Frequency and Timing of Dental Check-ups - Health Guide

The decision on how frequently to schedule check-ups for our patients stands as one of the most commonplace choices made by dentists. Traditionally, adults have been accustomed to undergoing routine check-ups every six months, irrespective of their individual risk of oral diseases such as tooth decay or gum disease.

These dental check-ups play a crucial role in the early detection of oral diseases, particularly dental decay and gum disease, while also assessing the overall health of the oral cavity. By identifying issues early on, dentists can intervene before decay or gum disease advances, potentially requiring more intricate treatments. The integration of information gathered during the check-up empowers dentists to utilise their clinical judgement, predicting an individual's likelihood of developing future dental diseases and offering tailored advice to address specific risk factors.

It's important to note that the risk of dental disease varies among individuals. The National Institute for Health and Care Excellence has recommended a personalised, risk-based check-up frequency. The time between check-ups is proposed to depend on an individual's anticipated risk, ranging from three to 24 months.

Nevertheless, this recommendation is based on evidence of low quality. Despite this, the common practice of encouraging patients to attend check-ups every six months persists. In primary care settings, where adults receive dental check-ups, there is high-certainty evidence indicating that, overall, there is no discernible difference in oral health between 6-monthly and risk-based check-up frequencies. Additionally, there is moderate- to high-certainty evidence suggesting little to no variation in oral health when comparing a 24-monthly check-up with either 6-monthly or risk-based check-ups over a four-year period. Consequently, considering the certainty of the evidence, further studies comparing check-up frequency for adults in primary care may be deemed unnecessary.

However, for children and adolescents, there is insufficient reliable evidence regarding the effects of 12-monthly and 24-monthly check-ups after two years.

What does this mean for adults undergoing routine check-ups? 

It indicates that the conventional practice of scheduling a universal, one-size-fits-all six-monthly check-up for all adults in routine check-ups is unlikely to enhance oral health compared to a personalised risk-based check-up approach or compared to check-ups every two years for patients at low risk of dental disease. 

These findings suggest that a risk-based check-up frequency can be supported, as it does not appear detrimental to oral health and is acceptable to patients. It's crucial to note that this evidence pertains to adults in routine check-ups, not individuals requiring emergency treatment or children.

Are there other risks associated with infrequent check-ups? One argument favouring six-monthly dental check-ups is the potential oversight of early-stage oral cancer lesions in patients attending less frequently. However, no studies in this review reported the effect of different check-up frequencies on detecting oral cancer.

Furthermore, individuals at a heightened risk of oral cancer also face an elevated risk of dental decay and gum disease. This includes those with higher alcohol intake, smokers, and individuals from lower socioeconomic statuses, who are at increased risk of all three diseases. A personalised risk-based check-up frequency offers the flexibility to schedule more frequent appointments for those at greater risk, while healthy patients can undergo less frequent check-ups. 

Emphasising the importance of checking the health of the mouth at every appointment, it is recommended to recall patients at high risk of dental disease and oral cancer more frequently than those at low risk of these conditions.

In the context of the COVID-19 global pandemic and its substantial impact on dental services worldwide, restricting patient access to dental treatment, this research gains added significance. While patient access to dental care may continue to be limited for some time, the findings of this review provide reassurance that extending intervals between check-ups beyond six months does not adversely affect oral health. 

This becomes particularly relevant in the current scenario where the COVID-19 pandemic has disrupted regular healthcare services.

Assessing an individual's risk of developing future dental disease involves a comprehensive evaluation by a dentist, considering various factors such as:

• Self-performed oral hygiene habits and timing (e.g., brushing teeth, flossing)
• Dietary habits, including the amount and frequency of sugar intake
• Fluoride use
• Tobacco use
• Alcohol intake
• Signs of active disease
• Plaque control
• Quantity and quality of saliva (which plays a protective role against dental disease)
• Past disease experience, assessed through the number of teeth with fillings or those previously extracted
• Medical history, including factors that may impact oral health

Synthesising this gathered information empowers the dentist to leverage their clinical judgement in predicting the individual's probable future disease experience. Subsequently, they can propose a personalised recall interval based on the risk assessment. 

This decision is a collaborative effort between the dentist and the patient, involving discussions on the recommended interval, exploration of patient preferences and expectations, and consideration of any pertinent financial implications.

In instances where uncertainty surrounds an individual's disease risk, an initially conservative recall interval can be extended if good oral health is consistently maintained. Conversely, if new risk factors are identified during a check-up, previously longer recall intervals can be adjusted to align with changes in the anticipated future disease experience.