Tooth decay is the most common, chronic childhood disease.
According to the California Department of Education, dental
problems are the cause of 874,000 school days missed each year,
which costs schools over $29 million annually in average daily
attendance funding. Dental caries is a preventable disease; yet,
more than half of California kindergarteners have experienced
tooth decay, and by third grade, this number rises to over 70
percent. Data show that more than a quarter of these children
have dental disease that, if left untreated, has deleterious
effects on children’s academic performance, social-emotional
development, sleep and nutrition, and leads to poor general
California State Requirements
The Kindergarten Oral Health Assessment (KOHA) requirement was
passed into law under the Education Code Section 49452.8 in 2005
by Assembly Bill 1433
(AB 1433). It requires all public school
kindergartners and only those first graders enrolling in
public school for their first year to have an oral
health screening completed by a licensed dental
The goal is to raise awareness about the importance
of oral health and help connect children to a regular source of
dental care. An oral health assessment is a quick,
basic screening to identify the overall health of the mouth.
It is not a full oral health evaluation, or
a substitute for regular, comprehensive appointments with
a dentist every 6 months.
It is one way schools can support children’s school
readiness and success by identifying children suffering from
untreated dental disease and helping parents establish a dental
Some schools in San Mateo County host free oral health screening
days on-site, provided by outside dental professionals and
organizations. The law was updated with Senate Bill 379
(SB 379) in 2017 to allow schools to use passive
consent for these oral health screening school
events. Passive consent means every child will receive a
screening unless their parent/guardian has
signed a form (an “opt-out” letter) indicating they would
not like their child to receive the screening.
The Oral Public Health Program collaborates with the San Mateo County Office of
Education to ensure all schools and districts are in
compliance with this KOHA mandate.
Public school grade levels that must meet this requirement
Kindergarten, not including
Transitional Kindergarten- All public school children
entering Kindergarten grade level must have the KOHA
completed. While students in Transitional Kindergarten
(TK) can technically complete the
assessment during their TK year, the required data for
those students (see below) should not be submitted until
their kindergarten year.
Any student in first grade in public
school, only if they did not attend public school
Kindergarten the prior year - Some children
do not attend public school Kindergarten, and their first year
in public school is first grade. For these first grade students
only–not all public school first
graders–the oral health assessment is required.
School staff responsibilities around KOHA data collection and
By the end of the school year, or by July
1st at the latest, the KOHA legislation
requires specific KOHA data to be totaled and
entered into a database annually by school staff.
The database developed for this purpose is called the “System for California
Oral Health Reporting,” or “SCOHR.” See step by step
instructions on how to use SCOHR below.
School staff often work closely with the County Local Oral
Health Program and with the County Office of
Education to comply with the KOHA data collection and entry
requirements (see more details below).
The Kindergarten Oral Health Assessment is different
from the first grade health exam requirement, and both
- The KOHA is required for public school kindergartners, and
only those first graders enrolling in public school for their
first year. It must be completed by a licensed dental
professional (a dentist or dental hygienist).
- The first grade health exam is required for first graders,
and must be completed by a medical professional.
- See our County Health webpage about all
childcare health requirements here.
How the KOHA requirement is communicated to parents/ guardians
The registration packet for each
public school kindergarten student contains the KOHA packet (see
below). The KOHA packet consists of:
KOHA Notification Letter- describes what the
requirement is, what parents need to do, and includes
information about how to access dental care in the county, as
well as basic oral health information
KOHA Form – the actual screening/assessment
form parents need to take to their child’s dental
appointment and have the dental provider complete. If the
child’s school is hosting a KOHA screening day, the dental
providers at the school will complete the required form there.
Waiver of the KOHA Requirement- dental
providers complete the KOHA assessment during the child’s
regular dental appointment. However, if children do not yet
have a dentist or dental insurance, cannot easily get to a
dentist during their Kindergarten year, or do not attend a
school hosting an on-site KOHA screening event, a waiver form
may be completed. Parents are encouraged to contact their
school health staff, Health Plan of San Mateo
Dental, or the Oral Public Health Program if they need help
completing the KOHA requirement.