Kindergarten Oral Health Requirement: Information for Dental Professionals

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 will identify children who need further examination and dental treatment, and will identify barriers to receiving care. You play a critical role in ensuring the success of this program. It’s an important step in improving children’s oral health.

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 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 the roles and responsibilities of dentists and office staff.

Schools notify parents or guardians about the requirement and provide information on the importance of oral health to overall health and school readiness. The materials that schools distribute also include Medi-Cal enrollment information.

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.

If you are already this family’s dentist, it should be a routine matter for your office to schedule a dental examination for the child. The oral health assessment requirement is not intended to alter your usual office protocol with regard to new or recall child exams. The only “additional” part of the visit is completion of the required assessment form.

If the child is already a patient-of-record and has had an examination within the last 12 months, the results of that exam will satisfy the requirement. Your office may want to develop a protocol for parents asking if you will complete the form based on the child’s record from the last exam.

The state-required assessment form is simply a tool to collect data about children’s oral health and communicate it to the state. The required form can be downloaded from the CDE website. To complete the form consistently with others, please follow these guidelines:

  • Box #1 records the date of the evaluation.
  • Box #2 records whether this child has ever experienced caries in his or her lifetime. That is measured by either signs of inactive disease (fillings) or active disease (visible caries). If either or both are seen, mark this box “yes.”
  • Box #3 records the needs of this individual child. If there is visible caries, mark this box “yes.” 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.”
  • Box #4 records treatment urgency, as follows:
    • “Urgent care” is indicated when signs or symptoms include pain, infection, swelling or soft tissue lesions lasting longer than 2 weeks (determined by questioning the child)
    • “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.

It should be noted that the assessment form is not intended to communicate your findings to the parent. That should be handled either through consultation with the adult present at the time of the evaluation, or through a form designed specifically for this purpose. If you participate in school-based screenings, that form should be supplied to you for completion. If you screen children in your office, CDA and CSPD have jointly created a Consent and Recommendations form for this purpose, available in the following languages: English, Chinese, Hmong, Russian, Spanish, Vietnamese.

As with all new and recall patients, ideally, children should receive a comprehensive examination in your office. In some instances, however, it may be a multi-step process before a child receives that desired exam.

It is therefore important for your office staff to develop a protocol for when the parent questions the need to make an appointment for an examination, citing the need for “just an assessment.” Many factors figure into the parent’s decision to schedule the recommended examination appointment, including available insurance coverage, the parents’ understanding of the difference between an assessment and an examination, and the parents’ expectation that an assessment, or basic screening, is all the child needs. Your office protocol should include a clear explanation of the differences between a basic screening and a comprehensive examination so that the parent can make a fully informed decision.

If this is the first time this child is seeing a dentist, it could also be the last. Don’t let that happen! You and your office staff have a unique opportunity to educate the parent on the importance of oral health and begin the process of establishing a dental home for this child. As a dental professional, it is important to inform parents of the value of a comprehensive examination; however, if this is not an option for the parent:

CDA encourages members to consider offering to screen the child and complete the assessment form in your office without charge. The law itself simply requires an “assessment” of the child’s oral health and the completion of the data collection tool. This requirement is intended, at a minimum, to identify if further dental examination and treatment is required.

If you choose to do a screening, rather than a comprehensive exam in your office, be very clear when the appointment is established that you will be conducting the screening, at no charge, as a public service. When the adult and child arrive, a consent form, very similar to the consent form used at school-based screenings, must be signed. This form will make it explicit that the child receiving the screening does not become a patient-of-record and will establish the parameters of the free service you are providing.

This is the critical place where the parent becomes 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 establish a dental home. All children who leave your office after a screening should leave with a document that informs them of the results of the screening.

CDA’s and CSPD’s jointly developed consent form for in-office screenings is available in multiple languages: 

Oral Health Screening Consent and Recommendations (English)
Oral Health Screening Consent and Recommendations (Chinese)
Oral Health Screening Consent and Recommendations (Hmong)
Oral Health Screening Consent and Recommendations (Russian)
Oral Health Screening Consent and Recommendations (Spanish)
Oral Health Screening Consent and Recommendations (Vietnamese)

Many schools work with local dental components or already established school-based screening programs to ensure all of their new kindergartners/first graders get at least a minimal evaluation. This is an opportunity to create effective systems of screening, triage, and referral for children whose families experience barriers to dental care. Your participation is essential to the success of these efforts.

On an individual basis, dental examinations provided to children that have some form of dental coverage, including Denti-Cal 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 encourages dentists to provide a dental screening to the child, free of charge, as a public service. A dental screening is not a billable service.

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