Introduction of Priority Oral Health Risk Assessment and Referral Tool- PORRT
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Transcript of Introduction of Priority Oral Health Risk Assessment and Referral Tool- PORRT
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Introduction of Priority Oral Health Risk Assessment and Referral Tool- PORRT
Kelly Close, RDH, MHA
Larry Myers, DDS, MPH
Marston Crawford, MD, FAAP
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Evolution of PORRT
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Carolina Dental Home (CDH) Pilot project in Craven,
Pamlico, and Jones Counties
Partnership of pediatricians and dentists
PORRT developed to refer youngest high risk children to dental home
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CDH lessons learned Physicians found PORRT easy to use Children evaluated were found to be:
80% low risk 15% moderate risk 5% high risk
Large increase in identification of white spot lesions: from 20% at baseline to 58% at follow-up
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Infant/Child Oral Evaluation
Expect a fussy and noisy patient!!!
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Needed for the oral evaluation…
Good source of directed light
2 x 2 gauze sponges for drying the teeth
Disposable dental mirror
PORRT (priority oral health risk assessment and referral tool)
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Positioning for the oral evaluation Use the knee-to-knee position with the child in the
parent’s lap, facing them(great for babies/small children)
Place the child on an exam table(good for larger, older children)
In either position, evaluate looking over the top of the child’s head
Parent holds child’s hands (or gives permission to staff), child’s legs around parent’s waist
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Knee-to-knee positioning
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Positioning…
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Positioning…
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Infant/child oral evaluation
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Healthy primary teeth (20 by age 3 )
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Cavity-free smile
Cavities
White spots
Cavities with abscess
Caries progression
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Urgent referral
2 year old in the Operating Room
Too late!
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White spot lesions (non-cavitated)
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White spot lesions: early childhood caries (ECC)
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White spot lesions
Photo provided by Joanna Douglass BDS DDS
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White spot lesions: disease in progress
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Maxillary anterior lingual caries
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Early childhood caries (cavitated)
Photo provided by Joanna Douglass BDS DDS
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Early childhood caries (cavitated)
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Early childhood caries/abscess
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Hypoplasia (enamel defects)
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Enamel defects
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Dentoalveolar trauma
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Trauma
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Delayed exfoliation“Double sets of teeth”
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NC Priority Oral Risk Assessment and Referral Tool - PORRT
Today’s date: ___ ___ / ___ ___ / ___ ___ Child’s MID# ___ ___ ___ -- ___ ___ -- ___ ___
Child’s last name:
Birth date: ___ ___ / ___ ___ / ___ ___ month day year
Child’s first name:
Child’s middle name:
Parent/Guardian’s relationship to child: 1 Mom 2 Dad 3 Grandparent 4 Other (specify)____________________________________
PRACTICE NAME:
PROVIDER NAME:
A. Questions for Parent/ Guardian
Yes1 No2 Referral Recommendation
1. Do you brush your child’s teeth at least once a day using toothpaste with fluoride? If 3 or more risk factors
(shaded boxes) are marked, refer to a Dentist.
2. Does your child drink fluoridated water?
3. Does your child drink juice or sweetened drinks between meals or eat sugary snacks?
4. Have you or anyone in your immediate family had dental problems?
5. Does your child sleep with a bottle filled with drinks other than water?
6. Is the child currently being seen by a dentist? 1 Yes 2 No
If yes, name of dentist:
Date of last appointment: ___ ___ / ___ ___ / ___ ___ month day year
B. Questions for Provider Based on Clinical Assessment
Yes1 No2 If Yes, Refer to a
7. Does the child have any special health care needs? Dentist
8. Does the child have cavities? (cavitated lesions) Dentist
9. Does the child have visible plaque on the teeth? Consider other risks
10. Does the child have enamel defects? Dentist
11. Does the child have white spot lesions? (non-cavitated lesions) Dentist
12. Does the child have any other oral conditions of concern? Dentist
13. Please check procedures performed today: 1 Oral evaluation 1 Fluoride Varnish 1 Parent Education
14. Was the child referred to a dentist? 1 Yes 2 No
a. If YES, name of dentist:
Provider Signature:
C. This section is to be completed by the Dental Office and faxed back to the referring physician
1. Date of dental appointment ___ ___ / ___ ___ / ___ ___ month day year
2. Did the patient show up for dental appointment? 1 Yes 2 No
3. Did patient call to cancel the appointment? 1 Yes 2 No
a. If yes, what reason was given?
4. Brief summary of dental findings:
5. Next dental appointment: Date: ___ ___ / ___ ___ / ___ ___ Time:
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PORRT Section AQuestions to ask parents
A. Questions for Parent/ Guardian
Yes1 No2 Referral Recommendation
1. Do you brush your child’s teeth at least once a day using toothpaste with fluoride? If 3 or more risk factors
(shaded boxes) are marked, refer to a Dentist.
2. Does your child drink fluoridated water?
3. Does your child drink juice or sweetened drinks between meals or eat sugary snacks?
4. Have you or anyone in your immediate family had dental problems?
5. Does your child sleep with a bottle filled with drinks other than water?
6. Is the child currently being seen by a dentist? 1 Yes 2 No
If yes, name of dentist:
Date of last appointment: ___ ___ / ___ ___ / ___ ___ month day year
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PORRT Section BClinical assessment
B. Questions for Provider Based on Clinical Assessment
Yes1 No2 If Yes, Refer to a
1. Does the child have any special health care needs? Dentist
2. Does the child have cavities? (cavitated lesions) Dentist
3. Does the child have visible plaque on the teeth? Consider other risks
4. Does the child have enamel defects? Dentist
5. Does the child have white spot lesions? (non-cavitated lesions) Dentist
6. Does the child have any other oral conditions of concern? Dentist
7. Please check procedures performed today: 1 Oral evaluation 1 Fluoride Varnish 1 Parent Education
8. Was the child referred to a dentist? 1 Yes 2 No
a. If YES, name of dentist:
Provider Signature:
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PORRT Section CCompleted by Dentist
C. This section is to be completed by the Dental Office and faxed back to the referring physician
1. Date of dental appointment ___ ___ / ___ ___ / ___ ___ month day year
2. Did the patient show up for dental appointment? 1 Yes 2 No
3. Did patient call to cancel the appointment? 1 Yes 2 No
a. If yes, what reason was given?
4. Brief summary of dental findings:
5. Next dental appointment: Date: ___ ___ / ___ ___ / ___ ___ Time:
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Dental Varnish/ PORRT ImplementationDr. Marston CrawfordScreening/ Evaluation
Education
Application
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Screening/evaluation
Every three months starting at first tooth eruption (maximum 6 procedures)
Any visit We pay a small bonus to our nurses for each
eligible patient identified and screened using the PORRT form. Form identifies both nurse and physician.
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Education
Doctor or midlevel Screen for sugar exposure and appropriate
drinking and brushing habits. Pathology and dental risks identified on oral
exam (may need dental mirror). Risks stratified and referral to general or
pediatric dentist made in manner of any other specialist referral. Follow-up is tracked by our AccessCare nurse.
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Application
Nurse applies at end of visit. Brush on dry teeth (easier if crying) No meals for 30 minutes Sugar free lollipop at checkout (if age
appropriate)
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Goal for Project: Connect the Docs! Increase these aspects of referrals
Quantity Quality Effectiveness Appropriateness
Work in progress
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Next month’s webinar October 14th
Dental varnish update
Questions?