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Recall intervals for oral health in primary care patients

  • Protocol
  • Intervention

Authors

  • P Beirne,

    HRB Cochrane Fellow, Corresponding author
    1. University Dental School and Hospital, Wilton, Cork, Ireland, Oral Health Services Research Centre, Wilton, Cork, IRELAND
    • P Beirne, HRB Cochrane Fellow, Oral Health Services Research Centre, University Dental School and Hospital, Wilton, Cork, Ireland, Oral Health Services Research Centre, University Dental School and Hospital, Wilton, Cork, IRELAND. pbeirne@iol.ie.

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  • A Forgie,

  • JE Clarkson,

  • HV Worthington


Abstract

This is the protocol for a review and there is no abstract. The objectives are as follows:

PRIMARY OBJECTIVES
The primary objectives of this review are:
(1) To determine the beneficial and harmful effects of different fixed recall intervals (for example 6 versus 12 months) for any one of the following different types of dental check-up:

  • clinical examination only;

  • clinical examination plus scale and polish;

  • clinical examination plus preventive advice;

  • clinical examination plus preventive advice plus scale and polish.

(2) To determine the relative beneficial and harmful effects between any of the different check-ups listed above at the same fixed recall interval (for example 12 months).
(3) To compare the beneficial and harmful effects of recall intervals based on clinicians' assessments of patients' disease risk with fixed recall intervals.
All methods used by clinicians to assess disease risk will be considered in relation to this objective (e.g. assessments based on patients' medical history, previous caries experience, dietary and oral hygiene practices, etc.).
(4) To compare the beneficial and harmful effects of no recall interval/patient driven attendance (which may be symptomatic) with fixed recall intervals.

  • In relation to objective (1) the following null hypotheses will be tested:

To test the null hypothesis of no difference in terms of clinical status, psychosocial and economic cost outcomes between each intervention mentioned in (1) at a fixed recall interval compared with itself at a different fixed recall interval.
e.g. No difference in outcomes between clinical examination at a fixed recall interval (e.g. 6 months) versus clinical examination at any other fixed (longer or shorter) recall interval (e.g. 3 months or 9 months).

  • In relation to objective (2) the following null hypotheses will be tested:

To test the null hypothesis of no difference in terms of clinical status, psychosocial and economic cost outcomes between each intervention mentioned in (1) at a fixed recall interval compared with any other intervention at the same fixed recall interval.
e.g. No difference in outcomes between clinical examination at one fixed recall interval (e.g. 6 months) versus clinical examination plus scale and polish at the same fixed recall interval (6 months).

  • In relation to objective (3) the following null hypotheses will be tested:

To test the null hypothesis of no difference in terms of clinical status, psychosocial and economic cost outcomes between each intervention mentioned in (1) at a fixed recall interval compared with a clinician risk-based recall interval.
e.g. No difference in outcomes between clinical examination at a fixed recall interval (e.g. 6 months) versus clinical examination at a risk-based recall interval.

  • In relation to objective (4) the following null hypotheses will be tested:

To test the null hypothesis of no difference in terms of clinical status, psychosocial and economic cost outcomes between each intervention mentioned in (1) at a fixed recall interval and no recall interval/patient driven attendance (which may be symptomatic).

SECONDARY OBJECTIVE
The secondary objective of this review is:
To determine the beneficial and harmful effects of different recall intervals for each of the different types of interventions mentioned above for specific age groups and according to initial levels of caries severity (DMFS, DMFT, or other measure).

The following age groups will be considered in the review. However, these may change depending on the data from the included studies:

  • Children aged 6 years of age and younger (< 83 months) (deciduous dentition)

  • Children aged 7-13 years of age (mixed dentition)

  • Adolescents aged 14-17 years of age (permanent dentition)

  • Young adults aged 18-25

  • Adults aged 26-55

  • Older adults aged 56 years and older.

(NOTE: The age groups outlined above have been selected taking into consideration reported rates of progression of dental caries, the stage of development of the dentition and reported risk ages for dental caries. The rate of progression of dental caries may be faster in the deciduous dentition than in the permanent dentition as the enamel and dentine are thinner in deciduous teeth and they have broader proximal contacts leading to potentially increase caries activity and more rapid progression of caries. For occlusal surfaces of molar teeth, the first 1-2 years after eruption are considered as 'risk ages' for new caries. For approximal surfaces, the first 4-5 years after contact with the neighbouring surface appear to be the ages when most new carious lesions occur (Espelid 2001). Data on the rates of progression of dental caries in adults appear to be sparse. However, it has been suggested that the period between 26-55 years of age may be a time of 'potential stability' (Pitts 1992). For adults over the age of 55 years, the potential for root caries becomes particularly relevant).