Dental check-ups

The six-monthly check-up is a convention rather than a recommendation. UK guidance is that the interval between examinations should be set for each individual and reviewed as circumstances change: between three months and a maximum of twelve months for anyone under eighteen, and between three months and a maximum of twenty-four months for adults.

So an adult with no decay, healthy gums, no history of problems and no smoking may be advised to come once a year or less often, while someone with active decay or gum disease may be seen every three months. Neither is a reward or a punishment; the interval is a clinical judgement about how fast things are likely to change. It is a fair question to ask what any given interval is based on, and a fair question to ask for it to be revisited if circumstances have changed — a new medicine that dries the mouth, a pregnancy, a diagnosis of diabetes, starting or stopping smoking.

The evidence behind fixed six-monthly recall is weak, and a large UK trial found no added clinical benefit from a scale and polish every six months compared with every twelve. That is not an argument for going less often than advised; it is a reason not to treat the calendar as the point of the exercise.

What an examination actually covers

Most of it is not about the teeth.

The history. Current medicines, including anything bought over the counter and any supplements; medical conditions; smoking and alcohol; anything that has changed. This is not administration. A great many medicines reduce saliva, which raises the risk of decay sharply and changes what prevention is advised. Some affect bleeding, healing or the safety of particular treatments. Bringing a written list, or a photograph of the packets, saves guesswork.

The teeth. Decay, including on surfaces that cannot be seen directly; existing fillings and crowns beginning to fail at their margins; cracks; wear from grinding or from acid.

The gums. Where they bleed, how far the attachment has been lost, and whether pockets have formed between gum and tooth. This is measured rather than eyeballed where there is any sign of disease, and the measurements are compared with previous visits, which is how gum disease is caught while it is still reversible.

The soft tissues — which is the most valuable part, and the part patients least often realise is happening. The lips, the tongue including its underside and edges, the floor of the mouth, the cheeks, the palate and the back of the throat are all examined, and the neck and the glands under the jaw are felt from the outside. This is a check for mouth cancer, and dentists find cases in people who came in for something else entirely. It takes a couple of minutes and is the reason a dental examination is worth having even when nothing hurts. Mouth ulcers, patches and sore tongue covers what the changes mean and which ones not to wait on.

The bite and the jaw joint. How the teeth meet, and whether the joint moves smoothly, clicks or is tender.

X-rays where there is a reason. Not as a routine at every visit, and not as a complete set simply because a patient is new. Each radiograph has a clinical justification, and how often they are taken is a judgement weighing what might be found against the radiation dose. A patient can ask why one is being taken, and should expect an answer.

For children there is also eruption to track, an eye on how the permanent teeth are coming through and whether an orthodontic opinion is needed, and fluoride varnish.

An examination is not in itself a clean. A scale and polish is separate treatment, carried out when there is calculus or staining to remove rather than automatically, and so is fluoride varnish for an adult. In England an examination falls within the lowest NHS charge band, along with X-rays, prevention advice and a scale and polish where needed — paying for dental care sets out how the bands work.

What comes out of it

Three things: an account of what was found, a treatment plan where anything needs doing, and a recall interval. For anything beyond the simplest course of treatment the plan should be in writing before work starts, showing what is proposed and what it will cost.

It is also the moment to raise anything odd, however unrelated it seems — a patch that has appeared, an ulcer that has not gone, a tooth that feels different, jaw pain, headaches on waking, bad breath that will not shift, a dry mouth. Several of those matter considerably more than they sound.

What not to wait for

A check-up is not the place to produce a three-month-old problem. Anything on this list warrants an appointment of its own:

• toothache, particularly if it wakes someone at night or responds to heat
• any facial swelling, which needs attention the same day, and urgent hospital attention if it is spreading, closing the eye, or making swallowing or opening the mouth difficult
• gums that bleed without being touched, or that have been bleeding for more than a couple of weeks of good cleaning
• a tooth that has become loose
• an ulcer, lump, or red or white patch anywhere in the mouth that has lasted three weeks
• a broken tooth or a lost filling or crown
• numbness anywhere in the mouth, lip or chin

For anyone who dreads going

Dental anxiety is extremely common, it ranges from mild dislike to a phobia that prevents appointments being made at all, and practices encounter it every working day. It is worth saying at the point of booking, because a practice that knows can allow more time and will often offer a first appointment that is only a conversation.

There is a great deal more that helps, from an agreed signal to stop through to sedation and treatment for the phobia itself. Dental anxiety covers it properly.

See also cleaning teeth and gums, gum disease and why dental care matters.