By Claudia HammondCorrespondent features
Is it really necessary to see the dentist every six months for good oral health? Claudia Hammond investigates.
Many of us think we should visit the dentist every six months – even if that’s not what we do in practice. However, whether these six-monthly checks are really necessary is up for debate. In fact, it’s not even clear where the six-month number came from in the first place. Some believe it dates back to the 18th centurylong before the advent of randomized controlled trials that could test its benefits.
People with many problems with their teeth, of course, need to visit the dentist often. But what about everyone else? Permanent teeth are most vulnerable to decay soon after they appear, so when children have just developed their first permanent teeth at the age of six to eight they need these regular check-ups. During adolescence, teeth are less vulnerable, until wisdom teeth erupt in your twenties. So the risk varies at different times of life.
In 2000, Three-quarters of dentists surveyed in New York City recommended six monthly exams, despite the absence of studies examining whether frequency of visits made a difference in patients at low risk of caries or gingivitis. Today, many organizations such as the American Academy of Pediatric Dentistry still recommend six monthly exams.
But for several decades some have argued that choosing six months as the ideal interval between visits is rather arbitrary. In 1977 Aubrey Sheiham, Professor of Public Health Dentistry at University College London, published an article in The Lancet lamenting the lack of evidence for six monthly checks. Almost 40 years later, still makes the same point.
In 2003 a systematic review looked at the research that had been done at the time. The results were mixed. Some studies found no difference between the number of decayed teeth, fillings, or missing teeth in those who went to the dentist often and those who did not, while other studies found fewer fillings in those who went a lot. When it comes to the gums, most research has found no difference in the amount of bleeding, plaque or gingivitis in permanent teeth. One study found that visiting the dentist more than once a year made no difference to the size of tumors when diagnosed with oral cancer, while another found that if people waited more than a year between visits, the tumors would they could be more advanced when detected.
Last year the Cochrane Collaboration conducted a similar systematic review of research, and were disappointed with what they found. The quality and quantity of research was simply too poor to support or refute the idea of semiannual audits. They found only one controlled study where patients were randomized to see the dentist either annually or every two years. Those who went annually did better, but it is possible that the dental staff knew whether patients were in the annual or biennial group, which could have influenced the treatment they received and biased the results.
There is something else to keep in mind. Even when a study finds, for example, that children who go to the dentist frequently have fewer fillings, there may be other factors at work. The same guys it may have other advantages; they may belong to a higher socio-economic group, eat healthier and have better quality dental equipment.
There is a secondary purpose to dental visits. Even if the dentist doesn’t find any problems, they’re likely to remind you to keep taking care of your teeth and cleaning them properly – even though There is no consensus on the best way to do this either.
So how often should you visit the dentist? Bodies like Beautiful, which provides guidance for the National Health Service in England and Wales, states that the frequency of visits to the dentist depends on the individual. They recommend that children go at least once a year because their teeth can decay more quickly, while adults without problems can wait up to two years. They go so far as to say so more than two years is fine for people who have shown dedication to the care of their teeth and gums. Similar advice is given elsewhere. An expert panel that reviewed the evidence in Finland in 2001 recommended that people under 18 at low risk could visit every 18 months to two years.
Where does that leave the rest of us the next time we get a card at the door reminding us that our next dentist visit is due? We’d all love an excuse to go less often, and the good news is that if you’re not having problems, you can probably wait a little over six months between visits. But exactly how long you can wait before your appointment in the dentist’s chair will depend on the assessment you and your dentist make of your individual risk.
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