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…

11. Infant/child oral evaluation

12. Healthy primary teeth (20 by age 3 )

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

14. Urgent referral 2 year old in the Operating Room 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. Delayed exfoliation “Double sets of teeth”

29. PORRT Section A Questions to ask parents

30. PORRT Section B Clinical assessment

31. PORRT Section C Completed by Dentist

32. Dental Varnish/ PORRT Implementation Dr. Marston Crawford Screening/ Evaluation Education Application

33. 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.

34. 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.

35. 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)

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

37. Next month’s webinar  October 14 th  Dental varnish update  Questions?