Patient awareness of orthodontic mobile phone apps

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.

Agreement of the Newly Developed Moyers' Equations and Moyers' Tables

OBJECTIVE

 This study aimed to develop the Moyers' prediction equation to be used with tooth widths predicting app on smartphone.

MATERIALS AND METHODS

 Four equations were developed separately for sex and dental arches. Internal validation with Moyers' table was finished. External validation on 37 subjects with agreement test of both Moyers' prediction equations and Moyers' prediction tables was performed.

STATISTICAL ANALYSIS

 A general linear model procedure was used to create four prediction equations. Internal validation was evaluated using the coefficient of determination. External validation was performed using Bland and Altman (BA) test.

RESULTS

 Four equations were developed for OrthoAnalysis app on smartphone. The overall coefficient of determination of all equations and prediction table was 0.998 (p < 0.05) indicating good agreement of the two methods. The agreement test on the 37 subjects was that the BA test revealed the BA limits of agreement between the residuals of two predictions was -0.001 mm and ranged from -0.143 to 0.140 mm with almost all plots lying inside this difference interval.

CONCLUSIONS

 In summary, four novel estimation equations were developed and showed very low difference to the well accepted original Moyers' prediction tables. Therefore, the equations used in the orthodontic app for predicting unerupted tooth width were verified and valid for clinical use.

Orthodontic apps: An assessment of content accuracy and validity

OBJECTIVE

To assess the content accuracy of orthodontic treatment information in patient-focused apps.

DESIGN

A cross-sectional review study.

SETTING

Orthodontic apps available on the UK Android and Apple App Stores.

METHODS

Apps identified in a previous research study and those identified via a questionnaire of specialist orthodontists were assessed for accuracy of content utilising an evidence-based checklist. The checklist covered five main orthodontically relevant themes and 32 codes with respective items.

RESULTS

The accuracy of information content for 16 patient-focused apps was assessed. Eight apps provided information related to orthodontic treatment and handling emergencies. Five apps were reminder apps and a small number (n = 3) contained games and timers for toothbrushing and aligners. With regard to the accuracy of information content, only two apps contained information across all five themes of the evidence-based checklist. Only one app received a score of 'fair - excellent' under the oral hygiene theme; interestingly, this app was the most commonly used patient-focused app. Eight apps containing orthodontic treatment information scored poorly as they had inaccurate information on handling emergency situations. None of the apps were deemed excellent with regard to accuracy of information content.

CONCLUSION

The orthodontic mobile apps assessed in this study mostly contained information of poor accuracy. Therefore, there is a need for high-quality apps with credible information supported by evidence to be developed.

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.

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.

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

INTRODUCTION

The objective of this project was to systematically review the effectiveness of mobile applications and social media-based interventions in producing a behavioral change in orthodontic patients.

METHODS

Electronic databases and reference lists of relevant studies were searched on March 1, 2021, with no language restrictions (PROSPERO: CRD42019157298). Randomized and nonrandomized controlled trials assessing the impact of mobile applications and social media-based interventions on orthodontic patients were identified. Primary outcomes included adherence to wear, appointment attendance, knowledge, oral health-related behaviors, oral hygiene levels, periodontal outcomes, and related iatrogenic effects. The quality of the included trials was assessed using the Cochrane risk of bias tools. A weighted treatment effect of interventions on periodontal outcomes was calculated. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation system.

RESULTS

A total of 3617 articles were identified. Of these, 16 studies (14 randomized controlled trials and 2 nonrandomized controlled trials) were deemed eligible. Nine randomized controlled trials were judged to be of either low or unclear risk of bias. The intervention was favored in relation to gingival and plaque indexes, standardized mean difference: -0.81 (95% confidence intervals [CI], -1.35 to -0.28) and -0.91 (95% CI, -1.64 to -0.19), respectively. However, no significant effect was observed in bleeding on probing (standardized mean difference: -0.22; 95% CI, -0.5 to 0.05). The level of evidence was high in probing depth and bleeding on probing outcomes.

CONCLUSIONS

A very low to moderate level of evidence supports the effects of mobile applications and social media-based interventions in producing positive behavioral changes in orthodontic patients. Further high-quality trials would assist in further elucidating the potential of these approaches to influence orthodontic treatment outcomes and experiences.

Orthodontic apps: an assessment of quality (using the Mobile App Rating Scale (MARS)) and behaviour change techniques (BCTs)

BACKGROUND

Apps have been shown to be an effective tool in changing patients' behaviours in orthodontics and can be used to improve their compliance with treatment. The Behaviour Change Techniques (BCTs) and quality (using MARS) within these apps have previously not been published.

OBJECTIVES

1. To evaluate the quality of these apps aiming to change behaviour. 2. To assess BCTs used in patient focused orthodontic apps.

METHODS

The UK Google Play and Apple App Stores were searched to identify all orthodontic apps and 305 apps were identified. All 305 apps were assessed for the presence of BCTs using an accepted taxonomy of BCTs (Behaviour Change Wheel (BCW)), widely utilised in healthcare. Of those containing BCTs, the quality was assessed using the Mobile App Rating Scale (MARS), a validated and multi-dimensional tool which rates apps according to 19 objective criteria. Data collection was carried out by two calibrated, independent assessors and repeated after 6 weeks for 25% of the apps by both assessors.

RESULTS

BCTs were found in 31 apps, although only 18 of them were analysed for quality and 13 apps were excluded. Six different BCTs were identified: these were most commonly 'prompts/cues', and 'information about health consequences'. All apps were shown to be of moderate quality (range 3.1-3.7/5). Inter-rater and intra-rater reliability for BCT and quality assessment were excellent.

CONCLUSIONS

The current availability of orthodontic apps of sufficient quality to recommend to patients is very limited. There is therefore a need for high-quality orthodontic apps with appropriate BCTs to be created, which may be utilised to improve patients' compliance with treatment.

Social media and orthodontics: Are our patients scrolling?

Objective:

To assess patients’ awareness of the availability of information related to orthodontics on social media, and to explore patients’ willingness to engage with social media to aid with orthodontic treatment.

Design:

Prospective cross-sectional survey.

Setting:

This survey was conducted at Croydon University Hospital orthodontic department.

Participants:

A total of 125 orthodontic patients, both new and in treatment. There were no exclusion criteria.

Methods:

All participants completed a questionnaire designed to explore their awareness, access to and utilisation of social media as well as their willingness to engage with social media to support orthodontic treatment. There were no age restrictions or exclusion criteria.

Results:

Of the patients, 99% had access to social media. Of these patients, 64% were aware that social media platforms were available to help with orthodontic treatment, 30% had utilised social media related to orthodontics, with the most popular platforms being Instagram (n = 17) and Snapchat (n = 12). Of the patients, 73% stated that they would be willing to use social media in the future to support orthodontic treatment.

Conclusion:

Social media can be engaging, accessible and versatile, and has been shown to be effective at improving patients’ knowledge regarding orthodontic treatment. As such, it may be used as a valuable tool for information provision to engage orthodontic patients. Awareness of the availability of orthodontics content on social media is increasing; however, only one-third of participants had previously used it to aid with orthodontic treatment. Given the availability of information on social media targeted at orthodontic patients there is a need to assess the quality of this information and if appropriate navigate patients towards high-quality, effective resources.

Attitude towards Telemonitoring in Orthodontists and Orthodontic Patients

The purpose of this study was to analyze the attitude of dentists and patients towards the use of Dental Monitoring^TM (DM), an orthodontic telemonitoring software. Thus, two different specially prepared specific questionnaires were administered to 80 dentists (40 were general dentists and 40 orthodontists) and 80 orthodontic patients. All dentists judged positively telemonitoring, as 96.25% of them considered telemonitoring indicative of high tech and high-quality treatment; 100% considered it a way to reduce the number of in-office visits; 17.5% agreed on a weekly telemonitoring frequency, 40% on a biweekly, and 42.5% on a lower frequency. Further, 97.5% of patients judged positively telemonitoring; 81.25% of them considered telemonitoring indicative of high-tech treatment; 81.25% declared to be interested in reducing the number of in-office visits through telemonitoring; 27.5% agreed on taking self-picture every week, 57.5% every two weeks, and 15% on a lower frequency. Both patients and dentists positively judged telemonitoring, considering it a technologically advanced tool increasing the perception of quality and accuracy of the treatment. Both groups were interested in reducing the number of in-office visits, although not all of them revealed to be ready to invest more money and time in it.

A Knowledge-Based Algorithm for Automatic Monitoring of Orthodontic Treatment: The Dental Monitoring System. Two Cases

BACKGROUND

In the dental field, digital technology has created new opportunities for orthodontists to integrate their clinical practice, and for patients to collect information about orthodontics and their treatment, which is called "teledentistry." Dental monitoring (DM) is a recently introduced orthodontic application that combines safe teledentistry with artificial intelligence (AI) using a knowledge-based algorithm, allowing an accurate semi-automatic monitoring of the treatment. Dental Monitoring is the world's first SaaS (Software as a Service) application designed for remote monitoring of dental treatment, developed in Paris, France, with Philippe Salah as the Co-founder and CEO.

CASES PRESENTATION

This report describes two cases in which DM system was essential to achieve the control of certain movements: it was possible to follow the movement, even if complex, such as the anterior cross of an adult patient and a lack of space in the canine of the growing patient. The software analyzed the fit and retention of the aligner, thus ensuring correct biomechanics. They were treated during the COVID-19 pandemic lockdown with aligners. The first case is a growing patient who was monitored during an interceptive orthodontic treatment to manage a retained upper canine. The second case is an adult patient forced to finalize his treatment of upper lateral incisor crossbite. The software analyzed the fit and retention of the aligner, thus ensuring correct biomechanics.

CONCLUSIONS

DM system appears to be a promising method, useful for improving the interaction between doctor and patient, generally acceptable and useful to patients, even in critical clinical situations, at least in cases with optimal compliance and ability to use the tool properly.

The Sheldon Friel Memorial Lecture 2020 It's not just about the teeth: Patient-centred Orthodontics

The provision of high-quality health care involves many different aspects, including safety, effectiveness, efficiency, and patient centredness. In order for care to be truly patient centred requires patients' views being sought and considered, and this may be achieved through patient-centred research. Patient-centred research is fundamentally important in contemporary health care and has many benefits; for example, it ensures that research is relevant, identifies those aspects of care that are important to patients, provides information that is important to current and future patients, and allows the integration of patients' views regarding how services may be enhanced in the future. This paper provides an overview of how we currently involve patients in orthodontic research, what this means to the specialty and how we can enhance patient involvement in the future.

How do you identify the patient with 'high expectations' of orthodontic treatment: An empirical approach

OBJECTIVES

To identify an empirical method for identifying patients with 'high expectations' of orthodontic treatment with fixed appliances using a questionnaire-based approach.

DESIGN

Secondary analysis of data from four studies which collected data on patients' expectations of orthodontic treatment using the same questionnaire.

SETTING

Secondary care orthodontic services.

PARTICIPANTS

All four datasets comprised new patients aged 12-15 years, with no history of orthodontic treatment, who fulfilled the criteria for NHS treatment using the Index of Orthodontic Treatment Need (IOTN). Unpublished dataset 1 comprised 100 participants, while dataset 2 had 70 participants, dataset 3 had 67 participants and dataset 4 comprised 40 participants.

METHODS

The questionnaire utilised in all studies had a question which asked respondents to rate seven different expectations of outcome relating to straight teeth, better smile, ease of eating, speaking, cleaning teeth, improved career prospects and social confidence. Dataset 1 was analysed to determine the proportion of patients who had rated all seven outcome expectation items at a maximum score. Similar analyses were performed for the other three datasets to explore the trend in the proportion of patients with high expectations over time.

RESULTS

For dataset 1, 2.0% of participants had high expectations, as defined by their scores on the questionnaire. The proportions for the datasets 2, 3 and 4 were 4.0%, 4.5% and 2.5%, respectively.

CONCLUSION

The method outlined provides an empirical basis for identifying patients with statistically infrequent high expectations. This can potentially help clinicians in the management of such patients.

Development of 'My Retainers' mobile application: Triangulation of two qualitative methods

OBJECTIVE

Diligent wear of removable orthodontic retainers requires prolonged adherence and is invariably necessary to preserve optimal results. Patient-informed behaviour-change interventions represent a promising and novel means of enhancing adherence to removable retainer wear. The aim of this study was to describe the development of a patient-informed mobile application designed to enhance retainer wear.

METHODS

App development encompassed consideration of participant preferences, social media posts, available interventions and behaviour change theories. Qualitative methods including analysis of publicly-available retainer-related posts on Twitter (n = 827) and one-to-one interviews were undertaken. Audio-recorded one-to-one interviews were undertaken to identify patient preferences in relation to features, content and design of the application. A criterion-based purposive sample of participants wearing vacuum-formed retainers for at least 4 years was used (n = 15). Thematic analysis of transcribed data was undertaken. These data were triangulated to inform design and content of the application.

RESULTS

The need to facilitate communication with the treating clinician, responsive reminder and tracking systems, and access to useful and engaging written and visual information, in addition to other personalised and interactive features were considered important. Concerns related to retainer wear shared on Twitter informed an exhaustive list of frequently-asked questions. Application features were mapped to relevant theoretical constructs. Determinants of existing behavioural change theories were also used to link application features to retainer wear and maintenance.

CONCLUSIONS

A holistic process involving both patient and professional input can be useful in informing the development of mobile applications. The orthodontic application ("My Retainers") will undergo further scrutiny in relation to its effectiveness in inducing behavioural change and concerning patient experiences prior to finalisation.

Availability of orthodontic smartphone apps

OBJECTIVE

To identify and profile the available orthodontic smartphone apps published on the UK Apple App Store and Google Play Store.

DESIGN

A review of available smartphone apps.

SETTING

London, UK.

METHODS

The Apple App Store and Google Play Store were accessed in October 2018; all orthodontic apps with a title and description available in English were included. Each app was classified according to the following criteria: name; target audience (patient or clinician); focus; platform (Apple App Store and/or Google Play Store); cost; rating and number of ratings; size; creation date; country of development and developer.

RESULTS

A total of 305 orthodontic related apps were identified for inclusion. The majority of apps were aimed at patients (n = 241) and the most of these were focussed on gaming (n = 136), many apps were also found to be developed by specialist practices (n = 63) and to provide knowledge for patients (n = 56). Two hundred and ninety-five apps were free, with some of these including the option of paying for in-app purchases. Most apps were developed in the USA (n = 84).

CONCLUSIONS

There has been an increase in the availability of orthodontic apps in recent years. The majority of available apps are patient-focused, most commonly games. A number of apps aim to elicit a behaviour change in our patients; therefore, there is a need to assess the quality and educational content of these.