The Six Month Dental Recall – Science or Legend?
Prevention is the hallmark of modern healthcare. Despite claims by ideologically driven individuals accusing physicians, dentists, and “Big Pharma” of wanting to keep people sick because we can make more money by treating the disease, this is assuredly not the case. In dentistry, prevention takes many forms: from encouraging people to brush and floss, to eating a healthy diet (especially one low in cavity promoting carbohydrates), to the fluoridation of toothpastes, mouthwashes, and community water supplies.
Buuuut
The actual science behind the six month recall
OK, so now we’ve established and accepted that the six month recall is the cornerstone of modern preventive dentistry. It’s taught in dental and dental hygiene schools worldwide and is practiced almost universally. It’s been elevated to the level of dogma, handed down on stone tablets from the dental gods on Mt. Sinai. So what does the science say? If you’ve read some of my previous Science Based Medicine posts or have listened to the podcast I co-host with fellow Science Based Medicine contributor Clay Jones, it won’t surprise you to learn that the science behind the six month recall is pretty lame, just like a lot of research is in dentistry.
There are some research papers, including meta-analyses, that cover the recall interval as it pertains to various outcomes. A 2007 Cochrane Review by Beime, et. al. concluded that:
There is insufficient evidence from randomised controlled trials (RCTs) to draw any conclusions regarding the potential beneficial and harmful effects of altering the recall interval between dental check-ups. There is insufficient evidence to support or refute the practice of encouraging patients to attend for dental check-ups at 6-monthly intervals.
Across the pond, a 1977 Lancet article by Sheiham concluded:
Persons having dental examinations at intervals longer than 6 months were not at a disadvantage. They did not have more severe dental caries or periodontal disease than those attending at intervals of 6 months. Neither was there any evidence that an interval of more than 6 months would affect the prognosis for orthodontic treatment. Oral malignancies are rare in British populations, and routine 6-monthly screening to detect oral malignancies is unreasonable.
And in the British Dental Journal (2003), Davenport et. al. in a systematic review stated:
There is no existing high quality evidence to support or refute the practice of encouraging six-monthly dental checks in adults and children.
Another Cochrane Database Systematic Review by Riley et. al. (2013) concluded pretty much the same thing as everyone else, saying:
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.
Studying whether recall intervals of varying lengths would have an effect on dental caries, Patel, et.al. summarized:
The authors conclude that the evidence for using a one-recall-interval-fits-all protocol to reduce caries incidence was weak. Studies that addressed the impact of recall interval on caries incidence were methodologically weak. The evidence was not strong enough to support using any specific one-recall-interval-fits-all protocol for all patients.
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