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School Dental Health Certificates

What Dental Professionals Need to Know About New York State School Dental Health Certificate Law

A law passed in 2007 and amended in 2013 requiring 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 dental practices, dentists and registered dental hygienists upon request that provide free or reduced cost dental assessments.

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 dental practices, dentists and registered dental hygienists is available upon request at the student's school to which students who need a comprehensive dental assessment 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 assessment?

The purpose of a dental assessment 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 registered 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 assessment within the last 12 months prior to the beginning of the school year in which the assessment and certificate is requested, the results of that assessment can be used to fill out the dental health certificate form. There is no need to conduct a separate assessment 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 their last assessment.

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 assessment 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" assessment. Many factors figure into a parent's decision to schedule the recommended assessment 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.

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.

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Oral Health Fact Sheet for Dental Professionals
Children with Attention Deficit Hyperactivity Disorder
Attention deficit hyperactivity disorder is a behavior disorder with developmentally
inappropriate inattention, impulsivity, and hyperactivity. (ICD 9 code 314.01)
Prevalence
• Reports are variable 2-18%; school based studies using DSM-IV criteria shows 11-16%; most commonly cited
range is 8-10%. ADHD is the most common neurobehavioral disorder of childhood.
• 4:1 boys.
• Diagnosed on the presence of observed behaviors in multiple settings.
Manifestations
Clinical
• Presentation is variable: inattentive, hyperactive, or inattentive/hyperactive types.
• Impulsivity, cognitive inflexibility, hyperactivity, short attention span, aggression, and difficulty with listening,
compliance, task completion, work accuracy, and socializing.
Oral
• Decreased attention span→ poor oral hygiene →potential for increased caries
• Bruxism
• High risk for dental/oral trauma
Other Potential Disorders/Concerns
• Oppositional defiant
• Obsessive-compulsive
• Anxiety
• Conduct
• Tic
• Mood (anxiety, depression, bipolar)
Management
Medication
• Prescribed based on symptoms for their intended purpose or used off label for associated conditions.
• Some children will go on medication “holidays” during times when they are not in school. Ask if the child has
taken medication, and avoid treatment during periods when child is off normal meds.
Hyperactivity
SYMPTOM      MEDICATION      SIDE     EFFECTS     
Generalized      Stimulants     (Ritalin,Adderall)      Xerostomia,     dysgeusia,     bruxism     
      Atomoxetine     (Strattera)           Xerostomia     
Repetitive     Behaviors      Antidepressants     (Wellbutrin,     Tofranil)      Xerostomia,     dysgeusia,     stomatitis,           
            gingivitis,     glossitis,     sialadenitis,                
            bruxism,     dysphagia,     discolored                
            tongue,     and     oral     edema     
Hyperactivity      Antihypertensive     (Clonidine,     Tenex)      Xerostomia,     dysphagia,     sialadenitis,                
            dysgeusia     Behavioral
Children with ADHD typically have significantly increased incidence in behavior management problems in the
dental office.
Guidance:
• Schedule appointments in the morning or at a time of day when child is least fatigued, most attentive, and best
able to remain seated in dental chair.
• Give short, clear instructions directly to child. Give only one instruction at a time.
• Use Tell-Show-Do approach when introducing new procedures.
• Tell child what is expected of him/her during the visit.
• Consider small rewards for appropriate behavior (stickers, etc). Positive reinforcement may be helpful in
obtaining compliance.
• Discuss appropriate behavioral interventions with parent. Determine if breaks are necessary during treatment.
• Consider use of nitrous oxide during treatment to manage behavior.
Dental Treatment and Prevention
• Monitor caries development, bruxism, and dental/oral trauma carefully.
Look for signs of physical abuse during the examination. Note findings in chart and report any suspected abuse to
Child Protective Services, as required by law. Abuse is more common in children with developmental disabilities and
often manifests in oral trauma.
Additional information: Special Needs Fact Sheets for Providers and Caregivers
References
• Bimstein, E., Wilson, J., Guelmann, M., Primosch, R. (200 Oral characteristics of children with attention-deficit
hyperactivity disorder. Special Care Dentistry, 28(3): 107-110
• Blomqvist, M., Holmberg, K., Fernell, E., Ek, U., Dahllof, G. (2006) Oral health, dental anxiety, and behavior
management problems in children with attention deficit hyperactivity disorder. European Journal of Oral
Sciences, 114(5): 385-390.
• Clinical practice guideline: diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder.
American Academy of Pediatrics. Pediatrics 2000; 105:1158-1170.
Additional Resources
• NIH Institute for Attention Deficit Hyperactivity Disorder
• Special Care: an Oral Health Professionals Guide to Serving Young Children with Special Health Care Needs
• Bright Futures Oral Health Pocket Guide
• American Academy of Pediatric Dentistry: 2011–2012 Definitions, Oral Health Policies and Clinical Guidelines
• MCH Resource Center
• ASTDD-Special Needs
• Block Oral Disease, MA
• NOHIC-NIDCR publications
• Free of charge CDE courses: MCH Oral Health CDE (4 CDE hours); NIDCR CDE (2 CDE hours)
Children with Attention Deficit Hyperactivity Disorder continued
DOH 160-027 March 2012
For persons with disab