"See you in six months!" That standard farewell, heard every day in most American dental offices, is starting to fade.
Swayed by the research, a growing number of dental insurance plans are rejecting the traditional semiannual cleaning. Instead, these plans are pushing dentists to see healthier patients less often and less healthy patients more often.
Starting next year, "some members … will be eligible for up to four periodontal maintenance or prophylaxis visits in a calendar year," the ODS Companies told dentists who participate its Oregon public employees dental insurance plan. "Other members with healthy mouths and low risk factors will be eligible for one prophylaxis in a calendar year." Kaiser Permanente and Willamette Dental negotiated similar policies with the Oregon employees.
The change stems from new research as well as two new trends within dentistry: minimally invasive dentistry and evidence-based dentistry. Minimally invasive dentistry seeks to cause the least amount of destruction to the natural structures of the mouth. As part of this approach, dentists assign patients to risk categories and set up different preventative plans for each category.
The November issue of the Journal of the California Dental Association will include a consensus statement signed by many of the nation's leading caries experts asserting that, "recall appointments at appropriate intervals are essential to monitor, renew, and reinforce the proposed caries management and prevention plan for the individual patient." And an article in the journal's October issue calls for as few as one routine visit per year, and as many as four.
Evidence-based dentistry calls into question practices that have never undergone the rigor of a clinical trial. In October, the Cochrane Database of Systematic Reviews analyzed the research on the frequency of routine visits and found that, "There is insufficient evidence to support or refute the practice of encouraging patients to attend ... dental check-ups at 6-monthly intervals."
The Cochrane reviewers also concluded that there isn't enough evidence to recommend changing to another recall pattern. But other researchers, looking beyond the mouth, have argued that certain people need more frequent visits because of pregnancy, diabetes, gum disease, or past kidney failure. Oral bacteria can increase the risk of preterm birth, according to a review article in the October, 2006 issue of the Journal of the American Dental Association. In the same issue, the journal reported on a review of studies showing that periodontal disease and diabetes can worsen each other.
On the basis of this research, Delta Dental of Michigan, Ohio, and Indiana announced last year it would pay for more frequent dental visits by diabetics and pregnant women diagnosed with gum disease or kidney failure, people who are undergoing dialysis, and those with suppressed immune systems due to chemotherapy or radiation treatment, HIV infection, organ transplant, and/or stem cell transplant.
Renaissance Dental announced it would follow suit with a similar change beginning next year. “By adding these additional cleanings and periodontal maintenance procedures, we hope to improve the overall health of our members and lower their total healthcare costs through advanced dental plan designs,” said Jed Jacobson, D.D.S., chief science officer for Renaissance, in a press release.
