School Dental Health Certificates Questions and Answers for Registered Dental Assistant

The form is  certificate form (30 KB). You can also contact the local school district.

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.
  1. 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.
  2. 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".
  3. 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.

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.

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.

We strongly encourage you to take the opportunity to volunteer to conduct screening sessions in a school.

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.

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.

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.