title: Preventive dentistry: practitioners' recommendations for low-risk patients compared with scientific evidence and practice guidelines.
abstract: BACKGROUND
  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 practicing in western New York State concerning the preventive procedures they would recommend and at what intervals for low-risk children, young adults, and older adults; and (2) review of the published, English-language literature for evidence supporting preventive dental interventions.
  
  
  RESULTS
  The majority of dentists surveyed recommended semiannual visits for visual examination and probing to detect caries (73% to 79%), and scaling and polishing to prevent periodontal disease (83% to 86%) for low-risk patients of all ages. Bite-wing radiographs were recommended for all age groups at annual or semiannual intervals. In-office fluoride applications were recommended for low-risk children at intervals of 6 to 12 months by 73% of dentists but were recommended for low-risk older persons by only 22% of dentists. Application of sealants to prevent pit and fissure caries was recommended for low-risk children by 22% of dentists. Literature review found no studies comparing different frequencies of dental examinations and bite-wing radiographs to determine the optimal screening interval in low-risk patients. Two studies of the effect of scaling and polishing on the prevention of periodontal disease found no benefit from more frequent than annual treatments. Although fluoride is clearly a major reason 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 patients exposed to fluoridated water and using fluoridated toothpaste.
  
  
  CONCLUSIONS
  Comparative studies using outcome end points are needed to determine the optimal frequency of dental examinations and bite-wing radiographs for the early detection of caries, and of scaling and polishing to prevent periodontal disease in low-risk persons. There is no scientific evidence that dental examinations, including scaling and polishing, at 6 month intervals, as recommended by the dentists surveyed in this study, is superior to annual or less frequent examinations for low-risk populations. There is also no evidence that in-office fluoride applications offer incremental benefit over less costly methods of delivering fluoride for low-risk populations.
authors.affiliation: Tri-County Family Medicine, Cohocton, New York 14826, USA.
authors.forename: P S
authors.initials: PS
authors.lastname: Frame
authors.forename: R
authors.initials: R
authors.lastname: Sawai
authors.forename: W H
authors.initials: WH
authors.lastname: Bowen
authors.forename: C
authors.initials: C
authors.lastname: Meyerowitz
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D003731:Dental Caries / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D006801:Humans; D009518:New York; D010510:Periodontal Diseases / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011313:Preventive Dentistry / Q000379:methods*; D012307:Risk Factors; D011795:Surveys and Questionnaires