Smartphone application-assisted oral hygiene of orthodontic patients: a multicentre randomized controlled trial in adolescents

Abstract

Summary Objective The aim of this trial was to test whether the use of a smartphone application (app) connected to a toothbrush improves the oral hygiene compliance of adolescent orthodontic patients. Design The study was designed as a multicentre, randomized, controlled clinical trial. Setting Two academic hospitals. Ethical approval The study was approved by the ethics committee. Subjects and methods This multicentre randomized controlled trial was conducted on 38 adolescents aged 12–18 years with full-fixed orthodontic appliances. Participants were randomly assigned either to a test group that used an interactive oscillating/rotating electric toothbrush connected to a brushing aid app or to a control group that used an oscillating/rotating electric toothbrush alone. At baseline, all patients received verbal and written oral hygiene instructions. Outcome measurements Data collection was performed at T1 (baseline), T2 (6 weeks), T3 (12 weeks) and T4 (18 weeks—end of the study). At each time point, the plaque index (PI), gingival index (GI) and white spot lesion (WSL) score were recorded. Several app-related parameters were evaluated. Patient-related outcome measures were investigated in the test group. Results Test and control groups were similar at baseline except for WSL score. Between T1 and T4, PI and GI decreased significantly in both groups but evolutions were globally similar in both groups. Interestingly, at T3 (12 weeks), the PI was significantly lower in the app group than in the control group (P = 0.014). Data showed a marked decline in the use of the app over time in the test group. Conclusions This trial, conducted over 18 weeks in two academic hospitals, showed no significant effect of the use of the app in promoting oral hygiene. Trial registration Not registered

Teledentistry and mHealth for Promotion and Prevention of Oral Health: A Systematic Review and Meta-analysis

“…The frequency of engagement with the strategies was weekly (once or twice a week; Eppright et al 2014; Jejurikar et al 2014; Bowen et al 2015; Abdaljawwad 2016; Jadhav et al 2016; Li et al 2016; Zotti et al 2016; Iqbal et al 2017; Kumar et al 2018; Araujo et al 2019; Scheerman, Hamilton, et al 2020) or daily (≥1 times per day; Alkadhi et al 2017; Marchetti et al 2018; Alkilzy et al 2019; Zotti et al 2019; Deleuse et al 2020; Scheerman, van Meijel, et al 2020). Only 2 studies had a one-time intervention (Cozzani et al 2016; Williams et al 2018).…”

“…All studies were published in English. From the authors contacted via email (Eppright et al 2014; Deleuse et al 2020), only Eppright et al (2014) provided additional information missed from the original report.…”

“…Regarding the interventions described in the studies, we found that apps (n = 9; Li et al 2016;Zotti et al 2016;Alkadhi et al 2017;Marchetti et al 2018;Alkilzy et al 2019;Zotti et al 2019;Deleuse et al 2020;Scheerman, Hamilton, et al 2020;Scheerman, van Meijel, et al 2020) and text messages (Eppright et al 2014;Jejurikar et al 2014;Bowen et al 2015;Abdaljawwad 2016;Cozzani et al 2016;Jadhav et al 2016;Iqbal et al 2017;Kumar et al 2018;Araujo et al 2019) were the most commonly used. Apps were combined with other strategies, such as educational messages (Li et al 2016;Scheerman, Hamilton, et al 2020), reinforcement messages (Li et al 2016;Marchetti et al 2018), reminders (Li et al 2016;Deleuse et al 2020;Scheerman, van Meijel, et al 2020), push notifications (Alkadhi et al 2017;Scheerman, van Meijel, et al 2020), videos (Li et al 2016;Alkadhi et al 2017;Scheerman, Hamilton, et al 2020;Scheerman, van Meijel, et al 2020), and selfies to evaluate plaque control (after using a plaque-disclosing tablet; Zotti et al 2016;Scheerman, Hamilton, et al 2020;Scheerman, van Meijel, et al 2020), or they were wirelessly connected to electric toothbrushes (Alkilzy et al 2019;Deleuse et al 2020). Some studies with apps allowed gamificatio...…”

What Are the Cleaning and Disinfection Methods for Acrylic Orthodontic Removable Appliance? A Systematic Review

“…In addition, children represent a large amount of the orthodontic population, in which oral hygiene compliance is not perfect, associated with a possible lack of dexterity. Hence, hygiene methods in patients undergoing orthodontic treatment with fixed appliances have been widely addressed in the literature, whether it was brushing method [8] possibly assisted with smartphone application [9], use of mouthwashes [10], or direct use of antimicrobial agents in brackets, wires and orthodontic adhesives [11,12].…”

Effectiveness of a digital device providing real-time visualized tooth brushing instructions: A randomized controlled trial

“…Sunstar Inc. (Osaka, Japan) has developed a digital device that provides visible brushing instructions, linked to a mobile application, to facilitate learning appropriate teeth brushing habits. Many similar applications and devices, which improve oral hygiene or promote oral health behavior, have been developed and there have been reported their effect of only mobile applications or especially with electric toothbrush [16][17][18][19][20][21]. However, little is known about their effect with manual toothbrush, and the association between visualized brushing instructions and plaque control or the habituation of appropriate brushing methods [22][23][24][25].…”