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Clarkson JE, Pitts NB, Fee PA, Goulao B, Boyers D, Ramsay CR, Floate R, Braid HJ, Ord FS, Worthington HV, van der Pol M, Young L, Freeman R, Gouick J, Humphris GM, Mitchell FE, McDonald AM, Norrie JDT, Sim K, Douglas G, Ricketts D. Examining the effectiveness of different dental recall strategies on maintenance of optimum oral health: the INTERVAL dental recalls randomised controlled trial. Br Dent J 2021; 230:236-243. [PMID: 33637927 PMCID: PMC7908962 DOI: 10.1038/s41415-021-2612-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/17/2020] [Indexed: 01/15/2023]
Abstract
Objective To compare the clinical effectiveness of different frequencies of dental recall over a four-year period.Design A multi-centre, parallel-group, randomised controlled trial with blinded clinical outcome assessment. Participants were randomised to receive a dental check-up at six-monthly, 24-monthly or risk-based recall intervals. A two-strata trial design was used, with participants randomised within the 24-month stratum if the recruiting dentist considered them clinically suitable. Participants ineligible for 24-month recall were randomised to a risk-based or six-month recall interval.Setting UK primary dental care.Participants Practices providing NHS care and adults who had received regular dental check-ups.Main outcome measures The percentage of sites with gingival bleeding on probing, oral health-related quality of life (OHRQoL), cost-effectiveness.Results In total, 2,372 participants were recruited from 51 dental practices. Of those, 648 were eligible for the 24-month recall stratum and 1,724 participants were ineligible. There was no evidence of a significant difference in the mean percentage of sites with gingival bleeding on probing between intervention arms in any comparison. For those eligible for 24-month recall stratum: the 24-month versus six-month group had an adjusted mean difference of -0.91%, 95% CI (-5.02%, 3.20%); the 24-month group versus risk-based group had an adjusted mean difference of 0.07%, 95% CI (-3.99%, 4.12%). For the overall sample, the risk-based versus six-month adjusted mean difference was 0.78%, 95% CI (-1.17%, 2.72%). There was no evidence of a difference in OHRQoL (0-56 scale, higher score for poorer OHRQoL) between intervention arms in any comparison. For the overall sample, the risk-based versus six-month effect size was -0.35, 95% CI (-1.02, 0.32). There was no evidence of a clinically meaningful difference between the groups in any comparison in either eligibility stratum for any of the secondary clinical or patient-reported outcomes.Conclusion Over a four-year period, we found no evidence of a difference in oral health for participants allocated to a six-month or a risk-based recall interval, nor between a 24-month, six-month or risk-based recall interval for participants eligible for a 24-month recall. However, patients greatly value and are willing to pay for frequent dental check-ups.
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Affiliation(s)
- Jan E Clarkson
- Professor, Dental Health Services Research Unit, University of Dundee, Dundee, UK
| | - Nigel B Pitts
- Professor, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Patrick A Fee
- Clinical Research Fellow, Dundee Dental Hospital & School, University of Dundee, Dundee, UK.
| | - Beatriz Goulao
- Statistician, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Dwayne Boyers
- Research Fellow, Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Craig R Ramsay
- Professor, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Ruth Floate
- Trial Manager, Dental Health Services Research Unit, University of Dundee, Dundee, UK
| | - Hazel J Braid
- Trial Administrator, Dental Health Services Research Unit, University of Dundee, Dundee, UK
| | - Fiona S Ord
- Research Hygienist, Dental Health Services Research Unit, University of Dundee, Dundee, UK
| | - Helen V Worthington
- Professor, The School of Dentistry, University of Manchester, Manchester, UK
| | - Marjon van der Pol
- Professor, Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Linda Young
- Programme Lead, Dental Directorate, NHS Education for Scotland, Edinburgh, UK
| | - Ruth Freeman
- Professor, Dental Health Services Research Unit, University of Dundee, Dundee, UK
| | - Jill Gouick
- Research Dental Nurse, Dental Health Services Research Unit, University of Dundee, Dundee, UK
| | - Gerry M Humphris
- Professor, Health Psychology, Bute Medical School, University of St Andrews, St Andrews, UK
| | - Fiona E Mitchell
- Research Dental Nurse, Dental Health Services Research Unit, University of Dundee, Dundee, UK
| | - Alison M McDonald
- Senior Trials Manager, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John D T Norrie
- Professor, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Kirsty Sim
- Research Hygienist, Dental Health Services Research Unit, University of Dundee, Dundee, UK
| | - Gail Douglas
- Professor, School of Dentistry, University of Leeds, Leeds, UK
| | - David Ricketts
- Professor, Dundee Dental Hospital & School, University of Dundee, Dundee, UK
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