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  Home  About Us State Unit Leadership Membership Information Latest News Calendar of Events Links CSPD Foundation Advocacy, Legislation and Regulatory Matters Find a Pediatric Dentist Members Only Online Continuing Education Professional Opportunities Contact Us of the American Academy of Pediatric Dentistry  |
 
CSPD Provides School Absence Information and AssistanceDentists, and pediatric dentists in particular, are often challenged by parents anxious to avoid school absence, even when that absence is for the purpose of health care delivery. Although most practitioners establish scheduling policies and protocols intended to minimize pupil absence in a manner consistent with the patient’s age, the nature of the service provided, and fairness to all families in the practice, many are still confronted with school policies that seem or profess to prohibit absence from school for the delivery of dental care during school hours. As pediatric dentists, we recognize the importance of regular school attendance and the effect on education of chronic absence. We also recognize the negative financial implications to the school from the state when daily attendance is reduced. For these reasons, we have long urged our members to work with parents and with schools to minimize attendance disruption for oral health services ----- and better oral health through regular preventive care visits is one strategy for accomplishing this goal. It is not realistic, however, to expect that all pediatric and adolescent oral health care services can be delivered outside of school hours. In fact, state law [California Education Code §48205(a)(3)] specifically provides that "a pupil shall be excused from school when the absence is for the purpose of having medical, dental, optometrical, or chiropractic services rendered." In an effort to provide clarity on this issue to dentists, parents, and school educators, the California Society of Pediatric Dentistry has joined with the California Dental Association to provide a downloadable Message to Parents and School Administrators Regarding School Absence for Dental Appointments. This one-page information sheet, which contains Oral Health Facts for Children, may be downloaded from the CSPD and CDA websites for printing and distribution by dentists and their staffs. In addition, CSPD has developed a template for a School Attendance Release Form which may be downloaded from the CSPD website and customized by members for individual office printing and distribution (This is a MS Word doc file). The form contains reference to §48205(a)(3) of the Education Code.
California Legislature 2009-10
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| AB 1524 (Hayashi) | Dental Licensure by Hybrid Portfolio Pathway - This bill would replace the clinical dental licensure examination administered by the Dental Board of California with an assessment process during enrollment at an in-state dental school. The Hybrid Portfolio Pathway (HPP) would utilize uniform standards of minimal clinical experiences and require a final assessment of the submitted portfolio at the end of the school program. |
| CSPD Position: | Watch |
| Comment: | Other current paths to dental licensure would remain available, including passage of the Western Regional Examination (WREB). Although treatment of the primary dentition or treatment of the minor dental patient are not delineated in the proposed statute as one of the seven portfolio areas or six core competency requirements, the Board has indicated that inclusion of certain pediatric dental procedures will be included in regulations being developed to implement the licensure by hybrid portfolio pathway. |
| AB 1783 (Hayashi) | Denti-Cal: Change of Location Form - This bill would allow a dentist enrolled as a Denti-Cal provider changing practice location within the same county to continue enrollment by the filing of a change of a change of address form with the Department of Health Care Services. |
| CSPD Position: | Under Consideration |
| Comment: | Existing law requires a dentist to file a new enrollment application for a change of address, a process that can take the better part of a year for approval. This change would allow uninterrupted practice, continuum of care to Dent-Cal patients, and conform to a similar provision already in place for physicians. |
| AB 2035 (Coto) | Self-Funded Dental Plans: Disclosure of ERISA Information - This bill would require that claimants of a self-funded dental plan be informed in explanation of benefits statements and other materials that the plan is subject to compliance with the federal Employee Retirement Income Security Act (ERISA) and not subject to state law governing health care coverage for dental plans. |
| CSPD Position: | Under Consideration |
| Comment: | This bill is identical to AB 745 (Coto), introduced in the last legislative session, which was vetoed by the Governor as "unnecessary". It enjoyed broad support in both houses of the legislature. Like AB 745, AB 2035 is sponsored by CDA. |
| SB 294 (Negrete) | Healing Arts Boards: Enforcement Provisions - Makes significant revisions to the enforcement programs of the 18 Healing Arts Boards under the jurisdiction of the Department of Consumer Affairs, including the Dental Board of California and the Dental Hygiene Committee of California. |
| CSPD Position: | Under Consideration |
| Comment: | The bill contains 50 provisions, of which about half would impact enforcement activities of the Dental Board of California. The most significant provisions would prohibit certain types of gag clauses in civil settlements, expand authority of the Board's Executive Officer to adopt default decisions and settlement agreements, permit increased accesses to documents and medical records for disciplinary actions and impose greater penalties if they are not provided, automatically suspend the license of incarcerated licensees, provide mandatory license revocation for sexual misconduct or for the status of being a sex offender, require more comprehensive reporting of convictions and criminal charges, and require suspension of the license of a licensee failing a diversion program. Some of these provisions are already essentially in place within the Dental Board of California. This bill will likely be superseded by SB 1111, introduced in the second session. |
| SB 1111 (Negrete) | Healing Arts Boards: Enforcement Provisions - The bill contains 37 provisions to facilitate the investigation of consumer complaints and the prosecution of licensees by the 18 Healing Arts Boards under the jurisdiction of the Department of Consumer Affairs. |
| CSPD Position: | Under Consideration |
| Comment: | This bill represents a monumental change to the enforcement capabilities of the Dental Board of California and the 17 other Healing Arts Boards, expanding on the provisions of SB 294. It was introduced as part of the Department of Consumer Affairs' Consumer Protection Enforcement Initiative to reform and streamline the enforcement process of the Healing Arts Boards it oversees and reduce by half the average time of investigation and prosecution of accused licensees. While the intent is in the public interest, there is concern, at the same time, to maintain fairness and due legal process for licensees. CSPD will likely take no position on this bill until its provisions are thoroughly evaluated by CDA, a process undertaken by legal counsel. |
| Past CA Dental Board Reports |
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August 2006
November 2006 February 2007 August 2007 November 2007 January 2008 March 2008 May 2008 August 2008 April 2009 July 2009 November 2009 February 2010 |
The Dental Board of California met February 25-26, 2010, in San Diego. The following summarizes actions and issues coming before the Board pertinent to pediatric oral health
Return to Top8-Hour Infection Control Course Requirement for Unlicensed Dental Assistants
AB 2637 (2008), which became operational January 1, 2010, redefined the dental assisting regulatory structure. This bill created the Orthodontic Assistant Permit, the Dental Sedation Assistant Permit and modified the scope of practice of the Registered Dental Assistant, Registered Dental Assistant in Extended Functions, and unlicensed dental assistant. Included in the provisions of this legislation is the requirement that beginning in 2010, dentist employers will be responsible for ensuring that unlicensed dental assistants complete, within one year of employment, one time only, a 2-hour course on the California Dental Practice Act (CDPA) and an 8-hour infection control course. Dentists will also be responsible for ensuring that unlicensed dental assistants in their employ obtain and maintain certification in basic life support (BLS).While the CDPA and BLS requirements can be met with existing courses, the 8-hour infection control course requires completion of a newly designed, Board-approved course specifically for unlicensed dental assistants. This course must contain a four-hour didactic component (which may be provided by electronic transmission) and a live, in-person two-hour pre-clinical and two-hour clinical component with no greater than six students per instructor which cannot be given by electronic transmission or distance learning.
The issue before the Board concerned whether this requirement was intended to apply to all unlicensed dental assistants or only those hired after January 1, 2010. The statute was ambiguous on this point. An opinion by the California Legislative Counsel, a nonpartisan public agency that drafts legislative proposals, prepares legal opinions, and provides other legal services to the Legislature, at the request of the bill's author, Mike Eng, concluded that the Dental Board could reasonably accept either interpretation. Further, it was the opinion of the Legislative Counsel that the courts would uphold either decision of the Board. With this information, the Board voted that the requirement that an unlicensed dental assistant must complete the 8-hour infection control course applies only to those individuals first hired by his or her current employer after January 1, 2010. The Board further decided that any unlicensed dental assistant who could produce evidence of satisfactorily completion of Board-approved Registered Dental Assistant training would be deemed to having met the requirement.
Comment: The action of the Board removes a formidable obstacle to continued employment for many of the estimated 40,000 to 50,000 unlicensed dental assistants currently working in California. Two situations, however, should be noted:
- If a dental assistant working for his or her current employer prior to January 1, 2010, leaves that employment, it becomes the responsibility the next employer to ensure that the requirement is met.
- If an employer changes employment entity (e.g. a sole proprietor becomes a corporation or a partnership or the practice is sold to a new practice owner), then the unlicensed dental assistant working under the January 1, 2010 prior-employment exclusion must now meet the requirement.
Additionally, it should be noted that the decision of the Board relates only to the infection control course. The employing dentist is still responsible for ensuring that all unlicensed dental assistants, regardless of their first date of employment, meet the requirements of completing the California Dental Practice Act two-hour course and of obtaining and maintaining certification in Basic Life Support.
Consumer Protection Enforcement Initiative (CPEI) of the Department of Consumer Affairs
The Department of Consumer Affairs (DCA) has initiated a series of reforms, termed the Consumer Protection Enforcement Initiative, to reform and streamline the enforcement process of the 18 healing arts boards it oversees. The program is intended to enable healing arts boards to more efficiently investigate consumer complaints and prosecute licensees under their jurisdictions. The goal is to reduce by half (from an average of 36 months to between 12 and 18 months) the conclusion of time needed for investigation and prosecution of accused licensees. The CPEI targets three areas:
- Administrative Reform: New performance measures and revised internal operations of the healing arts boards' Enforcement Divisions will be designed to streamline procedures, target problem investigations, and improve probation monitoring.
- Increase in Enforcement Resources: The Dental Board of California's Enforcement Division will grow by approximately 20%. Reforms include the hiring on non-sworn investigators and increasing the number of dental consultants, especially dental specialists, to review cases.
- Pursuit of Legislation: The DCA is sponsoring legislation, SB 1111 (Negrette McLeod), that would expand the powers of the healing arts boards and provide increased regulatory tools and authorities to more efficiently investigate and prosecute suspected violations of law by healing arts practitioners.
Comment: This bill represents a monumental change to the enforcement capabilities of the Dental Board of California and the 17 other Healing Arts Boards under the jurisdiction of the DCA. While the intent is in the public interest, there is concern, at the same time, to maintain fairness and due legal process for licensees accused of violations of the Dental Practice Act or other authority. The 37 separate provisions of the bill as introduced will need to undergo rigorous legal analysis and evaluation before CSPD can determine a position on this proposed legislation.
DBC Complaint and Compliance Unit Cite and Fine Authority
In an effort to streamline enforcement investigations, effective February 1, 2010, the Board's Complaint and Compliance Unit began citing and fining licensees who fail or refuse to comply with the Board's request for dental records. In the past, it was the Board's practice to send three letters, the last by certified mail, when records were requested. Beginning February 1, it is now the Board's practice to send a single certified letter to both subject dentists and to subsequent or previous providers. If, after 45, days the records are not received and the dentist has not been granted an extension or waiver from the Board, he or she will receive a second certified letter demanding the records accompanied by a citation and $5,000 fine. The Board's website now contains the following policy announcement:
Effective February 1, 2010, the Dental Board of California (Board) will be
uniformly citing and fining licensees who fail or refuse to comply with the
Board's request for dental records.Business and Professions Code Section 1684.1. (a) (1) states:
A licensee who fails or refuses to comply with a request for the dental records of a patient, that is accompanied by that patient's written authorization for release of record to the board, within 15 days of receiving the request and authorization, shall pay to the board a civil penalty of two hundred fifty dollars ($250) per day for each day that the documents have not been produced after the 15th day, up to a maximum of five thousand dollars ($5,000) unless the licensee is unable to provide the documents within this time period for good cause.Comment: The Board will entertain an informal appeal process of the fine if the records are produced and an appeal requested within 30 days. The appeal will be heard by the Board's Executive Officer. Continued failure to produce the requested records without adequate explanation will result in initiation of disciplinary proceedings.
Retroactive Fingerprinting Regulations
Currently the Dental Board of California along with other boards and bureaus of the Department of Consumer Affairs requires license applicants to provide electronic fingerprint records for a criminal background check prior to issuance of the license. Although required since1986, this licensure prerequisite was not retroactive. Dental licensees, therefore, who obtained licenses prior to that date have no electronic fingerprint record. As a result the Board has no criminal history or subsequent arrest records for any dentist licensed prior to 1986 or for any Registered Dental Assistants prior to 1999.To correct this situation, the Board approved regulatory language to amend the California Code of Regulations to require the submission of electronic fingerprint records to the Department of Justice as a condition of license renewal for any licensee without such records on file. The licensee will pay the costs of furnishing the fingerprints and the Department of Justice search, estimated at $50 to $60.
As another condition of license renewal, the licensee will be required to self-disclose whether, in the prior renewal cycle, he or she has been convicted of any violation of law in California or any other state or country, omitting traffic infractions under $1,000.00 so long as the infraction does not involve alcohol, dangerous drugs, or controlled substances.
Comment: The proposed regulatory language is still subject to a 15-day comment period and approval of what is known as the "rulemaking file" by the Office of Administrative Law before it becomes effective. It is anticipated that implementation will begin with December 2010 renewals.
The California Society of Pediatric Dentistry in collaboration with the California Dental Association has produced an advocacy binder dramatically illustrating The Consequences of Untreated Dental Disease in Children.
Designed for supporting CDA and CSPD efforts in promoting legislation and public policy which improve children’s oral health, the binder contains introductory information on the progressive and largely preventable nature of dental disease, full color illustrations of untreated pediatric dental conditions, and a Children’s Oral Health Fact Sheet
The binder is available for viewing and for downloading by CSPD members. (PDF Document, 1.2 MB)
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Groundbreaking legislation effective January 1, 2007 requires children entering public school for the first time in either kindergarten or first grade to present proof by May 31 of the school year of having obtained an oral health assessment. That assessment may be completed during the first year of school or any time in the 12 months prior to school enrollment.
CSPD, working with the California Dental Association, has long sought such regulation as a means of identifying children in need of oral health services and promoting the importance of oral health as an integral component of school readiness and ability to learn.
Dentists should be aware of the following provisions of the bill:
It is important for dentists to understand the difference between a dental examination, which can be performed only by a licensed dentist, and an oral health assessment, which can be performed by a range of licensed dental professionals. An oral health assessment identifies obvious or suspected oral health conditions that require, or might require, examination by a dentist. A dental examination diagnoses dental conditions and forms the basis for treatment recommendations.
A dental examination conducted in a dental office during the first school year or in the 12 months prior to school enrollment more than meets the minimum standards of the assessment requirement.
The goal of this legislation is to establish a regular source of dental care (a dental home) for every child. The program will also identify children in need of further examination and dental treatment and will help in the identification of barriers to the delivery of dental care.
For additional information all located on this page, please use the appropriate links:
Questions concerning California Oral Health Assessments may be directed to CSPD Public Policy Advocate, Dr. Paul Reggiardo, at Reggiardo@prodigy.net or by phone at 714-848-0234.
Return to TopWhat Does the Law Require?
What is an Oral Health Assessment?
The assessment, or evaluation, can be met in many ways. It can be a complete examination and treatment plan performed by a dentist, or it can be a more basic oral health evaluation, such as a screening, which can be performed by a dentist, hygienist or a registered dental assistant with supervision.
How should an office respond when a parent calls requesting the required "oral health assessment" for their child?
If the child is already a patient of record, it should be a routine matter to schedule a dental examination for the child. The oral health assessment requirement is not intended to alter your usual office protocol with regard to new or recall examinations. The only "new" part of the visit is completion of the required "assessment form." The form is simply a data collection tool and requires information on the following four items:
How should an office respond when the parent of a new patient calls making the same request?
As with all new patients, the child ideally should receive a comprehensive examination. In some instances, however, it may be a multi-step process before a child receives the desired exam. It is therefore important to develop a protocol when the parent questions the need to make an appointment for an examination, citing the request for "just an assessment."
Many factors may contribute to the parent's decision to schedule the recommended examination, including available insurance coverage, the parents' understanding of the difference between an assessment and an examination, and the parents' expectation that an assessment, or basic screening, is all the child needs. An office protocol should include a clear explanation of the differences between a basic screening and a comprehensive examination, so that the parent can make an informed decision.
If, after explaining the value of a comprehensive dental examination, the caller still requests only a screening assessment to meet the basic requirements of law, how might the office proceed?
When a dental examination is not feasible, the child will still benefit from the simple assessment intended to identify obvious unmet oral health needs and to provide a data collection tool for state-wide oral health planning. Therefore, CSPD encourages members to consider offering to screen the child and complete the mandated assessment form in the office without charge.
Under legislation long sought by CSPD and effective January 1 of this year, children enrolled in their first year of public school in either kindergarten or first grade are now required to obtain an assessment of their oral health as part of school readiness preparation. For children who already see a dentist and have established a dental home, compliance will be as simple as calling the office and requesting that the dentist fill-out and return the data collection form sent home by the school. Any dental examination conducted in the 12 months prior to the beginning of the school year will meet the assessment requirement, although dentists may wish to recommend a more recent examination when indicated in the best interests of the child. Parents have until May 31st to return the State’s data collection form to the school. While many schools districts are placing school information at the top of the form, dentists and parents may download and use the form available from the California Department of Education. A link to the California Department of Education website and a direct link to downloadable English and Spanish versions of the form are now available on the CSPD website (www.cspd).
For children who have not received a dental examination in the twelve months prior to school entrance, parents have several options. They may schedule a dental examination with a licensed dentist, they may arrange an oral assessment or screening evaluation by any licensed dental professional (a dentist, dental hygienist, or registered dental assistant under the direct supervision of the dentist), or they may request a waiver of the requirement. CSPD members have the opportunity to play a critical role in which decision is made by the parent.
The best decision for the child, and a significant intent of the legislation, is the establishment of a dental home through the scheduling of a comprehensive dental examination. When this is not possible or feasible, CSPD urges its members to consider providing a screening assessment in their office as a public service. It is important for both dentists and parents to understand the difference between a dental examination, which is a billable service and establishes the dental home, and a screening assessment which is not considered a billable service and only (1) collects the data required by the state concerning the incidence of treated and untreated dental caries and (2) identifies obvious or suspected conditions which require, or might require, examination and treatment by a dentist.
If a screening evaluation is conducted in the dental office it does not establish a dentist-patient relationship. Patients receiving such assessments do not become a patient-of-record and should not be expected to complete health histories or other office forms. To assist members providing these assessments, CSPD and CDA have developed a Consent and Recommendation Form for use in the dental office. The form provides for the consent of the parent or caregiver, explains the limitations and differences between an oral assessment and a comprehensive oral/dental examination, and provides a section in which the dentist can make recommendations concerning the child’s oral health. The form, in multiple languages, is downloadable from the CSPD website (www.cspd). It should be given to the parent or caregiver, along with the State data collection form, and a copy kept in the office for a period of one year. Oral evaluations performed in the dental office help parents meet the school requirement and serve as an introduction to the dental delivery system.
CSPD anticipates may school districts, especially those most impacted by oral health disparities, will work with local dentists and local component dental societies to establish school-based and school-linked oral health screenings to ensure pupils receive these assessments. Such screenings will provide an additional opportunity to create effective systems of triage and referral of children whose families experience barriers to dental care and the establishment of a dental home. CSPD encourages the participation of its members in these activities as well as in providing in-office assessments.
Ultimately, the success and survival of school-entrance oral health examinations and assessments will be judged by public compliance with the legislation. Parents may receive a waiver of the requirement by indicating the assessment poses an undue financial burden, cannot be completed because they are unable to locate a dental professional to perform the assessment, or by simply withholding consent. By facilitating the examination and assessment process, CSPD members make it less likely a parent will choose to use the waiver.
Paul Reggiardo, DDS
Public Policy Advocate
California Society of Pediatric Dentistry
February, 2007
| CSPD/CDA Developed In-Office Consent for Assessment and Recommendations |
State Required Oral Health Assessment-Waiver Forms |
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The state-required oral assessment form to be returned to the school is a simple data collection tool that requires the following four pieces of information.
The California Society of Pediatric Dentistry joins with other state health care and patient advocacy organizations in opposing elimination of adult dental services under the state Medi-Cal program. Oral health is integral to general health and not an optional health service. Eliminating adult dental care will have a profound adverse effect on low-income adults, will immediately increase the cost of emergency medical services delivered in hospitals and physician's offices, and will ultimately result in greater future obligations to the state's general fund as oral conditions worsen without appropriate care. Children served by Medi-Cal will be affected as well:
Members interested in CSPD's public policy stance may view the letters sent to Senate President proTem Darrell Steinberg and Speaker of the Assembly Karen Bass during state budget negotiations.
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On March 1 of this year, the California Department of Health Care Services (DHCS) implemented mandatory CDT-4 coding for all treatment authorization requests and claims submissions. CSPD member Jose Polido of Children's Hospital Los Angeles contacted CSPD recently to ask why CDT code D0140, defined by the ADA as a Limited Oral Evaluation -- Problem Focused, for situations of "emergency and trauma," is routinely denied by Denti-Cal when used for this purpose.
As indicated in the Medi-Cal Dental Program Provider Handbook (March 2008), Denti-Cal uses D0140 not for the broad range of problem-focused cases as specified by the ADA code, but instead, for payment of an initial orthodontic evaluation by a Medi-Cal Dental Program certified orthodontist.
According to a representative of the Department of Health Care Services, because orthodontic services are not generally a benefit of the Denti-Cal program, unless required by the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) medical necessity provisions of the Medicaid act (such as in the delivery of care for cleft lip and palate), the Department needed a CDT-4 diagnostic code for assessing such qualification. They choose D0140.
When asked, therefore, what code was appropriate and payable when a limited oral evaluation of emergency or trauma was provided [and other evaluation codes such as that for comprehensive oral evaluation (D0150) or periodic oral evaluation (D0120) were either inappropriate or unavailable], the DHCS representative suggested that for "problem focused" evaluations, providers should use D9430, which is defined in the Handbook as a catch-all, general "observation" code during regularly scheduled office hours in which no other services are performed (other than necessary radiographs and/or photographs).
Members should be aware, however, that Denti-Cal billing for D9430 requires "written documentation for payment" that "shall include the tooth/area, the chief complaint and the non-clinical treatment taken."
If, under the above DHCS guidelines, members experience claim denials, they are requested to contact CSPD's Public Policy Advocate, Paul Reggiardo, at 714-848-0234 or at Reggiardo@prodigy.net with the detail.
Return to TopWhen is coronal polishing considered an oral prophylaxis? The answer, of course, under the California Dental Practice Act, is never.
Section 1086 of the California Code of Regulations permits a Registered Dental Assistant to perform coronal polishing subject to certain conditions. One of these conditions is that the procedure must be performed under the direct supervision of a licensed dentist and only pursuant to the order, control and full professional responsibility of that supervising dentist. Under the provisions of direct supervision, the procedure must be checked and approved by the dentist prior to dismissal of the patient from the office. The Act states that "this procedure shall not be intended or interpreted as a complete oral prophylaxis (a procedure which can be performed only by a licensed dentist or registered dental hygienist)" and that the licensed dentist or a registered dental hygienist "shall determine that the teeth to be polished are free of calculus or other extraneous material prior to coronal polishing."
Section 1067 defines coronal polishing as a "procedure limited to the removal of plaque and stain from exposed tooth surfaces, utilizing an appropriate rotary instrument with rubber cup or brush and a polishing agent."
An oral prophylaxis is defined in the same section as "preventive dental procedures including complete removal of explorer-detectable calculus, soft deposits, plaque, stains, and the smoothing of unattached tooth surfaces. The objective of this treatment shall be creation of an environment in which hard and soft tissues can be maintained in good health by the patient."
Only a currently-licensed Registered Dental Assistant (RDA) may perform coronal polishing, which is considered part of an oral prophylaxis. Since January 1, 2006, all Registered Dental Assistants have been required to have completed an approved course in coronal polishing to obtain or renew their licenses.
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The Mission of the California Society of Pediatric Dentistry is to advocate optimal oral health and general welfare of infants, children, adolescents, and persons with special needs. The Society serves its members and represents the specialty of Pediatric Dentistry in California to achieve excellence in practice, education, and research.