This article first appeared on The Straits Times on 29 July 2019 (Monday). We have reproduced it for the information of those of you who missed it when it was published.
For the longest time, we have been told that the best way to keep our teeth in tiptop condition is to go for twice-a-year dental check-ups, but this has changed.
Although this advice remains common, there are now dentists who advise less frequent visits for those who have good oral health. Those who have dental diseases will clearly need to visit more often.
A check with the Ministry of Health (MOH) shows that personalised oral care is the focus today.
“The interval between dental check-ups is dependent on the individual patient’s dental risk assessment,” said an MOH spokesperson.
“Low risk patients are generally recommended to visit a dentist once every 12 to 18 months, while moderate and high risk patients may need more frequent reviews.”
MOH encourages patients to discuss the recommended frequency of dental check-ups with their dentists, as regular dental check-ups allow early detection of dental problems.
At the National Dental Centre Singapore (NDCS), Clinical Associate Professor Marianne Ong, a senior consultant from the periodontics unit at the Department of Restorative Dentistry said that those who have good oral health and are not susceptible to oral diseases can visit the dentist annually.
“On the other hand, those who have poor oral health may be more prone to developing dental caries (tooth decay) or gum disease due to poor oral hygiene and may need to visit a dentist every three to six months,” she said.
“This is to ensure that oral diseases are nipped in the bud.”
When picked up early, caries and gingivitis (early stage of gum disease) can be treated with the aim of minimising the consequences of leaving the disease untreated, she said.
For instance, the late stage of gum disease results in bone loss around teeth that is irreversible, also known as periodontitis, all of which can lead to more expensive dental treatment, she added.
“The ‘visit your dentist once every six months’ saying actually originated from a 1950s tooth powder advertisement in the United States,” said Assoc Prof Ong.
In light of a study published in 2013, in the Journal of Dental Research titled Patient Stratification For Preventive Care In Dentistry, dental professionals recommend that the frequency of an individual’s dental visits should be tailored by their dentists to accommodate for the individual’s current oral health status and health history, she said.
The study’s researchers speculated that high-risk patients, such as those who smoke or have diabetes, would likely benefit from more frequent dental visits, while low-risk patients may see the same benefits from only one cleaning per year.
Dr Fu Jiahui, a consultant at the Discipline of Periodontics at the National University Centre for Oral Health, Singapore, who also gave similar advice for the public to visit the dentist at least once a year, said the concept of personalised oral care has come up in recent years, driven in part by easy access to information on line.
“For the longest time, the advice has always been twice a year. In recent years, perhaps in the past 5-8 years, it has been more about profiling the patient,” she said.
Also, “there were review papers done in 2013 and 2018, both of which showed that there’s weak evidence to support that there’s a must to see a dentist every six month.”
That’s not to say that you cannot do so, or that it is totally not necessary to do so, or worse, that you should forget about seeing the dentist, she said.
Once a year is a general guide, and if needed, the dentist can then advise if more frequent check-ups will be necessary, depending on your risk, she said.
“As a periodontist, the patients I see have moderate to severe gum disease, so they come every three to four months.”
In the United Kingdom, the National Institute for Health and Care Excellence guidelines state that the frequency of dental check-ups should be tailored to the patient’s needs, with intervals of up to two years for adults in good oral health.
This is the group who have repeatedly shown that they can maintain oral health and who are not considered to be at risk of or from oral disease, it said.
The recommended interval for those who are below 18 years of age is 12 months as 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.
Are you a low-risk patient?
We will have greater insights into the oral health habits of Singaporeans, when the results of a national adult oral health survey that was commissioned last year are ready.
An oral health survey of 6,000 adults in 2006 showed that 45 per cent visit a dentist once a year and 31 per cent visit only when there is pain.
For someone who has not visited a dentist in a while, it may not always be clear if he or she is at low risk of dental diseases.
“The thing about dental diseases is that] most of them are not painful and people may not know they have one until it’s too late. Most of the time, people only seek help when they feel pain,” said Dr Ansgar Cheng, dental specialist in prosthodontics at Specialist Dental Group.
“It’s only from the dental examination that we know if there’s a disease going on, and we can get a good picture if we see the patient every six months.”
“Gum disease can take years to develop to the point that’s painful. The problem is you don’t know if it’s early stage or later stage disease if you don’t see your dentist,” said Dr Cheng.
“And some gum diseases can progress quite fast, I’ve seen some that worsened considerably in several months.”
His worry is that some diseases don’t get picked up early, when treatment is needed to prevent it from escalating into a more serious condition.
Dr Fu is also of the same view.
“The lay person won’t know whether he or she is a low-risk or high-risk patient,” she said.
“For the low-risk groups, we want to see them every year so that we can pick up any oral diseases that they may have, such as dental decay, gum disease, or even long-standing ulcers.”
A patient in a high-risk group would be one who smokes and/or have a chronic disease like diabetes, or gum disease, or it can be someone who have very poor oral hygiene, said Dr Fu.
“People will think they have good oral hygiene if they brush very well but they may be doing it the wrong way,” she said.
The state of one’s oral health includes not just the teeth, but the gums, tongue and mouth.
And if a smoker with poorly controlled diabetes develops gum disease, he may be at a higher risk of the gum disease progressing, she said.
In the first place, poorly controlled diabetic patients are more prone to develop periodontal disease, which may make it more difficult for them to control their blood sugar level,” said Assoc Prof Ong.
“This puts them at increased risk for diabetic complications such as kidney failure and retinopathy.”
It’s why the advice is for such patients to go for dental check-ups every two to four months, she said.
Another group of people who should do so would be those with multiple medical conditions and who are on multiple medications.
They are more prone to developing xerostomia (dry mouth) due to a reduction in saliva as a side effect of the medications, and a reduction in saliva can lead to increased risk of developing dental caries, said Assoc Prof Ong.
At the end of the day, dental guidelines are meant to show you the way to good health. Untreated dental decay and gum disease can lead to tooth loss, which can then lead to poor nutrition.
“It is your teeth, and you should take ownership of them. Do what you need to do to keep your own, healthy teeth for as long as possible,” said Dr Cheng.
“Teeth are like houses, if the foundation is damaged, no amount of work can keep them intact. if the foundation is good, repair work can be done on the house.”
