Targeting high risk patients

A recent assessment from the Cochrane Reports concluded that regular hygiene visits for scaling and polishing (a routine procedure for preventing gum disease and tooth decay) had no clinical benefit. Here’s the data which supports this conclusion:

“Healthy” patients with no scaling and polishing over 3 years had 39.3% of their teeth with bleeding gums.

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Targeting preventive services

The Cochrane Library recently updated its evaluation about the merits of a hygienist cleaning above and below the gum line. Its conclusion: target these procedures for those at very high risk of poor oral health because there is little evidence of clinical merit or cost-effectiveness for these hygiene procedures for adults at little or no risk.

While this makes sense, the reality is our dental insurance schemes in Canada do not recognize risk in their reimbursement for oral health services. Someone who is low risk has the same entitlements as those at high risk. Your gums are healthy — you get 10 units of scaling each year. Your gums are bleeding and inflamed — you get the same.

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