Introduction of Priority Oral Health Risk Assessment and Referral Tool- PORRT

Kelly Close, RDH, MHA

Larry Myers, DDS, MPH

Marston Crawford, MD, FAAP

Evolution of PORRT

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

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

Infant/Child Oral Evaluation

Expect a fussy and noisy patient!!!

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)

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

Knee-to-knee positioning

Positioning…

Positioning…

Infant/child oral evaluation

Healthy primary teeth (20 by age 3 )

Cavity-free smile

Cavities

White spots

Cavities with abscess

Caries progression

Urgent referral

2 year old in the Operating Room

Too late!

White spot lesions (non-cavitated)

White spot lesions: early childhood caries (ECC)

White spot lesions

Photo provided by Joanna Douglass BDS DDS

White spot lesions: disease in progress

Maxillary anterior lingual caries

Early childhood caries (cavitated)

Photo provided by Joanna Douglass BDS DDS

Early childhood caries (cavitated)

Early childhood caries/abscess

Hypoplasia (enamel defects)

Enamel defects

Dentoalveolar trauma

Trauma

Delayed exfoliation“Double sets of teeth”

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:

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

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:

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:

Dental Varnish/ PORRT ImplementationDr. Marston CrawfordScreening/ Evaluation

Education

Application

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.

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.

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)

Goal for Project: Connect the Docs! Increase these aspects of referrals

Quantity Quality Effectiveness Appropriateness

Work in progress

Next month’s webinar October 14th

Dental varnish update

Questions?