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

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

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

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  1. Introduction of Priority Oral Health Risk Assessment and Referral Tool- PORRT Kelly Close, RDH, MHA Larry Myers, DDS, MPH Marston Crawford, MD, FAAP

  2. Evolution of PORRT

  3. 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

  4. 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

  5. Infant/Child Oral Evaluation Expect a fussy and noisy patient!!!

  6. 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)

  7. 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

  8. Knee-to-knee positioning

  9. Positioning…

  10. Positioning…

  11. Infant/child oral evaluation

  12. Healthy primary teeth (20 by age 3 )

  13. Caries progression Cavity-free smile White spots Cavities Cavities with abscess

  14. 2 year old in the Operating Room Urgent referral Too late!

  15. White spot lesions (non-cavitated)

  16. White spot lesions: early childhood caries (ECC)

  17. White spot lesions Photo provided by Joanna Douglass BDS DDS

  18. White spot lesions: disease in progress

  19. Maxillary anterior lingual caries

  20. Early childhood caries (cavitated) Photo provided by Joanna Douglass BDS DDS

  21. Early childhood caries (cavitated)

  22. Early childhood caries/abscess

  23. Hypoplasia (enamel defects)

  24. Enamel defects

  25. Dentoalveolar trauma

  26. Trauma

  27. “Double sets of teeth” Delayed exfoliation

  28. PORRT Section AQuestions to ask parents

  29. PORRT Section BClinical assessment

  30. PORRT Section CCompleted by Dentist

  31. Dental Varnish/ PORRT ImplementationDr. Marston Crawford Screening/ Evaluation Education Application

  32. 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.

  33. 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.

  34. 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)

  35. Goal for Project: Connect the Docs! • Increase these aspects of referrals • Quantity • Quality • Effectiveness • Appropriateness • Work in progress

  36. Next month’s webinar • October 14th • Dental varnish update • Questions?

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