Study criticises six-monthly dental check-ups

Haydn Shaughnessy gets the reaction from two dentists to a recently published UK report on dental practices and discovers deep…

Haydn Shaughnessy gets the reaction from two dentists to a recently published UK report on dental practices and discovers deep criticism of the profession.

Sitting opposite a dentist and eating dinner are two activities best kept separate. If the dentist in question is Dr Aubrey Sheiham, professor of epidemiology at University College London, the red wine and the coffee with one spoon of sugar induce a confusing level of self-consciousness.

Prof Sheiham is passionate about teeth and, at the same time, critical of his fellow dental professionals in a patient, friendly kind of way.

The six-monthly recall for check-ups, he says, is absurd, particularly so for Ireland where levels of caries are lower than in the UK.

READ MORE

And cosmetic treatments for crooked teeth - the professor has a set that would serve most parents as an example - is preying on the vulnerability of the adolescent and their caring parents.

Controversial stuff, says Dr Denis O'Mullane, former chief adviser on dental treatment to the Irish Government and now editor of Community Dental Magazine.

Both dentists are responding to the results of a newly released study into dental recall intervals - the six- monthly check-up. A committee of experts in the UK has gone some of the way to concur with Prof Sheiham's views, though not nearly far enough according to the professor.

The authors of the report say that for children, dentists should vary recall from three months to one year depending on individual circumstances. In adults, it should vary from three months to two years.

Six months is out. For those with good dental hygiene, up to two years is in. The report makes quite clear that the six-monthly interval is no longer sound advice.

Though a UK report, Dr O'Mullane says it has broad relevance for Ireland and that, if anything, caries levels here are lower than in the UK. This might logically infer a need for longer recall intervals, although the doctor did not endorse such a view.

Dentists, say the report, should review dental health issues with each patient, agree the appropriate recall interval with them at the end of a course of treatment, and record the patient's agreement or disagreement in the patient record.

Why is this eminently sensible procedure still not good enough for critics of the dental profession?

According to Prof Sheiham, modern dental practice has been effective in reducing caries levels and in providing a self-repairing mechanism for tooth decay.

Water fluoridation and the widespread use of fluoride toothpaste can, to a certain extent, self-heal teeth. When decay appears, fluoride helps to re-mineralise the tooth around the decay, sealing it from further erosion. If a dentist drills and fills the tooth at this point, the re-mineralised area is stripped away and the tooth is free to begin rotting once more.

In other words, local dental intervention in the tooth can thwart the larger benefits of fluoridation.

According to Prof Sheiham, the UK report should have taken account of this epidemiological nuance. In a population where the blight of dental decay is being beaten back, dentists should be encouraged to leave teeth alone.

Prof Sheiham also points to a trend in the UK that supports his view. When the National Health Service decided to pay dentists a per capita fee for patients, rather than a fee per treatment, dentists en masse pushed out the recall interval so that they could fit in more patients.

This, he infers, is proof that the profession's own needs may, in important ways, over-ride good practice.

It is a controversial view and a minority view, says Dr O'Mullane who also says there is, in reality, a shortage of studies that provide good evidence on which to base advice. The UK report will, however, have an impact on dentistry in Ireland.

The report did not cover, but Prof Sheiham certainly makes a case for, dentistry being less active in cosmetic care. He argues, once the dessert menu has been dismissed, that dentists have been too quick to prey on children's fears over their appearance. In Ireland this is less of a problem, says Dr O'Mullane.

Department of Health guidelines are clear. Intervention is warranted only in extreme cases of mal-occlusion.