Usefulness of an app in improving oral hygiene compliance in adolescent orthodontic patients

The Impact of Mobile Applications on Improving Oral Hygiene Knowledge and Skills of Adolescents: A Scoping Review

Background/Objectives: During adolescence, dental caries, erosions, and gingival diseases can significantly impact quality of life. Currently, mobile applications are widely used in health promotion, especially among teenagers, as they offer a modern approach to oral health education. This scoping review aims to evaluate the effectiveness of mobile health (mHealth) applications in improving adolescents' behavior and knowledge regarding oral hygiene. Methods: Searches were conducted in the Medline/PubMed, Scopus, Web of Science, Embase, and Google Scholar databases. Both randomized and non-randomized clinical trials published between 2015 and 2024 were analyzed. Selected studies evaluated oral hygiene behavior (knowledge and skills), as well as Plaque Index and gingival health indicators, by comparing a control group receiving traditional education with an intervention group using mobile applications for education. Results: Out of 738 articles found, only 21 met the eligibility criteria. Of the total number of included studies, 14 (66.6%) reported that adolescents in the intervention group utilizing mobile applications demonstrated superior plaque control and reduced gingival bleeding compared to those in the control group. Notably, this outcome was observed even in studies employing a single-group design. In contrast, five studies (23.8%) found no statistically significant differences between groups, while two studies (9.6%) indicated that traditional educational methods were more effective than modern methods. Conclusions: The analyzed studies indicate that mobile health applications can be valuable tools for improving adolescents' oral health. However, some findings also demonstrate that traditional education methods yield similar positive effects.

A Descriptive Observational Survey on Italian Women’s Awareness of the Association Between Periodontal Disease and Pregnancy

The literature has identified several common acute and chronic complications associated with periodontal health during pregnancy, such as gingivitis, recession, periodontitis, and changes in systemic health, such as gestational diabetes, which may act as additional risk factors for chronic periodontal disease. Are the general public and health care providers aware of the potential risks of systemic and intrauterine inflammation caused by bacteria from the oral microbiota entering the bloodstream through inflamed gingival tissue and affecting the fetoplacental unit, leading to complications, such as preterm birth and reduced prenatal growth? A questionnaire-based survey, conducted between January 2023 and June 2023, aimed to assess patients’ personal oral hygiene practices and their understanding of the link between pregnancy and periodontal health. A total of 826 people completed a questionnaire for this study. The majority of women surveyed (86.9%) were not pregnant, but 77.7% had at least one child. The majority of women believed in good oral hygiene during pregnancy but lacked knowledge about how oral care can affect pregnancy outcomes.

Efficacy of a mobile phone application for the improvement of oral hygiene of patients undergoing fixed orthodontic treatment : A randomized controlled clinical trial

OBJECTIVES

This study aimed to assess the efficacy of a mobile phone application (app) to improve oral hygiene of patients undergoing fixed orthodontic treatment.

MATERIALS AND METHODS

This randomized controlled clinical trial was conducted with a total of 60 patients undergoing fixed orthodontic treatment in two groups: intervention and control (n = 30 each). A previously designed mobile app (Labkhand) was used by patients in the intervention group. Orthodontic plaque index (OPI) and modified gingival index (MGI) were recorded in the two groups at baseline (first session or T0), and after 1 (T1) and 3 (T2) months. The number of debonded/broken brackets was also recorded, and pain score of the patients was assessed at nine time points. Data were analyzed using the χ2 test, paired t‑test, and repeated measures analysis of variance (ANOVA; α = 0.05).

RESULTS

The two groups demonstrated no significant difference in OPI and MGI at T0 (P > 0.05). OPI and MGI at T1 and T2 were significantly lower in the intervention group than in the control group (P < 0.05). The number of patients with broken brackets in the intervention group was significantly lower than that in the control group (P = 0.017). The two groups reported no significant difference in pain score (P > 0.05).

CONCLUSION

The Labkhand mobile app successfully improved oral hygiene indices of patients undergoing fixed orthodontic treatment, and decreased the frequency of broken brackets after 1 and 3 months of use.

Social Media Use and Oral Health-Related Misconceptions in Saudi Arabia: Cross-Sectional Study

BACKGROUND

Social media has become a central tool in health communication, offering both opportunities and challenges. In Saudi Arabia, where platforms like WhatsApp, Snapchat, and Instagram are widely used, the quality and credibility of oral health information shared digitally remain critical issues. Misconceptions about oral health can negatively influence individuals' behaviors and oral health outcomes.

OBJECTIVE

This study aimed to describe the patterns of social media use and estimate the prevalence of oral health-related misconceptions among adults in Saudi Arabia. Additionally, it assessed the associations between engagement with oral health information, self-reported oral health, and the presence and count of these misconceptions.

METHODS

A cross-sectional survey was conducted over 10 weeks, targeting adults aged 15 years and older in Saudi Arabia. Data were collected from a total sample size (n=387) via a questionnaire distributed through targeted advertisements on Instagram, TikTok, Snapchat, and X (Twitter). The prevalence of oral health-related misconceptions was estimated using descriptive statistics, including counts and percentages. Chi-square tests described sociodemographic, social media engagement, and self-reported oral health. Logistic and Poisson regression analyses were used to assess associations between engagement and self-reported oral health with misconceptions. Logistic regression models provided odds ratios and adjusted odds ratios with 95% CI to assess the presence of oral health misconceptions. Poisson regression was used to calculate mean ratios and adjusted mean ratios (AMRs) for the count of misconceptions.

RESULTS

WhatsApp (n=344, 89.8%) and Instagram (n=304, 78.9%) were the most frequently used social media platforms daily. Common oral health misconceptions included beliefs that "Pregnancy causes calcium loss in teeth" (n=337, 87%) and "Dental treatment should be avoided during pregnancy" (n=245, 63.3%). Following dental-specific accounts was significantly associated with lower odds of having any misconceptions (adjusted odds ratio 0.41, 95% CI 0.22-0.78) and a lower count of misconceptions (AMR 0.87, 95% CI 0.77-0.98). Conversely, trust in social media as a source of oral health information was associated with a higher count of misconceptions (AMR 1.16, 95% CI 1.02-1.31).

CONCLUSIONS

Social media platforms are essential yet double-edged tools for oral health information dissemination in Saudi Arabia. Participants who followed dental-specific accounts had significantly lower misconceptions, while trust in social media as a source of information was linked to higher counts of misconceptions. These findings highlight the importance of promoting credible content from verified sources to combat misconceptions. Strategic collaborations with dental professionals are necessary to enhance the dissemination of accurate oral health information and public awareness and reduce the prevalence of oral health-related misconceptions.

Smartphone-Based Telemonitoring for Better Oral Health With Toothbrushes: 6-Month Randomized Controlled Trial

BACKGROUND

A toothbrush device that telemonitors toothbrushing is a technologically advanced solution providing personalized feedback on toothbrushing habits and oral hygiene. These devices integrate smartphone apps to enhance oral health compliance through dental professional feedback.

OBJECTIVE

This 6-month prospective randomized controlled trial aimed to compare the clinical effectiveness, defined as improved oral hygiene measured by plaque reduction and halitosis control, of an interactive telemonitoring toothbrush (ITT), an oscillating-rotating power toothbrush (ORT), and a manual toothbrush (MT).

METHODS

Participants were recruited offline from the Department of Advanced General Dentistry at Yonsei University Dental Hospital, South Korea. A total of 150 participants were randomly assigned to 3 groups (50 participants each): (1) an ITT connected to a smartphone app providing real-time feedback and weekly dental professional reviews, (2) an ORT with smartphone-based guidance requiring participants to send weekly brushing records via screenshots, and (3) an MT with a brushing diary for review. Data collection occurred in clinical settings. Primary outcomes included plaque reduction measured using the Simple Hygiene Score (SHS), while secondary outcomes included plaque reduction measured using the Turesky modification of the Quigley-Hein plaque index (QHI), reductions in halitosis, and changes in oral microbiota. All outcomes were assessed at baseline and 1 month, 3 months, and 6 months.

RESULTS

A total of 150 participants completed the study. Over 6 months, the SHS increased in the MT group (mean 3.16, SD 4.86 to mean 5.66, SD 5.20) but significantly decreased in the ITT group (mean 3.47, SD 5.50 to mean 2.27, SD 3.82; P=.004). Similarly, QHI decreased more in the ITT group (mean 1.79, SD 0.72 to mean 0.85, SD 0.63) than in the ORT (P<.001) and MT (P<.001) groups. Regarding microbiota, there were no significant differences in high-risk periodontal microbiota or the ratio of caries-risk to anticaries microbiota between the ITT and ORT groups. However, in the MT group, the ratio of caries-risk microbiota was significantly higher at the 3-month (P<.001) and 6-month (P=.005) recalls than at baseline and at the 3-month (P=.048) and 6-month (P=.03) recalls than at the 1-month recall. Poststudy questionnaires indicated that 45 of 50 ITT participants (92%) and 37 of 50 ORT participants (76%) reported improved brushing ability. The most effective feature in the ITT group was brushing training, while participants in the ORT group cited the brushing guide as most useful (P<.001). Satisfaction scores were higher in the ORT group (mean 7.90, SD 1.21) than in the ITT group (mean 7.15, SD 1.66; P=.004). The number of brushing events decreased significantly in the ORT group (P=.02), while brushing duration increased in the MT group (P=.01).

CONCLUSIONS

ITTs enable better oral hygiene management than MTs through dental professional feedback. However, further studies are needed to optimize feedback intervals and improve long-term adherence.

TRIAL REGISTRATION

Clinical Research Information Service (CRIS), Republic of Korea, KCT0009094; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=26110&search_page=L.

The Use of Social Media on Enhancing Dental Care and Practice Among Dental Professionals: Cross-Sectional Survey Study

Background

As digitalization continues to advance globally, the health care sector, including dental practice, increasingly recognizes social media as a vital tool for health care promotion, patient recruitment, marketing, and communication strategies.

Objective

This study aimed to investigate the use of social media and assess its impact on enhancing dental care and practice among dental professionals in the Philippines.

Methods

A cross-sectional survey was conducted among dental practitioners in the Philippines. The study used a 23-item questionnaire, which included 5 questions on dentists' background and demographic information and 18 questions regarding the use, frequency, and purpose of social media in patient advising and quality of care improvement. Data were analyzed using SPSS software, with frequency distributions and χ2 tests used to assess the association between social media use and demographic variables and the impact on dental practice.

Results

The 265 dental practitioners in this study were predominantly female (n=204, 77%) and aged between 20-30 years (n=145, 54.7%). Most of the participants were general practitioners (n=260, 98.1%) working in a private practice (n=240, 90.6%), with 58.5% (n=155) having 0-5 years of clinical experience. Social media use was significantly higher among younger practitioners (20-30 years old) compared to older age groups (P<.001), though factors such as sex, dental specialty, and years of clinical practice did not significantly influence use. The majority (n=179, 67.5%) reported using social media in their practice, primarily for oral health promotion and education (n=191, 72.1%), connecting with patients and colleagues (n=165, 62.3%), and marketing (n=150, 56.6%). Facebook (n=179, 67.5%) and YouTube (n=163, 61.5%) were the most frequented platforms for clinical information, with Twitter (subsequently rebranded X) being the least used (n=4, 1.5%). Despite widespread social media engagement, only 8.7% (n=23) trusted the credibility of web-based information, and 63.4% (n=168) perceived a potential impact on the patient-dentist relationship due to patients seeking information on the internet. Social media was also perceived to enhance practice quality, with users reporting significant improvements in patient care (P=.001).

Conclusions

The findings highlight that social media is widely used among younger dental practitioners, primarily for education, communication, and marketing purposes. While social media use is associated with perceived improvements in practice quality and patient care, trust in information on social media remains low, and concerns remain regarding its effect on patient relationships. It is recommended to establish enhanced guidelines and provide reliable web-based resources to help dental practitioners use social media effectively and responsibly.

Social media use and adolescent oral health: A scoping review

Introduction

Social media has revolutionized information sharing, particularly among adolescents who frequently use it for health-related content. However, their use of social media concerning oral health remains unclear. This scoping review aims to map available literature on the use of social media regarding oral health among adolescents.

Methods

Following Arksey & O'Malley's framework and PRISMA-SCR guidelines, comprehensive searches were conducted in Medline (Ovid), PubMed, and Scopus databases from January 2013 to December 2024. Reference lists of relevant studies were also reviewed. Two researchers independently screened and extracted relevant data from eligible studies. The data included publication year, authors, country, study design, aims, social media platforms, comparisons, assessed outcomes, and key findings. Descriptive statistics were used to summarize quantifiable aspects and content analysis was employed to define categories and report the key findings.

Results

Of 1938 records, 1312 titles and abstracts and 73 full-text articles were screened. Seventeen relevant studies were identified, including 2 reviews and 15 primary studies. These studies included six clinical trials and five cross-sectional studies. Three studies didn't indicate the study design. In addition to social media's effectiveness in improving oral health literacy, behaviors, and outcomes, such as plaque, gingival, and caries indices, the studies reported on patient compliance and sharing treatment-related experiences.

Conclusion

This review highlights the growing influence of social media on adolescents' oral health literacy and practices. Further research is necessary to explore adolescents' perspectives on social media use for oral health and develop effective interventions that address the unique needs of this demographic.

Cariogram-based Comparison of Caries Risk Profile in Preschoolers Before and After Giving Parent-oriented Educational Mobile Messages: A Randomized Controlled Trial

Background

Mobile health (mHealth) holds immense promise in revolutionizing personalized approaches to disease prevention. Parental involvement plays an important role in shaping children's oral health behaviors.

Aim

To assess and compare the effectiveness of parent-oriented educational mobile messages and conventional oral health education (OHE) in the caries risk profile among preschoolers using Cariogram.

Materials and methods

A double-arm, parallel-group randomized controlled trial was conducted with 100 mother-child pairs from four preschools. The study recruited mothers with smartphones, while children who were ill and without dental caries were excluded. A computer-generated table of random numbers was employed to randomize participants to the mHealth group (n = 50) and conventional OHE group (n = 50). The intervention group received educational messages via WhatsApp every 2 weeks for 4 months, alongside conventional OHE, and the control group (n = 50) received only OHE. The outcome assessor remained blinded throughout the study period. Cariogram was assessed at baseline and after 4 months.

Results

Among the 100 mother-child pairs who enrolled in the study, 84 completed it. The mHealth group showed a significant increase in the chance to avoid new cavities and a decrease in high-risk participants (p < 0.001). Additionally, the intervention group exhibited reduced Lactobacillus count, snack frequency, plaque amount, and increased fluoride exposure compared to baseline (p < 0.001). Intergroup comparisons revealed significant differences in most caries risk factors, except salivary flow rate, Streptococcus mutans count, decayed, missing and filled teeth (DMFT) scores, and buffering capacity.

Conclusion

This study demonstrated the effectiveness of parent-oriented mHealth education in reducing caries risk among preschoolers when compared to conventional OHE.

Clinical significance

This study provides evidence that supports the creation of digital strategies for early childhood caries prevention programs. These strategies empower individuals to take charge of their dental care, particularly laypersons, enhancing self-management.

CTRI number

CTRI/2023/03/050519.

How to cite this article

Varghese AS, Sankeshwari RM, Nagamoti MB, et al. Cariogram-based Comparison of Caries Risk Profile in Preschoolers Before and After Giving Parent-oriented Educational Mobile Messages: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2025;18(1):45-52.

Assessing effectiveness of WhatsApp messaging program in oral hygiene care for orthodontic patients: A randomised controlled trial

OBJECTIVE

To evaluate the difference in the oral hygiene status of participants with fixed appliances between a 'weekly WhatsApp application oral hygiene message reminders' trial group and a 'verbal instructions' control group over a follow-up duration of 12 weeks.

DESIGN

Prospective, single-blind, randomised controlled trial with an allocation ratio of 1:1 over a 12-week follow-up.

SETTING

Government Orthodontic Unit, Raub Dental Clinic, Raub, Pahang, Ministry of Health, Malaysia.

PARTICIPANTS

A total of 40 patients aged 13-25 years undergoing orthodontic treatment with fixed appliances.

METHODS

The 40 patients were recruited and randomly allocated to a control (n = 20) or trial group (n = 20). Participants in the trial group received weekly oral hygiene reminders via the WhatsApp application for 12 weeks, while the control group did not receive any reminders. The primary outcome was oral hygiene, which was measured by the single-blinded examiner using the Orthodontic Plaque Index (OPI) at three orthodontic check-ups: baseline (T0); 6-week follow-up (T1); and 12-week follow-up (T2).

RESULTS

The mean age of participants was 17 years, and 80% were female. At the end of the 12-week follow-up, improvements in OPI scores were observed, regardless of the intervention. At T2, the median OPI score for the trial group (n = 20) was 0 (interquartile range [IQR = 0) while that for the control group (n = 20) was 2 (IQR = 0). A Mann-Whitney U test revealed a statistically significant difference (P <0.05), with effect size r = 0.87 between the control and trial groups, whereby the latter witnessed marked improvement in OPI throughout the visits. No harms or adverse effects occurred in this trial.

CONCLUSION

The short-term findings demonstrated that participants receiving regular reminders of oral hygiene via WhatsApp messaging had a significant improvement in oral hygiene compared to the control group.

Mobile Health to Improve Efficacy of Interdental Brushing Among Periodontitis Patients: A Randomized Clinical Trial

AIM

Compliance with plaque control measures in open interdental spaces, an essential element in management of periodontitis, is reported to be poor. Mobile health (mHealth) approach is an effective approach for behavior change. This study aimed to assess the effectiveness of mHealth in improving plaque control in type 2 embrasures.

METHODS

Stage II or III, grade B periodontitis patients (n = 76) with type 2 embrasures were enrolled. Phase I therapy was provided in both groups. In the control group, interdental brushing instructions were given only at baseline and follow-up appointments. In the test group, interdental brushing was also reinforced by regular text messages for 3 months. Clinical parameters including plaque index (PI), papillary bleeding index (PBI), probing pocket depth (PPD), clinical attachment level (CAL), gingival index (GI), bleeding on probing (BOP), and interdental papillary height (IPH) were measured at baseline, 1, 3, and 6 months.

RESULTS

Intergroup comparison from baseline to 6 months showed a statistically significant difference (p < 0.05) between groups in all parameters with more reduction in mean values in test group. Intergroup comparison from 3 to 6 months showed a statistically significant difference (p < 0.05) in mean values of PI, PBI, GI, PPD, CAL, and IPH with higher reduction in test group. Intragroup comparison from 3 to 6 months showed statistically significant reduction in mean values in PI, PBI, PPD, CAL, and IPH only in test group (p < 0.05).

CONCLUSION

Cue to action through mobile text messages effectively augments compliance with the use of interdental brush, improves plaque control, and manages stage II or stage III periodontitis following subgingival instrumentation.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT05565404.

A short-term evaluation of oral hygiene education methods in fixed orthodontics patients: a randomized clinical trial comparing assistant training, software, and social media

OBJECTIVE

To compare the effectiveness of different oral hygiene education strategies on periodontal health in fixed orthodontic patients in a one-month period: assistant-led instruction, social media-based education, and custom-made software.

METHODS

Sixty orthodontic patients from Mashhad University of Medical Sciences' Dentistry School were randomly assigned into three groups. Each group received oral health education differently: via assistant instruction, educational videos on social media, or a researcher-designed software for Android smartphones. After a month, participants' oral health was evaluated using the plaque index (PI) and the gingival index (GI).

RESULTS

Assistant-led education group demonstrated the highest PI (1.26 ± 0.70) and GI (0.92 ± 0.67), while the software group reported the lowest indices (PI = 0.68, GI = 0.46 ± 0.46). The social media group's measurements fell between these extremes (PI = 0.89 ± 0.75, GI = 0.60 ± 0.52). Significant group differences were found for both PI and GI (P = 0.028 and P = 0.047, respectively). Pairwise comparison revealed significantly lower PI and GI in the software group compared to the assistant group. No significant differences were found between the social media and other groups.

CONCLUSION

Our results suggest that the use of specially designed software could be the most effective strategy for improving oral hygiene in orthodontic patients. Meanwhile, traditional assistant-led education showed the least effectiveness. The study supports the potential benefit of utilizing digital tools, such as bespoke software and social media, in oral health education for orthodontic patients.

TRIAL REGISTRATION

The study was registered in the Iranian Registry of Clinical Trials (IRCT) database with the identification code IRCT20200609047705N2 in 13.07.2021.

The 100 Most-Cited Randomised Controlled Trials in Orthodontics: A Bibliometric Study

INTRODUCTION AND AIM

Randomised controlled trials (RCTs) are recognised as the highest level of original evidence and provide essential evidence for dentists to practice evidence-based dentistry. By analysing the top 100 most-cited RCT reports in orthodontics, this study aimed to determine popular research topics, key authors, countries, journals, and their impacts.

METHODS

A comprehensive search was performed in the Web of Science (WoS) electronic database to identify the top 100 most-cited RCT reports in orthodontics. Publication and citation data were retrieved and further analysed and visualised using R Biblioshiny. The primary themes of the 100 articles were also determined. Additionally, the correlation between number of years since publication and citation counts was examined.

RESULTS

The top 100 most-cited RCT reports were published between 1992 and 2018, contributed by 419 authors across 22 journals, with an average citation count of 93.48. The US led with the highest number of publications (28) and citations (2552), followed by the UK (22 and 2061) and Australia (8 and 912). Notably, 20 of the top 24 authors with at least 4 publications are from the UK. The primary focus areas of the articles included early Class II treatment (n = 14), obstructive sleep apnoea (n = 14), demineralisation (n = 12), and pain and quality of life (n = 12). Besides, a positive correlation was found between the number of years since publication and citation counts (P < .001).

CONCLUSIONS

The top 100 most-cited RCT reports in orthodontics encompass a wide range of topics with varying focus areas across different time periods. This analysis recognises the contributions of scholars and offers valuable insights into the research trends within the field of orthodontics.

Are technology-based health education methods able to reduce oral health inequalities between the sexes in adolescents? A cluster randomized trial

PURPOSE

Determine if different technology-based health education interventions can reduce oral health inequalities between the sexes in a sample of adolescents.

METHODS

A cluster randomized clinical trial was conducted in three phases with an initial sample of 291 male and female adolescents 14-19 years of age. Phase I (n = 288) comprised a clinical examination performed by a calibrated examiner using the simplified oral hygiene index (OHI-S) and gingival bleeding index (GBI). Phase II involved two educational interventions: video (VD; n = 147) or oral counselling (OR; n = 141) with standardized content. In phase III, an App was made available to half of the clusters (OR + App; n = 66/OR without App; n = 71/VD + App; n = 63/VD without App; n = 63), and the clinical examination was performed a second time. Data were evaluated using descriptive analysis and nonparametric tests.

RESULTS

In phase I, boys had a lower standard of oral hygiene compared with girls, with higher mean OHI-S (p = 0.039) and GBI (p = 0.015). After VD and OR interventions, no significant difference between sexes was found regarding the mean OHI-S. However, males had a higher mean GBI compared with females in the OR group (p = 0.006). When the App was added to OR and VD groups, males in the 'OR without App' group had a higher mean GBI compared with females (p = 0.007).

CONCLUSION

This clinical trial demonstrated that educational interventions involving information technologies were effective at reducing oral health inequalities between the sexes among adolescents. However, oral counselling alone was not efficient in reducing GBI in male adolescents.

Patient adherence in orthodontics: a scoping review

BACKGROUND

Patient adherence is a key factor in achieving orthodontic treatment success. Despite an evolution in orthodontic healthcare, no recent comprehensive reviews are available on patient adherence in orthodontics. This scoping review provides an evidence-based overview of the literature available on multiple aspects of patient adherence in orthodontics, during both active treatment as well as during the retention phase. Knowledge gaps identified in the literature are listed.

METHODS

The protocol for this scoping review was registered in the Open Science Framework ( https://doi.org/10.17605/OSF.IO/EC6QD ). Electronic databases and reference lists of relevant studies were searched up to 9 February 2023. The inclusion criteria were studies investigating any form of patient adherence in orthodontics published in English from 2006 onwards. The exclusion criteria were studies investigating adherence in the following patients: those with an intellectual or physical disability that could affect their ability to coincide with their therapist's recommendations and advice, those with oral cleft and craniofacial conditions, and those treated solely for obstructive sleep apnoea. Non-peer-reviewed studies and case reports were also excluded.

RESULTS

A total of 3284 articles were identified, 60 of which met the criteria for final inclusion.

CONCLUSIONS

There is no conclusive evidence on which factors have a significant impact on patient adherence and how patient adherence can be promoted. The degree of patient adherence is generally not compared to achieved treatment results or stability of treatment results, making it difficult to provide clear statements about the impact of the degree of adherence on desired treatment results or orthodontic stability.

Using patients' oral photographs for oral hygiene motivation promotes periodontal health: a prospective randomized controlled trial

OBJECTIVES

The aim of this prospective, randomized, controlled, single-centered, examiner-blinded clinical trial was to evaluate the effectiveness of a personalized and visual oral health education program in addition to conventional oral hygiene education.

MATERIALS AND METHODS

Fifty-six non-smoker, right-handed participants (aged 30.34 ± 11.46 years) without clinical signs of periodontitis were randomly grouped: the intervention group (n = 28) received a personalized visualized oral health education combined with conventional oral hygiene education, and the control group (n = 28) received conventional oral hygiene education only. All participants were assessed for improved periodontal parameters (PI, GI, BOP, and PPD) at baseline, first month, and third month.

RESULTS

A significant reduction (p < 0.001) was observed in PI, GI, and BOP during two follow-up sessions compared to the baseline for the two groups. No differences were found for inter-group (p > 0.05) or intra-group (p = 1) comparison of PPD. PI (p = 0.012), GI (p = 0.032), and BOP (p = 0.024) scores were significantly reduced at the third-month follow-up assessment in the intervention group compared to the control group.

CONCLUSIONS

Clinical outcomes of periodontal health were significantly enhanced by the personalized and visual oral health education program applied in this study compared to the conventional oral hygiene education program.

CLINICAL RELEVANCE

Numerous studies reported additional interventions to the oral hygiene education program. However, we did not find any published studies investigating the role of patients' intra-oral photographs in oral care. This study's results demonstrated that a visually aided education program for oral hygiene motivation may help improve oral health.

CLINICAL TRIAL REGISTRATION

Registration number is "NCT06316505" and date of registration is 18/03/2024.

Awareness of orthodontic patients towards smartphone orthodontic apps

BACKGROUND

Mobile phone applications (apps) can potentially enhance patient care as they are easy to use and offer multifunctions. In 2019, 305 orthodontic apps were documented, many of which were patient-focused; however, there was little information on how popular these applications are with orthodontic patients. The main aim of this study was to evaluate how well patients were now aware of orthodontic applications.

METHODS

A survey asking 700 orthodontic patients about their knowledge of, access to, and use of orthodontic apps to facilitate their treatment resulted in 615 responses.

RESULTS

The results showed that a smartphone was owned by 96% of patients. Apple (Apple Inc., Cupertino, CA, USA) was the most used platform, followed by Android (Google LLC, Mountain View, CA, USA). Seventy-five percent of patients have previously used social media to research information, with YouTube (YouTube, San Mateo, CA, USA) being the most popular site. Only 3% of patients knew that applications were available to aid with orthodontic therapy and 12 patients had utilized an app linked to orthodontics. Nevertheless, 88% of patients said they would be open to using an app to supplement their treatment.

CONCLUSIONS

Although 88% of patients said they would be prepared to use an app to help with orthodontic treatment, there is currently a low level of knowledge of the existence of apps. Given the availability of applications geared toward those patients, it is necessary to evaluate these apps' quality and, when critical, direct patients toward high-quality, efficient apps.

Orthodontic adhesive loaded with different proportions of ZrO2 silver-doped nanoparticles: An in vitro μTBS, SEM, EDX, FTIR, and antimicrobial analysis

Zirconium dioxide silver-doped nanoparticles (ZrO2AgDNPs) impacts the adhesive material in terms of its physical characteristics, antimicrobial properties, degree of conversion (DC), and micro-tensile bond strength (μTBS) of orthodontic brackets to the enamel surface. A comprehensive methodological analysis utilizing a range of analytical techniques, including scanning electron microscopy coupled with energy-dispersive x-ray spectroscopy (EDX), Fourier-transform infrared (FTIR) spectroscopy, DC analysis, and μTBS testing. A light-curable orthodontic adhesive, specifically Transbond XT, was combined with ZrO2AgDNPs at 2.5% and 5%. As a control, an adhesive with no incorporation of ZrO2AgDNPs was also prepared. The tooth samples were divided into three groups based on the weightage of NPs: group 1: 0% ZrO2AgDNPs (control), group 2: 2.5 wt% ZrO2AgDNPs, and group 3: 5 wt% ZrO2AgDNPs. EDX graph demonstrated silver (Ag), Zirconium (Zr), and Oxygen (O2), The antibacterial efficacy of adhesives with different concentrations of NPs (0%, 2.5%, and 5%) was assessed using the pour plate method. The FTIR spectra were analyzed to identify peaks at 1607 cm-1 corresponding to aromatic CC bonds and the peaks at 1638 cm-1 indicating the presence of aliphatic CC bonds. The μTBS was assessed using universal testing machine (UTM) and bond failure of orthodontic brackets was seen using adhesive remanent index (ARI) analysis. Kruskal-Wallis test assessed the disparities in survival rates of Streptococcus mutans. Analysis of variance (ANOVA) and post hoc Tukey multiple comparisons test calculated μTBS values. The lowest μTBS was observed in group 1 adhesive loaded with 0% ZrO2AgDNPs (21.25 ± 1.22 MPa). Whereas, the highest μTBS was found in group 3 (26.19 ± 1.07 MPa) adhesive loaded with 5% ZrO2AgDNPs. ZrO2AgDNPs in orthodontic adhesive improved μTBS and has acceptable antibacterial activity against S mutans. ZrO2AgDNPs at 5% by weight can be used in orthodontic adhesive alternative to the conventional method of orthodontic adhesive for bracket bonding. RESEARCH HIGHLIGHTS: The highest μTBS was found in orthodontic adhesive loaded with 5% ZrO2AgDNPs. ARI analysis indicates that the majority of the failures fell between 0 and 1 among all investigated groups. The colony-forming unit count of S. mutans was significantly less in orthodontic adhesive loaded with nanoparticles compared with control. The 0% ZrO2AgDNPs adhesive showed the highest DC.

Investigation of mechanical properties, remineralization, antibacterial effect, and cellular toxicity of composite orthodontic adhesive combined with silver-containing nanostructured bioactive glass

BACKGROUND

The formation of white spots, which represent early carious lesions, is a major issue with fixed orthodontics. The addition of remineralizing agents to orthodontic adhesives may prevent the formation of white spots. The aim of this study was to produce a composite orthodontic adhesive combined with nano-bioactive glass-silver (nBG@Ag) for bracket bonding to enamel and to investigate its cytotoxicity, antimicrobial activity, remineralization capability, and bond strength.

METHODS

nBG@Ag was synthesized using the sol-gel method, and characterized using transmission electron microscopy (TEM), X-ray diffraction (XRD), and Fourier-transform infrared spectroscopy with an attenuated total reflectance attachment (ATR-FTIR). The cytotoxicity test (MTT) and antimicrobial activity of adhesives containing 1%, 3%, and 5% (wt/wt) nBG@Ag were evaluated, and the shear bond strength of the adhesives was measured using a universal testing machine. Remineralization was assessed through microhardness testing with a Vickers microhardness tester and scanning electron microscopy (SEM). Statistical analyses were conducted using the Shapiro-Wilk test, Levene test, one-way ANOVA, Robust-Welch test, Tukey HSD method, and two-way ANOVA.

RESULTS

The biocompatibility of the adhesives was found to be high, as confirmed by the lack of significant differences in the cytotoxicity between the sample and control groups. Discs made from composites containing nBG@Ag exhibited a significant reduction in the growth of Streptococcus mutans (p < 0.05), and the antibacterial activity increased with higher percentages of nBG@Ag. The shear bond strength of the adhesives decreased significantly (p < 0.001) after the addition of nanoparticles, but it remained above the recommended value. The addition of nBG@Ag showed improvement in the microhardness of the teeth, although the differences in microhardness between the study groups were not statistically significant. The formation of hydroxyapatite deposits on the tooth surface was confirmed through SEM and energy-dispersive X-ray spectroscopy (EDX).

CONCLUSION

Adding nBG@Ag to orthodontic adhesives can be an effective approach to enhance antimicrobial activity and reduce enamel demineralization around the orthodontic brackets, without compromising biocompatibility and bond strength.

Gamification and Oral Health in Children and Adolescents: Scoping Review

BACKGROUND

Oral health is a determinant of overall well-being and quality of life. Individual behaviors, such as oral hygiene and dietary habits, play a central role in oral health. Motivation is a crucial factor in promoting behavior change, and gamification offers a means to boost health-related knowledge and encourage positive health behaviors.

OBJECTIVE

This study aims to evaluate the impact of gamification and its mechanisms on oral health care of children and adolescents.

METHODS

A systematic search covered multiple databases: PubMed/MEDLINE, PsycINFO, the Cochrane Library, ScienceDirect, and LILACS. Gray literature, conference proceedings, and WHOQOL internet resources were considered. Studies from January 2013 to December 2022 were included, except for PubMed/MEDLINE, which was searched until January 2023. A total of 15 studies were selected following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The eligibility criteria were peer-reviewed, full-text, and empirical research related to gamification in oral health care, reports of impact, and oral health care outcomes. The exclusion criteria encompassed duplicate articles; unavailable full texts; nonoriginal articles; and non-digital game-related, non-oral health-related, and protocol studies. Selected studies were scrutinized for gamification mechanisms and outcomes. Two main questions were raised: "Does gamification in oral health care impact oral health?" and "Does oral health care gamification enhance health promotion and literacy?" The PICO (Patient, Intervention, Comparison, Outcome) framework guided the scoping review.

RESULTS

Initially, 617 records were obtained from 5 databases and gray literature sources. After applying exclusion criteria, 15 records were selected. Sample size in the selected studies ranged from 34 to 190 children and adolescents. A substantial portion (11/15, 73%) of the studies discussed oral self-care apps supported by evidence-based oral health. The most clearly defined data in the apps were "brushing time" (11/11, 100%) and "daily amount brushing" (10/11, 91%). Most studies (11/15, 73%) mentioned oral health care behavior change techniques and included "prompt intention formation" (11/26, 42%), "providing instructions" (11/26, 42%), "providing information on the behavior-health link" (10/26, 38%), "providing information on consequences" (9/26, 35%), "modeling or demonstrating behavior" (9/26, 35%), "providing feedback on performance" (8/26, 31%), and "providing contingent rewards" (8/26, 31%). Furthermore, 80% (12/15) of the studies identified game design elements incorporating gamification features in oral hygiene applications. The most prevalent gamification features were "ideological incentives" (10/12, 83%) and "goals" (9/16, 56%), which were found in user-specific and challenge categories, respectively.

CONCLUSIONS

Gamification in oral health care shows potential as an innovative approach to promote positive health behaviors. Most studies reported evidence-based oral health and incorporated oral health care behavior change techniques.

Effectiveness of internet-based nursing interventions for the treatment of patients with periodontitis

BACKGROUND

Periodontitis, one of the most common oral diseases, is a chronic inflammatory condition occur in response to bacterial plaque biofilms. Plaque control and oral hygiene instructions are the most widely used and effective nonsurgical treatment for periodontitis, which is based on a partnership between patient and clinician and requires a life-long commitment. The objective of this study was to analyze the effectiveness of internet-based nursing interventions for the treatment of patients with periodontitis. The findings from this study may help to enhance the therapeutic outcomes for patients with periodontitis.

METHODS

A total of 80 patients with periodontitis treated in Zhejiang Province Stomatology hospital from December 2021 to January 2023 were randomly selected and divided into control group and intervention group with 40 cases each. The control group was given routine oral health guidance and the intervention group received internet based nursing intervention. The periodontal pocket depth, percentage of periodontal pocket depth (PD) ≥ 4 mm, bleeding on probing (BOP)%, and self-efficacy scale for oral health care (SESS) were assessed and compared at four time points: initial visit, 6-8-weeks follow-up, 3-months follow-up, and 6-months follow-up.

RESULTS

There was no significant difference between the two groups in terms of age, gender, initial visit PD, initial visit PD ≥ 4 mm (%), initial visit BOP (%), and initial visit SESS (P > 0.05). The intervention group showed a significantly decreased percentage of PD ≥ 4 mm at 6-8 weeks and 6-months follow-up compared to the control group (P < 0.05). The PD, BOP%, and SESS scores of the intervention group were significantly better than those of the control group at 6-months follow-up (P < 0.05). There was no statistically significant difference in patient satisfaction between the two groups.

CONCLUSIONS

This study confirmed that the internet-based nursing intervention in conjunction with periodontal treatment was able to improve the periodontal pocket depth, gingival bleeding and the level of self-efficacy of patients, suggesting that it is necessary to carry out the extended oral hygiene instructions via internet-based platforms for the patients in clinical practice.

Effectiveness of e-learning to promote oral health education: A systematic review and meta-analysis

BACKGROUND

In recent times during and after the COVID-19 pandemic, e-learning is increasingly being used to give oral health education. However, the efficacy of e-learning in improving and promoting the oral hygiene and oral health knowledge, attitude and practice is unclear. Therefore, this systematic review and meta-analysis aim to clarify the effectiveness of e-learning compared to other conventional education methods for providing oral health.

METHODS

An electronic database search was performed on PubMed-Medline, Scopus, and CENTRAL (Central Register Cochrane of Controlled trials). Randomized controlled trials (RCTs), including cluster or group RCTs, were collected in this study. The risk of bias was assessed with the Cochrane Handbook for Systematic Reviews of Interventions. Five different meta-analyses were conducted for plaque index, gingival index, oral health knowledge, oral health attitude, and oral health practice using a random effects model.

RESULTS

A total of 282 articles were found through the database search; 19 articles were included in the qualitative synthesis and 9 articles in the quantitative synthesis. The meta-analysis found that compared with conventional education, e-learning exhibited no positive effect. However, the use of e-learning was superior to conventional education methods for oral health practice for adults in subgroup analysis.

CONCLUSIONS

This paper could not indicate the effectiveness of e-learning in comparison with conventional education for oral health in total. However, for adults, it may be effective to get the oral health practice compared to the conventional education. Our study limitation is that there are only few studies that have assessed the effectiveness of e-learning. Therefore, numerous further high-quality studies should be conducted regarding the efficacy of e-learning compared with conventional education methods for oral health promotion.

Social media as a tool for oral health promotion: A systematic review

Social media platforms are common means of sharing information, personal experiences, and lifestyle. They can also be utilized as cost-effective methods for individuals to acquire health information and promote oral health. The purpose of the present study was to systematically review the current literature on the interventions taken through social media for promoting lay people's oral health. This systematic review (PROSPERO: CRD42023395005) followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines. A comprehensive search was conducted in four electronic databases (PubMed, Scopus, Embase, and Cochrane Library) for relevant articles published between 2012 and 2023. Data such as study design, sample size, follow-up duration, utilized social media platforms and main findings were extracted from the eligible studies. The quality of the studies included in the systematic review was evaluated by the quality assessment tools for intervention studies recommended by the National Collaborating Centre for Methods and Tools. Out of the 1934 records identified in the initial search, 10 studies met the inclusion criteria and were included in the qualitative synthesis. These studies comprised seven randomized control trials, one field trial and two quasi-experimental. Various social media platforms, including Telegram, Instagram, YouTube, WhatsApp and Snapchat, were used for communication with patients. Some studies solely utilized social media interventions, while others combined online and traditional interventions. The quality assessment categorized 30% of the studies as "strong", 50% as "moderate", and the remaining as "weak". The implementation of social media interventions positively influenced multiple aspects of oral health among the laypeople. Online platforms such as YouTube, WhatsApp, Instagram, and Telegram can be effectively utilized to promote oral health among patients.

Effectiveness of AI-driven remote monitoring technology in improving oral hygiene during orthodontic treatment

OBJECTIVE

This study aimed to evaluate the effectiveness of Dental Monitoring™ (DM™) Artificial Intelligence Driven Remote Monitoring Technology (AIDRM) technology in improving the patient's oral hygiene during orthodontic treatment through AI-based personalized active notifications.

METHODS

A prospective clinical study was conducted on two groups of orthodontic patients. DM Group: (n = 24) monitored by DM weekly scans and received personalized notifications on the DM smartphone application regarding their oral hygiene status. Control Group (n = 25) not monitored by DM. Both groups were clinically assessed using Plaque Index (OPI) and the Modified Gingival Index (MGI). DM Group was followed for 13 months and the Control Group was followed for 5 months. Student-independent t test and paired t tests were used to investigate the mean differences between study groups and between time points for each group respectively.

RESULTS

At all time points, the mean differences indicated that the DM group had lower OPI and MGI values than the control group. The mean value for OPI and MGI were statistically significantly lower in the DM group (OPI = 1.96, MGI = 1.56) than in the control group (OPI = 2.41, MGI = 2.17) after 5 months. A rapid increase in mean OPI and MGI values was found between T0 and T1 for both study groups. A plateau effect for OPI scores appeared to occur from T1 to T5 for both study groups, but the plateau effect seemed to be more pronounced for the DM group than the study group. The MGI values for both study groups also increased dramatically from baseline to T5, however, a plateau effect was not observed.

CONCLUSIONS

The oral hygiene of orthodontic patients rapidly worsens over the first 3 months and plateaus after about 5 months of treatment. AIDRM by weekly DM scans and personalized active notifications may improve oral hygiene over time in orthodontic patients.

Association of oral health awareness and practice of proper oral hygiene measures among Saudi population: a systematic review

BACKGROUND

Several studies have proven that increasing oral hygiene knowledge correlates with good oral health status compared to those who lack this knowledge. Therefore, the aims of the study to evaluate the overall oral health awareness among the Saudi population based on knowledge and practice of proper oral hygiene measures.

METHODS

A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews guidelines. Cross-sectional, cohort, and case-control studies were included in the study and framed into a PICO question. Initially, a search was conducted on PubMed/Medline, Google Scholar, and Cochrane databases. Four independent reviewers screened the identified titles, abstracts, and full texts. Cohen's Kappa score was used to evaluate the level of agreement between the reviewers.

RESULTS

Forty cross-sectional studies and one prospective cohort study were included. Several studies showed that most students across all departments of universities knew the protective effects of fluoride on teeth. Two studies assessing the attitude and practice of oral hygiene found that most students knew that poor oral health leads to gum disease, and 59.1% were aware of maintaining oral hygiene using a toothbrush and paste. Most participants knew the importance of oral and dental care before pregnancy and how to reduce dental problems during pregnancy. Pregnant women clean their teeth daily and consider brushing and using toothpaste essential for pregnant women. Studies on oral hygiene practices of patients with diabetes reported that flossing habits were rated less important and most of their respondents never flossed their teeth.

CONCLUSION

Strong correlation between oral health knowledge and practices was observed, with the higher the knowledge level, the better the practice. Therefore, new technologies and strategies must be tested for an effective oral health system.

TRIAL REGISTRATION

A protocol was specified and registered with the International Prospective Register of Systematic Reviews (PROSPERO) on August 2020 (registration number CRD 42,020,200,373).

Is teledentistry effective to monitor the evolution of orthodontic treatment? A systematic review and meta-analysis

INTRODUCTION

With the advent of COVID-19, teledentistry and remote monitoring have become an imminent reality that allows orthodontists to monitor orthodontic treatment through virtual checkups, which complement in-office appointments.

OBJECTIVE

To evaluate the effectiveness of using teledentistry in monitoring the evolution of orthodontic treatment.

MATERIAL AND METHODS

Searches were performed in on-line databases. PECO strategy focused on comparing orthodontic patients exposed and not exposed to teledentistry. Searches and data extraction followed PRISMA guidelines. The assessment of the risk of bias and the certainty of the evidence was performed using the ROBINS-I and GRADE tools, respectively. A meta-analysis was also performed.

RESULTS

Out of 1,178 records found, 4 met the criteria and were included in the qualitative analysis. The risk of bias for follow-up assesment in aligner treatment was low to moderate; while for interceptive treatment, it was high. Studies are favorable to the use of teledentistry. The meta-analysis was performed with aligners studies only, due to heterogeneity. The certainty of the evidence was considered very low.

CONCLUSION

With very low certainty of evidence, teledentistry using Dental Monitoring® software is effective as an aid in monitoring the evolution of interceptive orthodontic treatment (high risk of bias) and, especially, treatment performed with aligners (low to moderate risk of bias). The meta-analysis evidenced a reduction in the number of face-to-face appointments (mean difference = -2.75[-3.95, -1.55]; I2=41%; p<0.00001) and the time for starting refinement (mean difference = -1.21[-2.35, -0.08]; I2=49%; p=0.04). Additional randomized studies evaluating corrective orthodontic treatment with brackets and wires are welcome.

The Use of Patient-Oriented Mobile Phone Apps in Oral Health: Scoping Review

BACKGROUND

Oral health is a significant part of general health. Poor oral health can influence an individual's appearance, self-esteem, eating, and speaking. The use of mobile phone apps has been growing in the field of medicine, including dentistry. However, to date, there is no evidence related to the availability of mobile apps focusing on various branches of dentistry.

OBJECTIVE

The aim of this study was to review the scientific literature on the use of patient-oriented mobile phone apps in oral health and summarize the key findings.

METHODS

A scoping review of published scientific literature on the use of patient-oriented mobile phone apps in oral health was conducted in accordance with the Joanna Briggs Institute. A search was performed in PubMed and Scopus for studies published between January 2000 and June 2021 that were written in English. All study types except for those reporting developmental protocols were included in this review. In total, 2 reviewers independently screened the studies using the eligibility criteria. The study protocol was registered in the Open Science Framework registries in June 2021.

RESULTS

The initial search yielded a total of 977 studies, 45 (4.6%) of which met the inclusion criteria. All the studies (45/45, 100%) were published after 2009. Most studies (31/45, 69%) concerned oral health promotion using mobile phone apps, followed by behavior management (5/45, 11%). More than half (23/45, 51%) of the included studies were conducted in Asian countries. Overall, 31% (14/45) of the studies focused on adolescents. A total of 51% (23/45) of the studies were randomized controlled trials (RCTs). Approximately 39% (9/23) of the included RCT studies reported a substantial reduction in dental plaque, and 26% (6/23) of the studies reported significant improvement in gingival health. Regarding dental anxiety management, 13% (3/23) of the RCT studies reported a significant decrease in mean heart rate and lower Facial Image Scale scores.

CONCLUSIONS

According to the literature, the use of mobile apps in oral health is increasing among patients, mainly children and adolescents. Many studies that have used mobile apps have focused on promoting oral health. However, other areas such as diagnostic and remote consultations (teledentistry) have until recently been neglected despite their great potential.

Mobile app for comprehensive management of orthodontic patients with fixed appliances : Design and use

OBJECTIVES

This study aimed to design and implement a mobile phone application (app) aiming to enhance the cooperation and oral hygiene of orthodontic patients.

METHODS

An orthodontic app named "Labkhand" was designed by a team of orthodontists and programmers according to the needs and scheduled interventions for patients. The aim of this app was to obviate the orthodontic needs of patients by providing educational content in the form of texts and videos, oral hygiene reminders, appointment reminders, and nutrition reminders. It also enabled instant messaging and chatting between patients and dental personnel. In this study, 61 patients were monitored during their orthodontic treatment procedure. All patients were evaluated using a questionnaire with 7 questions before and after a 6-month treatment period. A total of 31 patients were instructed to use the app, while the other 30 patients received treatment without the app. The collected data were analyzed using paired t‑test and analysis of covariance (ANCOVA) test.

RESULTS

While the control group's questionnaire score remained almost the same (P > 0.05), the mean questionnaire score of patients in the intervention group significantly increased after using the app compared to the baseline scores acquired before using the app (P < 0.001). The greatest improvement was noted in topics related to "reminding of appointments", "general information about orthodontic treatment", and "oral hygiene maintenance and instructions". "Quality of services" and "patient-orthodontist communication" showed the least improvement in patient satisfaction.

CONCLUSIONS

The Labkhand orthodontic app has multiple functions and can obviate the needs of orthodontic patients easily and at a low cost.

Influence of Reminder on Enhancing Compliance in Patients with Fixed Orthodontic Appliance Treatment (a Randomized Controlled Clinical Trial)

Purpose

Patient compliance during orthodontic treatment has a significant effect on the aims, outcome, and duration of the treatment. The aim of this study is to evaluate the influence of reminders on enhancing orthodontic patient compliance.

Patients and Methods

Twenty-six subjects undergoing orthodontic treatment with fixed appliances were randomly assigned into two groups: control (Ct) and intervention (In) groups. The oral hygiene parameters of plaque index (PI), bleeding index (BI), and white spot lesion (WSL) with appointment adherence and bracket fracture were recorded at base line (T0), 2 months (T1), 4 months (T2), and 6 months (T3). In group participants received weekly reminders and subjects' compliances were classified into poor, fair, and excellent compliance.

Results

Statistically significant differences were found in PI level at T2 between Ct and In groups (p-value = 0.006), whereas a non-significant difference was found for BI (p-value>0. 05). There was a statistically significant increase in WSL for the Ct group across the study time points (p-value = 0.03), while no significant change in WSL was detected for the In group (p-value>0.05). The compliance levels of In and Ct groups were excellent and fair, respectively.

Conclusion

The study suggests that weekly reminders can enhance the oral hygiene status in patients with orthodontic appliances (POA) and elevate the level of compliance to excellent.

Registration number

ClinicalTrials.gov NCT05331820.

Effectiveness of a New App in Improving Oral Hygiene in Orthodontic Patients: A Pilot Study

OBJECTIVES

The aim of this randomised clinical trial was to evaluate the effects of a mobile application (app) on the oral hygiene (OH) of adolescents undergoing fixed orthodontic treatment.

METHODS

Eight volunteers (14-19 years old) were randomly allocated to the experimental or control groups. Volunteers in the control group received standard OH (SOH) instructions, whilst volunteers in the experimental group received SHO + OH guidance and motivation through an app tailor-made for this study. Clinical assessments were made using the visible plaque index (VPI) and gingival bleeding index (GBI) at 5 different time points: before orthodontic device installation (T0); at baseline (T1); and 30 (T2), 60 (T3), and 90 (T4) days after randomisation. Significant differences were evaluated using Student t test and multilevel logistic regression analysis.

RESULTS

Although no significant difference could be observed, VPI at T1 and T2 were lower for volunteers in the experimental group (33.20 ± 19.29; 32.10 ± 7.72) than for the volunteers in the control group (42.11 ± 8.56; 43.59 ± 34.71). The same was observed for GBI, in which volunteers in the experimental group presented lower GBI at T1 and T2 (12.70 ± 8.10; 13.72 ± 7.39) than volunteers in the control group (27.53 ± 17.89; 20.38 ± 9.95). Good acceptance for using the app was shown by volunteers.

CONCLUSIONS

This study shows the potential utility of the mobile app for improving the OH of adolescents.

Does motivation via a smartphone application improve oral hygiene in patients undergoing orthodontic treatment?

DESIGN

This is a randomized cohort study.

COHORT SELECTION

The inclusion criteria comprised patients aged 14-19 years who started their orthodontic treatment using fixed appliances at the Orthodontic Clinic at Universidade Cruzeiro do Sul, San Paulo, Brazil. Only patients who had smartphones were included in this study. The exclusion criteria comprised patients who had previous orthodontic treatment, presence of any oral pathology, and chronic use of analgesic medication or presence of syndromes. Included patients were randomized to two groups (control and experimental).

DATA ANALYSIS

The oral hygiene of the included patients was evaluated clinically at five points in time: before bonding fixed orthodontic appliance (T0), immediately after randomization (T1), at 30 days after the beginning of the intervention (T2), at 60 days after the beginning of the intervention (T3), and at 90 days after the beginning of the intervention (T4). Oral hygiene was assessed using visual plaque index (VPI) and gingival bleeding index (GBI) at six sites of all teeth in every arch excluding third molars. Prior to the intervention, all patients who participated in this study underwent an oral hygiene session aimed to obtain a plaque index equal to zero and were given standardized oral hygiene instructions. Patients included in the control group were not given any structured oral hygiene follow-up in addition to the standard follow-up already established at the orthodontic clinic. Patients in the experimental group were instructed to install an application (A Dentista Cientista) that was designed especially for this study on their smartphones. This application aimed to guide and motivate patients daily in a playful way about performing oral hygiene practices. The application reminded the patients to perform their oral hygiene through an alarm.

RESULTS

A total of 11 patients were screened for study eligibility; 3 patients were excluded from the study. Eight patients were included in this study, four patients in each group. Although VPI and GBI values were reduced at T1 and T2 in the experimental group, there were no statistically significant differences for VPI and GBI between the groups at any time evaluated (P > 0.05). The patients who were included in the experimental group reported a good acceptability of the application and they would recommend it to other people. In addition, the patients who were included in the experimental group agreed that oral hygiene is crucial and 75% of them agreed that the application encouraged them to take better care of their oral health.

CONCLUSIONS

This study showed that mobile applications might help in improving the oral hygiene of orthodontic adolescent patients.

Changing clear aligners every 10 days or 14 days ? A randomised controlled trial

Objectives:

To compare 10-day and 14-day change regimens to achieve orthodontic tooth movement (OTM) in patients wearing clear aligners and to determine their subsequent pain perception.

Material and methods:

A total of 175 clear aligner patients were assessed for eligibility. Seventy-two patients were randomly assigned to a 10-day group (N = 36) and a 14-day group (N = 36) and were instructed to change the appliances every 10 or 14 days, respectively. OTM efficacy and OTM variation between the actual and predicted OTM digital models measured by shell-to-shell deviation, as well as pain perception determined by a visual analog scale (VAS), were assessed at T0 (baseline, before the placement of the aligners), T1 (stage 8, after completion of aligners #8), and T2 (stage 16, after completion of aligners #16).

Results:

The 10-day and 14-day groups showed similar OTM efficacy at both T1 and T2 for all types of tooth movements (p > 0.09 for all) and similar OTM shell-to-shell deviation at T1 (p = 0.06) and T2 (p = 0.22). The two groups also had similar VAS scores of pain perception throughout the study (p > 0.05 for all).

Conclusion:

The 10-day and 14-day groups showed similar tooth movement and pain perception, suggesting that the clear aligners may be changed every 10 days without a significant compromise in the clinical efficacy of OTM and patient comfort.

Trial registration:

ChiCTR, ChiCTR-IOR-15007532. Registered 17 November 2015, https://www.chictr.org.cn/showproj.aspx?proj=12500

Family behavior theory-based intervention via mobile messaging to improve oral health of adolescents: study protocol for a cluster randomized controlled trial

Background

Due to some unique physical, social and psychological features in the adolescent population, adolescents can be a time of heightened caries activity and periodontal disease. Oral health-related behaviors can be modified to improve oral health status. The family networks and the built environment can promote or inhibit health behaviors. The aim of this study is to implement and evaluate a behavior theory-based, integrated family intervention via mobile messaging to improve oral health of adolescents.

Methods

This is a three-arm parallel-design cluster-randomized controlled trial. This trial will allocate 12 local secondary schools (clusters) in Hong Kong to three test or comparison groups with a ratio 1:1:1. The enrolled Form II to IV students (ages 12 to 15) will be eligible for participation. The intervention to three study groups will be (i) Health Belief Model (HBM)-based mobile messaging to the adolescents and their parents, which will consist of several blocks of HBM-based messages and reinforcement during 24 weeks; (ii) same HBM-based messaging to adolescents only; and (iii) delivering e-version of oral health education pamphlets to adolescents. The primary outcome will be caries increment 2 years post-intervention. Changes in oral health self-efficacy and behaviors, oral hygiene, and gingival status will be the secondary outcomes.

Discussion

No school dental care service is available to secondary school students in Hong Kong. This study will be the first to test a theory-driven and family-engaged preventive intervention among adolescents in Hong Kong. Findings will contribute to developing a low-cost, feasible, and efficient oral health preventive program for adolescents.

Trial registration

ClinicalTrials.govNCT05448664. Registered on 7 July 2022.

Effectiveness of Smart Applications of Oral Hygiene Instructions on Periodontal Health Compared to Oral Information: A Prospective Study

Nowadays, smartphone applications are widely used in different areas of life, including medical science. The present study aimed to assess the effectiveness of a smartphone application of oral hygiene instructions (OHI) on periodontal health compared to the traditional chairside OHI. All the participants (n = 39) were divided into two groups: control group and test group. Participants of the control group were given verbal OHI and participants of the test group were asked to use a smartphone application to upkeep their oral habits. The gingival index (GI) and Quigley-Hein Turesky modification index (QHTMI) were used for scoring the plaque accumulation at baseline and after one month of the periodontal treatment. A paired t-test and an independent t-test were performed to compare the mean of GI and QHTMI between intra-group and inter-group, respectively. The paired t-test showed significant differences in GI and QHTMI improvement after one month in both groups. Moreover, the independent t-test showed no significant differences between the two groups. However, the test group showed a lower mean score in GI and QHTMI assessments compared to the control group. Smartphone applications in oral health applications did not exhibit any superiority in periodontal health over the traditional OHI method in the current study.

The Link between Stroke Risk and Orodental Status-A Comprehensive Review

One of the primary causes of disability and mortality in the adult population worldwide is stroke. A person's general health is significantly impacted by their oral and dental health. People who have poor oral health are more susceptible to conditions such as stroke. Stroke risk has long been linked to oral and dental conditions. The risk of stroke and its cost impact on the healthcare systems appear to be significantly reduced as a result of the decline in the incidence and prevalence of oral and dental illnesses. Hypothetically, better management of oral hygiene and dental health lead to reduced stroke risk. To the authors' best knowledge, for the first time, the potential link between dental health and stroke were cross-examined. The most typical stroke symptoms, oral and dental illnesses linked to stroke, and the role of oral healthcare professionals in stroke prevention are revealed. The potential mediating processes and subsequent long-term cognitive and functional neurological outcomes are based on the available literature. It must be noted that periodontal diseases and tooth loss are two common oral health measures. Lack of knowledge on the effects of poor oral health on systemic health together with limited access to primary medical or dental care are considered to be partially responsible for the elevated risk of stroke. Concrete evidence confirming the associations between oral inflammatory conditions and stroke in large cohort prospective studies, stratifying association between oral disease severity and stroke risk and disease effects on stroke survival will be desirable. In terms of clinical pathology, a predictive model of stroke as a function of oral health status, and biomarkers of systemic inflammation could be useful for both cardiologists and dentists.

Telediagnosis of dental caries: Possible or impossible? A pilot cross-sectional study

OBJECTIVES

The aims of this study were to evaluate the effectiveness of teledentistry (based on a home intraoral imaging protocol) in detecting dental caries and to assess the accuracy of this method compared to clinical examination.

METHODS

Forty-three patients were recruited for the study. Using a protocol for taking intraoral photographs at home with a smartphone proposed by the Dental School of Verona, a remote diagnosis of dental caries (TD) was performed by an experienced dentist. The same caries sites were also assessed by clinical diagnosis (CD) by a second experienced dentist. Ten photos were taken at home in five different perspectives, with and without flash, and emailed to one of the authors. The best five photos were selected for telediagnosis. The International Caries Detection and Assessment System (ICDAS II) score was used for caries diagnosis. Statistical tests were performed: Sensitivity and specificity of TD, the positive and negative predictive value of TD (PPV-NPV), and Spearman correlation to evaluate the relationship between the scores of TD and CD.

RESULTS

A total of 430 photographs were submitted; TD was performed on 215 photographs and 43 patients were visited. A total of 1201 teeth were analyzed. The sensitivity of TD was 74.0, the specificity was 99.1, the PPV of TD was 91.7, and the NPV was 96.4. The Spearman correlation was 0.816, showing a very strong correlation between the values obtained with TD and CD.

CONCLUSIONS

The study showed good potential for TD, which proved to be a feasible method to combine with routine caries diagnosis in daily preventive dentistry practice.

Role of Digital Media in Promoting Oral Health: A Systematic Review

Oral disease has affected almost half of the world’s population, causing an enormous economic burden. To overcome this huge problem, oral health promotion is one of the most cost-effective methods. Digital media can play a pivotal role in achieving the goal of reducing this burden by providing a wider platform to reach out to the population even in the areas of deficit oral health care service.

The aim of this systematic review is to assess the effectiveness of digital media in oral health promotion.

The combinations of terms in the following two broad categories were used to search the literature on PubMed, Cochrane Library articles, WHO guidelines on oral health promotion through digital media, and Google Scholar: Intervention (digital media, Mobile phones, Text messages, social media, Cell phones, MHealth application, Telemedicine, Television, Videos) and Outcome (Oral Health education, Oral health, Oral health promotion, Oral health literacy, Oral health knowledge, Oral health attitude, Oral health practice, Oral hygiene improvement). The review was conducted in two phases, using the standardized checklist applicable to studies. Initially, abstracts were retrieved, followed by the assessment of the full papers against the review criteria.

Among the selected studies, digital interventions helped in providing continuity of care and services in seven studies, eight addressed the increase in knowledge, attitude, and practice, and all the studies analyzed oral health needs.

The findings concluded that digital media-based interventions can enhance oral health literacy and help in tackling this problem among different age groups.

Oral Health Self-Management Ability and Its Influencing Factors among Adolescents with Fixed Orthodontics in China: A Mixed Methods Study

Objective. To understand the oral health self-management ability status and influencing factors among adolescent patients with fixed orthodontics in Nanjing and to provide a reference for formulating targeted intervention measures. Methods. A mixed research method was used. First, the convenience sampling method was used to select adolescent patients with fixed orthodontics admitted to the orthodontic department of a dental hospital in Nanjing from November 2021 to March 2022. The oral health self-management ability questionnaire was used for the investigation; then, 15 children with poor oral health management ability were selected for in-depth interviews. Results. The total score of oral health self-management ability of 290 adolescent children with fixed orthodontics was 45.6-90.8 points, with an average score of $69.63\pm 7.40$ of which knowledge, belief, and behavior dimension scores were $72.09\pm 10.47,68.50\pm 10.13,\text{and}67.63\pm 8.67$ , respectively, and the environmental score was $69.91\pm 12.50$ . Multiple regression analysis showed that sex, age, bracket wearing time, grade, and place of residence were related to the scores of each dimension of self-management. Qualitative research shows that the main reasons for the poor oral health self-management ability of adolescents with fixed orthodontics are the lack of awareness during fixed orthodontics, lack of knowledge channels, low compliance, inability to solve oral problems during treatment, difficulty in adhering to oral care behaviors, and lack of motivation to treat. Conclusion. The oral health self-management ability of adolescent children with fixed orthodontics needs improvement, and a precise health intervention plan should be formulated.

Factors Influencing Appliance Wearing Time during Orthodontic Treatments: A Literature Review

This review aims to analyze the multiple factors affecting patients’ level of compliance (how much they wear removable devices/clear aligners) during orthodontic treatments and to investigate the available methods and devices to monitor the appliance wearing time and to improve it. A literature search was conducted on electronic databases (Pubmed, Scopus, and Google Scholar). The results of the present study suggest that compliance indicators may misestimate the intraoral wearing time. Compliance is affected by patient-related factors (age, personality traits, the importance of personal appearance, self-perception of malocclusion), appliance-related factors (visibility, pain/discomfort), and clinician-related factors (trust, clear and complete communication, motivation). The motivation of pre-pubertal patients is mostly external, while adolescents/young adults have intrinsic motivation for orthodontic treatment. Patients’ self-reports tend to overestimate the appliance wearing time. Even if there is a lack of evidence, teledentistry might improve patients’ awareness of being monitored, thus increasing the time for which orthodontic devices are worn. Compliance is a key factor for clear aligner treatments, but high-quality studies focusing on this aspect are missing. Further studies should focus on how to handle the lack of cooperation and how to increase compliance in order to maximize the treatment’s results.

Experience of using a smartphone WeChat applet for dental anxiety assessment and preoperative evaluation: A nationwide multicenter study

Introduction

Dental anxiety is a multivariate phenomenon that regularly occurs during a dental procedure. Although it may lead to patients' safety concerns and adverse events in routine treatment, it is often ignored. The purpose of this research is to develop a novel WeChat Applet for dental anxiety (WADA) with the following features and aims: (1) to help patients with dental anxiety management; (2) provide patient with a physical status self-evaluation; and(3) provide a platform for online assessment and tele-consultancy by dentists. We aimed to test and verify whether such an applet could play a beneficial role before and after a dental procedure and facilitate management of high-risk patients during the COVID-19 pandemic.

Materials and methods

During the 12-month survey period (August 2020 to July 2021), a total of 180 patients aged 3–74 years from eight different cities (n = 180 at the end of treatment, n = 25 for the System Usability Scale (SUS) and follow-up interview) and 20 medical staff from eight different cities (n =20 for follow-up interview) were evaluated by WADA. At the end of the survey period, the results of the interviews were analyzed thematically.

Results

WADA assessment results from 180 patients and follow-up interview results from 45 participants were analyzed. In this study with a male to female ratio of 2:3, 75% were found to be suffering from dental anxiety, 86% were found with postoperative complications, and 11 cases were found to have contraindications to surgery. The total SUS score for WADA is 72.25 above the mean score, proving that WADA is a relevant and useful tool before and after dental treatment. Based on the results of the interviews, the following themes were identified: patient satisfaction; dentists' effectiveness; multi-center data integration; and increase its frequency of usage.

Conclusions

The WADA was developed for dental procedures and is effective for reducing treatment risks, improving patients' satisfaction and dentists' convenience, especially in terms of facilitating management of high-risk patient during the COVID-19 pandemic.

Impact of smartphone application usage by mothers in improving oral health and its determinants in early childhood: a randomised controlled trial in a paediatric dental setting

Purpose

Integration of smartphones has overcome barriers in traditional education; this trial aimed at exploring this ubiquitous platform in oral health education. A smartphone application promoting preschooler’s oral health was designed and its effectiveness was compared with that of common oral health education delivered in paediatric dental settings.

Methods

This controlled clinical trial was performed on preschooler–mother dyads referring to the clinic of Tehran School of Dentistry in 2019–2020. Initially, the dyads were randomly partitioned to application intervention or common training groups. The mothers answered an interviewer-administered questionnaire on paediatric dentistry knowledge, attitude and practice regarding children’s oral health; modified plaque index (m-PI) and modified gingival index (m-GI) of children were measured. Subsequently, the smartphone application was installed for application intervention group and an educational pamphlet and verbal explanations were given to common training group. In 1-month and 3-month follow-ups, the questionnaires and clinical measurement were re-done. A generalized estimating equation (GEE) was used to investigate the effect of training methods.

Results

Among the participants 51 dyad attended baseline and follow-up assessments. The preschoolers mean age was 4.6 ± 1.2 years and 54.4% were girls. Both trainings improved mothers’ knowledge and practice regarding children’s oral health and reduced children’s m-PI and m-GI (p < 0.050). The 3-month follow-up revealed a better m-GI in application intervention group (p < 0.001).

Conclusions

Considering the greater improvement of paediatric gingival status in the application intervention group, it appears that smartphone applications may provide a promising tool for more prolonged impacts in children oral health care.

Trial registration

IRCT, IRCT20131102015238N3. Registered 28 July 2019 https://en.irct.ir/trial/40933

Supplementary Information

The online version contains supplementary material available at 10.1007/s40368-022-00731-9.

Information and Communications Technology in Dentistry: an informative and educational approach for patients with fixed orthodontic appliances

Objective:

To develop and make available, at no cost to the user, Information and Communications Technology (ICT) tools for Dentistry, providing dental information and advice geared toward patients undergoing orthodontic treatment with fixed appliances.

Material and Methods:

A Dentistry-based content that contemplated information and advice concerning orthodontic treatment with fixed appliances was elaborated. The materials, which included instructions on oral hygiene and treatment strategies when faced with possible complications, were evaluated and validated by specialists, whose assessments reached a 85% approval. From the validated content, products using four distinct ICT tools were formulated.

Results:

The following technological products were developed: a program for community radios, three blog posts, four educational and informative videos, and a smartphone application - using texts, as well as images and videos. These ICT tools, geared toward patients wearing fixed orthodontic appliances, were made available by internet at no cost to the user, and the number of accesses is already expressive.

Conclusion:

These technological-scientific tools, developed and provided freely to the population, can aid patients during their treatment with fixed orthodontic appliances, contributing to the dissemination of reliable information, and clarifying doubts that may arise during orthodontic therapy. These free ICT tools serve to facilitate access to scientific knowledge, thereby favoring social inclusion, bearing in mind that this educational and informative material was offered in a simple and accessible manner to the general population.

Remote digital monitoring during the retention phase of orthodontic treatment: A prospective feasibility study

Objective

To evaluate if a remote digital monitoring system added at the end of orthodontic treatment could positively influence the retention phase by reducing the occurrence of misfit of removable appliances, number of emergency appointments (EA), and orthodontic relapse.

Methods

Twenty-seven patients who completed active orthodontic treatment were divided into the study and control groups. In addition to the standard chairside follow-up appointments at month 1 (T1), month 3 (T2), month 6 (T3), the study group patients were monitored using Dental Monitoring® with monthly intra-oral scans. Occurrence of misfit of removable retainers, number of EAs, and intercanine width change were recorded for both groups. Differences in EAs and retainer fit were assessed using the chi-square test. Intra-group and inter-group differences in the intercanine width were assessed with Friedman test and Mann-Whitney U test, respectively (α = 0.05).

Results

The study group showed a significantly lower occurrence of misfit of removable retainers (p = 0.027) compared to the control group. No significant inter- and intra-group difference was found in the EAs and intercanine width change at each time-point.

Conclusions

Integrating remote monitoring systems, such as Dental Monitoring®, to the retention phase of the orthodontic treatment may lower the occurrence of misfit of removable retainers. However, a small sample size and a short observation period limit the strength of this evidence. These preliminary results tentatively suggest that remote monitoring technologies may be beneficial, especially during the COVID-19 pandemic, when the regularity of in-office visits might be disrupted.

Smartphone use for tomographic evaluation: application in endodontic diagnosis

INTRODUCTION

Portable equipment that allows quick exchanges of information, such as smartphones, is increasingly important in Dentistry. Thus, they have become frequently used, with the potential to contribute to the tomographic evaluation. This study aimed to evaluate the accuracy of smartphone applications for diagnosing the root canal system (RCS) and measuring the root canal length.

METHODS

DICOM files of 92 lower incisor teeth were evaluated by two trained and calibrated examiners using the CS 3D Imaging software and two smartphone applications (DroidRender and Horos Mobile). The RCS was assessed according to Vertucci's classification, and the tooth length was measured using linear cusp-apex measurements. The diagnostic reference standard was obtained by the mode and the mean of the evaluations made by three experienced examiners using the CS 3D Imaging software. The diagnostic performance of RCS was evaluated using sensitivity (Se), specificity (Sp), and overall accuracy (Ac). The Bland-Altman analysis was used to assess the agreement of linear measurements.

RESULTS

The diagnostic tests showed similar performance between the smartphone applications (DroidRender: Se = 1.00; Sp = 0.95; Ac = 0.97; Horos: Se = 0.95; Sp = 0.94; Ac = 0.95) and the computer software (Se = 0.97 - 0.95; Sp = 0.93 - 0.96; Ac = 0.95 - 0.96). The smartphone applications showed discrepancies greater than 1.0 mm for the dental lengths, which may signal relevant differences in some clinical situations.

CONCLUSION

Smartphone applications offered similar diagnostic performance in comparison to the computer software for the RCS evaluation.

Concerns of orthodontic patients during the COVID-19 quarantine period

Introduction:

Quarantine protocols for coronavirus disease 2019 (COVID-19) pandemic has modified orthodontic appointments.

Objective:

to evaluate self-reported experience and needs of orthodontic patients during the quarantine period without in-person appointments.

Methods:

Thirty patients, aged 8 to 21 years, under active orthodontic treatment were randomly selected. A phone call questionnaire including questions on physical and emotional impacts of the quarantine of COVID-19 was applied during the second month of Brazilian quarantine.

Results:

Sixteen percent of the patients reported pain related to the orthodontic appliance. Appliance breakage was observed in 23.33%. Twenty percent felt the need of an emergency orthodontic appointment and 3.33% visited a private practice. Moreover, 23% reported that even in an emergency need, they would not search for an appointment, preferring to communicate with the orthodontist by WhatsApp. Oral hygiene self-perception status showed improvement in 36.67% and worsening in 6.67% of the patients, while 56.66% reported maintenance of the same hygiene status. Sixty percent were concerned about the orthodontic treatment. General concerns were primary related to health and a possible extension of the quarantine time.

Conclusions:

During COVID-19 quarantine, orthodontic patients demonstrated a low frequency of orthodontic appliance interference in daily life, and most of them reported a maintenance of oral hygiene habits. The frequency of appliance related pain and breakage was 16.67% and 23.33%, respectively. Patients’ main concern during the quarantine period was the fear of getting sick and the uncertainness about the extension of the quarantine period.

Influence of Multimedia Reminders on Oral Hygiene Status During Removable Orthodontic Treatment: A Randomized Controlled Trial

Introduction:

Orthodontic appliances complicate daily oral hygiene maintenance and enhance the formation of microbial biofilm on tooth surfaces and orthodontic appliances.

Objective:

This trial was conducted to assess the effect of reminders on oral hygiene of patients during removable orthodontic treatment.

Methods:

In this 2-arm parallel randomized controlled trial, 66 orthodontic patients with removable maxillary appliance were randomly allocated with 1:1 ratio to message reminders and the control group. The patients in the messaging group received one or two message reminders and educational videos weekly during the course of treatment. A single blinded examiner measured the plaque index (PI), gingival index (GI), and dental caries index of patients in both groups at baseline (T0) and one (T1), three (T2), and six (T3) months after the first day of treatment to assess their oral hygiene status during treatment.

Results:

A total of 30 patients in control group and 28 in reminder group completed the study. The PI and GI scores were increased neither in control group nor in message reminder group during T0 and T1, significantly. The PI and GI scores in message reminder group were significantly lower than those in the control group at T2 (PI: P = 0.001, GI: P = 0.003) and T3 (PI: P = 0.024, GI: P = 0.022). Slight significant increasing in the PI and GI score were found during T2 and T3 in message reminder group. Caries index showed no significant difference between two groups during study.

Conclusion:

It seems that reminders can efficiently promote oral hygiene of patients undergoing removable orthodontic treatment.

Artificial Intelligence in Orthodontic Smart Application for Treatment Coaching and Its Impact on Clinical Performance of Patients Monitored with AI-TeleHealth System

BACKGROUND

Treatment of malocclusion with clear removable appliances like Invisalign^® or Spark™, require considerable higher level of patient compliance when compared to conventional fixed braces. The clinical outcomes and treatment efficiency strongly depend on the patient's discipline. Smart treatment coaching applications, like strojCHECK^® are efficient for improving patient compliance.

PURPOSE

To evaluate the impact of computerized personalized decision algorithms responding to observed and anticipated patient behavior implemented as an update of an existing clinical orthodontic application (app).

MATERIALS AND METHODS

Variables such as (1) patient app interaction, (2) patient app discipline and (3) clinical aligner tracking evaluated by artificial intelligence system (AI) system-Dental monitoring^® were observed on the set of 86 patients. Two 60-day periods were evaluated; before and after the app was updated with decision tree processes.

RESULTS

All variables showed significant improvement after the update except for the manifestation of clinical non-tracking in men, evaluated by artificial intelligence from video scans.

CONCLUSIONS

Implementation of application update including computerized decision processes can significantly enhance clinical performance of existing health care applications and improve patients' compliance. Using the algorithm with decision tree architecture could create a baseline for further machine learning optimization.

Teledentistry and its applications in paediatric dentistry: A literature review

Background

During the unfortunate event of the COVID-19 pandemic, restrictions were placed on face-to-face interactions in dentistry to promote social distancing and reduce spread of virus. In order to provide dental services teledentistry was employed.

Objective

This article aims to review the literature and information available on the provision and utilization of teledentistry as a method to address oral health needs of paediatric patients.

Results

Teledentistry has been utilised in paediatric population for the purpose of oral health education and promotion, remote diagnosis and monitoring, and behaviour guidance. Studies involving paediatric population for aforementioned applications have shown that this practice strategy is beneficial to provide dental treatment in remote locations with little access to paediatric dental specialists, monitor patients between appointments, conduct remote diagnosis and screening programmes, promote oral health of children through dental education, and in pre-appointment behaviour guidance. This method was particularly useful during the current COVID-19 pandemic where dentists use their mobile phones, computer webcams for patient appointments while maintaining safe distance and avoid exposing themselves as well as patient to the virus.

Conclusion

Teledentistry can be a supplement to face-to-face methods of paediatric dental care, ultimately leading to better patient management. This technology can make a significant contribution in reducing the supply-demand gap of paediatric dental specialists in places where healthcare facilities are limited and ensure safety during the pandemic whilst providing dental care to paediatric patients. Further research is required for safe, effective and evidence-based use of teledentistry in the field of paediatric dentistry.

Kukaa Salama (Staying Safe): study protocol for a pre/post-trial of an interactive mHealth intervention for increasing COVID-19 prevention practices with urban refugee youth in Kampala, Uganda

INTRODUCTION

With over 82.4 million forcibly displaced persons worldwide, there remains an urgent need to better describe culturally, contextually and age-tailored strategies for preventing COVID-19 in humanitarian contexts. Knowledge gaps are particularly pronounced for urban refugees who experience poverty, overcrowded living conditions and poor sanitation access that constrain the ability to practise COVID-19 mitigation strategies such as physical distancing and frequent hand washing. With over 1.4 million refugees, Uganda is sub-Saharan Africa's largest refugee hosting nation. More than 90 000 of Uganda's refugees live in Kampala, most in informal settlements, and 27% are aged 15-24 years old. There is an urgent need for tailored COVID-19 responses with urban refugee adolescents and youth. This study aims to evaluate the effectiveness of an 8-week interactive informational mobile health intervention on COVID-19 prevention practices among refugee and displaced youth aged 16-24 years in Kampala, Uganda.

METHODS AND ANALYSIS

We will conduct a pre-test/post-test study nested within a larger cluster randomised trial. Approximately 385 youth participants will be enrolled and followed for 6 months. Data will be collected at three time points: before the intervention (time 1); immediately after the intervention (time 2) and at 16-week follow-up (time 3). The primary outcome (self-efficacy to practise COVID-19 prevention measures) and secondary outcomes (COVID-19 risk awareness, attitudes, norms and self-regulation practices; depression; sexual and reproductive health practices; food and water security; COVID-19 vaccine acceptability) will be evaluated using descriptive statistics and regression analyses.

ETHICS AND DISSEMINATION

This study has been approved by the University of Toronto Research Ethics Board, the Mildmay Uganda Research Ethics Committee, and the Uganda National Council for Science & Technology. The results will be published in peer-reviewed journals, and findings communicated through reports and conference presentations.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Registry (NCT04631367).

Impact of online communication and type of media formats in enhancing orthodontic patients' knowledge

OBJECTIVES:

This study aimed to evaluate the extent to which online communication can enhance patients' knowledge of orthodontic topics, as well as compare the effectiveness of images, video, and text messages as tools for delivering orthodontic information.

MATERIALS AND METHODS:

Two WhatsApp groups were created comprising 30 males and 33 females. The Google form template was used to formulate a 25-item questionnaire containing information related to orthodontic topics. At the beginning of the first stage, a link to the questionnaire was sent to the groups and their answers were given scores, which were referred to as (T1). During the second stage, a piece of daily information relevant to the field of orthodontics was sent to the groups over a 14-day period. On Day 15, the link to the previous questionnaire was sent again and the participants were asked to complete it for a second time. These answers were corrected, given scores, and labeled as (T2). Scores from the first and second stages were compared.

RESULTS:

There was a significant increase in the average total score from the first questionnaire (T1 = 15.3) to the second questionnaire (T2 = 17.9). All types of media formats were greatly effective in improving the patients' knowledge. Images proved to be the best tool for delivering information and were considerably more effective than video and text messages.

CONCLUSION:

This study indicates that WhatsApp as an online communication tool could be used to effectively enhance the knowledge of orthodontic patients. Images are the best method for delivering information to orthodontic patients.