How frequently should children and adults receive routine dental checks?

Summary of a HEN network member’s report

The issue

A marked improvement has been observed in the general oral health of the population of the United Kingdom over the last three decades, as measured by decreases in periodontal disease, caries and tooth loss in adults, and in caries in children. Still, there is an increasing incidence of oral cancer in adults and static levels of periodontal disease in children. Important inequalities in dental health remain, particularly across socioeconomic groups and between areas with and areas without fluoridated water supplies. This raises the question: should dental check intervals be more closely related to dental needs? The optimal frequency of dental checks has been the subject of interventional debate for almost three decades. There is no formal policy on their frequency in most developed countries.

Findings

A systematic review was conducted on the effectiveness and cost–effectiveness of routine dental checks of different frequencies. Only 29 studies met the inclusion criteria, and many of them exhibited major quality problems. The review compared findings in several areas.

• There was little consistency among the study results on the effect of different dental check frequencies on outcome measures such as DMFT, decay, and missing teeth. (DMFT is the number of decayed, missing and filled permanent teeth.)
• There was no consistency in the study findings on the effect of different dental check frequencies on outcomes such as bleeding, probing depth/pocket depth and presence of plaque/calculus.
• One study showed no association between dental check intervals of less than 12 months and oral cancer tumour size and stage at diagnosis. Another study reported that increasing the interval between dental checks to more than 12 months) may increase tumour size and stage at diagnosis.
• One cross-sectional study showed an association between dental check frequency and the perception that oral health affects quality of life.
• There was much uncertainty in published economic evaluations. The one formal cost–effectiveness study identified showed an incremental cost of US$ 73 per carious surface averted when comparing 12-month dental checks to no checks.
• Decision analysis, using data from the United Kingdom with very strong assumptions, suggests that increasing dental check intervals to more than 6 months would be more cost-effective in dental decay in deciduous and permanent teeth than decreasing the intervals to less than 6 months. However, the cost–effectiveness varies across risk-groups based on social class and the presence or absence of a fluoridated water supply.

Policy considerations

Little evidence exists to suggest an optimal frequency for dental checks in children and adults. A policy for dental check frequency can be tailored to the total population, population subgroups or individual patient risk. Further primary research is required in order to assess the relative clinical benefits and cost–effectiveness of different frequencies of dental checks for the most common oral diseases, including dental caries, periodontal disease and oral cancer.

The views expressed in this summary are based on a publication of a HEN Network member agency and do not necessarily represent the decisions or stated policy of WHO/Europe.

Source

The summary is based on a report by the United Kingdom National Coordinating Centre for Health Technology Assessment (NCCHTA).