Do patients really need to see us every six months—or is that just dental tradition?
For decades, “see your dentist twice a year” has been drilled into the public mind. It’s in commercials, printed on toothbrush boxes, and repeated by every hygienist since childhood. But if you stop and think about it, where did that come from? Who actually decided that every human mouth on the planet needs to be professionally cleaned every 180 days?
Here’s the surprising part: that six-month rule wasn’t born from science. It came from a marketing campaign in the 1950s created by toothpaste companies, not dental researchers. The slogan caught on, it sounded responsible, and over time it became the cultural norm. But we never stopped to ask: does it actually make clinical sense?
Today, in this edition of The Research Says, we are asking that question head-on: Do patients really need a six-month recall—or is twelve enough?
The Biology of Time and Disease
When you look closely at the biology, the traditional schedule starts to crumble. In adults, both dental caries and periodontal disease are generally slow-progressing conditions. Cavities don’t form overnight, and attachment loss doesn’t happen in a matter of weeks. These are diseases of time, biofilm, and behavior.
If a patient has a stable mouth, brushes effectively, flosses, and uses fluoride, their risk curve flattens dramatically. For these patients, the difference between six months and twelve simply isn’t biologically significant.
What the Evidence Actually Shows
Let’s move away from anecdote and look at the highest levels of evidence available.
1. The Cochrane Review (2023 Update)
We have to start with the heavyweight champion of evidence: the Cochrane Database of Systematic Reviews. Clarkson and colleagues published a massive review involving over 2,300 adults across 51 general dental practices.
Patients were randomly assigned to three groups:
- Standard 6-month recall.
- 12-month recall.
- Risk-based recall (determined by the dentist).
They followed these patients for four years. The results were crystal clear: There was zero difference.
The study found no difference in cavities, gum health, or quality of life between any of the groups. The patients who came every 12 months were just as healthy as those who came every six. The only difference? The 12-month group spent significantly less money, and the dental teams saved valuable chair time.
2. The NICE Guidelines (2024)
These findings formed the foundation of the updated NICE guideline (CG19) in the United Kingdom. After reviewing all available evidence, NICE stated directly: “There is no clinical justification for a universal six-month recall.”
Instead, they recommended recall intervals ranging anywhere from 3 to 24 months, based entirely on risk factors like caries experience, periodontal stability, and systemic health.
3. The American Context (JADA & Journal of Dentistry)
You might be thinking, “That’s the UK, does it apply here?” Yes.
- JADA (2021): A study of over 10,000 U.S. adults found that 6-month recalls led to slightly fewer restorative needs only for patients with high caries risk or poor oral hygiene. For healthy, low-risk adults, there was no measurable benefit.
- Journal of Dentistry (2019): A randomized clinical trial found that after three years, there was no difference in decayed, missing, or filled teeth—or periodontal attachment loss—between 6-month, 12-month, and risk-based groups.
Watch the full, in-depth guide.
The “Elephant in the Operatory”: The Hygiene Shortage
We cannot discuss recall intervals without addressing the current reality of the dental workforce. Right now, across the U.S., almost every dentist is struggling to hire hygienists.
The pipeline cannot keep up with demand. We have vacant hygiene chairs, overloaded providers, and long recall backlogs. We essentially have three options:
- Lower graduation standards (risky).
- Reimagine hygiene education (long-term).
- Take a hard look at what services are truly necessary.
I am looking at this completely objectively through the lens of evidence. The blanket default of every-six-month cleanings is not supported by research for healthy adults. Keeping low-risk patients on a 6-month cycle out of habit is an inefficient use of scarce resources.
The Solution: Risk-Based Recalls
The era of one-size-fits-all is over. The science tells us that the frequency of preventive visits should match the rate at which disease might realistically develop in that specific patient.
For most adults, 12-month recalls are just as effective as six. Here is how we translate this into a clinical protocol:
- High-Risk Patients: Active decay, bleeding gums, smokers, diabetics, poor home care.
- Protocol: 3 to 6-month intervals. They need professional maintenance to manage active disease.
- Moderate-Risk Patients:
- Protocol: 9-month intervals.
- Low-Risk Patients: Excellent home care, no active disease, stable history.
- Protocol: 12 to 18-month intervals.
Implementing This in Your Practice
This might feel uncomfortable at first. From a business standpoint, we often view the 6-month recall as the heartbeat of the practice. But consider this: your healthiest 6-month patients are often your least profitable group in hygiene. They take up prime chair time but require minimal treatment.
Meanwhile, high-need patients who need scaling or restorative work can’t get on the schedule because it’s packed with routine, low-risk prophys. That isn’t efficiency; that’s inertia.
How to make the switch:
- Assess at Every Exam: Document caries activity, perio status, and systemic health.
- Assign the Interval: Use your practice management system to create codes for “Low Risk (12mo)” and “High Risk (3mo).”
- Scripting: Train your team to say, “We’re customizing your recall schedule based on your actual oral health. You are doing so well that you qualify for a 12-month interval.”
Patients love this logic. It feels personalized, honest, and scientifically grounded.
Conclusion
The science is clear, the workforce reality is undeniable, and the opportunity is right in front of us. The 6-month recall is tradition, not evidence.
By adopting a risk-based model, you free up hygiene capacity, reduce burnout, and improve access for the patients who actually need your help. Modern dentistry isn’t about doing more—it’s about doing what matters most.
