BILL ANALYSIS
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THIRD READING
Bill No: AB 667
Author: Block (D)
Amended: 5/4/09 in Assembly
Vote: 21
SENATE BUS., PROF. & ECON. DEV. COMMITTEE : 10-0, 6/22/09
AYES: Negrete McLeod, Wyland, Aanestad, Corbett, Correa,
Florez, Oropeza, Romero, Walters, Yee
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : 77-0, 5/21/09 (Consent) - See last page
for vote
SUBJECT : Topical fluoride application
SOURCE : California Dental Association
DIGEST : This bill 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.
In addition, this bill 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 individual as who are being served
in that setting of program, according to the prescription
and protocol issued and established by a physician or
CONTINUED
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dentist.
ANALYSIS :
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 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. 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
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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.
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.
Background
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.
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
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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.
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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 6/30/09)
California Dental Association (source)
California Society of Pediatric Dentistry
Dental Health Foundation
ARGUMENTS IN SUPPORT : According to the California Dental
Association (CDA), the sponsor of this bill, this bill
clarifies 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
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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 will
benefit most.
ASSEMBLY FLOOR :
AYES: Adams, Ammiano, Anderson, Arambula, Beall, Bill
Berryhill, Tom Berryhill, Blakeslee, Block, Blumenfield,
Brownley, Buchanan, Caballero, Charles Calderon, Carter,
Chesbro, Conway, Cook, Coto, Davis, De La Torre, De Leon,
DeVore, Duvall, Emmerson, Eng, Evans, Feuer, Fletcher,
Fong, Fuller, Furutani, Gaines, Galgiani, Garrick,
Gilmore, Hagman, Hall, Harkey, Hayashi, Hernandez, Hill,
Huber, Huffman, Jeffries, Jones, Knight, Krekorian, Lieu,
Logue, Bonnie Lowenthal, Ma, Mendoza, Miller, Monning,
Nestande, Niello, Nielsen, John A. Perez, V. Manuel
Perez, Portantino, Price, Ruskin, Salas, Silva, Skinner,
Smyth, Solorio, Audra Strickland, Swanson, Torlakson,
Torres, Torrico, Tran, Villines, Yamada, Bass
NO VOTE RECORDED: Fuentes, Nava, Saldana
JJA:do 6/30/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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