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)
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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
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Physicians found PORRT easy to use
Children evaluated were found to be:
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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…
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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
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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 )
Caries progression
Cavity-free smile
White spots
Cavities
Cavities with abscess
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:
Child’s first name:
Parent/Guardian’s relationship to child: 1 Mom
2 Dad
3 Grandparent
PRACTICE NAME:
A.
___ ___ / ___ ___ / ___ ___
month
day
year
Child’s middle name:
4 Other (specify)____________________________________
PROVIDER NAME:
Questions for Parent/Guardian
Yes1
1.
Do you brush your child’s teeth at least once a day using toothpaste with fluoride?
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
No2
Referral Recommendation
If 3 or more
risk factors
(shaded boxes)
are marked,
refer to a
Dentist.
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?
8.
Does the child have cavities? (cavitated lesions)
Dentist
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?
13. Please check procedures performed today:
14. Was the child referred to a dentist?
a.
1 Oral evaluation
1 Yes
Dentist
1 Fluoride Varnish
1 Parent Education
2 No
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 A
Questions to ask parents
A. Questions for Parent/Guardian
Yes1
1.
Do you brush your child’s teeth at least once a day using toothpaste with fluoride?
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?
If yes, name of dentist:
1 Yes
No2
Referral Recommendation
If 3 or more
risk factors
(shaded boxes)
are marked,
refer to a
Dentist.
2 No
Date of last appointment:
___ ___ / ___ ___ / ___ ___
month
day
year
PORRT Section B
Clinical 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:
8.
Was the child referred to a dentist?
a.
If YES, name of dentist:
Provider Signature:
1 Yes
1 Oral evaluation
2 No
1 Fluoride Varnish
1 Parent Education
PORRT Section C
Completed 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
Implementation
Dr. Marston Crawford
Screening/ Evaluation
Education
Application
Screening/evaluation
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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
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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
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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!
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Increase these aspects of referrals
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Quantity
Quality
Effectiveness
Appropriateness
Work in progress
Next month’s webinar
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October 14th
Dental varnish update
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Questions?
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