required assessment form is simply, but importantly, a tool to collect data about children’s oral health and communicate it to the state. The form is not intended to communicate dentists’ findings to the parent or guardian. That should be handled in the same manner as before AB 1433: either through consultation with the caregiver present at the time of the evaluation, or through a form designed specifically for this purpose if no caregiver is present.

Legislation currently in development would strengthen AB 1433 in terms of data collection and oral health surveillance. CDA will keep members updated about the legislation on cda.org and in the CDA Update.

Learn more about the dental professional’s role under AB 1433 on CDA’s website.

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First-time resources available to participating Denti-Cal providers resulted in increased access to care for the nearly 6 million California children enrolled in the Medicaid dental program in the first half of 2016. In 2016, the Department of Health Care Services rolled out the 1115 waiver, known as Medi-Cal 2020, which allocated $740 million to the Dental Transformation Initiative.

“One of the things that I love about being a dentist is working in a profession filled with compassionate and caring people,” Carliza Marcos, DDS, says. “This spring, we will have a unique opportunity to express our commitment to helping those less fortunate in our community.” Marcos is chair of the San Mateo CDA Cares Local Arrangements Committee. CDA Cares will be held April 22-23 in San Mateo.