Children's Dental Health Certificate

The Players...

The New York State Dental Association and the New York State Dental Foundation have been working with the State Education Department and the Department of Health on the implementation of new legislation requiring all public schools to request dental health certificates from children entering certain grades.

The implementing regulations have been passed by the New York State Board of Regents and an approved School Dental Health Certificate Form has been created. These can be accessed on this Web site or on a New York State's Web site at http://www.schoolhealthservicesny.com.

In addition, dentists and the public will find the Question and Answer available on the New York State Education Department Office of Professions web site to be helpful in understanding the new legislation http://www.op.nysed.gov/dentnews.htm.

The purpose of the dental certificate is to determine whether a child is in “fit condition of dental health to permit his/her attendance at public schools” by providing a clinical assessment. Fit condition is defined as the absence of painful conditions, obvious swelling related to clinical evidence of open cavities, or any other condition that interferes with the student’s ability to chew, speak or focus on school activities.

Radiographs are not expected to be part of this assessment. Please call us with any questions you may have 1-800-255-2100.

Everything You Need to Know About Dental Health Assessments:
A Guide to Improving Children’s Health and Decreasing School Absences

A webinar for educators, school administrators, oral health providers, and all children's oral health stakeholders

As you may be aware, a law passed in 2007 requires New York State public schools to request a dental health certificate declaring
and why it is important.

To that end, the New York State Dental Foundation partnered with the New York State Departments of Education and Health to
sponsor a free webinar, Everything You Need to Know About Dental Health Assessments: A Guide to Improving Children’s Health
and Decreasing School Absences. This one-hour program, originally provided on August 5, 2009 enabled all participants the chance
to ask questions, share resources and learn about what you can do to promote this program.

We now invite you to view a recording of this previously aired webinar to learn more about children's dental health certificates. Should you have any questions, please contact us at (800) 255-2100. Thank you.

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Everything a parent and
dental professionals need
to know about the dental
health certificates. Click the
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Parents, health care professionals and school Q&A

What does this new law require?
The law requires that a notice of request for dental health certificates be distributed at the same time that parents or guardians of students are notified of health examination requirements. The notice must also state that a list of dentists is available upon request at the student's school to which students who need comprehensive dental examinations may be referred for treatment on a free or reduced cost basis. Dental health certificates, if obtained, should be made part of the school health record.

What is the definition of comprehensive dental examination as used in Section 903?
The purpose of the dental examination is to determine a child’s dental health condition. Therefore, it is defined for this purpose
as an assessment performed by a dentist or a dental hygienist under the general supervision of a dentist (charting caries and
periodontal conditions as an aid to diagnosis by the dentist) for the purpose of determining whether any painful conditions,
obvious swelling related to clinical evidence of open cavities, or any other condition that interferes with a student’s ability to
chew, speak or focus on school activities. Radiographs are not expected to be part of this assessment.

What should your office do when a parent calls opting to provide the school with the "Dental Health Certificate" for their
child?
If the child is already a patient-of-record and has had an examination within the last 12 months prior to the beginning of the school year in which the examination and certificate is requested, the results of that examination can be used to fill out the dental health certificate form. There is no need to conduct a separate examination to fill out the dental health certificate form. 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 examination.

What should your office do when someone calls requesting the "Dental Health Certificate" for their child's school and this is
the first time the caller has contacted your office?
As with all new and recall patients, ideally, children should receive a comprehensive examination in your office. It is therefore
important for your office staff to develop a protocol for when the parents request the need to make an appointment for a school
"Dental Health Certificate" examination. Many factors figure into a parent's decision to schedule the recommended examination
appointment, including available insurance coverage and the expectation that an assessment is all the child needs. You should clearly explain the fees charged for other investigations like x-rays and treatment, if needed.

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

If the caller does not want to schedule a comprehensive examination for their child, what’s the next step?
Parents may refuse an appointment for a number of reasons including the economic burden of follow up treatment, lack of
insurance coverage, and cooperation of the child. In that case, you may want to consider an initial assessment and counseling as a free service to the family. The oral health assessment is not intended to alter your usual office protocol with regard to new or
recall child examinations and it should not replace the need for comprehensive examination. Parents should be allowed to make a fully informed decision.

If you choose to do a free assessment, rather than a comprehensive examination, be very clear when the appointment is established that you will be conducting the assessment, at no charge, as a service. When the adult and child arrive, a consent
form, very similar to the consent form used at school-based assessments, must be signed (See the sample Dental Health
Certificate form). This form will make it explicit that the child receiving the assessment 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 an “assessment” becomes the opportunity to establish a dental home. All children who leave your office after an assessment should leave with a document that informs them of the results of the assessment.

For your convenience, instructions for filling out the assessment form, and other resources will be posted on this site as they
become available.

What happens if I declare that a child is not in fit condition of dental health to permit him/her attendance at the public
schools?
The law does not require that a student be withheld from attending classes. Students will not be denied entrance to school as a result of the findings on the dental health certificate. It is hoped that this will encourage parents to make arrangements for
treatment. You may also want to explore opportunities for providing care in consultation with local dental organizations. More information regarding ways to help families will be made available in the near future on the Department of Health webpage.

What if a I get a call from a school to help them for conducting dental health assessments?
We strongly encourage you to take the opportunity to volunteer to conduct screening sessions in a school.

How do I fill out the sample Dental Health Certificate form?

The sample Dental Health Certificate form is simply a tool to present the findings about a child’s oral health and communicate it to the school. To complete the form consistently with others, please follow these guidelines:

Section 1.
Ask the parent or a guardian to fill out this section.
Section 2.
I. Dental Health Condition
This section is to be completed by the dentist and signed. II. and III of Section 2 are optional. The
parent must initial to confirm that they consent to the optional information being provided to the school.
II. Oral Health Status

Caries Experience [Box #1] 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”.
Untreated Caries [Box #2] 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”.
Dental Sealant [Box #3] records the presence of a sealant on at least one permanent molar tooth. Respond “yes” for
presence, else “no”.
III. Treatment Needs Boxes #1 -4 record treatment urgency, as follows:
“No obvious problem” is indicated when the child’s oral health is good and in your judgment is only in need of routine examination and preventive visits.

“Will most likely need work at next routine dental check up " is indicated if caries or other changes are present but is not
likely to cause problems in the near future, or there are other treatment considerations, such as need for sealants.

“Dental care is needed” is indicated if the child has large cavities or needs orthodontic or other types of special care.

“Immediate dental care is required” is indicated when signs or symptoms include pain, infection, swelling or soft tissue
lesions lasting longer than 2 weeks

It should be noted that this form is not intended to communicate all your findings to the parent. That should be handled in
the same manner as other dental visits, either through consultation with the adult present at the time of the evaluation, or through a form designed specifically for this purpose.

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 tooth care at home and regular dental visits.

What is a dental health assessment?
The assessments are very basic, noninvasive, and take just a few minutes. Following the assessment, the dentist will provide the
family with the requisite health certificate, which will then be turned into the school. A dentist may determine that a child’s oral health condition is “not fit,” if a dental condition exists that interferes with a student’s ability to chew, speak or focus on school activities, including pain, swelling or infection related to clinical evidence of open cavities.” This does not preclude the student from attending school.”

What do I need in order to provide group assessments?
Assessments are basically visual caries assessments and do not require a dental office setting. The required supplies to be
provided are vinyl gloves (no latex due to possible allergies), tongue depressors, disposal mirrors, canister of antibacterial wipes and antibacterial hand sanitizers. We are asking dentists to provide a battery operated head lamp or flashlight as a light source and their own facial masks or shields. This request is based upon the possible lack of power outlets, as well as personal preference.

The facility should provide chairs, tables, clipboard/pens, and extra copies of certificates.

For now, we are asking that the local dental societies assist by obtaining supplies for assessments which are taking place in their components. Component dental societies have a better handle on the amounts needed for group assessments. Dentists that provide assessments in their own offices will be responsible for their own supplies. Please keep track of your purchases for
group assessments; while there is no guarantee, we may be able to obtain funding in the future to offset these costs.

What is a child needs treatment but is unable to afford dental treatment?
The Foundation is in the process of developing pilot programs which would utilize a network of dental volunteers to treat these
children. In the meantime, however, the screening dentist should ascertain whether the child is Medicaid of CHIP eligible, by
referring the family to its local Department of Social Services. DSS may also refer the child to a local Article 28 clinic or
community health center. Additionally, the family can also contact its district dental society to get a list of potential providers
and/or charitable organizations which provide free or reduced cost dentistry

How can I get the Dental Health Certificate form?
The form is available here. You can also contact the local school district.