Back To the Future with Recall Intervals
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- Published: Tuesday, 26 March 2024 10:22
- Written by Guy Tuggle
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The recent budget relies on economic growth that is by no means certain. The dental recovery plan also takes for granted future ‘wins’ for the dental economy. One of the major sources of extra capacity is to be achieved by squeezing regular attenders out of NHS dental practice diaries. This should then make spaces available for those with emergencies and those who have been unable to secure appointments, in turn reducing the pressure on both MP’s postbags and A&E departments.
Messaging from the NHS to dental teams is clear, the days of one size fits all routine examinations, are over. NICE guidance has come to the rescue, with the advice that many patients only need to be seen biennially.
A major new study published in BDJ Open may offer a more nuanced view.
Titled, ‘Impact of dental visiting patterns on oral health: A systematic review of longitudinal studies’ it found eleven papers that met the inclusion criteria. These came from five countries; Australia, Brazil, China, New Zealand and Sweden. Importantly the selected studies followed patients over up to 20 years. Studies of moderate to high quality were consistent in finding that regular attendance was associated with having less caries experience, fewer missing teeth and better oral health related quality of life. No correlation was found for periodontal condition.
In its introduction the paper provides a historical background to the debate about regular attendance. It explains that in 1977 a review suggested that blanket 6 month recalls might not be necessary. A further key study in 1985 showed that regular attenders especially those going every 6 months, had more filled teeth, and as a result higher caries experience than those who only attended with problems. Since then, there has been a gradual move towards risk based recall intervals, such as those advocated by NICE.
Most of the selected papers counted a dental visit within 12 months as ‘regular attendance,’ with one selecting a 6 month period and one having a 3 year definition. After looking at caries experience, periodontal condition, tooth loss, and oral health related quality of life, the paper came to its discussion points. Here, the review identified there was a “significant association between dental visiting patterns and oral health in contexts where dental services are established.” It went on: “The findings suggest that dental attendance serves as an important predictor of oral health, offering sufficient evidence to support the practice of encouraging routine dental checks in children and adults as outlined in the NICE guideline. This review could provide valuable evidence for early interventions and promotional strategies designed to prevent oral diseases in support of the WHO global strategy for oral health.”
Planning in NHS dentistry, such as it is, seems now to be aimed at mopping up emergencies and irregular attenders. For example, promotional material for the Dentaid mobile unit on the Isle of Wight makes it clear that this is a targeted service for priority groups and will be offering an episode of care. The recent GDPUK story about the Smile Together mobile surgery serving fishing communities in Cornwall and Devon, (dentistry on the road - 28th Feb) showed a similar focus.
In its conclusion, the review refers to the NICE guidance as a means of achieving “routine dental checks.”
This raise a very basic question about the studies selected for this review. NICE advises recalls at up to 2 year intervals. However 10 of the 11 papers used in the review worked on a 12 month recall interval.
With ICB’s looking to short term fixes, and NHS GDPs under pressure to thin out regular attenders, the service is moving further away from any pretence to a being preventative and maintenance based model.
NHS England will be providing some support, including leaflets, to help dental teams explain to regular attenders why their recalls will be less frequent. They are unlikely to quote the last sentence of the systematic review conclusions: “Dental attendance emerges as an important predictor of oral health across the life course, underscoring the importance of routine dental care.”
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