• National Collaborating Centre for Acute Care. Dental recall: recall interval between routine dental examinations. London (UK): National Institute for Clinical Excellence (NICE); 2004 Oct. 118 p. [153 references]

This is the current release of the guideline.

Levels of evidence categories (1++ to 4) and recommendation grades (A-D, GPP) are defined at the end of the "Major Recommendations" field.

Clinical Recommendations

D - The recommended interval between oral health reviews should be determined specifically for each patient and tailored to meet his or her needs, on the basis of an assessment of disease levels and risk of or from dental disease.

GPP - This assessment should integrate the evidence presented in this guideline with the clinical judgement and expertise of the dental team, and should be discussed with the patient.

During an oral health review, the dental team (led by the dentist) should ensure that comprehensive histories are taken, examinations are conducted, and initial preventive advice is given. This will allow the dental team and the patient (and/or his or her parent, guardian, or carer) to discuss, where appropriate:

• B - the effects of oral hygiene, diet, fluoride use, tobacco, and alcohol on oral health
• D - the risk factors (see the checklist in Appendix G of the original guideline document) that may influence the patient's oral health, and their implications for deciding the appropriate recall interval
• GPP - the outcome of previous care episodes and the suitability of previously recommended intervals
• GPP - the patient's ability or desire to visit the dentist at the recommended interval
• GPP - the financial costs to the patient of having the oral health review and any subsequent treatments.

GPP - The interval before the next oral health review should be chosen, either at the end of an oral health review if no further treatment is indicated, or on completion of a specific treatment journey.

The recommended shortest and longest intervals between oral health reviews are as follows.

• GPP - The shortest interval between oral health reviews for all patients should be 3 months.

  A recall interval of less than 3 months is not normally needed for a routine dental recall. A patient may need to be seen more frequently for specific reasons such as disease management, ongoing courses of treatment, emergency dental interventions, or episodes of specialist care, which are outside the scope of an oral health review.

• GPP - The longest interval between oral health reviews for patients younger than 18 years should be 12 months.

  There is evidence that the rate of progression of dental caries can be more rapid in children and adolescents than in older people, and it seems to be faster in primary teeth than in permanent teeth (see Section 3.1.2 of the full guideline document). Periodic developmental assessment of the dentition is also required in children.

  Recall intervals of no longer than 12 months give the opportunity for delivering and reinforcing preventive advice and for raising awareness of the importance of good oral health. This is particularly important in young children, to lay the foundations for life-long dental health.

• GPP - The longest interval between oral health reviews for patients aged 18 years and older should be 24 months.

  Recall intervals for patients who have repeatedly demonstrated that they can maintain oral health and who are not considered to be at risk of or from oral disease may be extended over time up to an interval of 24 months. Intervals of longer than 24 months are undesirable because they could diminish the professional relationship between dentist and patient, and people's lifestyles may change.

GPP - For practical reasons, the patient should be assigned a recall interval of 3, 6, 9, or 12 months if he or she is younger than 18 years old, or 3, 6, 9, 12, 15, 18, 21, or 24 months if he or she is aged 18 years or older.

GPP - The dentist should discuss the recommended recall interval with the patient and record this interval, and the patient's agreement or disagreement with it, in the current record-keeping system.

GPP - The recall interval should be reviewed again at the next oral health review, to learn from the patient's responses to the oral care provided and the health outcomes achieved. This feedback and the findings of the oral health review should be used to adjust the next recall interval chosen. Patients should be informed that their recommended recall interval may vary over time.

Definitions:

Levels of Evidence

1++

• High-quality meta-analyses, systematic reviews of randomized controlled trials (RCTs), or RCTs with a very low risk of bias

1+

• Well-conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias

1-

• Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of bias

2++

• High-quality systematic reviews of case-control or cohort studies
• High-quality case-control or cohort studies with a very low risk of confounding, bias, or chance and a high probability that the relationship is causal

2+

• Well-conducted case-control or cohort studies with a low risk of confounding, bias, or chance and a moderate probability that the relationship is causal

2-

• Case-control or cohort studies with a high risk of confounding bias or chance and a significant risk that the relationship is not causal

3

• Non-analytic studies (for example, case reports, case series)

4

• Expert opinion, formal consensus

Recommendation Grades

Recommendation Grades

A

• At least one meta-analysis, systematic review, or randomized controlled trial (RCT) rated as 1++, and directly applicable to the target population, or
• A systematic review of RCTs or a body of evidence consisting principally of studies rated as 1+, directly applicable to the target population, and demonstrating overall consistency of results

B

• A body of evidence including studies rated as 2++, directly applicable to the target population, and demonstrating overall consistency of results, or
• Extrapolated evidence from studies rated as 1++ or 1+

C

• A body of evidence including studies rated as 2+, directly applicable to the target population and demonstrating overall consistency of results, or
• Extrapolated evidence from studies rated as 2++

D

• Evidence level 3 or 4, or
• Extrapolated evidence from studies rated as 2+, or
• Formal consensus

GPP

• A good practice point (GPP) is a recommendation for best practice based on the clinical experience of the Guideline Development Group

An algorithm is provided in the original guideline document with a simplified overview of oral health assessment and oral health review

The type of supporting evidence is provided for each recommendation (see "Major Recommendations" field).

• National Collaborating Centre for Acute Care. Dental recall: recall interval between routine dental examinations. London (UK): National Institute for Clinical Excellence (NICE); 2004 Oct. 118 p. [153 references]

Not applicable: the guideline was not adapted from another source.

2004 Oct

National Collaborating Centre for Acute Care - National Government Agency [Non-U.S.]

National Institute for Clinical Excellence (NICE)

Guideline Development Group

Committee Members: Professor Nigel Pitts (Chair), Professor of Dental Health and Director of the Dental Health Services Research Unit, University of Dundee; Dr Paul Batchelor, Consultant in Dental Public Health, Eastman Dental Hospital, University College London; Research Director of the Centre for Dental Services Studies, University of York; British Association for the Study of Community Dentistry; Dr Jan Clarkson, NHS Education for Scotland Senior Lecturer in Dental Primary Care, University of Dundee; Cochrane Oral Health Group; Dr Clare Davenport, Clinical Research Fellow, West Midlands Health Technology Assessment Collaboration, University of Birmingham; Dr Ralph Davies, General Dental Practitioner, Nottinghamshire; British Dental Association; Ms Karen Elley, Consultant in Dental Public Health, Rowley Regis and Tipton Primary Care Trust, West Midlands; Mr Stephen Fayle, Consultant in Paediatric Dentistry, Leeds Dental Institute, Leeds Teaching Hospitals Trust; Faculty of Dental Surgery, Royal College of Surgeons of England; Mrs Eleanor Grey, Patient Representative; formerly Chair of the Lay Advisory Group, Faculty of General Dental Practitioners (UK); Dr Kathryn Harley, Consultant in Paediatric Dentistry and Honorary Senior Lecturer, Edinburgh Dental Institute; Ms Sara Hawksworth, Patient Representative; National Development Officer, Age Concern England; Professor Mike Lewis, Professor of Oral Medicine, Wales College of Medicine, University of Cardiff; Mr Peter Lowndes, General Dental Practitioner, Birmingham; Faculty of General Dental Practitioners (UK); Mr Mike Mulcahy, General Dental Practitioner, Worthing, West Sussex; Faculty of General Dental Practitioners (UK); Mr Derek Richards, Director, Centre for Evidence-Based Dentistry, Oxford; Dr Richard Seppings, General Dental Practitioner, Norfolk; British Dental Association; Dr Graham Smart, Specialist in Periodontics and Associate Regional Director of Postgraduate Dental Education, Oxford Region; Faculty of Dental Surgery, Royal College of Surgeons of England; Mrs Elaine Tilling, Education and Project Manager, British Dental Hygienists Association; Mr Peter Wilkins, General Dental Practitioner, Faculty of General Dental Practitioners (UK); Professor Helen Worthington, Professor of Evidence-Based Care, University of Manchester; Co-ordinating Editor, Cochrane Oral Health Group

National Collaborating Centre for Acute Care (NCC-AC): Dr Paul Beirne, Research Fellow, Oral Health Services Research Centre, University College Cork; Dr Jacqueline Dutchak, Director, NCC-AC; Dr Ian Needleman, Senior Lecturer in Periodontology and Director, International Centre for Evidence-Based Periodontal Health, Department of Periodontology, Eastman Dental Institute for Oral Health Care Sciences, University College London; Ms Guldem Okem, Health Economist, NCC-AC; Mr Carlos Sharpin, Senior Information Scientist and Systematic Reviewer, NCC-AC; Ms Louise Thomas, Research Associate, NCC-AC; Mr David Wonderling, Health Economist, NCC-AC

The Guideline Development Group were asked to declare any possible conflict of interest, and none that could interfere with their work on the guideline was declared.

This is the current release of the guideline.

This NGC summary was completed by ECRI on January 26, 2005. The information was verified by the guideline developer on February 21, 2005.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.