Considerations for school districts for dental services in the school setting

May 2011

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• Isthemobiledentalfacility,orportabledentalunit,registeredwiththeTexasStateBoardofDentalExaminers(SBDE)asrequiredbySBDERule§108.40?1

To check registration-http://www.tsbde.state.tx.us/index.php?option=com_content&task=view&id=123&Itemid=26

SBDE Rule §108.40 http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=5&ti=22&pt=5&ch=108&sch=D&rl=Y• Havealltreatingdentistsandalliedteammembers(dentalhygienistsanddentalassistants)presentedcopiesof

theirprofessionallicensesorrequiredcertification/registration?1

To verify licensing - http://www.tsbde.state.tx.us/index.php?option=com_content&task=section&id=6&Itemid=38• Arethelicensesandcertifications/registrationsvisiblypostedinthemobileunitorwherethedentalprofessionals

aretreatingthechildren?1 SBDE Rule §108.43 http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=5&ti=22&pt=5&ch=108&sch=D&rl=Y• Isthemobiledentalfacility,orportabledentalunit,displayingtheconsumerinformationsignasrequiredbythe

SBDE?1 SBDE Rule §108.3 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_

ploc=&pg=1&p_tac=&ti=22&pt=5&ch=108&rl=3• Haveallcontracteddentistspresentedcopiesofanyrequisiteanesthesia/sedationpermits?1

SBDE Rule Chapter 110 Sedation and Anesthesia http://www.tsbde.state.tx.us/index.php?option=com_content&task=view&id=107&Itemid=113• Haveallalliedteammemberspresentedcopiesofanyrequisiteexpandeddutycertificates?Certificatesmay

includethoserequiredfortakingx-rays,placingpitandfissuresealants,nitrousoxidemonitoring,andcoronalpolishing.1

SBDE Rules §114.2, §114.3, §114.4, §114.5, §115.2 http://www.tsbde.state.tx.us/index.php?option=com_content&task=view&id=107&Itemid=113

Considerations for school districts for dental services in the school settingTheseconsiderationsarebasedonrequestsbylocalschooldistrictsseekingguidancefromtheChildren’sOralHealthCoalition(COHC)torespondtomobiledentalcompanies,offeringtoprovidedentalservicestothechildrenintheirdistricts.TheseconsiderationsareofferedbyCOHCinthespiritoffulfillingitsmissiontoimprovetheoralhealthofchildreninourcommunity.

Eachdistrictcanusetheseconsiderationsindevelopingtheir ownprocessforresponding.Thisis notanallinclusivelist.TheChildren’sOralHealthCoalitionisnotaregulatoryorlicensingorganizationandthoseprofessionalorganizationsindentistryareimportantresourcesfortheschooldistricts.The considerations listed below are intended as suggestions and do not constitute professional advice nor should it replace your professional judgment. As always, the COHC strongly encourages you to follow your district’s policies and seek legal guidance from your district’s attorney regarding any agreement. The links presented in this document are up to date as of May 2011.Pleasemakesureyouareviewingthemostcurrentversionofthelaw.

Documentation considerations

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• Dothecontracteddentistsandalliedteammembershaveanydisciplinaryactionsagainstthem?1 For Disciplinary Action Information - http://www.tsbde.state.tx.us/index.php?option=com_content&task=section&id=6&Itemid=38• Isthemobiledentalfacility,orportabledentalunit,complyingwithallaspectsoftheHealthInsurancePortability

andAccountabilityAct(HIPAA)of1996(P.L.104-191)[HIPAA]?2 P.L.104-191http://aspe.hhs.gov/admnsimp/pl104191.htm• Hasthemobile/portableunitinformedtheschoolordistrictinwritingaboutthelimitationsofservicestheyintend

toprovide?• Hasthemobile/portableunitgiventheschoolordistrictwrittenproofofaprotocolforreferralincludingan

agreementwithlocaldentiststoprovidefollow-upandemergencycare?• Doesthemobile/portableunithaveaformalprocessfordatagatheringandrecordkeeping?• Arealloftheappropriateinformedconsentformspresentedtoandsignedbyparentspriortotreatingthe

children?Examplesofnecessaryconsentformsinclude–HIPAA,Consentfortreatment,Consentforspecificrestorativetreatment,ConsentforNitrousOxidetobeused,etc

• Istherea24houremergencycontactphonenumberprovidedbythemobile/portableunitfordentalemergencies?1

SBDE Rule §108.5 http://www.tsbde.state.tx.us/index.php?option=com_content&task=view&id=107&Itemid=113• Willthemobile/portableunitprovidetheschoolordistrictwiththedirectcontactnumberforthedentistwhoowns

thecompany?1 OnlyaTexaslicenseddentistmaylegallyownadentalpracticeinTexas.Thisincludesmobile/portableunits. Texas Occupations Code §251.003 http://www.tsbde.state.tx.us/index.php?option=com_content&task=view&id=108&Itemid=109• Whereistheofficeofrecordforthecompanyoperatingthemobile/dentalunit?1 SBDE Rule §108.43 http://www.tsbde.state.tx.us/index.php?option=com_content&task=view&id=107&Itemid=113• Istheschoolordistrict,andthecompanyoperatingthemobile/portableunit,awareoftheParental

AccompanimentrequirementforbillingMedicaid?3 HRC §§32.024(s)-(s-1) DSHS Rule §33.6 http://www.tmhp.com/HTMLmanuals/TMPPM/2010/2010TMPPM-23-06.html• Haveallemployeesofthecompanyowningthemobile/portableunit,whowillhavedirectcontactwiththe

childrencoveredunderthecontract/memorandaofunderstanding,undergonecriminalhistorychecksasrequiredbyTexasEducationCode§8.057?4

Texas Education Code §8.057 http://www.tea.state.tx.us/index2.aspx?id=5535&menu_id=840&menu_id2=79• Willtherebelanguagetranslationservicesprovidedbythedentalcompanyoperatingthemobile/portableunit?• Whatisrequiredfromtheschoolwhenamobiledentalcompanyispresent?• Whatistheschoolordistrict’sprofessionalliabilityinsurancerequirement?• Doesthedentalcompanyoperatingthemobile/portableunitintendtocomplywiththerequirementsgoverning

dentalx-rays?1 SBDE Rule §113.2 http://www.tsbde.state.tx.us/index.php?option=com_content&task=view&id=107&Itemid=113 Texas Administrative Code §289.232 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_

ploc=&pg=1&p_tac=&ti=25&pt=1&ch=289&rl=232• Arethechildrenidentifiedwithanappropriatenametagoncetheyareinthemobileunittokeepthepatientand

theirrecordsidentifiedandtogether?• Howmuchtime(approximately)willachildbeoutofclasswhenbeingseenbythemobiledentalcompany?

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Scope of care considerations• Whattypeofserviceswillthemobiledentalcompanybeproviding? - PreventiveServicesOnly–(i.e.screenings,exams,cleanings,sealants,fluoride,etc.) - PreventiveServicesandRestorativeServices(dentaltreatmentincluding,butnotlimitedto,fillings,rootcanals,

crowns,toothremoval,etc.)• Thereisadifferencebetweenascreeningandanexam.TherearealsorulessetbytheStateBoardofDentistry

regardingwhichdentalprovidersareallowedtodoscreeningsandexams.(seeattachedglossary) - Willthecompanybeprovidingscreeningsorexamsonthechildren? - Whowillbedoingthescreenings? - Whowillbedoingtheexams? - Whenwillradiographs(x-rays)betaken?• Ifrestorativeworkisbeingdonebythemobiledentalcompany,willtheparent/guardianbeallowedorrequiredtobe

presentforthetreatment?• Beforeanyrestorativeworkisdoneonthechild,willtheparentbegivenaninformedconsentwiththeirsignaturefor

consentpriortoanytreatmentbeingdoneonthechild?• Ifthemobiledentalcompanyprovidesrestorativeservices,wherewilltheybedone?(inthemobileunitattheschool

oratanoff-sitelocation?)• Howsoonwilltherestorativeservicesbedone?• Whatprocessorpolicydoesthemobilecompanyhaveforpatientstabilization,suchas

“papoosing”?DoesitmeettheAmericanAcademyofPediatricDentistryguidelines?5http://www.aapd.org/media/Policies_Guidelines/G_BehavGuide.pdf

Considerations for who will be seen• Whoisthetargetpopulationofthemobiledentalcompany? - Allchildren,eventhosewhoalreadyhaveanestablisheddentalhome(seetheattachedglossaryforthedefinitionof

adentalhome) - Childrenwhodonothaveanestablisheddentalhomeordentistofrecord? - ChildrenwhoonlyhaveMedicaid/CHIPcoverage? - ChildrenwhodonothaveMedicaid/CHIP,otherdentalinsurancecoverage,orpresentwithotherbarrierstoaccess

ofdentalcare?• Withthechildrenwhowillbeseenbythemobiledentalcompany,willallofthembeofferedandpresentedthesame

levelofcareandservicesdependingontheirindividualneedandnottheirMedicaidorinsurancestatus?• IfthemobiledentalcompanyadvertisesscholarshipsorgrantsforservicesrenderedonchildrenwithoutMedicaidor

CHIPcoverage, - Howmanystudentswillbeabletoreceivethesescholarships? - Whatlevelofcarewillthechildrenwithscholarshipsreceive? - Whatistheamountofthescholarshipcomparedtotheneededservices?• Willnon-studentsoradults,suchassiblingsorfamilymembersoftheschoolchildrenbeabletobeseenbythemobile

dentalcompany?

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Referral information considerationsFor those mobile dental companies who provide preventive services only, the following considerations may apply.

• Whoisthemobiledentalcompanygoingtoreferthechildrento,whowereidentifiedasneedingtohaverestorativetreatmentdone?5http://www.aapd.org/media/Policies_Guidelines/P_Ethic.pdf

• Doesthemobiledentalcompanyhaveawrittenandsignedagreementwiththedentisttowhomtheyaregoingtoreferthechildren?

• Doesthemobiledentalcompanyhaveawrittenandsignedagreementwithatleasttwoseparatepediatricdentistsandoralsurgeonstoreferthosechildrenwhomayneedmoreextensivetreatmentduetotheiridentifieddentaldisease?

• DothereferralsourcesacceptMedicaidandCHIP?• Aretheofficesofthereferralsourceswithinareasonabledistanceforthefamilytoaccessservices?• Howaretheparentsnotifiedwhentheirchildneedsdentaltreatmentotherthanwhatthemobiledental

companyprovided?• Willtheparentsofthechildrenidentifiedasneedingemergencydentaltreatment,bemadeawarethattheir

childrenneedtobeseenassoonaspossiblebyadentist?• Willtherebeassistanceprovidedbythemobiledentalcompanytohelpparentsmakeanappointmentwiththe

referraldentistwhenthechildrenneedimmediatedentaltreatment?

Reporting/record keeping considerations• Istheschoolgivenareportcardfromthemobiledentalcompanystatinghowmanyprocedureswere

performedattheirschool?(i.e.howmanyscreeningsweredone,howmanysealantsweredone,howmanychildrenwerereferredtohaverestorativetreatmentdone,etc?)

• Willtherebealistofnamesprovidedtotheschoolregardingthosechildrenwhoareidentifiedwithpresentdentaldiseaseandneedtobeseenbythereferreddentist?

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Glossary and other resourcesThe terms and resources provided are not an end all list of those terms used in the practice of dentistry, however they may be of assistance to you.

For further resources on dentistry and/or children’s dental health, please visit:

• TheAmericanAcademyofPediatricDentistry–www.aapd.org• TheAmericanDentalAssociation–www.ada.org• TheAmericanDentalHygienists’Association–www.adha.org• NationalMaternalandChildOralHealthResourceCenter-http://www.mchoralhealth.org/• TheAmericanAcademyofPediatrics-http://www.aap.org/healthtopics/oralhealth.cfm• TheTexasDentalAssociation-www.tda.org

Amalgam–Adentalfillingmaterialmadeofalloy.6

Bitewing-Atypeofdentalx-ray.

Calculus–Harddepositofmineralizedsubstance(hardenedplaque)thatstickstotheteethandhastoberemovedwithaprofessionalcleaning.Commonlyknownastartar.7

Caries–Commonlyusedtermfortoothdecay.6

Cavity–Missingtoothstructuremostcommonlycausedbytoothdecay.6

Composite–Adentalfillingmaterialmadeupofresinparticles.6

Deciduous teeth–Commonlyknownasprimaryorbabyteeth.

Dental Assistant-Dentalassistantsmustworkcloselywith,andunderthesupervisionof,dentists.Dentalassistantsmayperformavarietyofpatientcare,office,andlaboratoryduties.Theysterilizeanddisinfectinstrumentsandequipment,prepareandlayouttheinstrumentsandmaterialsrequiredtotreateachpatient,andobtainandupdatepatients’dentalrecords.Assistantsmakepatientscomfortableinthedentalchairandpreparethemfortreatment.Duringdentalprocedures,assistantsworkalongsidethedentisttoprovideassistance.Theyhandinstrumentsandmaterialstodentistsandkeeppatients’mouthsdryandclearbyusingsuctionhosesorotherdevices.Theyalsoinstructpatientsonpostoperativeandgeneraloralhealthcare.Dentalassistantsmaybetrainedonthejoborattendtrainingcoursesinprogramsthatmaylastanywherefrom4monthsto2years.7

Dental Home-Thedentalhomeistheongoingrelationshipbetweenthedentistandthepatient,allaspectsoforalhealthcaredeliv¬eredinacomprehensive,continuouslyaccessible,coordinated,andfamily-centeredway.Establishmentofadentalhomebeginsnolaterthan12monthsofageandincludesreferraltodentalspecialistswhenappropriate.5

Dental Hygienist –Dentalhygienistsremovesoftandharddepositsfromteeth,teachpatientshowtoperformgoodoralhygiene,andprovideotherpreventivedentalcare.Theyexaminepatients’teethandgums,recordingthepresenceofdiseasesorabnormalities.DentalHygienistsaregraduatesofaccrediteddentalhygieneprogramsincollegesanduniversitiesandmustpassawrittennationalboardandclinicalboardtoobtainlicensureineachstate.7

Exam–Athoroughevaluationoftheteethandsoftstructuresinthemouth(suchasgums,cheeks,andtongue).Usedtoexaminetheteethforsignsoftoothdecay.Typicallyincludesx-raystohelpdiagnosetoothdecayorotherdentalrelatedissue.Maybeperformedbyadentist.Maybeperformedbyadentalhygienist,ifadentistispresentandmakesthefinaldiagnosisandconfirmationofthetreatmentthatisneeded.Maynotbeperformedbyadentalassistant.1,6

Fluoride–Substancethatmaybeappliedtotheteethinaprofessionalstrengthintheformofgel,varnish,foam,orliquid.

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Gingiva–Gums

Gingivitis–Inflammationofthegums

Informed Consent-Informedconsentistheprocessofprovidingthepatientor,inthecaseofaminororincompetentadult,thecustodialparentorlegalguardianwithrelevantinformationregardingdiagnosisandtreatmentneedssothataneducateddecisionregardingtreatmentcanbemadebythepatientorcustodialparent/legalguardian.5

Mobile Dental Facility-Anyself-containedfacilityinwhichdentistrywillbepracticedwhichmaybemoved,towed,ortransportedfromonelocationtoanother.1

Pediatric Dentist–Adentalspecialist,whosepracticeislimitedtotreatmentofchildrenfrombirththroughadolescence,providingcomprehensiveoralhealthcare.6

Plaque–Soft,stickysubstancethataccumulatesonteethcomposedmostlyofbacteria.6

Prophylaxis–Aprofessionalcleaningoftheteeth,removingplaqueandhardenedbacteriaknownascalculus(tartar).6

Pulpotomy–Arootcanalprocureonaprimary(baby)tooth.

Radiographs–X-rays

Portable Dental Unit–Anynon-facilityinwhichdentalequipment,utilizedinthepracticeofdentistry,istransportedtoandutilizedonatemporarybasisatanout-of-officelocationincluding,butnotlimitedto,patients’homes,schools,nursinghomes,orotherinstitutions.6

School Health Clinic–Aschoolbasedhealthclinicthatprovidesdifferenttypesofhealthservicestothechildrenwithintheschool.

Screening-Aquicklookinsidethemouthtodetectobvioussignsoftoothdecay.Itiscustomarilyafreeserviceandnotaprocedurethatischargedtothepatient.

References1 TexasStateBoardofDentalExaminers2HealthInsurancePortabilityandAccountabilityActof19963TexasMedicaidandHealthCarePartnership4TexasEducationAgency5AmerianAcademyofPediatricDentistry6AmericanDentalAssociation,Current Dental Terminology,2009-20107UnitedStatesDepartmentofLabor,BureauofLaborStatistics

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DaleEdmiaston,LMFT,LCSW,LCDC,Director,FamilyandCommunityResources,FortWorthISD

TonyaFuqua,DDS,SaveaSmileManager,CookChildren’sBeckiHale,RDH,MA,Children’sOralHealthCoalitionCoordinator,CookChildren’sAprilHarris,ExecutiveDirectorofDentalHealthArlingtonGinnyHickman,LMSW-AP,AVP,CommunityHealthOutreach,CookChildren’sJackMorrow,DDS,PediatricDentist,ChairoftheChildren’sOralHealthCoalition

CindyO’Neal,RDH,MS,TarrantCountyCollegeDentalHygieneProgramDirectorCindyParsons,BSN,RN,SchoolNurseAdministrator,KellerISDKashaPerkins,InterimExecutiveDirector,MasonicChildren&FamilyServicesofTexasAliceTurner-Jackson,RN,BSN,MS,SchoolNurseAdministrator,FortWorth,ISDAmandaStallings,ExecutiveDirector,GillChildren’sServicesMaureenWeber,DDS,DepartmentofStateHealthServices

MissionToimprovetheoralhealthofchildreninTarrantCountythroughcommunitycollaboration.

VisionAllchildreninTarrantCounty,withafocusonchildrenagesbirththroughthirdgrade,willreceivepreventivedentaleducationandpreventivetreatment,emphasizinggoodoralhygiene.ChildreninTitle1schoolswithseveredentalproblemswillreceivedentalcareandcomprehensivepreventivedentaleducation.

Who we areTheChildren’sOralHealthCoalition(COHC),ledbyCookChildren’sCommunityHealthOutreachDepartment,seekstoimprovetheoralhealthofchildreninTarrantCountywithakeyfocusonunderservedchildren.Thecoali-tionisadiverse,county-widecollaborationmadeupofmorethan30organizationsandmeetsbi-monthly.TheCOHCfollowsastrate-gicplantoguidetheirworkinthecommunity.Thisplanhasbeenupdatedfivetimessince1999.TheCOHChastwosubcommitteestocarryouttheworkofthestrategicplan:

• TheCommunityAwarenessSubcommittee• TheLegislativeAdvocacySubcommittee

AbramDentalAetnaBetterHealthAllSmilesDentalCenterTheAllianceoftheFortWorth

DistrictDentalSocietyArlingtonISDChildCareAssociatesCityofFortWorthCommunitiesinSchoolsCookChildren’sHealthCare

SystemCookChildren’sHealthPlanCookChildren’sMedical

CenterCookChildren’sPhysician

NetworkCrowleyISDDentalHealthArlingtonEarlyHeadStartECIofNorthCentralTexasFortWorthDistrictDental

SocietyFortWorthISDGillChildren’sServices,Inc.

GreaterFortWorthDentalHygienists’Society

JPSHealthNetworkMasonicChildrenandFamily

ServicesofTexasMaximus,Inc.(TexasHealth

Steps)MissionArlington/Mission

Metroplex/AllanSaxeDentalClinic

RodeoDental&OrthodonticsSouthTexasDentalTarrantCountyCollegeDental

HygieneProgramTarrantCountyPublicHealth

DepartmentTexasWoman’sUniversity

DentalHygienceProgramUnitedCommunityCenters,

Inc.UnitedWayofTarrantCountyYMCASoutheastConsultingOrganizations/

Individuals:LocalDentistsResourceAgency:Department

ofStateHealthServices

Ad hoc committee members:

Children’s Oral Health Coalition Children’s Oral Health Coalition members:

*MembershipdoesnotconstituteendorsementbytheChildren’sOralHealthCoalitionorCookChildren’s.