Are Dental Screening Laws Working?

How effective are dental screening laws (DSLs) at addressing oral disease among children if obstacles limit their ability to connect children to dental care? The answer: not very successful. A lack of dental providers participating in Medicaid and failure to facilitate referrals for children who need follow-up care are some of the barriers preventing states’ successful implementation of these laws, according to a new Children’s Dental Health Project (CDHP) report.

Under DSLs, a child receives a dental screening prior to entering school from a provider who completes an evaluation form on the child’s oral health and submits the form to the school. The child should be connected to a dental provider if further treatment is needed.

The report, “State Dental Screening Laws for Examining the Trend and Impact,” identified several hurdles limiting DSLs from fulfilling their goals of improving the overall oral health of children and adolescents. CDHP researchers conducted interviews with 18 state dental and public health officials, and individuals with organizations focused on school-based health programs and children’s advocacy.

Factors hindering states from effectively implementing screening laws include states’ difficulty creating a mechanism to facilitate referrals for children who need follow-up care; states’ failure to use screening data to evaluate the impact of DSLs; the limited capacity of state oral health programs to coordinate or implement these laws; and inadequate numbers of dental providers participating in Medicaid.

“These findings tell us that simply requiring children to have a dental screening before entering school does not necessarily mean their oral health needs are met in the long term,” says Colin Reusch, MPA, director of policy at CDHP. “This report urges us all to look at better integrating systems so that coverage programs, school policies, and public health initiatives are all working together toward a common goal.”

When it comes to integrating screenings into a system of care, school officials and program administrators should ensure there are providers who are willing and ready to see children who need follow-up care, and that children’s health providers are provided with results of the dental screening.

Survey participants acknowledged the lack of dentists interested in serving as referral points, limiting the number of providers that school nurses and others could refer children who need follow-up treatment. Another barrier is a restriction placed on dentists who provide screenings, as they cannot refer children to their own practice. CDHP recommends dentists be willing to serve as dental homes or referral points for these children, and that states create systems for proper referrals and encourage providers to participate in Medicaid. Allowing medical providers to provide dental screenings was also suggested.

“State dental programs must have the mechanisms not only to have children screened, but also to connect children in need to dental homes. Dental homes become the permanent place where children can see dental providers for preventive services but also receive the restorative care they need to treat disease,” says Eleanor Fleming, PhD, DDS, MPH, author of the report, and Dental Public Health Resident at Boston University.

Meeting families where they already are, such as at health fairs or schools, or allowing dental therapists to provide dental screenings are potential avenues to increase access to care for children as transportation and coordination issues also impede access to care.

“Dental screening requirements shouldn’t be a burden on parents or school officials. So it’s important to look for the path of least resistance when it comes to the initial screening, and when connecting kids to care if problems are detected,” says Reusch.

If states have dental therapists, screening laws could be written to allow them to perform the screenings, which would integrate dental therapists as part of the dental team caring for those children, Fleming explains.

Currently, DSLs exist in the District of Columbia and 14 states that encourage school-age children to be screened for dental disease: California, Georgia, Illinois, Iowa, Kansas, Kentucky, Nebraska, New York, Oregon, Pennsylvania, Rhode Island, South Carolina, Utah, and West Virginia. These laws have also been proposed for Connecticut and Michigan.