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Insufficient evidence to support or refute a specific dental recall interval Critical Summary Prepared by: Greg Huang DMD, MSD, MPH; Analia Veitz-Keenan DDS; Stacy Geisler DDS, PhD 

OVERVIEW

  • Systematic Review Conclusion:

    There is no current reliable evidence to support or refute the common practice of six-month dental recall intervals.

  • Critical Summary Assessment:

    This Cochrane systematic review found only one randomized controlled trial that met inclusion criteria.

  • Evidence Quality Rating:

    Limited

A Critical Summary of:

Recall intervals for oral health in primary care patients

Beirne P, Clarkson JE, Worthington HV. Cochrane Database Syst Rev. 2007;(4):CD004346

  • Clinical Questions:

    To determine the relative benefit or harm of various dental recall intervals.

  • Review Methods:

    The authors conducted an all-language search of four electronic databases from January 1, 1966 to March 5, 2007. Inclusion criteria were: a) randomized controlled trials, b) subjects of all ages, c) dental check-ups received in primary care settings. Several outcomes were assessed, including clinical (caries, fillings, periodontal status, etc.), psychosocial (patient/parent satisfaction, oral comfort, etc.), and economic (patient and provider costs). Hand searching of reference lists was performed, and some authors were contacted to obtain additional information. Two individuals independently reviewed studies for inclusion, abstracted data, and assessed study quality.

  • Main Results:

    The authors identified 496 titles and abstracts in the initial search, from which 47 full reports were obtained. However, only one study met all inclusion criteria. The excluded studies either were irrelevant or nonrandomized trials. The included study had 188 participants that were enrolled at the ages of three, 16, and 18. The study found a significant increase in examination time when subjects were recalled every 12 months compared with every 24 months. However, there was no significant difference in decayed, missing or filled surfaces incrementally from the beginning to the end of the trial. The authors judged he study to be of poor methodological quality.

  • Conclusion:

    Of the 47 studies considered for inclusion, only one study met the established criteria for this systematic review. Based on that single randomized trial, the systematic review authors concluded that there was insufficient evidence to support or refute any particular recall interval.

  • Source of funding:

    Cochrane Fellowship – Health Research Board, Ireland; National Health Service, National Institute for Health and Clinical Excellence, UK; Department of Health Cochrane Review Incentive Scheme, UK; School of Dentistry, The University of Manchester, UK; Scottish Executive, UK; University College, Cork, Ireland.

Commentary:

  • Importance and Context:

    Since childhood, we have been instructed to “visit (our) dentist twice a year.” Using clinical, psychological and economic indicators, this review examined the benefit and risk provided by various recall intervals . Dr. Aubrey Sheiham raised this question more than 30 years ago to universal derision. The answer remains unclear (reference 1). Given the time, effort, and cost of biannual dental examinations, it is logical, reasonable, and important to determine the optimal recall frequency for individuals.

  • Strengths and Weaknesses of the Systematic Review:

    This was a thorough review with no apparent weaknesses. The authors searched four databases, and also searched reference lists and contacted authors. The inclusion criteria were stated, and lists of included and excluded studies, with reasons, were provided. Two independent reviewers assessed studies for inclusion, performed data abstraction, and judged the quality of the included studies.

  • Strengths and Weaknesses of the Evidence:

    Despite the clinical importance of the central question, only one randomized trial was identified, which was judged to be of poor methodological quality. The systematic review authors stated that reliable conclusions cannot be made based on the paucity of evidence provided by this randomized trial. The authors also discussed the non-randomized literature on this topic, which was assessed in a prior systematic review (reference 2), as well as in a practice guideline formulated by the National Health Service in England and Wales (reference 3). Interestingly, there was consistency in the randomized and nonrandomized trials, which suggest that on a population basis, the optimal recall interval is unknown.

  • Implications for Dental Practice:

    The current evidence does not provide clear guidelines for establishing appropriate recall intervals. Therefore, dentists should determine, with their patients, recall intervals based on each patient’s dental history, preferences, and risk status.

    [References:
    1. Sheiham A. Is there a scientific basis for six-monthly dental examinations? Lancet. 1977;2(8035):442-4.
    2. Davenport C, Elley K, Salas C, et al. The clinical effectiveness and cost-effectiveness of routine dental checks: a systematic review and economic evaluation. Health Technology Assessment 2003;7(7): 1-127.
    3. National Health Service. National Institute for Clinical Excellence Guideline. Dental recall: recall interval between routine dental examinations. London: NICE, 2004 (www.nice.org.uk/CG019).]

  • Critical Summary Publication Date: 3/6/2009

These summaries are not intended to, and do not, express, imply, or summarize standards of care, but rather provide a concise reference for dentists to aid in understanding and applying evidence from the referenced systematic review in making clinically sound decisions as guided by their clinical judgment and by patient needs. American Dental Association ©

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