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.
If you would like to comment on this article, or anything else you have seen on
Future, head over to our Facebook or Google+ page, or message us on Twitter.
Disclaimer
All content within this column is provided for general information only, and
should not be treated as a substitute for the medical advice of your own doctor
or any other health care professional. The BBC is not responsible or liable for
any diagnosis made by a user based on the content of this site. The BBC is not
liable for the contents of any external internet sites listed, nor does it
endorse any commercial product or service mentioned or advised on any of the
sites. Always consult your own GP if you're in any way concerned about your
health.