Having your teeth regularly examined by a dentist seems to have been recommended back as far the 18^th Century (Richards 2002) and subsequently the six-monthly visit became de rigueur.  The scientific basic for this interval was challenged by Sheiham in 1977  and there has subsequently been much debate about the clinical and cost-effectiveness of recall intervals. In 2004 the National Institute for Health and Care Excellence (NICE) have issued guidance recommending that the interval between oral health reviews should be determined specifically for each patient and tailored to meet their needs based on an assessment of disease levels and risk of or from dental disease. This is the latest update of the Cochrane review first published in 2005.

The  aim of this review was to determine the beneficial and harmful effects of different fixed recall intervals  for any one of the following different types of dental check-up:

• clinical examination only
• clinical examination plus scale and polish
• clinical examination plus preventive advice
• clinical examination plus preventive advice plus scale and polish.

Searches for randomised controlled trials were conducted in the Cochrane Oral Health Group’s Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, the US National Institutes of Health Trials Register and the WHO International Clinical Trials Registry Platform databases with no restrictions regarding language or date of publication

• Only 1 study (185 patients) that compared clinical examination every 12 months with one every 24 months.
• The study had a high risk of bias.
• For three to five-year olds with primary teeth, the mean difference (MD) in dmfs increment was -0.90 (95% CI -1.96 to 0.16) in favour of 12-month recall.
• For 16 to 20-year olds with permanent teeth, the MD in DMFS increment was -0.86 (95% CI -1.75 to 0.03) also in favour of 12-month recall.
• There is insufficient evidence to determine whether 12 or 24-month recall with clinical examination results in better caries outcomes.
• For three to five-year olds with primary teeth, the MD in time used by each participant was 10 minutes (95% CI -6.7 to 26.7) in favour of 24-month recall.
• For 16 to 20-year olds with permanent teeth, the MD was 23.7 minutes (95% CI 4.12 to 43.28) also in favour of 24-month recall.
• This single study at high risk of bias represents insufficient evidence to determine whether 12 or 24-month recall with clinical examination results in better time/cost outcomes.

The authors concluded

There is a very low quality body of evidence from one RCT which is insufficient to draw any conclusions regarding the potential beneficial and harmful effects of altering the recall interval between dental check-ups. There is no evidence to support or refute the practice of encouraging patients to attend for dental check-ups at six-monthly intervals. It is important that high quality RCTs are conducted for the outcomes listed in this review in order to address the objectives of this review.

Comment

In their discussion the authors note one ongoing multicentre, parallel-group randomised controlled trial in progress in the UK (the ’INTERVAL Dental Recalls Trial’) which is scheduled for completion in 2017. The rial is investigating whether risk-based recall intervals or a fixed-period 24-month recall are more effective and cost-effective in maintaining oral health than the traditional fixed- period six-monthly recall.

Links

Riley P, Worthington HV, Clarkson JE, Beirne PV. Recall intervals for oral health in primary care patients. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD004346. DOI: 10.1002/14651858.CD004346.pub4.

Richards D. The six-monthly dental check . Evidence-Based Dentistry (2002) 3, 61

Sheiham A. Is there a scientific basis for six-monthly dental examinations? Lancet. 1977 Aug 27;2(8035):442-4. PubMed PMID: 70653.

National Health Service, National Institute for Clinical Excellence Guideline. Dental Recall: Recall Interval Between Routine Dental Examinations. NICE 2004.

The INTERVAL study