Evidence-Based Guidelines Behind the Frequency of Routine Dental Examinations and Cleanings

Rio Salado Community College

Evidence-Based Guidelines Behind the Frequency of Routine Dental Examinations and Cleanings to Prevent Oral Disease

Kiley Stewart
English 102
James Palazzolo

Evidence-Based Guidelines Behind the Frequency of Routine Dental Examinations and Cleanings to Prevent Oral Disease

Within the world of dental healthcare, there are many reasons why dental examinations are crucial to the well-being of an individual. But what are the evidence-based guidelines regarding the frequency of routine dental cleanings and examinations for the prevention of oral disease known as Periodontal disease and dental caries? Based on current guidelines, two dental cleanings per calendar year are the recommendation for patients who have not already been diagnosed with Periodontal Disease. Dental examinations and regular cleanings help to prevent and avoid Periodontal Disease and dental caries but what evidence is there to support the need for regular cleanings and what is Periodontal Disease and dental caries? Good oral hygiene can affect the overall status of one's health, based on evidence found guidelines are presented by the Centers for Disease Control and Prevention and the American Dental Association regarding the frequency at which dental examinations and regular cleanings are completed to prevent oral disease such Periodontal Disease and dental caries.

Periodontal Disease is gum disease created by bacteria that is harbored beneath the gum tissue within the Periodontal ligament space. This disease is caused by the build of plaque on the teeth, plaque ultimately hardens over time and becomes what is referred to as calculus. Calculus is formed when plaque is left on the teeth over a period of time. When calculus sits on the teeth and gum tissue for too long the gum tissue becomes upset and irritated causing swelling and inflammation of the gum tissue as this persists the gum tissue starts to become loose and falls away from the tooth opening the Periodontal ligament space that wraps around the entire tooth subgingivally. As a result, the bacteria finds its way into that Periodontal ligament space and continues to grow. This bacteria and calculus continue to build from that point on, regardless of brushing, and ultimately cause the bone that holds the teeth in the gums to recede away from the teeth. This loss of bone and build-up of bacteria can cause foul breath, continued bone loss, bleeding, or swollen gums, and if not treated can ultimately cause the loss of teeth (CDC). Although an individual may fastidiously brush and floss their teeth there may be areas that are unable to be appropriately cleaned at home. Which is what has created the role and career of a Dental hygienist. Dental hygienists are trained on how to professionally clean the teeth and keep the gums free of bacteria. Once a patient has reached a level at which the build-up and calculus are too much a patient much be monitored and receive a procedure called Scaling and Root Planning with local anesthesia to remove all of the subgingival bacteria and calculus. This procedure can be avoided if patients are receiving professional dental cleanings and completing appropriate home care. Gum disease is not the only disease that can be present in the mouth. Dental caries or cavities are one of the oldest and most common diseases found in humans. Dental caries are permanently damaged areas of the tooth structure caused by bacteria which result in permanent tooth decay unless treated by a professional. If left untreated caries will continue to grow in size penetrating the tooth's enamel, dentin, and ultimately the tooth's pulp chamber or nerve. If dental caries are caught in regular dental examinations they can be removed and fixed with a dental filling or if severe enough Root Canal Therapy and crowns.

Current reccomendations for dental examinations and cleanings regardless of health status or age are at least two yearly visits to help prevent oral diseases such as Periodontal Disease or dental caries. According to the American Dental Association, "Viewed through the prism of the primary prevention of caries and/or gingivitis, a systematic review of the literature failed to arrive at consensus regarding optimal recall frequency to minimize either caries, or periodontal disease risk in part due to limited availability of studies addressing this topic. Nonetheless, in terms of the balance between resource allocation and risk reduction, it can be concluded that there is merit in tailoring a patient's recall interval to individual need based on assessed risk of disease." (ADA). While home care is absolutely crucial to lessen the need for extensive intervention it does not negate the need for bi-annual dental care and examinations. By seeing dental healthcare professionals regularly patients are able to not only lessen the risk of disease but also increase preventative measures and receive the necessary treatment to maintain healthy oral status quo. Per most dental insurance plans two cleanings and examinations are recommended and covered per calendar year. This is to prevent further and more extensive treatment. Literature provided by Delta Dental, a large dental insurance provider explains why, "You consider yourself to have great oral hygiene and regularly brush and floss your teeth to keep your mouth clean. Your excellent oral hygiene habits may lead you to wonder if you still need to visit your dentist on a regular basis. The answer is yes! Even if you take good care of your teeth and gums at home, it's still important that you regularly visit your dentist who is professionally trained to check for problems you may not see or feel yourself. The truth is, many dental problems like cavities, gum disease, and oral cancer don't become visible or cause pain until they are in the more advanced stage, which makes treatment and follow-up all the more extensive. Even if you are healthy today, your risk for dental disease can change over time and can be affected by factors like illness, diet changes, new medication usage, and more. So why risk it?" (Delta Dental). Based on current guidelines Delta Dental has created insurance plans that help to keep patients out of risk of oral disease and created preventative measures.

Based on the guidelines presented by the American Dental Association and Centers for Disease Control what evidence is provided that truly supports the need for the frequency at which individuals should receive dental cleanings and examinations? In February of 2021 a clinical study was conducted in the United Kingdom to examining the effectiveness of different dental recall strategies on maintenance of optimum oral health. The objective of this study was to compare the clinical effectiveness of different frequencies of dental recall over a four-year period. Participants were placed on the fixed-period 24-month recall interval and the fixed six-month recall interval groups were invited to attend their dentist at the scheduled time intervals for a routine dental check-up. The content of this check-up remained as per current practice. During this study they measured gingival tissue height through perio probing. As well as dental caries and calculus. At the conclusion of the four year clinical study the evidence does not support the need for six month recall appointments. "This trial compares the clinical effectiveness of frequency of dental recall appointments in primary dental care over four years. It comes to the controversial conclusion that there is no clinical benefit of a six-monthly recall compared to a risk-based recall or 24-month recall in those patients considered eligible. The absence of evidence of a difference between the three recall strategies therefore indicates a variable risked-based recall interval can be supported as it is not detrimental to oral health. The current evidence therefore suggests that current practice of scheduling six-monthly recall appointments for patients, regardless of their risk of developing dental disease, does not improve oral health." (Med journal). Based on the information provided in this clinical trial the necessity for the reccommended bi-annual cleanings per the American Dental Associate and Center of Disease Control is not supported. However six month recall appointments are highly favored by the general public but based on this trial a more personalized dental recall for examinations and cleanings is recommended for optimal oral disease prevention and health.

According to the information provided the frequency at which dental examinations and cleanings is conflicting due to the evidence provided in clinical trials. Based on guidelines presented by the American Dental Assocaition and the Centers for Disease Control in conjunction with Delta Dental two cleanings and examinations per calendar year are necessary for optimal oral health and oral disease prevention. Based on clincal trials ran there is no indication that two recall appointments are necessary. The frequency at which dental recall appointments are needed is personal and depends on a patients risk factors. When looking for evidence-based guidelines regarding the frequency at which an individual should receive dental cleanings and examinations is inconclusive. But to maintain the most optimal care and take preventative measures to insure the best oral health two dental cleanings and examinations are recommended.

Works Cited

This paper comes across as well researched and informative. It gives an insight into the development of gum disease and how dental hygeine plays an important role in preventing its occurrence. The research done is very well integrated into the essay, and does not come across as the essay being simply a cut and paste job. The insight that is provided prior to the given quotes helps the reader understand what the writer wishes to explain through the help of the in-text citation. It is definitely good to see such well researched information in this paper. You may want to consider splitting up the information in the paragraphs though, just for clarity sake. Sometimes discussions that need its own attention, via a separate paragraph get integrated into an existing paragraph, leading to a little confusion when reading that passage.