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How often do you need to see a dentist?

2014-09-29 04:47:50

Claudia Hammond

Is going to the dentist every six months really necessary for good oral health?

Claudia Hammond investigates.

A lot of us think that we should visit the dentist every six months even if

it s not what we do in practice. Whether those biannual check-ups are really

necessary is, however, a matter of debate. In fact, it s not even clear where

the six-month figure initially came from. Some believe it dates back to the

18th Century, long before the advent of randomised controlled trials that could

test its benefits.

People with a lot of problems with their teeth do, of course, need to visit the

dentist often. But what about everyone else? Permanent teeth are more

vulnerable to decay soon after they ve come through, so when children have just

grown their first permanent teeth at the ages of six to eight they need those

regular check-ups. In the teens, teeth are less vulnerable, until wisdom teeth

come through in your twenties. So the risk varies at different times of life.

In 2000, three-quarters of dentists surveyed in New York were recommending six

monthly check-ups, despite the absence of studies examining whether the

frequency of visits made a difference to patients at low-risk of tooth decay or

gum disease. Today, many organisations such as the American Academy of

Pediatric Dentistry still recommend six monthly check-ups.

But for several decades some have been arguing that the choice of six months as

the ideal space between visits is rather arbitrary. Back in 1977 Aubrey

Sheiham, a professor of dental public health at University College London,

published a paper in The Lancet bemoaning the lack of evidence for six monthly

check-ups. Almost 40 years on, he s still making the same point.

In 2003 a systematic review examined the research that had then been done. The

results were mixed. Some studies found no difference between the number of

decayed teeth, fillings or missing teeth in those who attended the dentist

frequently and those who didn t, while other studies found fewer fillings in

those who went a lot. When it came to gums most research found no difference in

the amount of bleeding, plaque or gingivitis in permanent teeth. One study

found that going to the dentist more than once a year made no difference to the

size of tumours at diagnosis with oral cancer, while another found that if

people waited more than a year between visits, tumours could be more advanced

when they were found.

Last year the Cochrane Collaboration performed a similar systematic review of

the research, and they were disappointed with what they found. The quality and

quantity of the research was simply too poor to back up or refute the idea of

six-monthly check-ups. They found just one controlled study where patients were

randomised to attend the dentist either annually or every two years. Those who

went annually did better, but it s possible that the dental staff knew whether

patients were in the annual or two-yearly group, which could have influenced

the treatment they received and biased the results.

There s something else we have to bear 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. Those same children may have other

advantages; they may belong to a higher socio-economic group, eat more

healthily and have better quality dental equipment.

There is a secondary purpose to dental visits. Even if the dentist doesn t spot

any problems, they are likely to remind you to keep on caring for your teeth

and cleaning them properly although there s no consensus about the best way

of doing that either.

How often should you visit the dentist, then? Bodies like Nice, which provides

guidance for the National Health Service in England and Wales, say that the

frequency of dental visits all depends on the individual. They recommend that

children go at least once a year because their teeth can decay faster, while

adults without problems can wait as long as two years. They even go as far as

to say that longer than two years is OK for people who have shown commitment to

caring for their teeth and gums. Similar advice is given elsewhere. An expert

group reviewing the evidence in Finland back in 2001 recommended that under-18s

who are at low risk could visit between every 18 months and two years.

Where does this leave the rest of us the next time we receive a card through

the door reminding us our next dental visit is due? We d all like an excuse to

go less often, and the good news is that if you don t have any problems you can

probably wait a little longer than six months between visits. But exactly how

long you can wait before your appointment with the dentist s chair will depend

on the assessment you and your dentist make of your individual risk.

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