The shiny new backpack has been purchased, along with a new collection of pens, organizers and notebooks.

And despite your child’s slight groans and sighs, you have made an appointment to visit the family’s primary care doctor for an annual medical physical. But included in the back-to-school routine should be a visit to a dentist for a check-up.

In fact, it’s a growing movement for states to require that a child receive a dental examination before entering school.

New York is the latest state to require parents or guardians to present evidence to a public school’s medical staff that his or her child has had a recent dental exam. It joins California, Illinois, Georgia, Rhode Island, Massachusetts, Oregon, Pennsylvania and the District of Columbia in requiring such check-ups.

Effective with the 2008 school year, New York’s law requires that students enrolling in pre-kindergarten, kindergarten or first grade must present a dental health certificate within 30 days after the student enters the grade.

Ongoing dental certificates are required at the same intervals as health certificates are –twice in elementary school (third and fifth grade) and twice in the secondary grades (seventh and ninth grades).

Legislative measures have been generally well-received by dentists and their professional societies, such as the American Dental Association, in part because studies show two trends: An increase in pediatric dental disease and a growing connection between dental health and a person’s overall medical condition.

“As (far as) school physicals are concerned, it’s time we stop severing the mouth from the rest of the body and know that a child is only healthy if both their mouth, as well as their body are healthy,” said Amy Paulin, a New York State assemblywoman who co-sponsored the state’s law.

She adds that tooth decay in children is painful, just as it is in adults. “A child can’t learn when he or she has a toothache, just like they can’t concentrate when they have a sore throat,” she said.

The Center for Disease Control reported in April that while the prevalence of tooth decay in permanent teeth has decreased, tooth decay in baby teeth increased among children ages two to five years.

“Baby teeth are important because they help maintain good nutrition by allowing proper chewing, “said Nicholas Tucci, DMD, a Great Neck, N.Y. dentist and the vice chairman of the Nassau County Dental Society’s access to oral health care committee.

Tucci said that regular dental check-ups and established hygiene will help children later in life in preventing periodontal disease which has been identified as a contributing factor in heart disease, diabetes and stroke.

A 2005 report by the American Journal of Preventive Medicine, for example, found that there is a progressive association between tooth loss and heart disease, even among nonsmokers.

The study found arthrosclerosis in 4.7 percent of the respondents without tooth loss, 5.7 percent for those missing 1 to 5 teeth, 7.5 percent missing 6-31 teeth and 8.5 percent with total tooth loss.

In the immediate, Tucci applauds dental certificate legislation because he believes that it is an important first step in providing a coalition between social service organizations, dental societies, parents and teachers in providing oral health care access to the underserved population including immigrants and underprivileged children.

“As a dentist, parent and taxpayer, I know this law will have a big impact on many children and have far reaching effects through the entire health care community,” said Tucci. “It is by far more compassionate, easier and more cost effective to prevent childhood decay by means of simple screenings and preventative techniques than it is to treat rampant decay in a neglected child.”

For more information regarding access to oral care visit:

American Dental Association http://www.ada.org

American Academy of Pediatric Dentistry http://www.aadp.org

New York Partners in Oral Health http://www.nypartnersinoralhealth.org