Step 2: Program Setup &amp; Logistics

Identifying Schools to Conduct Screenings

Programs should select schools based on demonstrated need, as evidenced by high disease rates and/or unmet needs. Students from low socio-economic backgrounds experience a higher burden of untreated dental caries nearly twice as more when compared to children from higher socio-economic backgrounds. The students enrolled in the Free and Reduced-Price Meal (FRPM) program can be used as a proxy measure for the percentage of students living at or below the federal poverty level. A new tool from the California Department of Education called DataQuest summarizes student information, including those eligible for FRPMs, which can be used to easily identify and prioritize schools (see demo here). A routine practice to identify eligible students is to target schools with greater than 50 percent of students eligible for FRPM. In some instances, the county office of education or the local school board can assist in identifying the schools with high unmet dental needs. Any school located in a rural setting is likely to have children at high risk for dental disease and would be important to include.

Prioritizing Screenings Based on School Grade

Priority 1: Kindergarten dental screening

Early diagnosis and intervention are key to minimizing the negative impacts of dental disease. Kindergarten offers the earliest time in schools for detecting dental need if prior dental care has been under- or un-utilized. Kindergarten dental screening offers a window of opportunity for:

Timely identification of children in need of dental services.
Providing guidance to access the required care and establish a dental home.
Educating students and families about the importance of maintaining oral health.

There are current policies and initiatives that support kindergarten dental screenings, such as the Kindergarten Oral Health Assessment (KOHA) requirement. AB 1433 and SB 379 laws require all students enrolling for the first time in public schools to complete the KOHA. Here are some resources about KOHA:

Priority 2: Third-grade students

Third grade is considered the age of mixed dentition. This is a period when the children have some remaining primary teeth and several erupting permanent teeth. By this age, almost all students have their first set of four permanent molars erupted. During the period of mixed dentition, children are at a higher risk of dental decay as they may not clean their teeth efficiently around erupting teeth and loose baby teeth due to tender gums.

By third grade, the permanent first molars are sufficiently erupted and adequately accessible for sealant placement, making this another priority age group for conducting dental screenings. Dental sealants are resin-based protective coatings placed on the decay-prone chewing surface of molar teeth. Dental sealants are one of the most effective preventive measures in minimizing the incidence of dental decay.

Establishing a Referral Pathway

An essential step to setting up a school-linked dental program is to identify local dental providers and community dental clinics that can serve as the dental home for students. Program administrators must identify and directly communicate with the local dental providers in the community that will agree to receive students that are referred for continued dental care.

Referral providers

Tips for compiling a list of referral sources

Referral lists should include details such as the address, contact information, days of operation, as well as indicating the providers that accept Medi-Cal Dental. It can be helpful to organize providers by neighborhood when there are many options.
Don't forget to identify and enlist local providers offering specialty dental care, such as orthodontists, treatment under general anesthesia, and willingness to accept new patients.
Make sure you identify dental providers with the capacity to see students in need of urgent care or experiencing a dental emergency. These providers must be able to schedule urgent appointments within 24-48 hours. The urgent dental care proivder list can include private dental providers in the community willing to offer care to urgent dental needs of students but may not be able to offer a dental home.

Obtaining Parent/Guardian Consent

Obtaining consent from parents/guardians is an essential step prior to conducting a dental screening. You should work closely with the school administrators or staff to develop the consent process.

Passive consent process (opting out)

A passive consent process (opting out) can be employed for the purpose of a dental screening at a school site, and Senate Bill 379 allows schools to conduct KOHAs with passive consent. Parents/guardians of students who wish to opt out of the dental screening may do so by notifying the school in writing. Some schools obtain a general passive consent for screenings such as vision, dental, and hearing at the time of registration for the school year. The dental team must verify if consent was sought at the time of registration for the school year and pay careful attention to families that declined consent.

Active consent process (opting in)

Any additional dental services (besides screening) provided at a school site would require procedure-specific active consent (opting in) from parents/guardians.

For preventive services such as dental prophylaxis or sealant placement at a school site, it may be helpful to request the student’s health information to identify any history of rheumatic fever, rheumatic heart disease, heart murmurs, asthma, or allergies. This allows the provider to take the necessary steps to provide safe dental services.

You can increase the number of consenting parents by:

Educating parents on the benefits of dental services being offered.
Providing fact sheets on dental services.
Ensuring confidentiality.
Providing consent forms that utilize culturally and linguistically appropriate language.
Providing concise consent forms with clear instructions, including the specified due date.
Coordinating the timely collection of consent forms and allowing acceptance of late submission of consent forms.
Conducting outreach through community health workers and community partners at health fairs and events.

Scheduling

Successful screening events take into account the scheduling needs and priority of partnering schools, including school bell schedule, school holiday and event schedule, fire drills, exams, etc. The screening team should prepare a detailed screening schedule that minimally includes: (1) the date(s) of the screenings, (2) which grade(s) and classes and the order in which classes will be screened, and (3) an estimate of time allocated for screening per class based on the number of students with parent/guardian consent. The screening checklist in the resources linked below can be customized to your program.

Estimating time needed

Returned consent forms will provide an estimate of students and classrooms to be screened to plan the appropriate time allocation. Prior to finalizing the screening dates, the dental team member communicates with the appropriate school staff regarding the estimated days and time required for the screening to be conducted.

Plan to screen children in the earlier half of the school day prior to snack recesses or lunch recess and take into consideration planning for makeup screenings for students absent on screening days. On average, a visual dental screening is allocated 1 to 2 minutes per student. When allocating time, providers must consider the time needed for set up, clean up, and documentation. For example, the screening team can allocate about 40 minutes to screen a class of 20 students.

Resources

Dental Screening Checklist

Screening Opt Out Form (Passive)

Treatment Consent Form (Active)

California Oral Health Technical Assistance Center

Step 2: Program Setup & Logistics

Identifying Schools to Conduct Screenings

Prioritizing Screenings Based on School Grade

Establishing a Referral Pathway

Obtaining Parent/Guardian Consent

Scheduling

Resources

Toolkits

California Oral Health Technical Assistance Center

California Oral Health Technical Assistance Center

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Step 2: Program Setup & Logistics

Identifying Schools to Conduct Screenings

Prioritizing Screenings Based on School Grade

Establishing a Referral Pathway

Obtaining Parent/Guardian Consent

Scheduling

Resources

Toolkits

California Oral Health Technical Assistance Center