Should the “every six months” rule apply to everyone?

How often do you get your oil changed? Every 3,000 miles? Or is it every 6,000 miles? Thanks to computers, most cars today will make that determination for you based upon the type of driver and the temperature extremes the car has to endure.

So why is it that you have been told to see the dentist every 6 months (or every 3 months if you have gum disease)? How can it be so for every human, without the predictable variability of life styles and environmental triggers being a factor? Who says you have to see the dentist every 6 months?

So why is it that you have been told to see the dentist every 6 months (or every 3 months if you have gum disease)? How can it be so for every human, without the predictable variability of life styles and environmental triggers being a factor? Who says you have to see the dentist every 6 months?

Well, we do, us dentists. We, in our infinite wisdom have decided, as a group of health care professionals concerned for the health of our patients, that it is in your best interest to come see us every 6 months. Every person, whether you have good teeth or not, whether your gums are healthy or not, whether you build up a lot of plaque and tartar or not, whether you are the world’s best brusher and flosser, or not. That’s right, everyone needs to see the dentist every 6 months. And we certainly are not about to the reward the patients that brush and floss regularly because the rules are the rules…

Is this sounding ridiculous yet?

I hope so, because it is. Let’s first discuss the origin of this insanity, as risible as it may sound. Afterwards, we’ll arm you with the knowledge to make the right decision in your own case.

So are you a fast driver that drives in very cold weather or dusty conditions, or do you baby your car, warm it up every morning and drive like the owner of a Zamboni in an ice rink? How soon would your car’s onboard computer tell you to go in for service? And where (and when) did the profession of dentistry come up with that 6 month interval?

From Amos and Andy of course, a TV show from the 50s! I’m not joking. First a wildly popular radio show, a television adaptation ran on CBS-TV from 1951 until 1953, and continued in syndication though 1966. The show was sponsored by Pepsodent Tooth Powder. Toothpaste had not yet been invented (the procedure was to put some powder on the palm of your hand, wet your toothbrush, and touch the powder with your brush) and in those days going to see the dentist was not a routine activity. In fact, most people went to see a dentist when they needed an extraction or when they were in pain. The Pepsodent ad campaign was quite successful, and in an attempt to appease dentists and gain their recommendation, stated in the ad that in addition to brushing twice daily, that they see their dentist twice yearly (or every 6 months).

Yes, the ad men of Pepsodent (clearly “mad men”) are responsible for determining the frequency of your dental cleaning visits today!

Tartar and plaque form in the mouth at different rates. I can’t tell you how many times I’ve seen a patient for a recall cleaning visit only to see them two weeks later for a scheduled filling and already see tartar forming on the teeth. I also have some patients that need to come in for a cleaning only every 12 months. When dentists polish the teeth, the pellicle (skin of the tooth) is removed, but will reappear in 3 days. The sticky biofilm (plaque) will then stick to the pellicle.

Home care is vital in determining this rate of buildup of the product that is partially responsible for gum disease. Good brushers and flossers (determined by the frequency and quality of doing so) of course will fare better and last longer before needing another cleaning. It is extremely important to remember that gum disease is 100% preventable, but once seen in the mouth it is not 100% curable, and is less than 100% arrestable. So patients (and dentist) need to be armed with methods that properly address and pay for this degree of infection.

And the plot thickens: The insurance companies prefer the “Amos and Andy gig” by a wide margin. They like the steadiness of the 6 month recall concept. It means they have their providers, the dentists that have joined their plan, doing periodontal work for prophy fees! The insurance companies are then able to essentially reduce the utilization of the plan, which in turn increases profits. In the mean time the patient is being undertreated and the dentist is either committing malpractice or committing financial suicide.

The Amos and Andy rubber stamp of the 6 month recall has allowed the insurance carriers (their actuaries) to accurately predict their risk (the outlay of cash to provide for the utilization of the plan). By this quantifying of gum disease into absolute terms, they then know how much to add (to the bottom line) for profit.

The dentist is seeing something completely different. She is seeing a huge group of patients (80%) that need more than just 6 month recalls. Sure, the dentist can bill for SRP (scaling and root planing, otherwise known as “a deep cleaning”). However, it does not provide for the patient that is not yet inflicted with the disease but exhibits patterns that need more aggressive attention to prevent the disease.

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Tags: Bleaching/whitening of teeth