Preventive dentistry: Practitioners' recommendations for low-risk patientscompared with scientific evidence and practice guidelines

Introduction: The purpose of this article is to compare published evidence supporting procedures to prevent dental caries and periodontal disease, in low-risk patients, with the actual preventive recommendations of practicing dentists. Methods: Methods included (1) a survey questionnaire of general dentists pr acticing in western New York State concerning the preventive procedures the y would recommend and at what intervals for low-risk children, young adults , and older adults; and (2) review of the published, English-language liter ature for evidence supporting preventive dental interventions. Results: The majority of dentists surveyed recommended semiannual visits fo r visual examination and probing to detect caries (73% to 79%), and scaling and polishing to prevent periodontal disease (83% to 86%) for low-risk pat ients of all ages. Bite-wing radiographs were recommended for all age group s at annual or semiannual intervals. In-office fluoride applications were r ecommended for low-risk children at intervals of 6 to 12 months by 73% of d entists but were recommended for low-risk older persons by only 22% of dent ists. Application of sealants to prevent pit and fissure caries was recomme nded for low-risk children by 22% of dentists. Literature review found no studies comparing different frequencies of denta l examinations and bite-wing radiographs to determine the optimal screening interval in low-risk patients. Two studies of the effect of scaling and po lishing on the prevention of periodontal disease found no benefit from more frequent than annual treatments. Although fluoride is clearly a major reas on for the decline in the prevalence of dental caries, there are no studies of the incremental benefit of in-office fluoride treatments for low-risk p atients exposed to fluoridated water and using fluoridated toothpaste. Conclusions: Comparative studies using outcome end points are needed to det ermine the optimal frequency of dental examinations and bite-wing radiograp hs for the early detection of caries, and of scaling and polishing to preve nt periodontal disease in low-risk persons. There is no scientific evidence that dental examinations, including scaling and polishing, at 6 month inte rvals, as recommended by the dentists surveyed in this study, is superior t o annual or less frequent examinations for low-risk populations. There is a lso no evidence that in-office fluoride applications offer incremental bene fit over less costly methods of delivering fluoride for low-risk population s. (C) 2000 American Journal of Preventive Medicine.