Recall intervals for oral health in primary care patients

Lead author Patrick Fee explains, “This research is valuable when considering the significant impact of the COVID-19 global pandemic and its effect on dental services worldwide, limiting patient access for dental treatment. Patient access to dental care may remain limited for some time. However, the results of this review provide reassurance to those providing and seeking dental treatment that intervals between check-ups can be extended beyond six months without detriment to the oral health of patients.

This review finds that a risk-based check-up is not detrimental to oral health and is acceptable to patients. There has been a longstanding international debate about the optimal frequency of dental check-ups and this review includes the most current and robust evidence available to investigate this issue. But it should be stressed this is about adults having routine check-ups, not those who need to seek emergency treatment or children.”

Why have a dental check-up?
A dental check-up helps to keep your mouth healthy and lets your dentist see if you have any dental problems. It allows your dentist to deal with any problems early, or even better, to prevent problems from developing. Leaving problems untreated may make them harder to treat in the future.

What happens in a check-up?
At each check-up your dentist will usually:

• examine your teeth, gums and mouth;
• ask about your general health and if you have had any problems with your teeth, mouth or gums since your last check-up;
• advise you about tooth-cleaning habits, and your diet, smoking and alcohol use;
• if appropriate, recommend treatment needed for any dental problems.

After your check-up, the dentist will recommend a date for your next check-up. Traditionally, check‑ups are recommended every six months. However, some people are at higher risk of developing dental problems and may need more frequent check-ups, while others may not need check-ups so often.

Why the team did this Cochrane Review
Having check-ups every six months might help to keep your mouth healthy and avoid dental problems in future, but could also lead to unnecessary dental treatments. However, having check-ups less often might let dental problems get worse and lead to difficult and expensive treatment and care. The author team wanted to identify the best time interval to have between dental check-ups.

What did the authors do?
They searched for studies that looked at the effect of different time intervals between dental check-ups. The authors looked for randomised controlled studies, in which people were assigned to different intervals at random. These studies usually give the most reliable evidence.

Search date: included evidence published up to 17 January 2020.

What did the authors find?
The authors found two studies with 1736 people who had regular dental check-ups. One study was conducted in a public dental clinic in Norway in children and adults aged under 20 years. It compared 12-monthly and 24-monthly check-ups, and measured results after two years. The other study was in adults at 51 dental practices in the UK. It compared six-monthly, 24‑monthly and risk-based check-ups (where time between check-ups depended on an individual's risk of dental disease), and measured results after four years.

The studies looked at how different intervals between check-ups affected:

• how many people had tooth decay;
• how many tooth surfaces were affected by decay;
• gum disease (percentage of bleeding sites in the gums); and
• quality of life (well-being) related to having healthy teeth and gums.

No studies measured other potential unwanted effects.

What are the results of the review?
In adults, there was little to no difference between six-monthly and risk-based check-ups in tooth decay (number of tooth surfaces affected), gum disease and well-being after four years; and probably little to no difference in how many people had moderate-to-extensive tooth decay.

There was probably little to no difference between 24-monthly and six-monthly or risk-based check-ups in tooth decay (number of people and number of tooth surfaces affected), gum disease or well‑being, and may be little to no difference in how many people had moderate-to-extensive tooth decay.

The authors did not find enough reliable evidence about the effects of 12-monthly and 24-monthly check-ups in children and adolescents after two years. This was because of problems with the way that the study was conducted.

How reliable are these results?
They are confident that there is little to no difference between six‑monthly and risk‑based check-ups in adults for number of tooth surfaces with decay, gum disease and well‑being. They are moderately confident there is little to no difference between 24-monthly check-ups and six-monthly or risk-based check-ups in number of tooth surfaces with decay, gum disease and well-being.

Conclusions
Whether adults see their dentist for a check-up every six months or at personalised intervals based on their dentist's assessment of their risk of dental disease does not affect tooth decay, gum disease, or well-being. Longer intervals (up to 24 months) between check-ups may not negatively affect these outcomes. Currently, there is not enough reliable evidence available about how often children and adolescents should see their dentist for a check-up.

• Read the full review on the Cochrane Library 
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