TWENTY-SEVENTH LEGISLATURE, 2013
STATE OF HAWAII
A BILL FOR AN ACT
RELATING TO DENTAL HEALTH.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that most states are not doing enough to prevent tooth decay, unnecessarily driving up health care costs for families and taxpayers. A new report by the Pew Center on the States, Falling Short: Most States Lag on Dental Sealants, grades all fifty states on their efforts to prevent decay by improving access for low-income children to sealants, clear plastic coatings applied to the chewing surfaces of molars. In the report, states were graded based on four indicators: having sealant programs in high-need schools; allowing hygienists to place sealants in school-based programs without requiring a dentist's exam; collecting data regularly about the dental health of schoolchildren and submitting it to the national oral health surveillance system; and meeting a national objective on sealants set by the federal government's Healthy People 2010 goals.
Hawaii was one of only five states to receive a grade of "F", with a total of one out of eleven possible points. An "F" grade indicates that a state is lagging far behind in prevention efforts and could be doing more to reduce pain and costs associated with dental problems. Research shows that providing dental sealants through school-based programs is a cost-effective way to reach low-income children, who are at greater risk of tooth decay.
The legislature further finds that school-based dental sealant programs provide sealants to children who are least likely to receive them otherwise. Studies have shown that tooth decay of molars dropped an average of sixty per cent up to five years after sealant application in a school program. Sealants also prevent decay at one-third the expense of filling a cavity.
States wishing to establish a school-based sealant program must also explore potential funding avenues. Some states with school-based dental sealant programs, such as Ohio, receive funding through the federal Maternal and Child Health Block Grant. Other funding possibilities may also be available, including program-generated revenue through collections from medicaid. The legislature notes that medicaid currently covers sealants for eligible recipients in Hawaii.
The legislature additionally finds that the Pew Center on the States report noted that Hawaii was one of eight states with the most restrictions on dental hygienists, the primary practitioners who apply sealants in school-based programs. Removing unnecessary restrictions on dental hygienists will eliminate expensive and unnecessary barriers to serving children in school-based sealant programs.
The legislature finds that the State must take proactive steps to make prevention of tooth decay among Hawaii's children a top priority.
Accordingly, the purpose of this Act is to:
(1) Require the director of health to participate in the national oral health surveillance system, a national database managed by the federal Centers for Disease Control and Prevention and the Association of State and Territorial Dental Directors;
(2) Permit dental hygienists to apply preventative sealants, in consultation with a licensed dentist, at federally qualified health centers and in school-based dental sealant programs;
(3) Require the department of health to establish and administer a school-based dental sealant program in a high-need demonstration school;
(4) Require the department of health to report to the legislature about the department's efforts to prioritize prevention of tooth decay among the State's children; and
(5) Appropriate funds to establish and administer a school-based dental sealant program in a high-need demonstration school, including plans to implement the program on a statewide level.
SECTION 2. Section 321-63, Hawaii Revised Statutes, is amended to read as follows:
"§321-63 Director's specific duties and powers. To carry out the purposes of this part, the director of health shall:
(1) Take such action as may be necessary, and authorized by law, to meet conditions prescribed for participation in all related federal dental health programs and the regulations adopted thereunder; determine qualifications of personnel requiring professional training and licenses and correlate the programs of the department with the profession and related agencies for the proper and efficient functioning of the department;
(2) Enter into cooperative arrangements with other departments, agencies, and institutions, public or private;
(3) Participate in the national oral health surveillance system, a national database managed by the federal Centers for Disease Control and Prevention and the Association of State and Territorial Dental Directors;
(3)] (4) Submit plans relating to
dental health to the United States Public Health Service and make application
for such federal funds as will assist in carrying out the purposes of this
(4)] (5) Accept on behalf of the State
and deposit with the director of finance any grant, gift, or contribution from
the federal government or other source made to assist in meeting the cost of
carrying out the purposes of this part and expend the same for such purposes; and
(5)] (6) Make an annual report on
activities and expenditures pursuant to this part, including recommendations
for additional plans, measures, or legislation relating to the purposes of this
SECTION 3. Section 447-3, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:
"(b) Clinical dental hygiene may be
practiced by a licensed dental hygienist. The practice of clinical dental
hygiene is defined as the removal of hard and soft deposits and stains from the
portion of the crown and root surfaces to the depth of the gingival sulcus,
polishing natural and restored surfaces of teeth, the application of preventive
chemical agents to the coronal surfaces of teeth, which chemical agents have
been approved by the board of dental examiners, and the use of mouth washes
approved by the board, but shall not include the performing of any repair work
or the preparation thereof, or any other operation on the teeth or tissues of
the mouth; provided that nothing in this subsection shall prohibit a dental hygienist
from using or applying topically any chemical agent which has been approved in
writing by the department of health for any of the purposes set forth in part V
of chapter 321[
,]; provided further that nothing in this subsection
shall prohibit a dental hygienist from applying preventative sealants, in
consultation with a licensed dentist, in a school-based dental sealant program
established pursuant to Act , Session Laws of Hawaii
2013, or at a federally qualified health center; and other procedures
delegated by a dentist in accordance with the rules of the board of dental
In addition, a licensed dental hygienist may administer intra-oral infiltration local anesthesia and intra-oral block anesthesia under the direct supervision of a dentist after being certified by the board, and for those categories of intra-oral infiltration local anesthesia and intra-oral block anesthesia for which the licensed dental hygienist has been certified through a course of study meeting the requirements of this chapter."
SECTION 4. (a) The department of health shall establish and administer a school-based dental sealant program in a high-need demonstration school to provide sealants to high-risk students with susceptible permanent molar teeth.
(b) The department of health shall consult with the department of education; department of human services, med-QUEST division; federally qualified health centers; community health centers; and members of the oral health community in establishing and administering the program. A needs assessment shall be conducted to determine what area of the State would best serve as the location of the demonstration school. The needs assessment may include considerations related to geographic area; target population, including income level and school grade; and the number of students eligible for the program.
(c) The department of health shall establish a plan for a statewide school-based dental sealant program and submit applications for any federal funds that may be available for the program.
(d) The department of health shall submit a report to the legislature no later than twenty days prior to the convening of the regular session of 2015. The report shall detail the department's efforts to prioritize prevention of tooth decay among the State's children, including:
(1) Progress in implementing the school-based dental sealant program at the demonstration school;
(2) Strategies and goals associated with implementing a statewide school-based dental sealant program;
(3) Steps taken to secure funding and sustainability of the statewide school-based dental sealant program;
(4) The department's plan to meet the United States Department of Health and Human Services' Healthy People 2010 oral health objective 21-8, which calls for fifty per cent of the State's eight-year-old and fourteen-year-old children to have sealants on their permanent molar teeth; and
(5) Any recommendations, including proposed legislation, needed to implement the statewide school-based dental sealant program.
SECTION 5. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2013-2014 and the same sum or so much thereof as may be necessary for fiscal year 2014-2015 for the department of health to establish and administer a school-based dental sealant program in a high-need demonstration school, including plans to implement the program on a statewide level.
The sums appropriated shall be expended by the department of health for the purposes of this Act.
SECTION 6. In printing this Act, the revisor of statutes shall insert in section 3 of this Act the corresponding Act number of this Act.
SECTION 7. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 8. This Act shall take effect on January 1, 2054; provided that it shall be repealed on January 1, 2057.
Dental Hygienists; School-based Dental Sealant Program
Permits dental hygienists to apply preventative sealants, in consultation with a licensed dentist, in a school-based dental sealant program or federally qualified health center. Requires the Department of Health to establish and administer a school-based dental sealant program in a high-need school. Appropriates funds. Effective January 1, 2054. Repealed on January 1, 2057. (SB343 HD1)
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