Every six months, millions of NHS dental patients get a routine check-up—but a new trial asks whether that fixed interval is the best use of time and money. The problem is that the standard six-month recall, entrenched in practice for decades, may be too frequent for low-risk patients and too infrequent for high-risk ones. The 2004 NICE guidance recommended a risk-based approach—personalised intervals based on a full oral health assessment—but it has not been rigorously tested against fixed intervals of 6 and 24 months. This trial directly compares all three strategies in general dental practices across the UK, including urban and rural settings, fluoridated and non-fluoridated water areas, and diverse income communities. If the risk-based strategy proves as effective at maintaining oral health—measured by gum inflammation and quality of life—while costing less, it could reshape NHS dental recall policy. Patients at low risk might visit every two years, freeing up appointments for those who need more frequent care. The trial also tracks patient anxiety, satisfaction, and economic outcomes like NHS costs and quality-adjusted life years, giving funders a full picture of value. This is applied health services research with a direct route to policy change.
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This parallel-group randomised controlled comparison of three forms of dental recall strategy (6 month recall, risk-based recall, and 24 month recall), will evaluate the effectiveness and cost effectiveness of these strategies by assessing their impact on maintaining oral health. Ethical concerns over the use of a 24 month recall interval expressed by some dental practitioners have been addressed by randomisation within two strata. The risk-based recall strategy is that advocated by the 2004 NICE guidance on Dental Recall - personalised variable intervals determined according to risk information derived from comprehensive oral health assessment and review. The two fixed-period recall strategies are the traditional six month interval between routine check-ups or 24 month recall interval between routine check-ups. The research will be carried out in general dental practices across the UK. Participating dentists will represent a cross-section of practitioners operating in a range of different circumstances (e.g. urban or rural settings; high, middle or low income communities; fluoridated (Birmingham, Newcastle-upon-Tyne) or non-fluoridated water (Scotland, Wales, Northern Ireland, England). Primary outcomes are gingival inflammation/bleeding on probing at the gingival margin, measured according to the Gingival Index of Loe, and oral health-related quality of life, as measured by the Oral Health Impact Profile-14. Secondary outcomes will be assessed in terms of caries experience at both enamel and dentine thresholds using the validated International Caries Detection and Assessment System (ICDAS). Patient-centred outcomes include dental anxiety, oral health related knowledge, attitude and behaviours, satisfaction with care and use and reason for use of dental services. Economic outcomes include NHS costs, patient incurred costs, general population preferences, willingness to pay, generic quality of life (EQ-5D-3L), quality adjusted life years (QALYs) and incremental cost per QALY gained. All clinical outcomes operate at a sufficiently early stage of disease to assess the impacts of preventive care and health maintenance and are measured at four years by trained examiners who are blinded to allocation.
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