Kindergarten Oral Health Requirement: Information for Schools

Schools notify parents or guardians about this requirement when they register their children for school, and provide information on the importance of oral health to overall health and school readiness. It also requires schools to provide enrollment information for Medi-Cal (required forms available at www.cde.ca.gov).

Children entering public school for the first time, in kindergarten or first grade, are required to have a dental checkup by May 31 of the first school year. The evaluation must be completed by a licensed dental professional. 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 office that takes their child’s insurance, cannot afford to pay for it, 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. All required forms will be provided to schools by the California Department of Education. These forms are available in multiple languages on the CDE website.

Dental decay is the most common chronic childhood disease, more common than both asthma and obesity, affecting nearly two-thirds of California’s children by the time they reach third grade. Dental decay is easily preventable. However, it is also a progressive infection that does not heal without treatment. If cavities are not treated, children can develop infections severe enough to require emergency room treatment and their adult teeth may be permanently damaged. Children need their teeth to eat properly, speak properly, smile and feel confident. Children with cavities eat poorly, stop smiling, are distracted from learning and miss school. The requirement for children upon initial entry into public school, in kindergarten or first grade, to have their oral health evaluated is intended to:

• Raise parents’ awareness of the importance of oral health to overall health and readiness to learn
• Connect children with dental professionals who can care for their oral health
• Assist in enrolling children in government benefit programs, such as Medi-Cal and Healthy Families
• Maximize existing systems of care and reimbursement before creating new systems
• Identify locally specific barriers-to-care to assist communities in responding to their children’s oral health needs
• Provide data for further advocacy

The law directs schools to distribute the oral health education materials and the assessment-waiver document to parents who are registering their child in public school for the first time, in either kindergarten or first grade. Schools collect the assessment-waiver document by May 31 of the school year, and are responsible to aggregate the data contained on the form and report it, by district, to their County Office of Education by July 1 of each year.

The assessment-waiver form collects the following data with the express intention to identify not only the number of children entering school with untreated decay, but to identify specific access-to-dental care barriers. When data is unavailable, that will also be recorded (item #7).

• The total number of pupils who are subject to the requirement
• The total number who presented proof of an assessment
• The number who are assessed and found to have untreated decay
• The number who are assessed and found to have experienced dental disease (measured as either treated or untreated dental decay)
• The number who could not complete an assessment due to financial burden
• The number who could not complete an assessment due to lack of access to a licensed dental professional
• The number who could not complete an assessment because of lack of parental consent
• The number who did not return either the assessment form or the waiver request to the school

The school has the vital role of communicating the importance of oral health to parents and of being the guardians of the information that is collected and reported. All reasonable efforts to encourage parents to seek a dental checkup for their child and to return the paperwork, regardless of whether or not the evaluation was completed, are essential to fulfilling the intent of the law. The school personnel responsible for data collection and aggregation are not specified by law and will vary from district to district. Office administrators, office secretaries, health clerks or school nurses may be involved in this process for example.

Beyond the requirements of the law, schools have historically played an important role in ensuring children are healthy and ready to learn. As barriers to oral health care are identified for your school’s children, sharing the data with school board members, parent-teacher organizations, community organizations, (e.g. Rotary Club), your local dental society and local public health agencies will assist the development of partnerships and strategies to build capacity to meet these needs. The data can be a valuable asset in further oral health advocacy for your families – we encourage you to share it.

School nurses have historically been the ones to receive a child in pain, determine the source of the discomfort, render care as appropriate and make the necessary referral. We have heard from many school nurses that their number 1 problem is untreated dental disease. The role of school nurses will not change with this requirement.

The requirement is intended to identify dental problems earlier, thereby reducing the number of children’s visits to the school nurse for undiagnosed dental disease. The requirement is also expected to provide added support for the dental referrals nurses make, in that the school nurse cannot “sign off” on a child’s oral health. By requiring that a dental professional do this assessment, the State is emphasizing to parents that their child’s oral health must be cared for by dental professionals and reinforces the referrals that school nurses make for children with dental disease.

No, the law states it must be completed by a “dental professional.” The ultimate goal of this law is to connect children with a regular source of dental care. The law requires schools to educate parents about the importance of oral health to overall health and readiness for school and encourages parents to locate a source of dental care, be that a private dentist or a community clinic, for this dental evaluation. Additionally, information to support enrolling children in Medi-Cal is also provided to parents. This law serves as the impetus to make a connection that is ideally not a one-time event, but can become a regular source of care.

An ongoing challenge for school nurses who provide basic assessments (i.e. screenings) for children at school is follow through on referrals made. This law provides another tool to back up a recommendation to see a dentist for comprehensive evaluation and care. What’s more, this law also measures the specific barriers encountered when the parent does not follow through on that recommendation.

While much of the data being collected will be forwarded to the County Office of Education and may be useful for advocacy at the state level, there are also data that may be useful at the local level and which school personnel may want to review. The assessment-waiver forms will identify:

• Children entering kindergarten who have untreated decay
• Children entering kindergarten who have an urgent need for care
• Children who do not have any form of dental insurance and who may benefit from local programs that assist with enrollment in the Medi-Cal program

While the law determines the data that school districts must report to their County Office of Education, the California Department of Education has not developed a form for this purpose nor prescribed the exact manner in which it is reported. However, the San Joaquin County Office of Education (SJCOE) has developed a web-based System for California Oral Health Reporting (SCOHR) that is sophisticated and, at the same time, very user friendly. It aggregates reports statewide and will allow an unprecedented opportunity to study and utilize the reported data. Schools, districts or COEs interested in participating should contact SJCOE, CEDR department, at [email protected] or visit the SCOHR website.

Collaboration: One of the key initial purposes of the law is to learn first hand the specific barriers children face to receiving oral health care in their communities. As difficult as it may be to just collect the data and not immediately respond, it will be most powerful to allow what is actually happening with regard to access-to-dental care to be measured. Once this data is collected and reviewed, it presents an unparalleled opportunity for school board members, school administrators, school nurses, community leaders and dental professionals to collaborate to build capacity to better meet the oral health needs of the children in their community who continue to experience barriers to care.

Partnering with parents: California Dental Association (CDA) encourages member dentists to offer dental screenings in their offices for children, free of charge as a public service, when parents do not choose to schedule comprehensive dental examinations for their child, but instead request the minimum assessment required by law. Involving parents directly in this process opens up the important opportunity for them 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. This is the place where a “screening” becomes the opportunity to begin the process of establishing a dental home for their child, so that the restorative and preventive care can be provided that will keep their child healthy.

Working to remove barriers: Additionally, schools and school districts with many families who experience barriers to dental care may work with local dental and dental hygiene component societies and already established school-based programs to ensure all of their new kindergartners or first graders receive at least a minimal evaluation. This is an opportunity to create effective systems of screening, triage, and referral for children whose families continue to experience barriers to dental care.

On an individual basis, dental examinations provided to children who have some form of dental coverage, including Medi-Cal or commercial insurance, will be paid for by those benefit plans – as all include dental examinations as a benefit. 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 described above.