The age old question of what is the correct recall interval for a periodontal patient has had the magic systematic review treatment and the answer is.....wait for it.......further evidence is required. What a shocker. How many systematic reviewers does it take to change a light bulb? Further evidence required. So there is no evidence that 3/12 recalls for maintenance work for everyone. Anyone who has periodontal recall patients would agree.
What was interesting about this review published in December 2015 in the journal of evidence based dental practice was part of the conclusion which, as well as saying we need more research, mentions "The merits of risk-based recommendations over fixed recall interval regimens should be explored."
And this makes total sense to me. Why have a one size fits all approach. Patient centred care is the way to go, and CQC and NICE say so too.
It points to the need for regular risk assessment and modification of care plans as needs change. We should be completing a risk assessment of a patient every time we see them. But how best to do this?
One worry I have around this published lack of evidence is that the stretching of intervals between Oral Health Assessment and Oral health reviews by NICE were met with some concern. There is potential for supervised failing in both caries and periodontal prevention. A very real issue of achieving health for the patient then stretching the recall sessions until the scores go up again. That is not maintenance, that is supported failure and re-infection.
And when we have a growing body of evidence linking chronic inflammation associated with uncontrolled periodontal disease and systemic illness, is there such a thing as over reviewing when it comes to obtaining and maintaining periodontal and gingival health?
This is another topic for a staff meeting discussion and I suggest at least an annual review of risk assessment protocols in your practice.
One system that I have supported in its implementation is the oral heath review being carried out to a certain stage by a trained dental nurse, reducing time in chair with both hygienist and dentist. This working in triage method is incredibly rewarding for the team, efficient in time and economics, and allows a high standard of maintenance of health for patients.
GSK and Corsodyl have packaged a gum care risk assessment pack which you can receive for free and is a good place to start.
Another great tool out there for risk assessment is Previser
PreViser gives dental clinicians a way to objectively analyse their patients' oral disease risk and severity. These analyses are delivered as personalised reports that improve care planning accuracy and patient acceptance and compliance.
A comprehensive assessment includes assessments for perio, caries, oral cancer and tooth wear. Alternatively individual reports can be generated for perio, caries and oral cancer.
To save time, the patient can be given access on a tablet or computer in reception to complete the non-clinical elements of the assessment.
However you choose to implement risk assessment for recall length, the key thing is to ensure you are attaining and maintaining stability in the patients oral health. And you tend to find those patients who have achieved health are just as keen as you to keep those recall review sessions and maintain the health you helped them achieve.
