Kentucky School Advocate
July/August 2015
In Conversation With…features an interview between a leader or figure involved in public education and a representative of the Kentucky School Advocate.
Dr. Stephanie Mayfield, commissioner of the Kentucky Department for Public Health since October 2012, discusses the importance of state law [KRS 156.160(j)], which has required since 2011 proof that 5-year-olds or 6-year-olds have had a dental screening or examination by Jan. 1 of their first year of school.
She also outlines other initiatives aimed at improving the oral health of Kentucky schoolchildren.
Q: How long has this law been on the books?
A: Since the 2010-11 school year, a dental screening by a dentist, dental hygienist, physician, registered nurse, advanced practice registered nurse or physician assistant has been required by the Kentucky Board of Education for 5-year-olds and 6-year-olds.
Q: How are schools doing as far as getting the word out to parents about this requirement?
A: Based on the numbers we are seeing for the percent of children getting the screenings, it is trending upward. In 2010-2011, for children in public schools, we went from 39 percent to 52 percent of children receiving services in the 2013-14 school year. That is a direct indication that the word is getting out and that there are obviously outreach efforts there. We are seeing other evidence of favorable trends, such as the percent of districts that are participating. In 2010-11, we went from roughly 94 percent to roughly 98 percent in the 2013-2014 school year.
Also, the percentage of children having exams has gone up. Dentists perform exams. Dental exams went from 73 percent in 2010-2011 school year to 82 percent in 2013-14 school year so it is looking favorable.
Q: So there is a difference between screenings and exams? Only dentists give exams?
A: Yes, and the exams could be more extensive and incorporate the screening. Obviously, being a dentist, they don’t have to refer the patient. They can follow through with additional examinations and treatments as needed.
Q: What is the school’s role in disseminating information about the screenings?
A: There is a Kentucky dental screening examination form that is part of the regulation. The law says that for the 5- and 6-year-olds in public school, evidence shall be submitted by Jan. 1 of the year they are first enrolled in public schools showing that they have had the screening. The regulations promulgated to support that law state that with the dental exam, a form will be filled out indicating the dental screening and examination were done. The form has several parameters that the schools look at. We have a state dentist who looks at the percent of children receiving the services and we look at how many districts are participating.
Q: What should a school do if a child comes to school without proof of screening?
A: The Department of Education has the policy on that. We collaborate with them, but they have specifics on their policy and how they reach out to families and children.
(Editor’s note: For information on state health exams, dental screenings and immunization requirements visit: http://education.ky.gov/comm/newtoKY/Pages/Kentucky-Enrollment-Requirements.aspx
Local school boards also set policies related to required screenings and exams, including time frames for when they must be completed or updated.)
Q: The screenings can be done by a range of health professionals. Why is that important?
A: It increases access by providing a variety of providers who can screen. But there is a caveat. The screening can be done by the variety of providers that I listed earlier who have been trained. Our state dentist has been very active in making sure physicians, the dental hygienists, the nurses and others are trained. Many of our school nurses have been already trained.
Q: Can screenings be done at the same time as the physical exam that is also required for these children?
A: Yes.
Q: What happens if a screening shows there are problems?
A: The child is referred to a dentist.
Q: Do we know how many children are being referred?
A: Yes, we have some information on children who needed the referrals. This could be a little skewed, because as more dentists are seeing patients there are more likely fewer referrals unless they are going for specialized dental work. In 2010-11 we saw 5.4 percent of forms marked for referrals, in 2012-13 it went down to 3.6 percent, but again with the number of exams being done by dentists the referral mark may need some qualifications. We do know the percent of districts with less than 50 percent of children receiving the services, in other words, having a screening or exam, is decreasing, meaning more students are accessing the services.
Q: A new pilot program, funded through a grant from the Department of Public Health, has placed public health dental hygienists in five county and district health departments. These dental hygienists visit the public schools to provide assessments, cleanings, fluoride varnishes and dental sealants. Tell me a little more about this program.
A: The public health dental hygienists are going to be instrumental in advancing the dental health of our students. The program is in collaboration with Education as the hygienists go into the schools to perform their services. The health departments in the pilot right now have about a 21-county outreach. The program will be funded for five more health departments in the coming year.
In order to be one of the health departments selected, you must have a collaborative agreement with a dentist so that children can be referred to a dentist.
Q: The public health dental hygienist also helps ensure families follow through when their child is referred to a dentist?
A: Yes. The public health dental hygienist gives the student information for their parents about their results and recommendations for a follow-up. They are also trained to be navigators to help get the student to the dentist. The dental hygienists give parents the proper reminder and see if there is any impediment to getting the children to that dental appointment.
Q: Explain the connection between dental health and success in school.
A: If you are in pain, it is hard to study. If you want to increase the rate of school attendance, then being healthy enhances the school attendance rate. It’s the same if you want to increase graduation rates. Health is so important and we want to reduce barriers to learning. Among the goals of KRS.158.6451 is that schools shall reduce physical and mental barriers to learning. Certainly I would think that if there is an unrecognized or recognized dental problem and it has not been treated and cared for, that child is at risk for school attendance, for not being able to learn and for not being able to achieve.
Q: How has Medicaid expansion affected children’s dental care?
A: Since the Medicaid expansion in January 2014, we have seen an increase in pediatric dental visits. In 2013, we had 58.8 percent of pediatric dental visits and in 2014, we went to nearly 63 percent so we did see an uptick in pediatric dental visits among those who were insured by Medicaid. There were about 10,000 more pediatric dental visits in 2014 compared to 2013.
Q: Do we know the percentage of schoolchildren in Kentucky who have untreated dental decay?
A: In the Kentucky Health Now program, one target is to decrease untreated dental decay in children by 25 percent and we were working off a baseline of 35 percent of third-graders with untreated dental decay statewide in 2001.
Q: You have said that the statewide health initiative Kentucky Health Now (kyhealthnow.ky.gov), which involves multiple state agencies, is a good resource for educators and school leaders.
A: Kentucky Health Now includes seven health goals to be achieved by 2019. We recognized oral health as being an issue that strongly needs to be addressed in Kentucky. Reducing the percentage of children with untreated dental decay and in increasing adult dental visits, those are goals. And we have strategies wrapped around those goals.
Q: You cite the work on decreasing youth smoking rates as one of the collaborative successes between Education and Public Health.
A: We are one of the highest states in the nation in terms adult smoking and in the percent of youth smokers. However, we have made considerable gains with youth smoking. Currently we are at about 18 percent; nationwide, it is about 15.8 percent, so we are still above national average but we are down from 24 percent in 2011. And that was accomplished with Education and with Public Health. It is an indication of how effective we can be when we collaborate and address issues at our schools.
Q: How important is this continued collaboration?
A: Public Health needs to continue to have, and we want to have, a strong collaboration with Education. With us working together and with other partners, we want to keep oral health high on our list and ensure that we can eliminate the disparities we currently are seeing in terms of access to full dental services. With Education collaborating with Public Health, we can take full advantage of the Medicaid expansion and of children who have other insurances.