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Associated Topics

Recall intervals for oral health in primary care patients

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


BACKGROUND: The frequency with which patients should attend for a dental check-up and the potential effects on oral health of altering recall intervals between check-ups have been the subject of ongoing international debate for almost 3 decades. Although recommendations regarding optimal recall intervals vary between countries and dental healthcare systems, 6-monthly dental check-ups have traditionally been advocated by general dental practitioners in many developed countries. OBJECTIVES: To determine the beneficial and harmful effects of different fixed recall intervals (for example 6 months versus 12 months) for the following different types of dental check-up: a) clinical examination only; b) clinical examination plus scale and polish; c) clinical examination plus preventive advice; d) clinical examination plus preventive advice plus scale and polish. To determine the relative beneficial and harmful effects between any of these different types of dental check-up at the same fixed recall interval. To compare the beneficial and harmful effects of recall intervals based on clinicians' assessment of patients' disease risk with fixed recall intervals. To compare the beneficial and harmful effects of no recall interval/patient driven attendance (which may be symptomatic) with fixed recall intervals. SEARCH STRATEGY: We searched the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Reference lists from relevant articles were scanned and the authors of some papers were contacted to identify further trials and obtain additional information. Date of most recent searches: 5th March 2007. SELECTION CRITERIA: Trials were selected if they met the following criteria: design - random allocation of participants; participants - all children and adults receiving dental check-ups in primary care settings, irrespective of their level of risk for oral disease; interventions - recall intervals for the following different types of dental check-ups: a) clinical examination only; b) clinical examination plus scale and polish; c) clinical examination plus preventive advice; d) clinical examination plus scale and polish plus preventive advice; e) no recall interval/patient driven attendance (which may be symptomatic); f) clinician risk-based recall intervals; outcomes - clinical status outcomes for dental caries (including, but not limited to, mean dmft/DMFT, dmfs/DMFS scores, caries increment, filled teeth (including replacement restorations), early carious lesions arrested or reversed); periodontal disease (including, but not limited to, plaque, calculus, gingivitis, periodontitis, change in probing depth, attachment level); oral mucosa (presence or absence of mucosal lesions, potentially malignant lesions, cancerous lesions, size and stage of cancerous lesions at diagnosis). In addition the following outcomes were considered where reported: patient-centred outcomes, economic cost outcomes, other outcomes such as improvements in oral health knowledge and attitudes, harms, changes in dietary habits and any other oral health-related behavioural change. DATA COLLECTION AND ANALYSIS: Information regarding methods, participants, interventions, outcome measures and results were independently extracted, in duplicate, by two review authors. Authors were contacted, where deemed necessary and where possible, for further details regarding study design and for data clarification. A quality assessment of the included trial was carried out. The Cochrane Collaboration's statistical guidelines were followed. MAIN RESULTS: Only one study (with 188 participants) was included in this review and was assessed as having a high risk of bias. This study provided limited data for dental caries outcomes (dmfs/DMFS increment) and economic cost outcomes (reported time taken to provide examinations and treatment). AUTHORS' CONCLUSIONS: There is insufficient evidence from randomised controlled trials (RCTs) to draw any conclusions regarding the potential beneficial and harmful effects of alterin 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. 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.

Insufficient evidence to support or refute a specific dental recall interval

Stacy Geisler DDS, PhD; Greg Huang DMD, MSD, MPH; Analia Veitz-Keenan DDS .


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 Evidence


Structured Abstract

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 © 2019