The routine six-monthly dental check-up urged on NHS patients is finally on the way out after years in which its value has been questioned.
Adults will instead be asked to return in between three months and two years, depending on dentists' assessment of their oral health. Children will have a maximum of a year between appointments.
Patients will also be advised to brush their teeth twice a day with fluoride toothpaste, use floss or interdental brushes, cut down on sugary snacks and fizzy drinks, and reduce or give up smoking and alcohol.
The National Institute for Clinical Excellence (Nice), the government watchdog on both the clinical value and cost-effectiveness of treatments, is proposing the change on check-ups despite admitting to a lack of reliable scientific evidence about the value of different recall intervals.
This worries the British Dental Association, which says the evidence for the Nice propos als is "very weak" - although it welcomes the end of a "one-size-fits-all" approach.
Six-monthly checks have been customary since the founding of the NHS. Funding arrangements assume they happen, with dentists being paid £7.05 for a basic examination. Patients pay £5.64 of this.
Many patients attend far less frequently and the way in which dentists are paid will change next year from "piece work" arrangements for check-ups, fillings or other procedures to a system that recognises the importance of disease prevention, health assessment and longer-term treatment.
The change in routine checks has yet to be classed as formal guidance, and consultation on the idea will continue until next month.
The government hopes the reforms will help put NHS dental services back on track and end politically embarrassing shortages which have led to huge queues for state-funded places at some surgeries and even "tooth ferry" trips from the Isle of Wight to France for cheap private treatment. Nice says the end of the six-month check "should be seen as an integral part of the evolution of NHS dentistry".
It says: "Patients should be informed that a single 'set' recall interval for their entire lives may not be deemed appropriate and that the recall interval may vary over time to take into account any changes in their risk of or from oral disease."
Factors such as diabetes, heart and gum disease, sugar and alcohol consumption, smoking and high-sugar diets should all be taken into consideration when agreeing intervals between checks.
Nice suggests that the two-year gap will only be appropriate if a patient's teeth and mouth are "very healthy". Any longer interval might "unacceptably diminish" the relationship between patients and dentists. Nice will also advise patients to contact their dentists for earlier appointments if they have pain or bleeding of gums between checks.
