News & Current Issues in the Dental Professions
School Dental Health Certificates
What Dental Professionals Need to Know About New York State School Dental Health Certificate Law
A law passed in 2007 requires New York State public schools to request, or ask, for a dental health certificate of students, at the time of school entry and in grades K, 2, 4, 7, and 10, declaring their dental health condition. Beginning in school year 2008-2009, schools must notify parents or guardians to request a dental health certificate and must provide a list of dentists upon request that provide free or reduced cost dental examinations.
At present, only about 50% of school aged children visit a dentist once a year. The ultimate goal of this program is to establish a dental home for each child. No child should have to suffer the consequences of poor oral health. While medical certificates are required for students, this new law also encourages students to obtain dental health certificates and is an important step in improving children’s oral health.
What follows are Questions & Answers designed to address common concerns regarding the roles and responsibilities of dentists and office staff. You are urged to check the Department's School Health Services website for program updates, information for parents, and to download forms and other helpful materials.
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.
- 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.
- 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".
- 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.
How can I get the Dental Health Certificate form?
The form is available here ( 30 KB). You can also contact the local school district.
Acknowledgement: This Question and Answer document is based on a brochure developed by the California Dental Association.