Six months? A year?

08 April, 2024 / editorial

In the case of NHS dental reform, its check-up will come at six months – at the Scottish Dental Show

Six months? A year? Or, specifically, according to the oral health of the individual?

The question of how often people should attend a check-up at their dentist is not new. In the seventies and eighties, studies cast doubt on the worth of six-monthly checks. One, in the seventies, said that they may not be necessary “considering the slow rate of dental caries progression, decreased caries activity with age, and the presence of fluoride in water”¹. It further suggested that extending the interval between examinations may reduce unnecessary treatment.

Nearly a decade later a cross-sectional study² revealed that regular attenders, particularly those who visited dentists every six months, had a higher number of filled teeth and thus, higher caries experience than those attending only when in trouble. The authors of this study suggested that regular attendance is suitable only to prevent tooth loss and maintain dental function, but not effective in preventing further dental caries or disease.

However, with the progression of time and research, as well as the increasing reorientation of dental care towards prevention, dental professionals’ advocacy for regular dental visits has been substantiated by a growing body of evidence. Given the preventability of most dental diseases, contemporary science thus supports risk-based recall intervals, as recommended by the National Institute for Health and Care Excellence (NICE).

A systematic review³ published in 2022, consisting of mainly cross-sectional studies, suggested that routine dental visits are associated with positive impacts on oral health, including a higher number of remaining teeth and better perceived oral health. Epidemiological evidence, based on cross-sectional studies, indicated that symptomatic dental attenders tend to have poorer oral health than those who adhere to routine dental visits, as demonstrated by greater caries experience, and more decayed and missing teeth.

Last month, a review of longitudinal studies investigating the impact of dental visiting patterns on oral health was published⁴. It found an “association between regular dental visiting pattern and improved oral health, notably less dental caries experience and better oral health-related quality of life. Dental attendance emerges as an important predictor of oral health across the life course, underscoring the importance of routine dental care”.

So, regular attendance for everyone would seem to be a key determinant in good oral health; 12-monthly visits might be fine for some, six monthly might be necessary for others. But the question of interval length becomes moot when we consider that more than a third of the five million patients registered with an NHS dentist in Scotland have not had a check-up or treatment for three years. New figures also show that almost a quarter of the patients have not visited an NHS dentist for five years, and one in ten have not been seen for ten years.

Reasons cited include a lack of appointments due to a shortage of dentists and the declining number of practices taking on NHS patients. Dental practitioners claim the true cost of treatments provided on the NHS are not being fully covered. As a result, according to the Scottish Liberal Democrats, who obtained the figures from Public Health Scotland under freedom of information laws, some patients are having to resort to “drastic and barbaric options” to obtain treatments, including buying do-it-yourself dental equipment online and travelling abroad.

A survey last year found that 82 per cent of NHS dentists in Scotland no longer take on new patients with similar numbers saying they will reduce their NHS list. Some patients have already resorted to paying for more expensive private dental treatment while others are calling the NHS 24 helpline for advice on toothache and other oral problems after being unable to get NHS dentist appointments. A lack of appointments took calls to the 24-hour emergency advice service from 25,509 in 2019 to 67,189 in 2023.

The Scottish Government said that the Public Health Scotland data precedes the introduction of NHS dental reform from 1 November last year and cannot be taken as indicative of participation in the current environment. A spokesperson said: “We remain committed to improving access to NHS dentistry in Scotland, following the significant interruption posed by the pandemic and – since this snapshot as of 30 September 2023 – have introduced significant dental payment reform with the aim of encouraging dentists to provide more NHS dentistry. In the first month following these changes, nearly 400,000 patients were seen by an NHS primary care dentist — early vindication that our reforms are working.”

On Friday 31 May, as part of its education programme, the Scottish Dental Show (sdshow.co.uk) will be hosting a session (10.30-11.30, Speaker Room 1) with the Scottish Government to provide an update on dental reform – six months on – and an opportunity for the profession to share its experience.