School Entrance Oral Health Assessments
Groundbreaking legislation effective January 1, 2007 requires children entering public school for the first time in either kindergarten or first grade to present proof by May 31 of the school year of having obtained an oral health assessment. That assessment may be completed during the first year of school or any time in the 12 months prior to school enrollment.
CSPD, working with the California Dental Association, has long sought such regulation as a means of identifying children in need of oral health services and promoting the importance of oral health as an integral component of school readiness and ability to learn.
Dentists should be aware of the following provisions of the bill:
- Public schools will notify parents and guardians of the requirements imposed by law and provide a standardized form that can be used to record the results of the oral health assessment.
- Parents and guardians may be excused from compliance by indicating the assessment imposes an undue financial burden, cannot be completed because of a lack of access to a dentist or other licensed oral health professional, or because they choose to withhold consent.
- Assessments may be completed by any California-licensed Dentist, Registered Dental Hygienist, or Registered Dental Assistant acting under the direct supervision of the dentist.
It is important for dentists to understand the difference between a dental examination, which can be performed only by a licensed dentist, and an oral health assessment, which can be performed by a range of licensed dental professionals. An oral health assessment identifies obvious or suspected oral health conditions that require, or might require, examination by a dentist. A dental examination diagnoses dental conditions and forms the basis for treatment recommendations.
A dental examination conducted in a dental office during the first school year or in the 12 months prior to school enrollment more than meets the minimum standards of the assessment requirement.
The goal of this legislation is to establish a regular source of dental care (a dental home) for every child. The program will also identify children in need of further examination and dental treatment and will help in the identification of barriers to the delivery of dental care.
For additional information all located on this page, please use the appropriate links:
Questions concerning California Oral Health Assessments may be directed to CSPD Public Policy Advocate, Dr. Paul Reggiardo, at Reggiardo@prodigy.net or by phone at 714-848-0234.
Return to Top
Information on Oral Health Assessments
What Does the Law Require?
- Beginning January 1, 2007, schools must notify parents or guardians about this new requirement and 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 is an Oral Health Assessment?
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 a registered dental assistant with supervision.
How should an office respond when a parent calls requesting the required "oral health assessment" for their child?
If the child is already a patient of record, it should be a routine matter 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 examinations. 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 four items:
- The date of the evaluation
- The presence (yes or no) of caries experience as evidenced by visible dental caries or dental restorations
- The presence (yes or no) of visible untreated dental caries
- Assignment to a category of treatment urgency as follows:
- Urgent (if the child experiences pain or there is evidence of dental infection)
- Early Dental Care (if caries appears visible without accompanying signs or symptoms or it appears the child would benefit from immediate sealant placement)
- No Obvious Problems (if the child's teeth appear to be visually healthy and there is no apparent reason for the child to be seen before the next routine check-up)
If the child is a patient-of-record and has had an examination within the last 12 months, the results of that previous examination will satisfy the requirement of the new law.
How should an office respond when the parent of a new patient calls making the same request?
As with all new patients, the child ideally should receive a comprehensive examination. In some instances, however, it may be a multi-step process before a child receives the desired exam. It is therefore important to develop a protocol when the parent questions the need to make an appointment for an examination, citing the request for "just an assessment."
Many factors may contribute to the parent's decision to schedule the recommended examination, 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. An office protocol should include a clear explanation of the differences between a basic screening and a comprehensive examination, so that the parent can make an informed decision.
If, after explaining the value of a comprehensive dental examination, the caller still requests only a screening assessment to meet the basic requirements of law, how might the office proceed?
When a dental examination is not feasible, the child will still benefit from the simple assessment intended to identify obvious unmet oral health needs and to provide a data collection tool for state-wide oral health planning. Therefore, CSPD encourages members to consider offering to screen the child and complete the mandated assessment form in the office without charge.
Return to Top
- If choosing to do a screening, rather than a comprehensive exam in the 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, an In-Office Consent and Recommendation Form, very similar to the consent form used at school-based screenings, should be signed. This form will make it explicit that the child receiving the screening is not a patient-of-record and will establish the parameters of the free service you are providing. CSPD and CDA have jointly developed an In-Office Consent and Recommendation Form for use in the dental office which is available on the CSPD and CDA websites. This form should be filled-out and given to the parent, along with the state-mandated data collection form (which is returned to the school). The dentist is advised to keep a copy of these forms together in a separate file for a period of one year, after which they may be discarded.
- Providing an assessment in the dental office provides an opportunity for the parent 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. The "screening" can become an invitation to establish a dental home for the child.
CSPD Members Play Critical Role
School Entrance Oral Assessments Up and Running
Under legislation long sought by CSPD and effective January 1 of this year, children enrolled in their first year of public school in either kindergarten or first grade are now required to obtain an assessment of their oral health as part of school readiness preparation. For children who already see a dentist and have established a dental home, compliance will be as simple as calling the office and requesting that the dentist fill-out and return the data collection form sent home by the school. Any dental examination conducted in the 12 months prior to the beginning of the school year will meet the assessment requirement, although dentists may wish to recommend a more recent examination when indicated in the best interests of the child. Parents have until May 31st to return the State’s data collection form to the school. While many schools districts are placing school information at the top of the form, dentists and parents may download and use the form available from the California Department of Education. A link to the California Department of Education website and a direct link to downloadable English and Spanish versions of the form are now available on the CSPD website (www.cspd).
For children who have not received a dental examination in the twelve months prior to school entrance, parents have several options. They may schedule a dental examination with a licensed dentist, they may arrange an oral assessment or screening evaluation by any licensed dental professional (a dentist, dental hygienist, or registered dental assistant under the direct supervision of the dentist), or they may request a waiver of the requirement. CSPD members have the opportunity to play a critical role in which decision is made by the parent.
The best decision for the child, and a significant intent of the legislation, is the establishment of a dental home through the scheduling of a comprehensive dental examination. When this is not possible or feasible, CSPD urges its members to consider providing a screening assessment in their office as a public service. It is important for both dentists and parents to understand the difference between a dental examination, which is a billable service and establishes the dental home, and a screening assessment which is not considered a billable service and only (1) collects the data required by the state concerning the incidence of treated and untreated dental caries and (2) identifies obvious or suspected conditions which require, or might require, examination and treatment by a dentist.
If a screening evaluation is conducted in the dental office it does not establish a dentist-patient relationship. Patients receiving such assessments do not become a patient-of-record and should not be expected to complete health histories or other office forms. To assist members providing these assessments, CSPD and CDA have developed a Consent and Recommendation Form for use in the dental office. The form provides for the consent of the parent or caregiver, explains the limitations and differences between an oral assessment and a comprehensive oral/dental examination, and provides a section in which the dentist can make recommendations concerning the child’s oral health. The form, in multiple languages, is downloadable from the CSPD website (www.cspd). It should be given to the parent or caregiver, along with the State data collection form, and a copy kept in the office for a period of one year. Oral evaluations performed in the dental office help parents meet the school requirement and serve as an introduction to the dental delivery system.
CSPD anticipates may school districts, especially those most impacted by oral health disparities, will work with local dentists and local component dental societies to establish school-based and school-linked oral health screenings to ensure pupils receive these assessments. Such screenings will provide an additional opportunity to create effective systems of triage and referral of children whose families experience barriers to dental care and the establishment of a dental home. CSPD encourages the participation of its members in these activities as well as in providing in-office assessments.
Ultimately, the success and survival of school-entrance oral health examinations and assessments will be judged by public compliance with the legislation. Parents may receive a waiver of the requirement by indicating the assessment poses an undue financial burden, cannot be completed because they are unable to locate a dental professional to perform the assessment, or by simply withholding consent. By facilitating the examination and assessment process, CSPD members make it less likely a parent will choose to use the waiver.
Paul Reggiardo, DDS
Return to Top
Public Policy Advocate
California Society of Pediatric Dentistry
Download Appropriate Forms
Return to Top
Tips for Completing the State-Required
Oral Health Assessment Form
The state-required oral assessment form to be returned to the school is a simple data collection tool that requires the following four pieces of information.
- The date of the child's oral evaluation or examination, which may occur anytime during the first year of school or up to 12 months prior to school entrance.
- Is there evidence the child has experienced decay? The form asks if visible caries and/or fillings are present. If either or both are detected by visual or by radiographic examination, the YES box should be checked. If a child is found to have one or more untreated carious lesions, then he/she will automatically be marked positive in this section and the next.
- Is there evidence of untreated dental decay? If a dental examination is performed, the answer to this question is easily determined. When only a visual screening assessment is done, the dental professional must make an educated judgment. To standardize responses, it is recommended that if there appears to be as little as 0.5 mm of enamel loss and a brown discoloration of the occlusal or smooth enamel surface, the form should be marked YES.
- Is there a treatment urgency? The form provides three options:
- "Urgent" is indicated if there are signs or symptoms of pain, infection, or soft tissue swelling.
- "Early Dental Care" is indicated when dental caries is suspected or present without other accompanying signs or symptoms. Sealant indications such as deep fissured groves or while enamel demineralization also qualify the child for this designation.
- "No Obvious Problems Found" is indicated when the teeth appear visually sound and the child appears to need only routine dental examination.