How often should you see your dentist for a check-up?

Why have a dental check-up?

A dental check-up helps to keep your mouth healthy and lets your dentist see if you have any dental problems. It allows your dentist to deal with any problems early, or even better, to prevent problems from developing. Leaving problems untreated may make them harder to treat in the future.

What happens in a check-up?

At each check-up your dentist will usually:

· examine your teeth, gums and mouth;

· ask about your general health and if you have had any problems with your teeth, mouth or gums since your last check-up;

· advise you about tooth-cleaning habits, and your diet, smoking and alcohol use.

· if appropriate, recommend treatment needed for any dental problems.

After your check-up, the dentist will recommend a date for your next check-up. Traditionally, check‑ups are recommended every six months. However, some people are at higher risk of developing dental problems and may need more frequent check-ups, while others may not need check-ups so often.

Why we did this Cochrane Review

Having check-ups every six months might help to keep your mouth healthy and avoid dental problems in future, but could also lead to unnecessary dental treatments. However, having check-ups less often might let dental problems get worse and lead to difficult and expensive treatment and care.

We wanted to identify the best time interval to have between dental check-ups.

What did we do?

We searched for randomised controlled studies in which people were assigned at random to different time intervals between check-ups. Randomised controlled studies usually give the most reliable evidence.

Search date: we included evidence published up to 17 January 2020.

What we found

We found two studies with 1736 people who had regular dental check-ups. One study was conducted in a public dental clinic in Norway in children and adults aged under 20 years. It compared 12-monthly and 24-monthly check-ups, and measured results after two years.

The other study was in adults at 51 dental practices in the UK. It compared six-monthly, 24‑monthly and risk-based check-ups (where time between check-ups was set by dentists and depended on an individual's risk of dental disease), and measured results after four years.

The studies looked at how different intervals between check-ups affected:

· how many people had tooth decay;

· how many tooth surfaces were affected by decay;

· gum disease (percentage of bleeding sites in the gums); and

· quality of life related to having healthy teeth and gums.

No studies measured other potential unwanted effects.

What are the results of our review?

In adults, there was little to no difference between six-monthly and risk-based check-ups in tooth decay (number of tooth surfaces affected), gum disease and quality of life after four years; and probably little to no difference in how many people had moderate-to-extensive tooth decay.

There was probably little to no difference between 24-monthly and six-monthly or risk-based check-ups in tooth decay (number of people and number of tooth surfaces affected), gum disease or well‑being, and may be little to no difference in how many people had moderate-to-extensive tooth decay.

We did not find enough reliable evidence about the effects of 12-monthly and 24-monthly check-ups in children and adolescents after two years. This was because of problems with the way that the study was conducted.

How reliable are these results?

We are confident that there is little to no difference between six‑monthly and risk‑based check-ups in adults for number of tooth surfaces with decay, gum disease and quality of life.

We are moderately confident there is little to no difference between 24-monthly check-ups and six-monthly or risk-based check-ups in number of tooth surfaces with decay, gum disease and quality of life.

Conclusions

Whether adults see their dentist for a check-up every six months or at personalised intervals based on their dentist's assessment of their risk of dental disease does not affect tooth decay, gum disease, or quality of life. Longer intervals (up to 24 months) between check-ups may not negatively affect these outcomes.

Currently, there is not enough reliable evidence available about how often children and adolescents should see their dentist for a check-up.

Authors' conclusions: 

For adults attending dental check-ups in primary care settings, there is little to no difference between risk-based and 6-month recall intervals in the number of tooth surfaces with any caries, gingival bleeding and oral-health-related quality of life over a 4-year period (high-certainty evidence). There is probably little to no difference between the recall strategies in the prevalence of moderate to extensive caries (moderate-certainty evidence).

When comparing 24-month with either 6-month or risk-based recall intervals for adults, there is moderate- to high-certainty evidence that there is little to no difference in the number of tooth surfaces with any caries, gingival bleeding and oral-health-related quality of life over a 4-year period.

The available evidence on recall intervals between dental check-ups for children and adolescents is uncertain.

The two trials we included in the review did not assess adverse effects of different recall strategies.

Read the full abstract...
Background: 

There is ongoing debate about the frequency with which patients should attend for a dental check-up and the effects on oral health of the interval between check-ups. Recommendations regarding optimal recall intervals vary between countries and dental healthcare systems, but 6-month dental check-ups have traditionally been advocated by general dental practitioners in many high-income countries.

This review updates a version first published in 2005, and updated in 2007 and 2013.

Objectives: 

To determine the optimal recall interval of dental check-up for oral health in a primary care setting.

Search strategy: 

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 17 January 2020), the Cochrane Central Register of Controlled Trials (CENTRAL; in the Cochrane Library, 2019, Issue 12), MEDLINE Ovid (1946 to 17 January 2020), and Embase Ovid (1980 to 17 January 2020). We also searched the US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. We placed no restrictions on the language or date of publication when searching.

Selection criteria: 

We included randomised controlled trials (RCTs) assessing the effects of different dental recall intervals in a primary care setting.

Data collection and analysis: 

Two review authors screened search results against inclusion criteria, extracted data and assessed risk of bias, independently and in duplicate. We contacted study authors for clarification or further information where necessary and feasible. We expressed the estimate of effect as mean difference (MD) with 95% confidence intervals (CIs) for continuous outcomes and risk ratios (RR) with 95% CIs for dichotomous outcomes. We assessed the certainty of the evidence using GRADE.

Main results: 

We included two studies with data from 1736 participants. One study was conducted in a public dental service clinic in Norway and involved participants under 20 years of age who were regular attenders at dental appointments. It compared 12-month with 24-month recall intervals and measured outcomes at two years. The other study was conducted in UK general dental practices and involved adults who were regular attenders, which was defined as having attended the dentist at least once in the previous two years. It compared the effects of 6-month, 24-month and risk-based recall intervals, and measured outcomes at four years. The main outcomes we considered were dental caries, gingival bleeding and oral-health-related quality of life. Neither study measured other potential adverse effects.

24-month versus 12-month recall at 2 years' follow-up

Due to the very low certainty of evidence from one trial, it is unclear if there is an important difference in caries experience between assignment to a 24-month or a 12-month recall. For 3- to 5-year-olds with primary teeth, the mean difference (MD) in dmfs (decayed, missing, and filled tooth surfaces) increment was 0.90 (95% CI −0.16 to 1.96; 58 participants). For 16- to 20-year-olds with permanent teeth, the MD in DMFS increment was 0.86 (95% CI −0.03 to 1.75; 127 participants). The trial did not assess other clinical outcomes of relevance to this review.

Risk-based recall versus 6-month recall at 4 years' follow-up

We found high-certainty evidence from one trial of adults that there is little to no difference between risk-based and 6-month recall intervals for the outcomes: number of tooth surfaces with any caries (ICDAS 1 to 6; MD 0.15, 95% CI −0.77 to 1.08; 1478 participants); proportion of sites with gingival bleeding (MD 0.78%, 95% CI −1.17% to 2.73%; 1472 participants); oral-health-related quality of life (MD in OHIP-14 scores −0.35, 95% CI −1.02 to 0.32; 1551 participants). There is probably little to no difference in the prevalence of moderate to extensive caries (ICDAS 3 to 6) between the groups (RR 1.04, 95% CI 0.99 to 1.09; 1478 participants; moderate-certainty evidence).

24-month recall versus 6-month recall at 4 years' follow-up

We found moderate-certainty evidence from one trial of adults that there is probably little to no difference between 24-month and 6-month recall intervals for the outcomes: number of tooth surfaces with any caries (MD −0.60, 95% CI −2.54 to 1.34; 271 participants); percentage of sites with gingival bleeding (MD −0.91%, 95% CI −5.02% to 3.20%; 271 participants). There may be little to no difference between the groups in the prevalence of moderate to extensive caries (RR 1.05, 95% CI 0.92 to 1.20; 271 participants; low-certainty evidence). We found high-certainty evidence that there is little to no difference in oral-health-related quality of life between the groups (MD in OHIP-14 scores −0.24, 95% CI −1.55 to 1.07; 305 participants).

Risk-based recall versus 24-month recall at 4 years' follow-up

We found moderate-certainty evidence from one trial of adults that there is probably little to no difference between risk-based and 24-month recall intervals for the outcomes: prevalence of moderate to extensive caries (RR 1.06, 95% CI 0.95 to 1.19; 279 participants); number of tooth surfaces with any caries (MD 1.40, 95% CI −0.69 to 3.49; 279 participants). We found high-certainty evidence that there is no important difference between the groups in the percentage of sites with gingival bleeding (MD −0.07%, 95% CI −4.10% to 3.96%; 279 participants); or in oral-health-related quality of life (MD in OHIP-14 scores −0.37, 95% CI −1.69 to 0.95; 298 participants).

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