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Interceptive Versus Therapeutic Recare Intervals
By Nancy Miller RDH BA
February 2009

We are all familiar with the idea of the 2 times a year recare interval for our patient base. In reality, there was no scientific basis for this interval. An Ipana toothpaste ad in the 1950’s had Bucky Beaver advocating that “You should brush three times a day and visit your dentist two times a year!” A Madison Avenue advertising executive created the 6-month interval for routine patient visits. While it’s not a bad idea to have semi-annual visits to ensure small problems stay that way, there are indications for more frequent visits for our periodontally involved patients.

Laboratory research shows that the bacteria and spirochetes associated with periodontal breakdown of oral tissues become virulent and destructive in a petri dish medium after 90 days. At that point they proliferate very rapidly and overcome any healthy bacteria. Comparing a gingival /sulcus pocket to a petri dish, when these virulent microorganisms overtake the healthy bacteria levels, there will be breakdown of the periodontal tissues that will lead to inflammation and infection.

Research shows that if these bacteria are periodically disturbed and debrided, the tissue will show a healthy response. Since 90 days (3 months) is the period of time needed for the bacteria to reach toxic levels, disturbing them at that point will not allow destruction to begin or progress. When a periodontally compromised patient chooses to wait 6 months for this interruption of bacteria, the toxicity builds for three months to levels that will destroy and inflame tissues. Therefore, the patient will need therapy at that point, and tissues will have been damaged. At the 3-month level, little destruction will have taken place and the tissue will already be healthier, and the patient will have a more comfortable experience. Since it’s easier and more reasonable to intercept or prevent damage than to repair it, the 3-month interval usually should be the period of time between periodontal maintenance visits. Thus, the terminology an interceptive as opposed to a therapeutic recare interval.

Nancy Miller, RDH, has over 35 years of clinical experience, including 15 years with a periodontal practice. She currently practices part-time with an excellent cosmetic/restorative dentist in Green Bay. She holds active licenses to practice in Wisconsin, Michigan and Florida. She graduated from Ferris State University in Michigan with her Associate’s Degree in Dental Hygiene, and also holds a Bachelors Degree in Communications and Management from Concordia University-Wisconsin. She is an adjunct faculty member at Northeastern Wisconsin Technical College since 1990. In 1992 Nancy began her own consulting and lecture business, ultraconcepts, focusing on periodontal therapy via ultrasonic instrumentation and debridement using the technique taught her by Dr. Thomas Holbrook, Tampa, Florida. She is also a product evaluator and development advisor for the Hu-Friedy Instrument Company of Chicago, Illinois.