Dental Readiness Inspection - Job Corps

Dental Readiness Inspection - Job Corps

Dental Readiness Inspection Pamela Alston, DDS, MPP Lead Oral Health Specialist Kevin T. Avery, DMD, MPH Oral Health Specialist

Webinar Objectives After this presentation, participants will be able to: Describe the clinical technique for conducting the Dental Readiness Inspection. Identify the signs and symptoms that should be documented in the student health record. Share with students the results of the Dental

Readiness Inspection in a motivating way. Why? What? Who? Where? When? How?

Questions Why perform the dental readiness inspection? PRH-Chapter 6 timeframe

responsibility PRH-6.10(R2): A dental readiness inspection shall be completed within 14 days after arrival by the center dentist or designee as determined by the center dentist who authorizes the activity by a written

personal authorization. The dental readiness inspection shall be documented in the appropriate section of the Job Corps Physical Examination Form. [revised April 18, 2013] Documentation requirements

Why? To identify urgent care needs To lower the broken appointment rate by letting students opt in or out of becoming a Job Corps patient of record To assist students in making an informed decision about becoming a patient of record To implement standards for oral inspections

Before I forget, Derrick, heres the dental plan. I wish I had been ready to receive dental care when I was in Job Corps!

From The New Yorker Magazine What is the dental readiness inspection? Clinical Oral Evaluations vs. Pre-Diagnostic Services

designated by the federal government as the national terminology for reporting dental services Dental Procedure Definitions D0190 Screening: A screening, including state

or federally mandated screenings, to determine an individuals need to be seen by a dentist for diagnosis D0191 Assessment: A limited clinical inspection that is performed to identify possible signs of oral or systemic disease, malformation, or injury, and the potential need for referral for diagnosis and treatment

D0120-D0180 Evaluations Reference: CDT 2013 Dental Procedure Codes, Page 7, 2012 American Dental Association Who is responsible for performing the dental readiness inspection? Sample Scope of Work

Center Dentist Sample Personal Authorization Under authorization, [insert center nurse/dental hygienist/dental assistant name] may perform the dental readiness inspection.

[Center Dentist Signature] [Date] Where is the dental readiness inspection performed? When shall the dental

readiness inspection be completed? How is the dental readiness inspection performed? Dental Readiness Inspection Armamentarium

Personal Protective Equipment [PRH6.12, R13(d)] Light source Tongue depressor or mouth mirror Student health record [PRH-6.10,

R2(b)] Clinical Technique Retract the lip Look in the wide open mouth

JC Physical Exam Form, Section 15 Gaping Hole in Tooth UL LL LR UR Gaping hole in tooth

Severe Reported Pain Severe Swelling in Mouth or Jaw Bleeding in Mouth

Gingiva Extraction site Painful Sore That Interferes With Eating Decayed Tooth

Gaping hole in tooth LR Other Sore on lip UR Sores on both corners of lip

Sores all over tongue Braces Review the Oral Health Section of the Job Corps Health History Form

From JC Health History form No Obvious Serious Oral Health Problems JC Physical Exam Form, Section 15

Signature Findings Date Lack of findings

Findings Diagnosis What is next? Immediate treatment Healthcare Guidelines, PRH-6.12, R9 Emergency Care, PRH6.10, R2(e)

Oral Examination Elective oral examination upon student request including x-rays to precede dental treatment [PRH-6,

Exhibit 6-4, B.1.] . Laying Out the Options Educate the Student Use your resources!

Chronic Caries Disease Recurrent Decay Please let me through, gentlemen. Im a dental hygienist.

From The New Yorker Bleeding in Mouth Chronic Periodontal Disease Ive always hated hospitals,

dentists offices, and jails. But this is Job Corps. The dental folks dont hurt and they are nice. From The New Yorker Gauge if the Student is Ready to

be a Dental Patient Criticism is Ineffective Criticism Leads to Disgust Nonverbal expressions of disgust

Criticism Leads to Anger Nonverbal expressions of anger: b,d,e What Does Work? Taking a motivational approach Discussing how oral health and oral health care fits with the

students goals Explaining what the student can expect realistically Difference Between DRI & OE

Motivational statement Value of oral health services Can reverse refusal Conscious decision

Procedure to make apt/ Receive basic oral care Signatures Youre right, Jack, that does look like a cavity. Now on to other business

Yes, I did my best to educate and motivate him. Too bad he refused an oral exam to diagnose it.

from The New Yorker Did you educate him on how cavities can get worse and impact

performance at JC or in the workplace? Well, we will be here for him if he changes his mind. He might qualify for basic oral care

under our priority system. Oral Exam Consent/Refusal for Minors Q. For minors, will we need to mail the refusal home for parents to sign? A. There is no PRH guidance for

obtaining the parental/guardian refusal. The center can consult state law. It may be possible to obtain a telephone refusal with a witness. Be sure to document on the consent/refusal form. Timeframe for Oral Exam

Q. If the student requests an oral exam, can it be done immediately if you have the time to do it? A. The PRH does not specify a timeframe. The decision is left up to the center. Refusing Students

Q. Is the center dentist able to refuse to treat students who previously declined an oral exam? A. Students may reverse their previous decision to refuse an oral exam. Document the consent in the SHR. Follow your scheduling procedure. Handling Walk-Ins Q. How should the Health and Wellness Center

staff respond if a student presents with an oral health issue when the Center Dentist is not on center? A. Follow your SOP dealing with students who request a visit outside of open hours when the center dentist is not on center. Depending upon a nurse's assessment, healthcare guidelines may be followed and/or the student

may receive a dental appointment with a timeframe commensurate with the urgency of need. Legality of the Dental Assistant Performing the Dental Readiness Inspection Q. Where does the liability stop for the dentists? What if the Dental Assistant performs the dental readiness

inspection and misses an interproximal lesion and the student has issues with an abscess? A. The inspector is not performing an assessment or evaluation. The Dental Assistant is performing the equivalent of a screening. The Center Dentist can check with the state dental board to ascertain the legality of a Dental Assistant performing the dental readiness inspection. Otherwise, the Center Dentist can make a

different arrangement. Minor Consent to Oral Examination Q. If the student is a minor, does the parent/guardian have to fill out a request for the exam? A. Parents sign a consent statement for the

oral exam on the ETA 6-53 Job Corps Health Questionnaire. It suffices as a consent. When the student signs the consent, they are acknowledging their assent. Centers may want to contact parents/guardians of minors who refuse the oral exam and basic oral care. Commendable Practice

New Haven JCC Tips for a Healthy Mouth Oral Health kit --Martha Kurilec, DMD, Center Dentist Commendable Practice A JCC Health and Wellness Center

implemented a student pay grid with fake money to use to pay for Health and Wellness services. Students are educated on the importance of health insurance and the importance of making responsible and savvy decisions as it relates to health and wellness care.

Commendable Practice At Phoenix JCC Students with dental conditions who refuse the oral exam after seeing the RDH for the dental readiness inspection are counseled by the Center Dentist. They receive the oral exam right after counseling if they consent. Otherwise, they sign the refusal.

Parents/guardians of minors notified by phone and the call is documented. Students who receive oral health in the community are assisted as needed with scheduling appointments. Legality of Dental Assistant Performing the Dental Readiness Inspection Comment: I can see that my malpractice

carrier may not like the current protocol becausehaving someone other than the dentist diagnose decay with the standard of care being breached, the lawyers are going to love this one. Response: There is an established Job Corps community standard for performing the inspection, documenting and communicating

results. The Center Dentist is responsible for performing it or delegating it to a staff person who can legally and skillfully perform an inspection with a personal authorization. Desire to Understand & Accomplish the Dental Readiness Inspection Comment: I was in the United States Air

ForceI have never heard of this inspection. I know of the Type 1 Dental Readiness Exam (full x-ray series or panorex x-ray) or Type II exams for all. Be sure and explain what a dental readiness inspection is and how it is accomplished. Response: I hope that as a result of todays webinar you know what a dental readiness

inspection is and how it is accomplished. Getting Education and Training to Become Employed No Longer a Pipe Dream Of course, with the position that has the benefitsmedical, dental, et cetera there is no salary.

Thanks to Job Corps, I know the benefits are worth a lot! From The New Yorker There will be times particularly in the early stages of change

when courageous acts, informed and skilled, will be absolutely essential to change health care as we know it.Ed ONeil, Influencing Change (2-01-11)

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