ALBANY - Some states are trying to fill in a potentially deadly gap in health care for children by seeking proof of good dental health before they enter school.

New York in September will join seven states and the District of Columbia in adopting school-based measures to ensure dental health. But the existing regulations have weaknesses, the result of political and fiscal compromise to become laws at all. And despite the death of a 12-year-old boy last year in Maryland by brain infection that started as a toothache, many parents aren't taking the effort seriously despite the distraction from school studies and lifelong complications tooth decay can bring. A recession and diminishing health care coverage can push dental care further down a family's priority, where it may be seen mostly as a cosmetic issue, according to national dental associations.

“I have memories of 10 or 12 times when I panicked when I saw the child,” said Dr. Beverly A. Largent, a dentist specializing in children's teeth for 23 years in the rural Kentucky town of Paducah. Especially in poor urban and rural areas nationwide, children often only get dental care when the pain and swelling are too much to bear, she said.

The Centers for Disease Control and Prevention calls tooth decay one of the most chronic infectious diseases for children. While tooth decay in all age groups for adults is declining, childhood tooth decay is rising. And children from poor families have twice as much untreated decay as children in wealthier homes.

In school, the pain erodes concentration, decay can inhibit a child's speaking, appearance and self-esteem, and infections can be deadly. Deamonte Driver of Prince George's County in Maryland had a toothache that his mother, on a low fixed income, couldn't get treated quickly partly because it's hard to find dentists who will take Medicaid or deeply discount care for children in families of the working poor.

After two operations and a long hospital stay paid by Medicaid, the 12-year-old boy died of an infection in his brain. The Washington Post estimated the public cost of care at more than $250,000. In most places, taking care of the tooth early would have cost $60.

New York's law, for example, requests that parents provide a dental health certificate showing the student has seen a dentist before entering second, fourth, seventh and 10th grades.

If the family doesn't send one in, the school will provide a list of dentists that will perform an exam for free or little cost - to the family.

“We certainly know and appreciate the importance of having children have these examinations and screenings,” said New York Senate Education Committee Chairman Stephen Saland of Poughkeepsie. “But we felt it was important not to impose that burden on local school taxes.”

A new program will bring dental screenings to Head Start programs to a half-dozen states this summer, with a goal to build a nationwide network in five years, said Marianthi Bumbaris of the American Academy of Pediatric Dentistry based in Chicago.