DEVELOPMENT AND INITIAL USE OF A PRIMARY CARE ORAL ASSESSMENT TOOL
This presentation describes the development and use of an oral risk assessment tool for primary care. A primary care oral assessment tool, PCOAT evaluates patients’ level of oral health risk indicating need for oral health.
Background
Historically, physical assessment training for most nurses and physicians did not include an examination of buccal areas, teeth, and tongue. Care of oral structures has been the dentists’ realm. Recently, research established links between oral health, cardiovascular disease and diabetes, as well as, associations with dementia, preeclampsia and low birth weight.
Brief Description
Health care providers in a rural, community-based health center recognized oral conditions affecting their patients’ overall health. A disproportionate burden of oral disease is borne by the least advantaged. Many patients experience barriers in obtaining dental care, or simply lack knowledge of oral care importance.
An inter-professional collaborative, including a dentist, nurse practitioner, and nurse midwife, researched oral risk assessment tools. All existing tools required oral and radiographic evaluations not available or practical in primary care. Therefore, the inter-professional team utilized ideas from oral risk tools and developed an oral assessment tool appropriate for primary care.
Health care providers set standards for PCOAT use during new patient visits, annual exams, well child visits, and with diabetic patients. During pilot testing of the PCOAT, providers and staff gave input for modifications of the tool.
The PCOAT designates risk status for oral health diseases in low, moderate and high categories. Based on individual risk levels, a discussion ensues between the health care provider and patient about self-management goals such as oral hygiene, diet choices, consumption of sweets, tobacco avoidance, and the affects oral health on overall health. A risk score of moderate or high prompts a discussion about self-care changes, a dental referral, and potentially an increase in visits to monitor oral health.
Outcomes Achieved
Health care providers admit to struggles with incorporating oral history and assessment into deeply ingrained practice routines. A dental professional referral network was established at the request of health care providers. The network provides dental resources for uninsured and underinsured patients who need surgery and/or dental prosthesis.
Community health workers assist patients with transportation, insurance issues or other barriers that impede dental appointment attendance. Patients express gratefulness for help with obtaining oral care. Anecdotal clinical outcomes on selected cases demonstrate improved HbA1c outcomes after dental treatment.
From August 2013 through September 2014, 207 PCOATs were completed on children and adults with permanent dentition. Of those patients, 16 or 7.7 percent were in the low risk category, 55 or 32.4 percent were moderate risk, and 124 or 59.9 percent were at high risk for oral conditions.
Conclusions
PCOAT has provided a systemic approach to oral health assessment and management in primary care. Patients have increased awareness of oral health, especially pregnant women, children and people with diabetes. Further assessment of PCOAT in other primary care settings, as part of disease assessment and management protocols, can further tool refinement, validity and reliability.