Christine Farrell

LANSING – The Department of Health and Human Services launched the Kindergarten Oral Health Assessment Program to ensure that young children have healthy smiles.

However, successfully putting it into practice has been like pulling teeth.

Tooth decay is the most common chronic childhood disease and is responsible for 51 million missed school hours annually nationwide, according to the Michigan Oral Health Coalition.

The program was designed not only to address oral health concerns, but also to improve attendance rates.

“The intent of the advocates is to make sure that children have a good opportunity to have a good education,” said Christine Farrell, the oral health section manager at Health and Human Services.

“If you have poor teeth and you’re in pain, you’re certainly not going to be able to sit and listen, learn well, speak well or eat well. So, it was a matter of making sure kids stay healthy,” she said.

The program provides free oral health screenings for incoming kindergarteners.

It offers screenings at preschools, school registration events, community events and in schools. Screenings can also be performed at dental practices in the 76 participating counties.

“It’s really just a look in the mouth. They don’t take X-rays, they don’t really use a lot of instruments,” said Norm Hess, the executive director of the Michigan Association for Local Public Health.

“They basically have the child open their mouth, and if there are any obvious dental problems like visible cavities – if there’s an infection present or a gum disease that’s very obvious – they send those children on for a more specific assessment from a dental provider,” he said.

A pilot program began in 2021.

When the program was initially introduced, it was optional for parents to have their children screened. However, as of the start of the 2024-25 school year, parents are now required to have their children screened before entering kindergarten.

According to Health and Human Services, 35,000 children have been screened since the program’s start. On average, one in four have been referred for needed treatment.

While most counties are in the program, seven have yet to participate: Livingston, Arenac, Gladwin, Clare, Roscommon, Osceola and Isabella, according to the department.

Even among those that are participating, some struggle to fully implement the program, according to Hess.

“The biggest barrier right now is getting a program up and running. It is not always easy to recruit a dental hygienist, and it takes a lot of coordination with schools,” Hess said.

“Some of them are still in the starting-up phase so they haven’t actually implemented it,” he said.

“There are some health departments who just do not have the capacity to do one more thing,” he said.

These problems are particularly spotlighted in rural communities, including one area where 10 counties are covered by only one hygienist: Crawford, Kalkaska, Lake, Manistee, Mason, Mecosta, Missaukee, Newaygo, Oceana and Wexford counties.

According to the Centers for Disease Control and Prevention, as of 2024 approximately 57 million Americans live in an area with a shortage of dental health professionals, 67% of those areas are in rural communities.

While the Department of Health and Human Services reports that the hygienist shortage hasn’t significantly affected the program’s rollout in most areas, it does impact parents’ ability to seek recommended follow-up care, particularly for families who rely on Medicaid or require urgent procedures.

Big Rapids dentist Margaret Gingrich said, “It’s just getting into a dentist, especially in rural areas like up here. It’s finding somebody to take patients because we are so busy and we do have staff shortages.”

Gingrich is a former president of the Michigan Dental Association and testified in favor of the program at a legislative hearing.

“It has caused us to be more cognizant of what Medicaid reimburses because it’s a shortage of hygienists,” Gingrich said.

“Wages (for hygienists) have gone up substantially, and that has affected how many kids we are able to take that are on Medicaid,” she said.

Some counties contract with agencies like Smiles On Wheels and My Dental Center, which have provided staff to conduct the assessments.

Health and Human Services and other advocates like the Michigan Dental Association are working to ensure that parents are aware of the program.

“We need to educate the parents to know that they should be brushing baby teeth,” Gingrich said.

“Just because they fall out doesn’t mean that they’re unimportant, or that they don’t have to have the decay taken out of them,” she said.

In addition, the department has been working to ensure that minority communities that are typically underserved are getting necessary resources to promote good hygiene among children.

According to a 2019 national study by the American Academy of Pediatric Dentistry, the number of dental problems was highest for Hispanic children aged 2 through 19, while non-Hispanic Black children were more likely to have untreated dental problems.

Farrell said, “We attend Detroit SisterFriends meetings to promote oral health and provide information about early childhood dental care and provide them with toothbrushes and tooth materials.”

“We also have embedded an oral health coordinator in the Detroit Public School Community District, and she manages their six mobile dental programs,” she said.

The department plans to begin a statewide marketing campaign for the program in May to raise parents’ and schools’ awareness of the program.