BILL ANALYSIS
-----------------------------------------------------------------------
|Hearing Date:June 22, 2009 |Bill No:AB |
| |667 |
-----------------------------------------------------------------------
SENATE COMMITTEE ON BUSINESS, PROFESSIONS AND
ECONOMIC DEVELOPMENT
Senator Gloria Negrete McLeod, Chair
Bill No: AB 667Author:Block
As Amended:May 4, 2009 Fiscal: Yes
SUBJECT: Topical fluoride application.
SUMMARY: Authorizes a dental assistant to apply topical fluoride when
operating in a school-based setting or a public health program created
or administered by a federal, state, county, or local governmental
entity under the general direction of a licensed dentist of physician;
allows any person, within a public health setting or a public health
program that is created or administered by a federal, state, or local
government entity, to apply topical fluoride, including fluoride
varnish, to the teeth of individuals who are being served in that
setting or program, according to the prescription and protocol issued
and established by a physician or dentist;
Existing law:
1)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 the Department of Public Health (DPH). Requires the
topical application program to be under the general direction of a
licensed dentist and may include self-application. Specifies that
treatment may only be provided for a student if the parent or
guardian or responsible relative or adult who has assumed
responsibility for the student's care and custody; a letter stating
that such treatment is desired.
2)Establishes the California Children's Dental Disease Prevention
Programs (CCDDPP) (also referred to as community dental disease
prevention program) within the DPH that may be offered to school
children in preschool through sixth grade, and in classes for
AB 667
Page 2
individuals with exceptional needs, by a local Sponsor. Requires
the CCDDPP to include educational programs 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.
3)Establishes the Committee on Dental Auxiliaries within the Dental
Board of California to establish education programs and curriculum
for all dental auxiliary programs, including those of dental
assistants.
4)Defines direct supervision to mean supervision given by a licensed
dentist, who must be physically present in the treatment facility
during the performance of those procedures. Defines general
supervision to mean supervision of dental procedures based on
instructions given by a licensed dentist but not requiring the
physical presence of the supervising dentist during the performance
of those procedures.
5)Defines a dental assistant as an individual who without a license
may perform basic supportive dental procedures, as authorized, under
the supervision of a licensed dentist. Defines basic supportive
dental procedures as those procedures that have technically
supportive characteristics, completely reversible, and are unlikely
to precipitate potentially hazardous conditions for the patient
being treated.
6)Specifies the duties a dental assistant may perform under the
general or direct supervision of a supervising licensed dentist.
Permits a dental assistant to apply topical fluoride under the
direct supervision of a supervising licensed dentist.
This bill:
1)Allows a dental assistant to apply topical fluoride when operating
in a school-based setting or a public health program created or
administered by a federal, state, county, or local governmental
entity under the general direction of a licensed dentist of
physician.
2)Allows any person, within a public health setting or a public health
program that is created or administered by a federal, state, or
local government entity, to apply topical fluoride including
fluoride varnish to the teeth of individuals who are being served in
that setting or program; according to the prescription and protocol
issued and established by a physicians or dentist.
AB 667
Page 3
3)States that topical application of fluoride may include, according
to the prescription and protocol established by the dentist,
self-application or application by another person.
4)Makes other technical non-substantive changes.
FISCAL EFFECT: According to the Assembly Appropriations Committee, no
direct fiscal impact to the Dental Board of California, the California
Department of Public Health, and the California Department of
Education to continue oversight of school-based and public health
dental practice in California.
COMMENTS:
1.Purpose. According to the California Dental Association (CDA), the
Sponsor of this bill, this measure would clarify that, in public
health and school-based settings, any person may apply topical
fluoride, including fluoride varnish, according to the prescription
and protocol established by a dentist or physician, which would
create a cost-effective and safe opportunity to help reduce dental
disease in high-risk populations. CDA points out that tooth decay
is the most common chronic disease among children, and left
untreated decay may cause chronic pain, infection, failure to thrive
and delayed growth, school absenteeism, the inability to concentrate
and interference with intellectual tasks. CDA states that tooth
decay prevention requires optimal exposure to fluoride, including
fluoride rinses or supplements and fluoride varnish, a newer form of
high-concentration topical fluoride that can be easily painted on
teeth two or four times a year. In addition, fluoride varnish is
inexpensive and safe even for the very youngest children, and the
application is safe, quick, simple and requires no special dental
equipment and minimal instruction. CDA states that although
fluoride varnish has been proven to be more effective, fluoride
rinses or supplements are more frequently used in community and
school-based health programs because once they are prescribed by a
dentist or physician, they can be administered by non-health care
providers, such as teachers, parents, and volunteers. CDA indicates
that non-health care providers have not been permitted to administer
fluoride varnish because the law is currently unclear whether it is
legal for them to do so. Restricting non-health care providers from
applying fluoride varnish creates a needless barrier to the
expansion of fluoride varnish programs to the high-risk populations
who would benefit most.
2.Background.
AB 667
Page 4
a) Prevalence of poor oral health among children. A 2008 study
by the California Health Care Foundation indicates that children
who are poor and from minority households suffer greater burden
of oral disease; particularly cavities. The study points out
that despite growing awareness of the lifelong effects of poor
oral care, nearly one quarter of California children have never
been to a dentist, including half of all children under the age
of five. There are several reasons identified for the
inequality, including lack of access to dental care. Many
children living in poverty, facing language/cultural barrier, or
with no dental insurance often do not visit the dentist until
much later after primary teeth have started to decay.
b) California Children's Dental Disease Prevention Programs. DPH
administers the CCDDPP through the Office of Oral Health. There
are 33 CCDDPP programs operating in 31 counties, serving
approximately 300,000 preschool and elementary school children in
California each year. These 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.
Under this bill, children eligible to participate in CCDDPP may
receive fluoride varnish from any person, including dental
assistants.
3.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.
4.Arguments in Support. Supporters including the California Society
of Pediatric Dentistry and the Dental Health Foundation indicate
that this bill clarifies existing law to ensure that any person may
apply fluoride varnish once a prescription and protocol have been
issued in public health and school-based settings.
AB 667
Page 5
SUPPORT AND OPPOSITION:
Support:
California Dental Association (Sponsor)
California Society of Pediatric Dentistry
Dental Health Foundation
Opposition:
None on file as of June 16, 2009
Consultant: Rosielyn Pulmano