By Erik Skinner
State lawmakers are locked in a constant tug of war between responding to urgent challenges and using limited resources.
As policymakers search for ways to maximize finite funding, children’s dental screenings in schools can be a useful tool to leverage oral disease prevention into efforts to improve timely and cost-effective access to dental services and treatment.
Children’s dental screening laws ensure that schools provide students with oral health screenings from a dental provider. Similar to vision screenings and immunization requirements, children’s dental screenings can provide opportunities for referrals to necessary dental services so children are ready to learn and grow in school.
Of all chronic diseases facing children, early childhood caries, or cavities, are the most prevalent and preventable. Early childhood caries and other oral disease are responsible for lost school days and other outcomes that affect children’s ability to learn.
State legislators, school administrators, state health agencies, dental providers and other oral health stakeholders consider policies related to licensure, workforce, reimbursement, nutrition, dental insurance and school-based health centers that affect oral health access, in addition to school dental screening laws.
Dental screening laws may have a component that provides sealants if the screening indicates sealant application is necessary. Dental screening for young children in school is an opportunity for preventing, diagnosing and treating oral disease and also provides oral health education in a supportive setting.
Fourteen states and the District of Columbia have dental screening laws: California, Georgia, Illinois, Iowa, Kansas, Kentucky, Nebraska, New York, Oregon, Pennsylvania, Rhode Island, South Carolina, Utah and West Virginia—with South Carolina, Utah and West Virginia enacting laws in the last decade.
The scope and provisions of each law vary considerably across states. One important component of these laws is the decision to make the screenings mandatory or voluntary. Mandating compliance can be a delicate issue because the school district then requires the screening in order for the child to attend school. Each state evaluates compulsory or non-compulsory screening in its own way.
Many dental screening programs use the screening procedure as an opportunity to establish a child’s dental home or, in other words, where the child is a regular patient at a practice or clinic.
Evaluation of state dental screening laws points to mixed results in the laws’ ability to establish a dental home when screenings indicate referral to treatment is necessary. Screening laws do not, however, inherently provide a mechanism for connecting children with the appropriate care. While dental screening in schools does not guarantee better health outcomes, these screenings can reinforce good oral hygiene and link students with unmet oral health needs to providers, services or a more detailed assessment.
Children’s dental screening programs can also start outside the legislature. For example, Iowa’s Department of Public Health partnered with the Iowa Bureau of Oral and Health Delivery Systems to conduct an “open-mouth survey” of third graders in 72 Iowa public schools. The state dental director coordinated with the elementary schools to develop data on the oral health of Iowa’s children.
Another purpose was to evaluate the extent to which Iowa’s I-Smiles program was successful in administering dental sealants and securing a payment source for dental care. State lawmakers can identify similar screening and survey infrastructure and programs in their own state by speaking with their state dental director or boards of dentistry or dental hygiene.
Other state departments of health produce more general data that can guide lawmakers considering dental screening laws. Oral health experts and epidemiologists in Vermont’s Department of Health partnered with the Association of State and Territorial Dental Directors (ASTDD) to produce the report Keep Smiling Vermont: The Oral Health of Vermont's Children.
Interestingly, researchers used screenings to gather the data and screening was a theme throughout the report’s recommendations section to improve children’s oral health.
While states create, administer and collect data on their dental screening programs in many different ways, school dental screening programs provide a touchpoint for states as they work to prevent oral disease and connect children in need of services with the appropriate providers or resources.
Erik Skinner is a policy associate in NCSL's Health Program.