The influence of mobile applications and social media-based interventions in producing behavior change among orthodontic patients: A systematic review and meta-analysis

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.

Effectiveness of Mobile App Interventions to Improve Periodontal Health: Protocol for a Systematic Review and Meta-Analysis

BACKGROUND

Periodontal health plays a key role as a shared reference point for evaluating periodontal diseases and identifying significant treatment outcomes. Providing adequate instruction and enhancing the motivation of patients to maintain proper oral hygiene are crucial factors for successful periodontal treatment, with self-performed regular oral hygiene identified as a critical factor in improving the outcomes of treatment for periodontal diseases. Recently, mobile health (mHealth) solutions, especially mobile apps, have emerged as valuable tools for self-management in chronic diseases such as periodontal disease, providing essential health education and monitoring capabilities. However, the use of mHealth apps for periodontal health is complex owing to various interacting components such as patient behavior, socioeconomic status, and adherence to oral hygiene practices. Existing literature has indicated positive effects of mHealth on oral health behaviors, knowledge, attitude, practice, plaque index score, and gingivitis reduction. However, there has been no systematic review of mobile apps specifically targeting patients with periodontal disease. Understanding the design and impact of mHealth apps is crucial for creating high-quality apps.

OBJECTIVE

The aim of this systematic review and meta-analysis is to evaluate the effectiveness of existing mobile apps in promoting periodontal health.

METHODS

A comprehensive search strategy will be performed in multiple electronic databases (PubMed, EBSCOhost, CINAHL Plus, Dentistry & Oral Sciences, ScienceDirect, Scopus, and Cochrane Central Register of Controlled Trials) with the following keywords in the title/abstract: "mobile application," "mobile health," "mHealth," "telemedicine," "periodontal health," "periodontitis," and "text message." Only randomized controlled trials will be included that assessed the following outcomes to measure periodontal health improvement: gingival index, bleeding index, periodontal pocket depth, and clinical attachment loss. Covidence will be used for data collection, and a PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) flowchart will be used to describe the selection process of the included, identified, and excluded studies. The Confidence in Network Meta-Analysis approach will be used for meta-analysis of the extracted data from the included studies.

RESULTS

This review will not require ethical approval since no primary data will be included. As of July 2024, a total of 83 articles retrieved from various databases have been imported to Covidence with 13 articles deemed eligible for inclusion in the review. The review is currently ongoing and is expected to be complete by the end of 2024 with the results published in early 2025.

CONCLUSIONS

This systematic review and meta-analysis will contribute to developing mobile apps with enhanced criteria to improve periodontal clinical outcomes. The review emphasizes the importance of mHealth and preventing periodontal disease, which can set the stage for informed global health care strategies.

TRIAL REGISTRATION

PROSPERO CRD42022340827; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=340827.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/50479.

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.

Awareness and usage of mobile applications as an orthodontic diagnostic tool among Croatian orthodontic clinicians

OBJECTIVE

To assess the impact of gender and orthodontic qualification length on the awareness, knowledge and usage of orthodontic diagnostic mobile applications, non-diagnostic mobile applications and social media platforms among orthodontic clinicians.

DESIGN

Cross-sectional questionnaire-based study.

SETTING

The Republic of Croatia.

PARTICIPANTS

A total of 92 orthodontic specialists, members of the Croatian Dental Chamber.

METHODS

This study was conducted using a questionnaire distributed via email to orthodontic clinicians between May and July 2022.

RESULTS

In total, 92 respondents were divided into groups according to sex and median orthodontic qualification length: more recently qualified (MRQ) with ⩽12 years; and longer qualified (LQ) with >12 years. Nearly one-third of respondents did not have any prior knowledge of mobile applications used as an orthodontic diagnostic tool. MRQ respondents were more interested in using mobile apps as opposed to computer software for digital analysis (P < 0.05). This interest was in a negative correlation with orthodontic qualification length (P < 0.01) and was more prevalent among female respondents (P < 0.001). About one-third (32.6%) of respondents did not use non-diagnostic mobile applications and 44.6% did not use social media platforms. Nearly two-thirds (62%) of the respondents did not promote their work through social media. Male respondents and LQ promoted their work more frequently than others (P < 0.05). The usage of other mobile applications was in a positive correlation with the knowledge and awareness of orthodontic mobile applications (P < 0.05).

CONCLUSION

Orthodontic clinicians lacked knowledge, awareness and the usage of orthodontic diagnostic mobile applications according to sex and orthodontic qualification length. One-third used non-diagnostic mobile applications and less than half used social platforms in daily clinical work.

A Systematic Umbrella Review of the Effects of Teledentistry on Costs and Oral-Health Outcomes

Teledentistry offers possibilities for improving efficiency and quality of care and supporting cost-effective healthcare systems. This umbrella review aims to synthesize existing systematic reviews on teledentistry and provide a summary of evidence of its clinical- and cost-effectiveness. A comprehensive search strategy involving various teledentistry-related terms, across seven databases, was conducted. Articles published until 24 April 2023 were considered. Two researchers independently reviewed titles, abstracts and full-text articles. The quality of the included reviews was critically appraised with the AMSTAR-2 checklist. Out of 749 studies identified, 10 were included in this umbrella review. Two reviews focusing on oral-health outcomes revealed that, despite positive findings, there is not yet enough evidence for the long-term clinical effectiveness of teledentistry. Ten reviews reported on economic evaluations or costs, indicating that teledentistry is cost-saving. However, these conclusions were based on assumptions due to insufficient evidence on cost-effectiveness. The main limitation of our umbrella review was the critically low quality of the included reviews according to AMSTAR-2 criteria, with many of these reviews basing their conclusions on low-quality studies. This highlights the need for high-quality experimental studies (e.g., RCTs, factorial designs, stepped-wedge designs, SMARTs and MRTs) to assess teledentistry's clinical- and cost-effectiveness.

Smartphone Applications in Dentistry: A Scoping Review

This scoping review aims to investigate the latest literature concerning the use of smartphone applications (apps) in the prevention, management, and monitoring of oral diseases. Smartphone applications are software programs that are designed to run on smartphones. Nowadays, smartphones are regularly used by people of all ages, and mobile health apps (MHAs) represent an important means of spreading information related to oral health, which is the state of the mouth and teeth, including the gums and other tissues. Several apps have been designed to promote prevention, diagnosis, and therapeutic adherence monitoring. This scoping review considered randomized clinical trials, cross-sectional studies, before-after (pre-post) studies with no control group, and observational studies. Once the inclusion and exclusion criteria had been defined, a preliminary confined search was performed on PubMed and Scopus; key terms from the collected articles were selected to design a search strategy, and then a search of all the included articles' reference lists was run for further research. Studies were excluded if they did not fulfill the inclusion criteria. The preferred reporting items for scoping reviews (PRISMA-ScR) consensus was followed. The risk of bias was evaluated by providing a qualitative analysis of the clinical studies via the National Heart, Lung, and Blood Institute (NHLBI) Quality Assessment of Controlled Intervention Studies, Observational Cohort Studies, and Cross-Sectional Studies (NHLBI, NIH). A total of 21 studies were included in this review. As it is clear from the studies selected, the literature indicates that MHAs are effective in improving oral hygiene in adolescents and children and reducing the dental plaque index, including in patients undergoing orthodontic treatment. MHAs are also able to reduce the symptoms of patients affected by obstructive sleep apnea-hypopnea syndrome (OSAHS) and improve the swallowing-related quality of life of elderly patients. MHAs are furthermore recommended to decrease dental anxiety among patients, both during dental procedures and the post-operative period. MHAs are useful to spread knowledge about traumatic dental injuries among non-oral health professionals and to monitor dental erosion and awake bruxism. MHAs' clinical outcomes might have been influenced by the demographic features of the subjects involved. Further studies considering a longer follow-up period and larger samples are needed. In conclusion, MHAs can be considered a useful tool to monitor oral disease and increase patients' quality of life related to oral health.

Does using mobile applications and social media-based interventions induce beneficial behavioral changes among orthodontic patients?

DESIGN

Systematic review and meta-analysis of randomized controlled trials (RCTs) and controlled clinical trials (CCTs). The protocol of the study was registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42019157298).

DATA SOURCES

Seven electronic databases (MEDLINE, Web of Science Core Collection, Unpublished Clinical Trials accessed through clinicaltrials.gov, Embase, LILACS, ProQuest Database, The Cochrane Library) were searched. Additionally, the reference lists of the included studies were hand searched.

STUDY SELECTION

Clinical trials (RCT and CCT) that assessed the impact of the interventional use of mobile applications and social media among orthodontic patients were included. The review question was defined in PICO format as follows: population (P) = patients (no age restriction) undergoing orthodontic treatment using fixed, removable, or functional appliances, or patients in the retention phase that are wearing fixed or removable retainers; intervention (I) = mobile applications and social media-based interventions; comparison (C) = control group that did not receive any adjunctive intervention; outcome (O) = behavior changes in orthodontic patients after receipt of the intervention. Two authors independently conducted literature search from inception up to March 2021.

DATA ANALYSIS

Social media-based interventions and mobile applications (or bespoke) were used in the form of reminders (WhatsApp reminders) and provision of information including YouTube videos and Instagram posts. Primary outcomes included adherence to wearing appliances or adjuncts, oral hygiene levels, oral health-related behaviors, periodontal outcomes, appointment attendance, knowledge, and related iatrogenic effects. Treatment-related experiences and patient-reported outcomes were assessed as secondary outcomes.

RESULTS

16 studies (14 RCTs and 2 CCTs) were included in the qualitative synthesis, of which only 7 studies were included in the quantitative synthesis (meta-analysis). Results from meta-analyses showed that the intervention was favored in relation to gingival index (GI) (number of studies = 4, standardized mean difference [SMD] = -0.81, 95% confidence interval [CI] = -1.35 to -0.28, P = 0.00, certainty of evidence = very low), plaque index (PI) (number of studies = 7, SMD = -0.91 [95% CI, -1.64 to -0.19], P = 0.01, certainty of evidence = very low), and bleeding index (BI) (number of studies = 4, SMD = -0.22 [95% CI, -0.50 to 0.05], P = 0.11, certainty of evidence = high). Sensitivity analysis was performed (including additional 3 studies for GI and 5 studies for PI), which also favored the intervention in relation to GI (number of studies = 7, SMD = -0.60 [95% CI, -1.01 to -0.18], P = 0.00, certainty of evidence = very low), and PI (number of studies = 12, SMD = -0.67 [95% CI, -1.14 to -0.19], P = 0.01, certainty of evidence = very low).

CONCLUSIONS

Limited evidence supports beneficial behavior change among orthodontic patients when using mobile applications or social media-based interventions.

The awareness and usage of orthodontic apps and social media by orthodontists in the UK: A questionnaire-based study

OBJECTIVE

To assess the awareness and usage of mobile apps and social media among orthodontic clinicians to support patients with orthodontic treatment, support the professional development of orthodontists, and identify any relevant apps and social media platforms currently recommended to patients.

DESIGN

Cross-sectional questionnaire-based study.

SETTING

United Kingdom.

METHODS

A questionnaire was developed and distributed to members of the British Orthodontic Society (BOS). To increase the response rate, the questionnaire was circulated at three time points between January and March 2020.

RESULTS

A total of 149 orthodontists responded to the questionnaire (15% response rate) with 113 orthodontists completing all questions (11.4%). Of those who answered, 81% (n = 111) had been qualified for >10 years, 35% worked in practice (n = 48), 34% worked in a hospital (n = 47) and 26% worked in both hospital and practice (n = 36). The results indicated that 20% of clinicians (n = 22) used apps to support patients and 33% (n = 37) reported using apps for professional purposes. Brush DJ appeared to be the most popular patient focused app (39%, n = 18) whereas the IOTN (17%, n = 8), Invisalign (17%, n = 8) and Dental Monitoring apps (9%, n = 4) were the most popular clinician-focused apps. With regard to social media, 53% (n = 60) of respondents reported that they used social media to communicate generic orthodontic information and promote their practice to patients. The most commonly used social media platforms were Facebook and Instagram. Of respondents, 96% expressed a willingness to recommend an evidence-based mobile app to patients if available, and 88% were willing to recommend an evidence-based social media platform.

CONCLUSIONS

Orthodontic clinicians are utilising mobile apps and social media to support both patients and their own professional development. There is a willingness to increase the use of evidence-based platforms and apps to support patients.