The purpose of this research was to compare the sensitivity and specificity from oral health screenings and examinations by varying categories of need for care. 126 children in K-2 were both screened and examined for oral health needs. Visual screenings, using tongue blade and artificial light, were conducted by two dental hygienists who noted the number of decayed teeth and categorized cases as having "immediate" or "other" need for care. Subsequently, an oral examination, using mirror, explorer, artificial light and mobile dental chair, was conducted by a dentist who noted decay by tooth and surface and categorized cases as having "urgent," "some," or "no" need for care. Combining the dentist’s categories into "urgent" and "other," and excluding four cases which were referred for reasons other than decay, the sensitivity and specificity rates were 60% and 88% respectively, with a Kappa=.43. Paired t and McNemar tests showed that statistically significantly more teeth were identified as decayed by examination for BOTH those cases which the hygienists and the dentist agreed should be referred AND for those cases which only the dentist thought should be referred. A second categorization of need for care was based on the agreement or lack thereof regarding the presence of decay. The sensitivity and specificity rates were 61% and 95% respectively, with a Kappa=.58. In both categorizations of need, the hygienists’ screening yielded high specificity providing evidence that use of this system for detecting decay is unlikely to result in referral for unnecessary care.