Authors' objectives:

This review aims to address the following questions:

- How effective are routine dental checks of different recall frequencies in improving quality of life and reducing the morbidity associated with dental caries and periodontal disease in children?

- How effective are routine dental checks of different recall frequencies in improving quality of life, reducing the morbidity associated with dental caries, periodontal disease and oral cancer, and reducing the mortality associated with oral cancer in adults?

- What is the cost-effectiveness of routine dental checks of different recall frequencies in improving quality of life and reducing the morbidity associated with dental caries and periodontal disease in children?

- What is the cost-effectiveness of routine dental checks of different recall frequencies in improving quality of life, reducing the morbidity associated with dental caries, periodontal disease and oral cancer, and reducing the mortality associated with oral cancer in adults?

Authors' results and conclusions: Effectiveness: Information from 25 articles reporting the results of 29 studies are included in this review. Twenty-four studies addressed the effectiveness of dental checks on caries; nine concerned periodontal disease, two oral cancer and one quality of life. The studies included in the effectiveness review were poorly reported, which limited internal comparison (between studies) and also external comparison with the current UK situation. Heterogeneity across studies with regard to the intervention under study further limited external comparison with the current UK situation. Only four studies addressing caries in permanent or deciduous teeth included 6 months as a comparison frequency and thus addressed the review question from a UK perspective. A sensitivity analysis conducted on the outcome of dental caries indicated that the findings presented below were robust to the methodological quality of the studies. Caries: There was little consistency in the direction of effect of different dental check frequencies between studies for outcome measures in deciduous, mixed or permanent dentition. Two separate studies demonstrated no significant difference between dental check frequency and decayed, missing and filled teeth in deciduous or mixed dentition. One study reported a significant reduction in the number of fillings with individualised dental check frequencies compared with a blanket recall policy of 12 months or longer in mixed dentition. There was a preponderance of studies reporting an increase in decay, a decrease in the number of teeth, and a decrease in fillings, with less frequent dental checks in permanent dentition. Periodontal disease: A single study demonstrated a decrease in attachment level with a decrease in dental check frequency, which was of uncertain statistical significance. There was no consistency in the direction of effect of different dental check frequencies in permanent dentition between studies for: bleeding, probing depth/pockets, presence of plaque/calculus, bone score, gingivitis and periodontal health. Oral cancer: One study suggests that dental check recall intervals of less than 12 months do not impact on tumour size at diagnosis. One study reports that decreasing dental check frequencies (more than 12 months) may significantly increase the stage and size of tumours at diagnosis. Quality of life: One study demonstrated a significant association between increasing dental check frequency and the perception that oral health affects quality of life.

Authors' recommendations: There is little existing evidence to support or refute the practice of encouraging 6-monthly dental checks in adults and children. Decision analysis modelling using current UK data to investigate further the cost-effectiveness of different dental check recall frequencies on the experience of dental decay in deciduous and permanent dentition suggests that moving to longer (more than 6-monthly) dental check frequencies, rather than shortening the currently practised recall interval, would be more cost-effective. However, the model demonstrates that cost-effectiveness varies across risk groups and therefore consideration should be given to whether a population recall policy or a recall policy based on individual risk would be more appropriate. Given the limitations of existing UK epidemiological data, it was not possible to undertake a modelling exercise to investigate the cost-effectiveness of different frequencies of dental checks on the experience of periodontal disease or on the morbidity and mortality associated with oral cancer. There is a need for further primary research addressing the role of the dental check and its effectiveness in different oral diseases.

Authors' methods: Systematic review, Economic evaluation

Project Status: Completed

URL for project: http://www.hta.ac.uk/1215

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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