Back in March my blogging friend, Carrie, wrote a post titled The Great Dental Hoax: Why Twice a Year Cleanings Mean Nothing.  Wow, what a compelling title!  Did she know some secret that I’ve been missing all these years?  I have to say that after reading her post, I was left speechless, digesting all that she had to say.  But by the end of the article, I was still left wondering why we don’t need dental cleanings twice a year.

I was slightly fooled by the title.  As I mentioned, I thought Carrie was going to share some miraculous insight into why we don’t need 2 cleanings per year.  Instead, the hoax was that this standard of care in dentistry was not based on any science.  Yep.  That’s right.  This rule that we’ve all come to live by was based on a Pepsodent ad campaign from 1929.  The slogan to brush twice daily and visit the dentist twice a year was simply a marketing ploy to sell more toothpaste.  And the dental community embraced it.

But does that mean it’s really a hoax?  Does that mean it is wrong and we are all getting swindled by the dentist?

No way!

As a profession, we have to start out with a standard for the general patient.  We may know a lot of our patients, but many come through the door that we don’t get to know.  We have to at least start with a general guideline.  Is every 3 months overkill?  For many, yes.  Is every year too long?  For many, yes.  How about every 6 months?  In my experience, it seems to work for most.  We have to start somewhere, right?  We don’t always know what is necessary for an individual until we get to know them and their habits, and that can take a long time.  (If anyone has seen any studies on this standard of care, feel free to share.  Since I don’t practice anymore, I don’t care enough to do the research myself!)

Some people can indeed maintain great oral health with only one visit per year, but in my experience, this is a very small minority.  This is the person that never accumulates calculus and never has tooth decay.  This is the person who has such impeccable home care that they do the hygienist’s job for them on a daily basis.  They haven’t had periodontal disease or decay in the past, so their risk of suddenly developing it is slim.

But is a 6-month visit really just about the cleaning?

Remember that the patient is also getting an exam every 6 months.  Oh yeah… the exam!  We know that periodontal disease is a chronic disease usually affecting older adults.  So, what if the 55-year-old woman decides she’s going to skip her dental visits for a few years because she has had healthy gums her whole life?  She finally decides to get back in and suddenly finds out she has moderate periodontitis.  This could have been prevented if she had been coming in for regular cleanings.

Or we’ve all seen the 30 year-old who comes in with a sensitive tooth.  He hasn’t been to the dentist for 5 years because he’s never had a cavity in his life.  But on this day, though his tooth looks fine on examination, the x-ray shows a HUGE cavity going right into the nerve of the tooth.  Suddenly this patient with a perfect history is shocked to find out he needs a root canal and a crown.  What does this guy always say after he has the work done?  “Oh, man!  I’ve learned my lesson.  I will never do that again;” because he knows this relatively massive procedure could have been prevented.

We have to ask ourselves, is it worth the risk?

For me it’s not.  Could I get away with having my teeth cleaned every year?  Probably.  But how challenging, inconvenient, or expensive does it need to be to outweigh the risk that a small problem going on in my mouth could turn into a bigger, more expensive, challenging, and painful problem in a year’s time.  It just doesn’t outweigh it for me.

It’s not just about getting a cleaning.  It’s also about educating, preventing, and having some regularity with which you can check things out to see if they’re okay.  Dental problems can be very slow to progress, show no symptoms, or even be nearly invisible. But they can also progress very rapidly.  Are you willing to take that chance?

I love the title of Carrie’s post, but I have to respectfully disagree with Carrie that “dental cleanings twice a year mean nothing.”  In fact, I think they mean a lot more than some patients realize.

It’s clear from reading Carrie’s post that it was really about so much more than how frequently people should visit the dentist.  She has so much more to say about the state of dentistry, that I have to finish my response in a second post.  Stay tuned for part 2.

What do you think?  Hoax or not?