Recall intervals for oral health in primary care patients

Philip Riley; Helen V Worthington; Jan E Clarkson; Paul V Beirne

doi:10.1002/14651858.CD004346.pub4

Intervalos de visita para la salud oral en pacientes de atención primaria

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Referencias

References to studies included in this review

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Wang N, Marstrander P, Holst D, Ovrum L, Dahle T. Extending recall intervals ‐ effect on resource consumption and dental health. Community Dentistry and Oral Epidemiology 1992;20(3):122‐4.

References to studies excluded from this review

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Grimm WD, Curth K, Rumler KD, Walther C. Clinically controlled studies of the optimum recall interval of public health care patients [Klinisch‐kontrollierte untersuchung uber den optimalen recallabstand dispensairebetreuter patienten]. Stomatologie der DDR 1986;36(12):728‐32.

Schulz R, Seefeld G. Therapy of gingivitis. Investigations of the effectiveness of preventive care program in dental practice [Untersuchungen uber die Effektivitat von praventiven betreuungsprogrammen unter den bedingungen einer stomatiologischen praxis]. Stomatologie der DDR 1989;39(1):12‐6.

References to ongoing studies

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INTERVAL Dental Recalls Trial. Ongoing study 01/09/2011.

Additional references

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Burt B, Eklund SA. Dentistry, Dental Practice and the Community. 5th Edition. Philadelphia: WB Saunders Company, 1999.

Chapko MK, Fisher ES, Welch HG. When should this patient be seen again?. Effective Clinical Practice 1999;2(1):37‐43.

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Davenport C, Elley K, Salas C, Taylor‐Weetman CL, Fry‐Smith A, Bryan S, et al. The clinical effectiveness and cost‐effectiveness of routine dental checks: a systematic review and economic evaluation. Health Technology Assessment 2003;7(7):1‐127.

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Department of Health (UK). Modernising NHS Dentistry ‐ Implementing the NHS Plan. London: Department of Health, 2000.

Department of Health (UK). NHS Dentistry: Options for Change. London: Department of Health, 2002.

Department of Health, England. NICE Recall Intervals and Oral Health ‐ a Briefing for Dentists and Practice Teams, March 2011. Available from www.gov.uk/government/uploads/system/uploads/attachment_data/file/215663/dh_126005.pdf (accessed 08 December 2013).

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Elderton RJ. Routine six‐monthly checks for dental disease?. British Dental Journal 1985;159(9):277‐8.

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Field EA, Morrison T, Darling AE, Parr TA, Zakrzewska JM. Oral mucosal screening as an integral part of routine dental care. British Dental Journal 1995;179(7):262‐6.

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GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ 2004;328(7454):1490.

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Hausen H. Caries prediction ‐ state of the art. Community Dentistry and Oral Epidemiology 1997;25(1):87‐96.

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Kay EJ. How often should we go to the dentist?. BMJ 1999;319(7204):204‐5.

Kelly M, Steele J, Nuttall N, Bradnock G, Morris J, Nunn J, et al. Adult Dental Health Survey. Oral Health in the United Kingdom 1998. London: Her Majesty's Stationery Office, 2000.

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Lam S, Baros H, O'Grady M, Kendall G, Messer L, Slack‐Smith L. Patterns of attendance of children under 12 years at school dental service in Western Australia. The Open Dentistry Journal 2012;6:69‐73.

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National Health Service, National Institute for Clinical Excellence Guideline. Dental Recall: Recall Interval Between Routine Dental Examinations. NICE 2004. Available from www.nice.org.uk/CG019.

Patel S, Bay RC, Glick M. A systematic review of dental recall intervals and incidence of dental caries. Journal of the American Dental Association 2010;141(5):527‐39.

Perlus J. Determining recall frequency: a controversial issue. Ontario Dentist 1994;71(7):31‐5.

Petitti DB, Grumbach K. Variation in physicians' recommendations about revisit interval for three common conditions. Journal of Family Practice 1993;37(3):235‐40.

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Schwartz LM, Woloshin S, Wasson JH, Renfrew RA, Welch HG. Setting the revisit interval in primary care. Journal of General Internal Medicine 1999;14(4):230‐5.

Scott G, Brodeur JM, Olivier M, Benigeri M. Parental factors associated with regular use of dental services by second‐year secondary school students in Quebec. Journal of the Canadian Dental Association 2002;68(10):604‐8.

Sheiham A. Is there a scientific basis for six‐monthly dental examinations?. The Lancet 1977;2(8035):442‐4.

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Sheiham A. Routine check‐ups (letter to the editor). British Dental Journal 2000;189(4):181‐2.

Spencer AJ. Frequency of Dental Check‐Ups. Working Paper No 11. Australian Research Centre for Population Oral Health, The University of Adelaide, South Australia 2009. Available from www.adelaide.edu.au/oral‐health‐promotion/resources/prof/htm_files/Working_Paper_11‐_Frequency_of_Dental_Check_Ups_‐_Spencer_AJ.pdf.

Tan EH, Batchelor P, Sheiham A. A reassessment of recall frequency intervals for screening in low caries incidence populations. International Dental Journal 2006;56(5):277‐82.

Tobacman JK, Zeitler RR, Cilursu AM, Mori M. Variation in physician opinion about scheduling of return visits for common ambulatory care conditions. Journal of General Internal Medicine 1992;7(3):312‐6.

Todd JE, Lader D. Adult Dental Health in the United Kingdom 1988. London: Her Majesty's Stationery Office, 1991.

Tomar SL. There is weak evidence that a single, universal dental recall interval schedule reduces caries incidence. The Journal of Evidence‐Based Dental Practice 2011;11(2):89‐91.

Wang NJ, Holst D. Individualizing recall intervals in child dental care. Community Dentistry and Oral Epidemiology 1995;23(1):1‐7.

References to other published versions of this review

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Beirne P, Forgie A, Clarkson JE, Worthington HV. Recall intervals for oral health in primary care patients. Cochrane Database of Systematic Reviews 2005, Issue 2. [DOI: 10.1002/14651858.CD004346.pub2]

Beirne P, Clarkson JE, Worthington HV. Recall intervals for oral health in primary care patients. Cochrane Database of Systematic Reviews 2007, Issue 4. [DOI: 10.1002/14651858.CD004346.pub3]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

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Wang 1992

Methods	Trial design: parallel‐group RCT (2 arms) Location: public dental clinic, Tromsø, Norway Number of centres: 1
Participants	Inclusion criteria: children and adolescents who received regular dental care in one public dental clinic in Norway; participants entering the trial were either 3, 16 or 18 years of age Exclusion criteria: children classified as 'at risk'. Criteria for classification of 'risk patients': 3 years: more than 0 dmft 16 years: at least 1 decayed surface and 4 or more initial carious lesions and more than 10 DMFT 18 years: at least 1 decayed surface and 4 or more initial carious lesions and more than 12 DMFT Baseline caries (DMFS) (mean and SD): 3‐year olds (12‐month group: 0 ± 0; 24‐month group: 0 ± 0); 16‐year olds (12‐month group: 10.6 ± 7.7; 24‐month group: 11.4 ± 5.7); 18‐year olds (12‐month group: 11.9 ± 6.7; 24‐month group: 13.7 ± 6.8) Age at baseline: stratified into 3‐, 16‐, and 18‐year olds Gender: not reported Number randomised: 241; 3‐year olds (12‐month group: 35; 24‐month group: 35); 16‐year olds (12‐month group: 50; 24‐month group: 51); 18‐year olds (12‐month group: 35; 24‐month group: 35) Number evaluated: 185; 3‐year olds (12‐month group: 27; 24‐month group: 31); 16‐year olds (12‐month group: 43; 24‐month group: 35); 18‐year olds (12‐month group: 23; 24‐month group: 26)
Interventions	Comparison: 12‐month recall versus 24‐month recall 1 dentist and 1 hygienist provided all dental care. The hygienist examined 3‐year old patients at the initial, intermediate and final visits. The dentist examined the 16 and 18‐year olds and provided operative treatment for all the children Duration of study: 24 months
Outcomes	DMFS increment; total time (the sum of clinical examination time, operative treatment, acute visits (unscheduled extra visits initiated by the participant) and minutes wasted when the participant did not show up)
Notes	Funding source: not reported Sample size calculation: not reported Adverse effects: not reported
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "The participating children were randomly allocated to two groups" Comment: insufficient information
Allocation concealment (selection bias)	Unclear risk	Quote: "The participating children were randomly allocated to two groups" Comment: insufficient information
Blinding of participants and personnel (performance bias) All outcomes	High risk	Blinding of participants was not possible. Blinding of personnel was not mentioned
Blinding of outcome assessment (detection bias) All outcomes	High risk	1 dentist and 1 dental hygienist provided all dental care and examined the participants. Therefore blinding of outcome assessment was not carried out
Incomplete outcome data (attrition bias) All outcomes	Low risk	22% dropped out from the 12‐month group; 24% dropped out from the 24‐month group; all drop‐outs were due to leaving the area
Selective reporting (reporting bias)	Low risk	Outcomes stated in the methods section were reported in full
Other bias	Low risk	No other apparent biases

DMFS = decayed, missing, filled surfaces; DMFT/dmft = decayed, missing, filled teeth; RCT = randomised controlled trial; SD = standard deviation

Characteristics of excluded studies [ordered by study ID]

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Study	Reason for exclusion
Grimm 1986	Not a randomised controlled trial. In this study treatment and control groups were formed according to the age of participants
Schulz 1989	Unable to contact authors to determine if this study was a randomised controlled trial (paper in German) This study was fully translated with a view to determining its eligibility. However, we were unable to ascertain from this translation if it was a randomised trial. In addition the interventions and comparison groups were poorly described. The authors state that "55 test persons participated in this study. They had gingivitis caused by plaque at the age 15 and 25 years (17.7 years on average). Not included were pregnant women, patients with internal diseases, with prosthetic restorations and untreated caries. 15 test persons took part in 3 different programmes, over a period of 3 months that had the following objectives: oral hygiene instructions and motivation (dental nurse) as well as professional tooth cleaning (dentist). 1 group made up of 10 test persons (group IV) served as the control group. The programme of group III with 1 motivation session without teeth cleaning training was designed to check which results the frequent examination with an oral hygiene pass/check book produces. From the results of the test group we expected indications of the motivating effect of the professional teeth cleaning and of the importance for the reduction of gingivitis as such"

Characteristics of ongoing studies [ordered by study ID]

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ISRCTN95933794

Trial name or title	INTERVAL Dental Recalls Trial
Methods	Multicentre, 3‐arm, parallel‐group, randomised controlled trial
Participants	Adult patients (18 years of age or older) in the United Kingdom, who are dentate, have visited their dentist in the previous 2 years, and receive all or part of their dental care as an National Health Service patient
Interventions	6‐month fixed‐period recall versus risk‐based recall versus 24‐month fixed‐period recall
Outcomes	Primary 1. Health‐related quality of life measured using an annual, self administered patient questionnaire. Questionnaire will include a global assessment of quality of life using short form Oral Health Impact Profile, a standardised measure of health outcome (EQ‐5D) and a specially developed, context‐specific, health‐related quality of life measure 2. Periodontal disease assessed by gingival inflammation/bleeding measured according to the Gingival Index of Loe Secondary 1. Caries experience assessed at both the enamel and dentine thresholds using the validated International Caries Detection and Assessment System (ICDAS). The ICDAS criteria measure both early and more advanced stages of caries. For early caries, ICDAS measures the surface changes and potential histological depth of carious lesions by relying on surface characteristics related to the optical properties of sound and demineralised enamel prior to cavitation. All surfaces of all teeth will be examined and the status of each recorded in terms of caries and restorations. This system allows the recording of both preventive and operative care needs 2. Plaque measured according to the Silness and Loe Plaque Index, calculus measured according to the Ramfjord Calculus Index and a colour‐coded UNC periodontal probe will be used to measure periodontal pocket depth and clinical attachment level. The assessments will be made at 4 years by trained examiners who are blinded to allocation 3. Patient‐centred outcomes including dental anxiety, oral health related knowledge, attitudes, and behaviours, use of and reason for use of dental services (including symptoms and pain), and satisfaction with care measured using annual, self administered questionnaire. Total duration of follow‐up: 4 years 4. Dentist attitude towards the different recall strategies measured using a self administered questionnaire at month 0 and at 4 years All clinical outcomes are measured at 4 years by trained examiners who are blinded to allocation
Starting date	01/09/2011
Contact information	[email protected]
Notes	Funding source: NIHR Health Technology Assessment Programme ‐ HTA (UK) Sample size: In total, 2288 participants will be recruited in order to retain 1735 at 4 years Anticipated end date: 28/02/2017

Data and analyses

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Comparison 1. Clinical examination at 12 months versus clinical examination at 24 months

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Caries (dmfs/DMFS increment) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.1 Comparison 1 Clinical examination at 12 months versus clinical examination at 24 months, Outcome 1 Caries (dmfs/DMFS increment).
1.1 3‐5 year olds (primary teeth)	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.2 16‐20 year olds (permanent teeth)	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Total time (minutes) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.2 Comparison 1 Clinical examination at 12 months versus clinical examination at 24 months, Outcome 2 Total time (minutes).
2.1 3‐5 year olds (primary teeth)	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.2 16‐20 year olds (permanent teeth)	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]

Figure 1

Study flow diagram.

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Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Analysis 1.1

Comparison 1 Clinical examination at 12 months versus clinical examination at 24 months, Outcome 1 Caries (dmfs/DMFS increment).

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Analysis 1.2

Comparison 1 Clinical examination at 12 months versus clinical examination at 24 months, Outcome 2 Total time (minutes).

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Summary of findings for the main comparison. Clinical examination at 12 months versus clinical examination at 24 months

Clinical examination at 12 months compared with clinical examination at 24 months for oral health
Patient or population: children and adults Settings: public dental clinic Intervention: clinical examination at 12 months Comparison: clinical examination at 24 months
Outcomes	*Illustrative comparative risks (95% CI)**		No of participants (studies)	Quality of the evidence (GRADE)
	Assumed risk	Corresponding risk
	12‐month recall	24‐month recall
Caries (dmfs/DMFS increment) ‐ 3‐5 year olds (primary teeth) Higher values represent worse caries Follow‐up: 2 years	The mean caries score in the 12‐month group was 0.9	The mean caries score in the 24‐month group was 0.9 higher (1.96 higher to 0.16 lower)	58 (1 study)	⊕⊝⊝⊝ very low^{1, 2, 3}
Caries (dmfs/DMFS increment) ‐ 16‐20 year olds (permanent teeth) Higher values represent worse caries Follow‐up: 2 years	The mean caries score in the 12‐month group was 0.79	The mean caries score in the 24‐month group was 0.86 higher (1.75 higher to 0.03 lower)	127 (1 study)	⊕⊝⊝⊝ very low^{1, 2, 3}
Total time (minutes) ‐ 3‐5 year olds (primary teeth) Higher values represent worse time/cost outcomes Follow‐up: 2 years	The mean total time used by each participant in the 12‐month group was 52 minutes	The mean total time used by each participant in the 24‐month group was 10 minutes lower (6.7 higher to 26.7 lower)	58 (1 study)	⊕⊝⊝⊝ very low^{1, 2, 3}
Total time (minutes) ‐ 16‐20 year olds (permanent teeth) Higher values represent worse time/cost outcomes Follow‐up: 2 years	The mean total time used by each participant in the 12‐month group was 86.2 minutes	The mean total time used by each participant in the 24‐month group was 23.7 minutes lower (4.12 lower to 43.28 lower)	127 (1 study)	⊕⊝⊝⊝ very low^{1, 2, 3}
CI: confidence interval; dmfs/DMFS: decayed, missing, filled surfaces
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ Single study at high risk of performance and detection bias with unclear methods of sequence generation and allocation concealment ² Only low risk participants who had previously received regular dental care, including health promotion and preventive services were included ³ Low sample size

Summary of findings for the main comparison. Clinical examination at 12 months versus clinical examination at 24 months

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Comparison 1. Clinical examination at 12 months versus clinical examination at 24 months

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Caries (dmfs/DMFS increment) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

1.1 3‐5 year olds (primary teeth)	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.2 16‐20 year olds (permanent teeth)	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Total time (minutes) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

2.1 3‐5 year olds (primary teeth)	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.2 16‐20 year olds (permanent teeth)	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 1. Clinical examination at 12 months versus clinical examination at 24 months

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Referencias

References to studies included in this review

Wang 1992 {published data only}

References to studies excluded from this review

Grimm 1986 {published data only}

Schulz 1989 {published data only}

References to ongoing studies

ISRCTN95933794 {unpublished data only}

Additional references

AAPD 2013

Anthonappa 2008

Audit Commission 2002

BDA 2000

Brothwell 1998

Brown 1995

Bullock 2001

Burt 1999

Chapko 1999

Clarkson 2009

Clovis 2002

Conway 2002

Davenport 2003

Deep 2000

DeSalvo 2000

DoH 2000

DoH 2002

DoH 2011

DTB 1985

Egger 1997

Elderton 1983

Elderton 1985a

Elderton 1985b

Elley 2001

Field 1995

Frame 2000

GRADE 2004

Gussy 2013

Hausen 1997

HDA 2001

Higgins 2011

Jones 2013

Kay 1999

Kelly 2000

Lahti 2001

Lam 2012

Lock 1986

McGrath 2001

Mejare 1999

Mejare 2004

Murray 1996

NHS Executive 2002

NICE 2004

Patel 2010

Perlus 1994

Petitti 1993

Pitts 1983

Reekie 1997

Renson 1977

Renson 2000

Richards 2002

Riordan 1997

Royal College 1997

Rücker 2008

Schwartz 1999

Scott 2002

Sheiham 1977

Sheiham 1980

Sheiham 1985

Sheiham 2000

Spencer 2009

Tan 2006

Tobacman 1992

Todd 1991

Tomar 2011

Wang 1995

References to other published versions of this review

Beirne 2005

Beirne 2007