Dental hygienist Quinesha Brewer lets Giovanni know what to expect.

Tooth decay is the most common chronic disease of childhood and is responsible for 51 million missed school hours nationally each year. In Michigan, almost half of Head Start children have tooth decay and close to one-third have untreated decay. If left untreated, it can cause children pain, inability to eat certain foods, and loss of sleep, all of which make it difficult to pay attention in school. 

To address childhood tooth decay, the Michigan Department of Human Health Services (MDHHS) launched the Kindergartener’s Oral Health Assessment Program (KOHA).  

“There is a law for children starting school, either kindergarten or first grade, that requires them to see a dentist or an adult hygienist to have a screening to look for decay in the mouth,” says Christine Farrell, MDHHS oral health director. “We’ve added this in addition to the hearing and vision screening to make sure we’re looking at the whole health of a child and making sure they have a healthy mouth — and that will help them learn as they go into school.

Dental hygienist Quinesha Brewer shows Giovanni how to brush.

Expanded access to dental care

While hearing and vision screening assessment was first legislated in 1949, the KOHA program was not introduced until 2020. Initially, dental screening was an optional service not required for children to have before entering school. In December 2023, the policy was changed, requiring children to have a dental screening before school entry for the 2024-25 school year. The MDHHS is getting all 45 health departments across the state to implement the KOHA program in phases.

Christine Farrell“The state is partnering with local health departments to provide this program. We started with 18 health departments in the first phase,” says Farrell. “For some schools and counties, it’s been in place now for a couple years and for others it will be new this coming fall. For example, Ingham county has had it for the last three years whereas Wayne county has yet to implement it.”

Currently, 32 health departments have implemented the new assessment program. The goal is to have all 45 health departments on board before the start of the 2024-25 school year. The state-funded program was widely received by Michigan families with 10,441 children screened in FY 2023 by 20 health departments. 

“We’re actively recruiting the health departments now by talking with the health departments, their partners, health officer staff and advocates,” says Farrell. “We’re hoping during this 2024-24 school year, we will have all 45 in place.”  

Administered by local health departments, KOHA screens children getting ready to enter kindergarten at preschools, Head Start programs, school enrollment events, and community screening events before the start of kindergarten or first grade. The brief assessment, performed by a dental hygienist, looks for any tooth decay. If present, a summarized report informs the parents of interventions needed based on urgency. 

“A hygienist will sit the child down, have a flashlight or a headlamp or some exterior lighting, ask them to open their mouth, have a disposable mirror, and just look in the mouth. It's a basic observation for obvious signs of either pain, infection, decay, or cavities,” says Kimberly Singh the chief of community and governmental affairs with My Community Dental Centers (MCDC). “If we see that restorative care might be needed, then your child should go to the dentist, or on the other extreme, like urgent needs, those results will go home in a summarized letter, as well as a list of dentists that are accepting children. We will then follow up.”

Dad lets Giovanni know everything is cool.

Decreasing decay in Detroit

Singh is in the process of making the program accessible to Detroit schools. This will not only allow more children to be screened, but will make dental screenings more convenient for families in Detroit. The assessment is free for parents unless they prefer for it to be performed by their own dental provider. Parents then have their dentist fill out the KOHA form required for school entry.

Kimberly Singh“We know the best way is to bring those services into the schools to the children, to make it convenient. So we're working on parental permission slips and logistics,” says Singh. “ We want to make sure everything is ready before we 100% launch, and we tie what's required, how important it is, and what the value is to where these children can get the services.”
 
For mass outreach in Detroit, MCDC will be offering free assessments every Wednesday from July 31st to August 21at at the Detroit Health Department on Mack Avenue. Flyers and social media posts will help get the word out about these assessment opportunities. MCDC is also attending various community events, block parties, and other places where young children gather this summer to provide free assessments and raise awareness. . 

“Ultimately, we want the program to become a link for children with ongoing dental care,” says Singh. “We want it to be easy, cost efficient and combat any barriers, but it does not replace a dental home where thorough, comprehensive exams are performed.”

Dentist, Dr. Gina Tischendorf, takes a final peak at Giovanni's teeth.

Rural families brush up on dental care

Sanilac County Health Department  (SCHD) started the KOHA program in February 2023 and has continued to reach out to the community to inform families that the service is accessible. The county had been seeing high numbers of children with emergency room visits due to dental decay.

“We didn't have a community dental center here, so our health department, with some other community partners, advocated to bring a dental center here,” says Katie O’Mara, SCHD nursing director. “From there, when we were made aware of the new requirements of the KOHA program, we paired up with MCDC.”

The collaboration not only helps with outreach and completing the assessments, but also eliminates the need for SCHD to hire a dental hygienist. 

“We would have to hire our own dental hygienists and go through a bunch of hoops,” O’Mara says. “This isn't our area of expertise, so it just made sense to partner with MCDC to help us implement the program.”

Since the health department has a larger presence in the community, O’Mara is responsible for assisting the MCDC getting the program out to local families. SCHD also handles financial responsibilities. The MCDC executes the dental assessments, reports documentation, provides a list of dentists in the area, and performs any follow-ups that may be needed. 

“They've helped me get in contact with a lot of the schools and local programs like the Great Start collaborative in Sanilac County,” says Carly Szyska, registered dental hygienist and MCDC KOHA program coordinator. “I am able to reach out to the public and make my face more familiar to everyone, especially the kids.”

Sanilac County has more than 400 children starting kindergarten this year. Szyska has performed 125 assessments since April. To ensure that families can access these services, Szyska also provides them with information about local transportation options. 

“Just starting out and having this program introduced to the county, 125 is a good number,” says Szyska. “I think I’ll be able to tackle most of them by the beginning of the school year.” 

For children, going to the dentist for the first time can be a frightening experience. But if a child gets comfortable with going to the dentist at an early age, Szyska says that fear starts to dissipate. 

“I recommend, if they can, the parent bring the child to their dental appointments so they’re familiar with the atmosphere,” says Szyska. “Make teeth brushing a family event two times a day. And do anything that would get them used to the dental chair and good dental hygiene.”

Monique Bedford is an aspiring journalist, currently freelancing for Issue Media Group publications. She graduated from Oakland University in fall of
2022 with a bachelor's degree in journalism and a minor in Spanish. Monique has experience in solutions journalism, media design, and hosting a radio show. When she's not writing, you can always find her studying different cultures and languages, reading her favorite newspaper, The New York Times, and spending quality time with her friends and family.

Photos by Doug Coombe.
Photo of Katie O’Mara courtesy Sanilac County Health Department.

The Yours, Mine, and Ours — Public Health series highlights how our state's public health agencies keep us healthy, safe, and informed about issues impacting physical and mental health in our communities, homes, workplaces, and schools. The series is made possible with funding from the Michigan Association for Local Public Health.