BILL ANALYSIS
AB 667
Page 1
Date of Hearing: April 14, 2009
ASSEMBLY COMMITTEE ON HEALTH
Dave Jones, Chair
AB 667 (Block) - As Amended: April 2, 2009
SUBJECT : Topical fluoride application.
SUMMARY : Clarifies that any person, including dental
assistants and non-health care personnel, may apply topical
fluoride varnish in public health and school-based settings
according to the prescription and protocol of a dentist or
physician. Specifically, this bill :
1)Allows a dental assistant to apply topical fluoride under the
general direction of a licensed dentist or physician when
operating in a school-based setting or public health program.
2)Specifies that any person may apply topical fluoride,
including fluoride varnish, within a public health setting or
public health program according to the prescription and
protocol issued and established by a dentist or physician.
3)Clarifies that the topical fluoride program is required to be
under the direction of a licensed dentist and may include
self-application or application by another person in
accordance with the prescription and protocol established by
the dentist.
EXISTING LAW :
1)Permits a dental assistant to perform specified duties,
including topical fluoride applications, under the general
supervision of a supervising licensed dentist.
2)Establishes community dental disease prevention programs
(CDDPP) that may be offered to school children in preschool
through sixth grade, and in classes for individuals with
exceptional needs, by a local sponsor. Permits the local
sponsor to be a city or county health department, county
office of education, superintendent of schools office, school
district, or other public or private nonprofit agency approved
by the Department of Public Health (DPH).
3)Requires the CDDPP components to include educational programs
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that promote dental health and specified preventive services,
including ongoing plaque control, dental sealants, and
supervised application of topical prophylactic agents for
caries prevention, as approved by DPH.
4)Requires students of public and private elementary and
secondary schools, except students of community colleges, to
be provided the opportunity to receive within the school year
the topical application of fluoride or other decay-preventing
agent in a manner approved by DPH. Specifies that the topical
application program must be under the general direction of a
licensed dentist and may include self-application.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the sponsor of this bill,
the California Dental Association (CDA), tooth decay affects
over 50% of California's children by the time they reach
kindergarten; low-income children are at greatest risk. CDA
states that children with high-risk factors for tooth decay
benefit most from the application of fluoride varnish, a newer
form of high-concentration topical fluoride that is easily
"painted" on teeth two to four times a year and safe even for
very young children. According to CDA, most community and
school-based health programs use less effective fluoride
rinses or supplements because they can be administered by
non-health care providers, such as teachers, parents, or
volunteers, once they have been prescribed by a dentist or
physician. However, CDA notes that the law is currently
unclear regarding whether it is legal for these non-healthcare
personnel to administer fluoride varnish. This bill removes a
barrier to the expansion of fluoride varnish programs in
public settings by clarifying that dental assistants and
non-health care professionals may apply fluoride varnish in
these settings when a prescription and established protocol
from a licensed dentist or physician have been issued for its
use.
2)CHILDREN'S ACCESS TO DENTAL CARE . The California HealthCare
Foundation (CHCF) reports in a 2008 fact sheet on children's
use of dental care in California that the burden of oral
disease continues to fall more heavily on children from poor,
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minority households. While the American Academy of Pediatric
Dentistry recommends that children visit the dentist within
six months of getting their first tooth and no later than
their first birthday, CHCF notes that many children from
families living in poverty, facing language or cultural
barriers, or with no dental insurance, often do not visit the
dentist until much later, after primary teeth have started to
decay. Furthermore, despite increasing awareness of the
lifelong effects of poor oral care, CHCF reports that nearly
one quarter of California children 11 years of age or younger
have never been to a dentist, including half of all children
under the age of five.
3)CDDPP . DPH administers CDDPP through the Office of Oral
Health. 33 CDDPP programs operate in 31 counties, serving
approximately 300,000 preschool and elementary school children
in California each year. The programs are managed by local
health departments, county superintendents of schools, or
nonprofit agencies, who work to increase access to dental care
and educate the public to prevent early childhood cavities,
oral injuries, and dental disease. Health educators and
teachers who participate in the programs explain the
importance of dental health to students and oversee the
brushing and fluoride components in the classroom. Each
program has five mandatory components consisting of fluoride
supplementation, dental sealants, plaque control, oral health
education, and an active oral health advisory committee.
Dental screenings are optional.
4)PRIOR LEGISLATION . AB 3071 (Chan) of 2006, which was held on
the Senate Floor, would have made changes to the program
requirements in CDDPP to ensure that educational programs and
preventive services are evidence-based and age-appropriate.
5)SUPPORT . The sponsor, CDA, writes in support that the simple
clarification in this bill to ensure that any person may apply
fluoride varnish in public health and school-based settings
once a prescription and protocol from a dentist or physician
has been established creates a cost-effective and safe
opportunity to help reduce dental disease in high-risk
populations. The California Society of Pediatric Dentistry
(CSPD) cites in support of this bill a 2006 study that found
that oral health counseling combined with fluoride varnish
application was significantly more effective than oral health
counseling alone in decreasing the incidence of dental decay
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in a population of minority children from low-income
households and, equally important, no adverse events or
effects were reported. CSPD adds that this bill is needed to
clarify that dental assistants, otherwise limited to direct
supervision in the dental office setting, and non-health care
providers, are among those who may participate in providing
these preventive services in specific settings.
REGISTERED SUPPORT / OPPOSITION :
Support
California Dental Association (sponsor)
California Society of Pediatric Dentistry
Opposition
None on file.
Analysis Prepared by : Cassie Rafanan / HEALTH / (916)
319-2097