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From Trisha's Desk Trisha O’Hehir, RDH, BS, Hygienetown Editorial Director

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Recall Intervals
– by Trisha E. O’Hehir, RDH, BS, Hygienetown Editorial Director

What is the ideal recall interval to prevent disease? Is it three, four, six or 12 months? Or maybe it’s two weeks? Before you decide on the recall interval for your next patient, look at the research to see how well each one works, and in the end, decide based on each individual’s needs.
Six Months
The standard today is the six-month recall, set in stone by insurance companies. It isn’t based on science, but rather by toothpaste advertising many decades ago. Some think it was Amos and Andy on the radio talking about Pepsodent while others attribute it to Bucky Beaver and Ipana toothpaste with the 1941 Dental Health Achievement Certificate that encouraged good oral hygiene and seeing the dentist twice a year.

Despite the lack of scientific evidence supporting six-month recalls, they continue. A study done in Sweden evaluated two-week dental hygiene visits provided in the school clinic. One hundred children saw the hygienist every two weeks for oral hygiene instructions, cleaning and fluoride. Another group of 100 children saw their family dentist and hygienist at traditional intervals. After two years, most of the 100 kids seeing the hygienist every two weeks had no new decay or gingivitis – a success. However, a few kids were at greater risk for decay, and despite good care, that small subgroup developed a total of 19 carious lesions. As bad as that sounds, results were much worse for kids in the control group with a total of 575 carious lesions. Regular six-month recalls didn’t work for these kids.

Three Months
Indirectly we see that not all patients on three-month recalls are doing well. Study researchers often report subjects for a periodontal study were selected from those receiving regular perio maintenance visits every three months, but qualified for the study having 5mm pockets with bleeding. Three months didn’t work for them. Studies measuring bacterial re-growth following instrumentation reported return to baseline levels at eight to 10 weeks. That’s closer to two months, not three.

Two Weeks
There is research to support a two-week interval to reverse gingivitis or establish tissue health. In 1965, Dr. Harold Löe reported his research on experimental gingivitis in man, now considered a classic study. With no oral hygiene, people develop gingivitis in two weeks. Resuming oral hygiene reverses gingivitis. Many researchers use the two-week recall for several months after surgery, before moving to a longer interval.

For patients with active disease, the two-week interval can stop disease progression. This is really therapy, and not a recall to maintain health. It’s an option for patients showing signs of active breakdown, those with a compromised immune system, or for patients going through times of stress interfering with normal plaque control routines.

Individualized Intervals
The primary criteria suggested by researchers is history of past disease, suggesting that those with 2mm of attachment loss should be considered at risk for further periodontal breakdown and therefore be seen more often than people with no attachment loss. Periodontally healthy patients with no attachment loss can be seen every 12 months. According to published research six-month visits provided no added periodontal value. Establishing a foundation of excellent oral hygiene habits will insure health when intervals are lengthened.

Risk factors that compromise healing or predispose people to disease progression are smoking, diabetes, poor oral hygiene, genetics, age, and medications that dry the mouth. Just remember, patients should come in for recall visits healthy – no bleeding and no calculus. When that happens, your interval is perfect. You are indeed keeping healthy people healthy.

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112 Perio Reports
116 Profile in Oral Health: Undercover Dental Hygiene
Dentaltown Magazine
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