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Title Mobile Phone Application Intervention on Oral Health Is Effective at Improving Oral Hygiene in Adolescents
Clinical Question Can the use of a mobile phone application as health behavior promotion tool be as effective as conventional oral hygiene instructions in improving oral hygiene in adolescents aged 10-18 years old?
Clinical Bottom Line A mobile phone application can be used effectively as an adjunct tool in managing gingivitis, promoting oral health, and enhancing oral hygiene for adolescents aged 10-18 years old. However, these results may not generalize to the broader adolescent population because some studies included in this review had focused exclusively on orthodontic patients. Therefore, more research is needed to confirm the efficacy of mobile apps for improving oral hygiene behaviors in general adolescent populations.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 30761580Toniazzo/20191,402 adolescents, adults, and mothers of young children in 15 studiesSystematic review with meta-analysis
Key resultsOf the 15 studies included in the analysis, 12 (80%) used text messages, and 13 (87%) demonstrated superior outcomes from the intervention of mobile technology. When examining combined standardized mean differences (SMD), the dental plaque index (based on 10 studies) exhibited a substantial reduction of –9.43 (95% CI –14.36 to –4.495; I2 = 99%, p < 0.001), while gingival bleeding (based on seven studies) showed a noteworthy decline of –8.54 (95% CI –13.16 to –3.91; I2 = 99%, p < 0.001). These findings indicate a significant improvement in dental plaque control and a reduction in gingival bleeding in groups that incorporated the mobile health (mHealth) strategy.
#2) 31520040Sharif/2019130 participants (10 to 18 years old) in two studiesSystematic review of randomized trials
Key resultsThe comprehensive assessment using the GRADE framework indicated a moderate level of evidence supporting the efficacy of a mobile phone app in reducing plaque scores, while the effectiveness in decreasing bleeding scores was deemed high. There is some indication that mobile phone apps can enhance adherence to oral hygiene recommendations among orthodontic patients.
#3) 31291683Scheerman/2020132 participants (12 to 16 years old)Randomized Controlled Trial
Key resultsAt the 6-week follow-up, the intervention resulted in a notable decrease in gingival bleeding (B = −3.74; 95% CI −6.84 to −0.65) and an increase in the use of fluoride mouth rinse (B = 1.93; 95% CI 0.36 to 3.50). At the 12-week follow-up, the intervention group exhibited a significant reduction in dental plaque buildup (B = −11.32; 95% CI −20.57 to −2.07) and the number of areas with plaque accumulation (B = −6.77; 95% CI −11.67 to −1.87) compared to the control group. These findings indicate that adolescents wearing fixed orthodontic appliances can enhance their oral hygiene when they receive standard care alongside a mobile application offering oral health education and automated guidance.
Evidence Search (Mobile application OR Smart phone application OR mobile phone) AND (oral hygiene) AND (adolescents)
Comments on
The Evidence
Toniazzo et al. (2019) systematically reviewed MEDLINE-PubMed, Scopus, EMBASE, Google Scholar, and Cochrane Library databases. The studies that met their inclusion criteria focused on outcomes related to plaque, gingival bleeding, and/or knowledge about oral health. Potential bias was evaluated using the Cochrane tool and the GRADE system. Additionally, two separate meta-analyses were conducted. The quality of the evidence in this systematic review was rated very low according to the GRADE system. Sharif et al. (2019) included two studies in their systematic review; one examined the use of text messages, and the other explored the use of a mobile app. Both studies focused solely on patients undergoing orthodontic treatment. The findings suggest some evidence supporting the claim that using mobile phone apps can be beneficial in enhancing compliance with oral hygiene recommendations. These results align with recent systematic reviews of the effectiveness of reminders, including the use of mobile phone apps for this purpose, in enhancing the oral hygiene of orthodontic patients. Scheerman et al. (2020) collected app usage data during a 12-week intervention period. At 6- and 12-week follow-ups, all participants in the intervention group were given access to the WhiteTeeth app in addition to usual care, and were reminded to enter their user data into the mobile app. A control group received conventional care instructions only. Overall, the current evidence on mobile phone apps for oral hygiene is of low quality due to high-risk bias, heterogeneity, and other limitations in the available studies. Additional clinical trials based on behavior change theories, with larger sample sizes and longer follow-up, are imperative to establish the efficacy of mobile phone apps at improving oral hygiene in adolescent patients.
Applicability Mobile phone apps have the potential to be invaluable tools for enhancing compliance with oral hygiene recommendations and improve oral health. The use of mobile apps and text messages may promote behavior changes and improve oral hygiene in adolescent dental patients. However, it is important to note that the applicability of these findings is limited because the primary focus of some studies were adolescent orthodontic patients and reflected some ambiguity regarding their potential for bias. Furthermore, some patients included in the systematic review were adults and mothers of young children.
Specialty/Discipline (Public Health) (Orthodontics) (Pediatric Dentistry)
Keywords Mobile application; oral hygiene; adolescents
ID# 3552
Date of submission: 11/01/2023spacer
E-mail jangm1@livemail.uthscsa.edu
Author Mira Jang, DDS
Co-author(s) Nida-e-Haque Mahmud, BDS, DDS
Co-author(s) e-mail mahmud@livemail.uthscsa.edu
Faculty mentor/Co-author Noorpreet Kaur, BDS, MPH
Faculty mentor/Co-author e-mail kaurn1@uthscsa.edu
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