App-based oral health promotion interventions on modifiable risk factors associated with early childhood caries: A systematic review

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.

Impact of Oral Health Chatbot With and Without Toothbrushing Training on Childhood Caries

OBJECTIVES

Standalone oral health chatbots targeting young children's oral health are rare. The aim of this research was to compare the effectiveness of a standalone chatbot and a combination chatbot with in-person toothbrushing training for caregivers in improving young children's oral health.

METHODS

A randomised, parallel, 2-group pretest-posttest design was employed with 320 caregiver-child pairs (aged 6-42 months). Group I (160 pairs) used the 21-Day FunDee (modified) chatbot along with in-person toothbrushing training, whilst Group II (160 pairs) used only the 21-Day FunDee Plus chatbot. Oral examination assessed plaque levels and caries, whilst a self-administered questionnaire evaluated oral hygiene care, dietary practices, and oral health perceptions based on the protection motivation theory (PMT). Data were analysed using 2-way repeated-measures analysis of variance, a t test, and chi-square measures for group comparisons.

RESULTS

The majority of caregivers were Muslim mothers. No significant differences were observed between groups at the baseline, 3-month, and 6-month follow-ups in mean dmft (Group I: 4.16, 4.64, and 5.30 vs Group II: 4.30, 5.54, and 5.82), mean plaque scores (Group I: 0.72, 0.53, and 0.55 vs Group II (0.84, 0.52, and 0.59), and most dietary habits. However, significant improvements were found within groups from baseline to follow-ups in plaque reduction, toothbrushing practices, overall knowledge score, PMT perceptions, proper tooth brushing, fluoride toothpaste usage, and dietary behaviours (frequency of bottle feeding, frequency of nocturnal bottle feeding, proportion of children who went to bed without consuming anything after cleaning their teeth before bedtime). The significant differences between groups were found in self-efficacy at all time points, but only at the 6-month evaluation for percentage of fluoride toothpaste and overall PMT perceptions.

CONCLUSIONS

Both interventions were comparable in preventing caries, reducing plaque, improving feeding practices, increasing parental involvement in tooth brushing, and enhancing knowledge. The standalone chatbot 21-Day FunDee Plus presents a viable alternative for promoting oral health in young children.

Saudi Electronic Caries Assessment Tool (SECAT) Development: Mixed Methods Feasibility Study

Background: Dental caries is a significant public health challenge globally, particularly acute in Saudi Arabia's remote areas with limited healthcare access. Traditional paper-based methods for recording epidemiological data have limitations in data collection, storage, and sharing, highlighting the need for mobile solutions to enhance dental surveillance in resource-limited settings. Objective: To develop and evaluate the Saudi Electronic Caries Assessment Tool (SECAT), a mobile application designed for collecting dental caries data in remote locations, following a user-centered design approach. Methods: This mixed-methods feasibility study was conducted in three stages: (1) requirement gathering through semi-structured interviews with 12 dental professionals to explore experiences and needs; (2) development of the SECAT application using Flutter frontend and Supabase backend; and (3) evaluation through usability testing with 18 clinicians and heuristic study with five domain experts. Results: The usability study revealed an 82% overall satisfaction rate among clinicians, with 78% strongly endorsing the application's user-friendly features. Expert evaluation highlighted the application's utility for remote areas and offline functionality. Key improvements implemented based on feedback included an automated tooth recognition system, enhanced visualization protocol, and integration of clinical metrics. Primary limitations identified included the need for improved color contrast and individual-level calculations of dental indices. Conclusions: The SECAT application demonstrated high satisfaction and acceptability among dental health providers for collecting examination data in remote locations. The preliminary evaluation identified both limitations and positive aspects, particularly regarding utility in areas with limited internet connectivity. The SECAT mobile application could be valuable aid for caries assessment in remote places and also in school and community-based dental health programs.

Development of Chatbot-Based Oral Health Care for Young Children and Evaluation of its Effectiveness, Usability, and Acceptability: Mixed Methods Study

Background

Chatbots are increasingly accepted in public health for their ability to replicate human-like communication and provide scalable, 24/7 services. The high prevalence of dental caries in children underscores the need for early and effective intervention.

Objective

This study aimed to develop the 30-Day FunDee chatbot and evaluate its effectiveness, usability, and acceptability in delivering oral health education to caregivers of children aged 6 to 36 months.

Methods

The chatbot was created using the artificial intelligence (AI) chatbot behavior change model, integrating behavioral change theories into content designed for 3-5 minutes of daily use over 30 days. A pre-post experimental study was conducted from December 2021 to February 2022 in Hat Yai District, Songkhla Province, and Maelan District, Pattani Province, Thailand. Fifty-eight caregivers completed a web-based structured questionnaire at baseline and 2 months post baseline to evaluate knowledge, protection motivation theory-based perceptions, and tooth-brushing practices. Usability was assessed via chatbot logfiles and a web-based questionnaire at 2 months post baseline. Acceptability was evaluated through three methods: (1) open-ended chatbot interactions on day 30, (2) a web-based structured questionnaire at 2 months post baseline, and (3) semistructured telephone interviews with 15 participants 2 weeks post intervention. Participants for interviews were stratified by adherence levels and randomly selected from Hatyai and Maelan districts. All self-reported variables were measured on a 5-point Likert scale (1=lowest, 5=highest).

Results

The chatbot was successfully developed based on the 4 components of the AI chatbot behavior change model. Participants had a mean age of 34.5 (SD 8.6) years. The frequency of tooth brushing among caregivers significantly improved, increasing from 72.4% at baseline to 93.1% two months post baseline (P=.006). Protection motivation theory-based perceptions also showed significant improvement, with mean scores rising from 4.0 (SD 0.6) at baseline to 4.5 (SD 0.6) two months post baseline (P<.001). The chatbot received high ratings for satisfaction (4.7/5, SD 0.6) and usability (4.7/5, SD 0.5). Participants engaged with the chatbot for an average of 24.7 (SD 7.2) days out of 30. Caregivers praised the chatbot's content quality, empathetic communication, and multimedia design, but noted the intervention's lengthy duration and messaging system as limitations.

Conclusions

The 30-Day FunDee chatbot effectively enhanced caregivers' perceptions of oral health care and improved tooth-brushing practices for children aged 6-36 months. High user satisfaction and engagement demonstrate its potential as an innovative tool for oral health education. These findings warrant further validation through large-scale, randomized controlled trials.

Teledentistry Applied to Health and Education Outcomes: Evidence Gap Map

BACKGROUND

Teledentistry is a field of activities that comprises information and communication technologies (ICTs) applied to dentistry, including the exchange of clinical information, patient care, and the use of educational strategies across remote distances. Its use has grown progressively over the past decades-intensified by the COVID-19 pandemic-and has been improving the provision of dental services and educational strategies ever since.

OBJECTIVE

This evidence gap map (EGM) study aims to present a collection of systematic reviews (SRs) with meta-analyses to answer the question "What are the applications of teledentistry in dental services and dental education?" by identifying gaps and current evidence on the improvement of health care and education.

METHODS

The EGM methodology has been developed by the Latin American and Caribbean Center on Health Sciences Information and is based on the concept created by the International Initiative for Impact Evaluation. Embase, PubMed, and Virtual Health Library databases were used for the literature research, using terms for teledentistry associated with eHealth, dental education, and oral health care. The data obtained from the included studies were then characterized in a Microsoft Excel spreadsheet, with a matrix containing 8 intervention groups (combined interventions, e-learning and tele-education, teleconsultation and teleservice, telemonitoring, telediagnosis, telescreening, ICTs, and artificial intelligence) and 8 outcome groups (diagnosis accuracy, education and professional training, user behavior, clinical practice, patient-centered outcomes, clinical outcomes, health services management, and access to health services). The quality of the studies was assessed using AMSTAR2 (A Measurement Tool to Assess Systematic Reviews). The visual analytics platform Tableau (Salesforce) was used to graphically display the confidence level, number of reviews, health outcomes, and intervention effects.

RESULTS

The confidence level obtained by the criteria applied was high for 28% (19/68) of the studies, moderate for 6% (4/68), low for 15% (10/68), and critically low for 51% (35/68). Among the interventions, the ICT group stood out with 182 (36.8%) out of 494 associations, followed by interventions with e-learning and tele-education (n=96, 19.4% of associations), telediagnosis (n=67, 13.6%), and combined interventions (n=53, 10.7%). Most of the outcomes were aimed at education and professional training (97/494, 19.6% of associations), patient-centered outcomes (74/494, 15%), and health services management (60/494, 12.1%).

CONCLUSIONS

This EGM presents an overview of the contributions of teledentistry in patient care, health services, clinical practice, and education. The study results may help guide future research and policy decisions and serve as a convenient virtual tool for accessing valuable evidence-based information on teledentistry.

Why Is Caries Prevention in Children So Difficult? A Narrative Opinion

Caries is among the most common non-communicable diseases worldwide, yet it is commonly described as preventable. Caries prevention is, however, difficult and complex, since the disease has strong social, parental, behavioral, political, medical/genetic, and psychological elements, and the payment models are targeted at traditional conservative care. The aim of this paper is to discuss some key issues that make caries prevention in children be perceived as "difficult": i) the communication gap between researchers and clinicians, creating unrealistic expectations of intervention efficacy; ii) the skewed distribution of caries and the problem of reaching children with the highest need; iii) limited access to care, which is a threat to oral health, in particular in low-socioeconomic-status, underserviced, and remote communities; and iv) the need to adopt behavior change models to affect the modifiable risk factors that are shared with other non-communicable diseases. Dentists cannot simply rely on fluoride exposure; proper education and training in caries risk assessment, behavior change models targeted at oral hygiene and sugar intake, and collaboration with primary healthcare and local school authorities are avenues that aid in caries prevention and reduce the uneven burden of the disease. Online education and mobile apps may help to promote oral health in areas with shortages of dental work force.

The Feasibility and Acceptability of a Mobile Application for Oral Health Education Among Adults in Rwanda

Background

Mobile technology health application (mobile Apps) can assist people manage their health and wellness, encourage healthy lifestyles, and provide valuable information whenever necessary.

Objective

This study aimed to evaluate the feasibility and acceptability of a mobile App for oral health education among adults in Rwanda.

Methods

This was a descriptive cross-sectional study. A total of 111 adult participants evaluated the acceptability and feasibility of the BrushDJ mobile App after using it for three months. At the end of this period, an online survey was conducted using a structured questionnaire consisting of questions on demographics, habitual oral health, assessing acceptability, and assessing the feasibility of the mobile App. Descriptive statistics were performed to analyse demographic characteristics, the feasibility and acceptability of the mobile App. Bivariate analysis using the Chi-square test was performed to detect significant associations amongst the variables.

Results

The response rate was 81% (n=90) of 111 participants who took part in the study, with the majority of participants 44.44% (n=40) aged between 18 and 27 years old. Just over half of the participants were male 51.11% (n=46). The mobile App was found to be highly acceptable (87.78%; n=79) and considered highly feasible (84.44%; n=76) by most of the participants. The differences in acceptability and feasibility across education levels were statistically significant (p=0.000 for acceptability and p=0.038 for feasibility).

Conclusion

The study revealed that the mobile App for oral health education (BrushDJ) was highly acceptable and feasible among the participants. The mobile App had a user-friendly interface and comprehensive guidance on oral hygiene procedures facilitated by its diverse and well-integrated functions.

Time Efficiency, Reliability, and User Satisfaction of the Tooth Memo App for Recording Oral Health Information: Cross-Sectional Questionnaire Study

BACKGROUND

Digitalizing oral health data through an app can help manage the extensive data obtained through oral health surveys. The Tooth Memo app collects data from oral health surveys and personal health information.

OBJECTIVE

This study aims to evaluate the evaluate the time efficiency, reliability, and user satisfaction of the Tooth Memo app.

METHODS

There are 2 sections in the Tooth Memo app: oral health survey and personal oral health record. For the oral health survey section of the Tooth Memo app, different data entry methods were compared and user satisfaction was evaluated. Fifth-year dental students had access to the oral health survey section in the Tooth Memo app during their clinical work. The time required for data entry, analysis, and summary of oral health survey data by 3 methods, that is, pen-and-paper (manual), Tooth Memo app on iOS device, and Tooth Memo app on Android device were compared among 3 data recorders who entered patients' information on decayed, missing, and filled permanent teeth (DMFT) index and community periodontal index (CPI), which were read aloud from the database of 103 patients by another dental personnel. The interobserver reliability of the 3 different data-entering procedures was evaluated by percent disagreement and kappa statistic values. Laypeople had access to the personal oral health record section of this app, and their satisfaction was evaluated through a Likert scale questionnaire. The satisfaction assessments for both sections of the Tooth Memo app involved the same set of questions on the app design, usage, and overall satisfaction.

RESULTS

Of the 103 dental records on DMFT and CPI, 5.2% (177/3399) data points were missing in the manual data entries, but no data on tooth status were missing in the Android and iOS methods. Complete CPI information was provided by all 3 methods. Transferring data from paper to computer took an average of 55 seconds per case. The manual method required 182 minutes more than the iOS or Android methods to clean the missing data and transfer and analyze the tooth status data of 103 patients. The users, that is, 109 fifth-year dental students and 134 laypeople, expressed high satisfaction with using the Tooth Memo app. The overall satisfaction with the oral health survey ranged between 3 and 10, with an average (SD) of 7.86 (1.46). The overall satisfaction with the personal oral health record ranged between 4 and 10, with an average (SD) of 8.09 (1.28).

CONCLUSIONS

The Tooth Memo app was more efficacious than manual data entry for collecting data of oral health surveys. Dental personnel as well as general users reported high satisfaction when using this app.

"I Just Wanted a Dentist in My Phone"-Designing Evidence-Based mHealth Prototype to Improve Preschool Children's Oral and Dental Health: Multimethod Study of the Codevelopment of an App for Children's Teeth

BACKGROUND

Dental caries in preschool children is a global health concern. With increased access to technology and the disruption of health care during the pandemic, mobile health apps have been of interest as potential vehicles for individuals' health maintenance. However, little is known about caring for their child's teeth and what their preferences would be regarding the content or design of an oral health app.

OBJECTIVE

This study aims to co-design the prototype of an app named App for Children's Teeth with parents, providing a source of information for them about caring for their children's teeth and promoting positive dental habits.

METHODS

This multimethod study conducted user involvement research with a purposive sample of parents or carers of children aged ≤6 years to (1) understand their use of the internet through the eHealth Literacy Scale and interviews, (2) determine their opinions about content related to children's oral health, and (3) collect feedback about the app's acceptability using the Theoretical Framework of Acceptability. There were three stages: (1) interviews with parents to understand their needs, preferences, and abilities; (2) prototype design with app developers; and (3) parent feedback interviews using the think aloud method for data collection. Data were deductively analyzed using a codebook strategy, whereas data from the think aloud sessions were analyzed inductively using reflexive thematic analysis.

RESULTS

The prototype design stage involved 10 parents who reported using the internet for health information but found it to be scattered and contradictory. Parents generally welcomed the App for Children's Teeth but expressed concerns about screen time and practicality. They suggested guidance regarding oral hygiene practices, teething symptoms, and pain relief. Parents appreciated features such as clear fonts, categorization according to their child's age, and "In a Nutshell" bullet points. Topics that resonated with parents included information about teething, finding a dentist, and breastfeeding. They believed that the app aligned with their goals and offered suggestions for future developments, such as outlining the process of finding a dentist and incorporating a forum for parents to communicate and exchange ideas.

CONCLUSIONS

The coproduction design approach highlighted parents' need for solutions such as mobile health apps to access reliable information about oral health. Parents identified key design concepts for the app, including a simple and uncluttered interface, content categorization according to their child's age, and practical guidance supported by visual aids. Despite potential challenges related to screen time restrictions, parents provided insights into how such an app could fit seamlessly into their lives.

TRIAL REGISTRATION

Open Science Framework; https://osf.io/uj9az.

DIGITAL DENTISTRY AND ITS IMPACT ON ORAL HEALTH-RELATED QUALITY OF LIFE

Over the past 50 years, digitization has gradually taken root in dentistry, starting with computer tomography in the 1970s. The most disruptive events in digital dentistry were the introduction of digital workflow and computer-aided manufacturing, which made new procedures and materials available for dental use. While the conventional lab-based workflow requires light or chemical curing under inconsistent and suboptimal conditions, computer-aided manufacturing allows for industrial-grade material, ensuring consistently high material quality. In addition, many other innovative, less disruptive, but relevant approaches have been developed in digital dentistry. These will have or already impact prevention, diagnosis, and therapy, thus impacting patients' oral health and, consequently, their oral health-related quality of life. Both software and hardware approaches attempt to maintain, restore, or optimize a patient's perceived oral health. This article outlines innovations in dentistry and their potential impact on patients' oral health-related quality of life in prevention and therapy. Furthermore, possible future developments and their potential implications are characterized.

Prospective acceptability of using mHealth interventions for oral health promotion in a sample of Egyptian women: A cross-sectional study

Background

Unless a health intervention is acceptable to target audience and aligns with their needs and preferences, there is increased likelihood that they would not engage with and benefit from it as planned. Despite that, there is paucity of studies exploring acceptability of oral health promotion interventions prior to implementation. This cross-sectional study was designed to investigate Egyptian women's "prospective acceptability" to use mobile technologies in promoting access to oral health services.

Methods

A total of 959 participants completed a questionnaire, based on Sekhon's theoretical framework of acceptability, either in-person or virtually. Data was collected on sociodemographics, smartphones' ownership and usage patterns, acceptability to use mHealth interventions, and any potential motivators and barriers. Chi-square test was used for descriptive statistics and regression analysis was performed to identify predictors of acceptability to use digital technology in improving oral and dental health.

Results

83 % of women residing in urban settings versus 80.7% in rural settings believed that mHealth could improve health outcomes. WhatsApp was identified by 68% of participants as the preferred application for adopting mobile health services. Health awareness (36.8%) and effort & time saving (29%) were the most commonly cited motivators for using mHealth while lack of time (33%) and privacy issues (14.2%) were the main barriers.

Conclusions

mHealth is perceived as a highly acceptable approach for promoting oral health among Egyptian women. However, mHealth interventions should take into consideration privacy concerns and personal security when targeting this group.