Norman Swan: If you have a dentist, she probably sends you a six-monthly recall to come in for a check-up and you no doubt feel guilty if you don’t go. The question is whether there is any evidence that the check-up does your teeth or mouth any good compared to seeing her less frequently. That’s what a group of researchers have tried to find out by reviewing studies which have asked just that. Dr Patrick Fee is a dental researcher at the University of Dundee in Scotland, and was the lead author on the paper. I spoke to him earlier.
Patrick Fee: Pleasure to be with you, thanks for the invite Norman.
Norman Swan: Before we get to the research, what constitutes a dental check-up in terms of good practice, good dental practice?
Patrick Fee: How often to see our patients is perhaps the most commonly made decision about dentists, and many adults around the world will be used to going to see their dentists on a six-monthly basis, the rationale behind a check-up being to detect early signs and symptoms of dental disease, whether that be decay, gum disease, as well as an examination of the soft tissues of the mouth. Traditionally this is a check-up based on a scheduled six-month check-up, irrespective of an individual’s actual likely risk of developing disease.
Norman Swan: And are x-rays are part of that? They seem to be…in Australia they seem to do a lot of x-rays.
Patrick Fee: Certainly x-rays are one of the diagnostic tools that dentists have, and an examination will always be a visual examination of the teeth and soft tissues first of all, with x-rays then indicated to detect early signs of decay, generally between the teeth, it’s difficult to assess just with a visual check-up and they can spot signs of disease around the end of teeth, the bone levels around teeth, that we can’t assess just by looking at the teeth. So x-rays certainly can help supplement.
Norman Swan: But the main purpose is to detect and prevent tooth decay.
Patrick Fee: Correct, it’s a dual function by detecting early signs of disease and also providing preventative advice to patients, whether that be on improving their self-performed cleaning, giving dietary advice, or smoking cessation advice where appropriate.
Norman Swan: The purpose of this particular review, as I said earlier, was what are the recall intervals. How often should you come, what the evidence is for that benefit. What did you find?
Patrick Fee: This research is a Cochrane review which pulls together all the best available scientific evidence. There’s been a call for research in this specific area for several decades now because any guidance for dentists on how often to see patients for check-ups has been based on weak scientific evidence. That is really until now. We looked for all randomised clinical trials that allocated patients to different check-up frequency, and we searched for studies that were conducted in the general dental practice setting and in regular dental attendance so that the results will be most relevant to practising dentists.
And the result of this review really questioned whether a universal six-month check-up is the best frequency, because we considered patients who were attending at different check-up frequencies, so those who were attending every six months, some who were attending every two years for a check-up, and some who were attending based on their likely risk of developing disease, so what we know as a personalised risk based check-up. And we found that after four years, those attending on any of these check-up frequencies had similar oral health after four years of follow-up.
Norman Swan: Was any sense of regularity worth it, or was it simply the best outcome was from people who said, look, you’ve got a heap of dental decay there, I’m going to have to see you fairly frequently to get this in order, or something like that, or you’ve got heart disease and you wouldn’t want your gums to go wrong, we need to check you up on a regular basis, something like that. What was the story there?
Patrick Fee: Essentially we examined all of the patients on a broad range of outcome measures. So we looked at dental decay, gum health, gum disease, patient well-being, patient satisfaction with their check-up frequency. Between our groups of six-month check-up, two-year check-up, and personalised risk-based check-up, we found no differences across any of our outcome measures.
So I suppose the findings are not that no one should attend for dental check-ups on a six-monthly basis. There will be some patients, as you say, who are at high risk of decay or gum disease where six-monthly or even a three-monthly check-up will be appropriate, but it’s this universal six-monthly check-up for everyone that doesn’t seem appropriate when the oral health of patients seen at intervals based on their risk or low risk patients seen every two years have similar oral health at four years.
Norman Swan: So let’s assume you’re living in an area with fluoridated water, you’ve got very little dental decay, very few fillings in your mouth, is any kind of regular check-up worth it if you’ve got a good mouth?
Patrick Fee: Yes, so essentially what we’ve seen here is we’ve seen a group of patients at low risk of dental decay and gum disease who were attending the dentist every two years. Their oral health was very similar to those who were seen either every six months or risk based. So we have low-risk patients who were attending every two years had oral health that was similar to those who attended every six months. There is a positive message here, that the results appear to show that dentists can accurately assess individual patient’s risk of developing dental disease and allocate them to an appropriate check-up frequency.
Norman Swan: So what are the questions your dentist should be asking you in order to make that risk based decision?
Patrick Fee: So we know a number of risk factors that are associated with oral disease. We know that self-performed cleaning to remove plaque improves oral health. We know that, as you say, exposure to fluoride reduces decay, either through fluoridated water or fluoridated toothpaste. Dietary habits are related to oral disease, so particularly the frequency of intake of sugary foods. Smoking and alcohol, and a patient’s general health, particularly what medication they are on or conditions that may affect the quality or quantity of saliva which helps to protect our teeth from decay.
Norman Swan: And in these COVID-19 times, what are the implications here?
Patrick Fee: Absolutely, I think there’s a really positive message here, that in terms of current times, the research is valuable when considering the impact of the COVID-19 pandemic, we know that dental practices were closed, patient access for dental treatment has been limited, and access to dental care might remain limited for some time. But the results of this review provide reassurance really that intervals between check-ups can be extended beyond six months without detriment to oral health.
Norman Swan: Patrick, thanks for joining us.
Patrick Fee: Thanks Norman.
Norman Swan: So there you are, relief, you can go a little bit less frequently, unless you’ve got a risk factor. Patrick Fee is a dentist and a dental researcher at the University of Dundee in Scotland.