What Dental Professionals Need to Know

This year 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 a 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. You are urged to check the CDA Update and visit cda.org for program updates and to download forms and other helpful materials.

- What does this new law require?
- What should our office do when a patient calls needing the school required “oral health assessment” for their child?
- How do I fill out the state-required assessment form?
- What should our office do when someone calls needing the “oral health assessment” required by their child’s school and this is the first time the caller has contacted our office?
- If the caller does not want to schedule a comprehensive examination for their child, what’s the next step?
- Will there be school-based screenings, health fairs and other no-cost screenings organized to meet this requirement?
- How will this new requirement be paid for?

What does this new law require?

Beginning January 1, 2007, schools must notify parents or guardians about this new requirement 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.
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 should our office do when a patient calls needing the school required “oral health assessment” for their child?

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 “new” 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 of the new law. 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.

For your convenience, the assessment form, protocols for filling out the assessment form, and other helpful materials will be posted on the CDA Web site at cda.org as they become available.

How do I fill out the state-required assessment form?

The state-required assessment form is simply a tool to collect data about children’s oral health and commnicate it to the state. 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 this form is not intended to communicate your findings to the parent. That should be handled in the same manner as before AB 1433: 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 form for this purpose. It is available in English, Chinese, Hmong, Russian and Spanish here.

What should our office do when someone calls needing the “oral health assessment” required by their child’s school and this is the first time the caller has contacted our office?

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 the caller does not want to schedule a comprehensive examination for their child, what’s the next step?

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 legislation 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.

The CDA Web site will post the appropriate consent and result/recommendation form for in-office screenings. This form will also address moving a child from “not-a-patient of record” status to “patient-of-record” status, should the parent decide to make an appointment based on the result of the screening and your recommendations.

Will there be school-based screenings, health fairs and other no-cost screenings organized to meet this requirement?

We anticipate impacted schools will 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.

How will this new requirement be paid for?

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

California Dental Association and California Society of Pediatric Dentistry have jointly developed a screening consent and recommendation form for dental screenings that are conducted in private dental offices (school-based screening programs typically use their own forms for this purpose). This form makes it explicit that the child receiving the screening does not become a patient-of- record and will establish the parameters of the free service provided. This consent/recommendation form, as well as other support materials for this requirement, can be downloaded from cda.org.
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 creation of the required oral health education materials and the assessment form, distribution and collection, and data aggregation, reporting and maintenance. 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.