Findings call biannual teeth cleanings into question

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New research is suggesting that while people at high-risk of periodontal disease should visit the dentist at least twice a year, others at lower risk may be fine with an annual checkup.

The new findings, just published in the Journal of Dental Research, raise questions about the standard six-month recall for all adults, suggesting instead an approach that stratifies care according to risk. In an era where health costs are skyrocketing, the researchers say their findings could cut wasteful spending and better target care.

“Prevention reduces tooth loss, but little evidence supports biannual preventive care for all adults,” concluded the researchers, led by William Giannobile, D.D.S., M.S., D.M.Sc., chairman of the department of periodontics at the University of Michigan School of Dentistry, in the article “Patient Stratification for Preventive Care in Dentistry.”

In a June 10 piece for The New York Times, “Rethinking the Twice-Yearly Dental Visit,” Catherine Saint Louis reported on the findings.

“For decades, dentists have urged all adults to schedule preventive visits every six months. But a new study finds that annual cleanings may be adequate for adults without certain risk factors for periodontal disease while people with a high risk may need to go more often,” she wrote, noting that almost half of Americans age 30 and older have periodontal disease which can lead to tooth loss.

“The findings suggest that for low-risk patients, a yearly prophylactic visit does prevent tooth loss over a protracted period of 16 years, and there’s no significant difference in an added visit,” Dr. Robert J. Genco, a periodontist and SUNY distinguished professor of oral biology at the University at Buffalo, who was not involved in the study, told Saint Louis. “They found if you had more than one risk factor, that maybe two visits isn’t optimal.”

The team evaluated 16 years worth of insurance claims for 5,117 adults to determine whether tooth loss could be linked to once- or twice-annual dental visits in patients at varying risk of disease. Patients were determined to be at high risk it they had diabetes, were smokers, or had certain variations in the interleukin-1 gene, which some studies have suggested may be linked to periodontal disease. Low-risk patients did not have any of those factors.

Researchers found that statistically speaking, low-risk patients fared as well whether they got one visit a year or two. But for high-risk patients, the frequency of preventive visits seemed to make a significant difference. Slightly more than 22 percent of the high-risk patients who got one visit a year had a tooth extracted, compared with roughly 17 percent who had two visits a year.

“If you are high risk, it is much more important for you to be seen frequently, but for the low-risk people it’s not,” Giannobile noted in the Times.

“The take-away is not that you don’t need to see the dentist, it’s that each patient needs to be treated in their own individual way,” he added.

Saint Louis wrote that two authors of the study own shares in Interleukin Genetics, the company that makes the genotype test for interleukin-1. The company helped finance the study along with the National Institutes of Health, she added..

One critic of the study noted that research did not address the subjects’ oral hygiene which plays an important role in tooth retention.

“Nonetheless,” Saint Louis wrote, “ he praised the research because it “sounds the signal that it is time to make dentistry more individual and more personalized” and added, “We ought to be able to tailor the treatment to the need.”

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