A Mobile App (WhiteTeeth) to Promote Good Oral Health Behavior Among Dutch Adolescents with Fixed Orthodontic Appliances: Intervention Mapping Approach

Validation of an improved questionnaire assessing the social cognitive constructs of the Health Action Process Approach among parents regarding brushing their children's teeth

OBJECTIVE

The Health Action Process Approach (HAPA) describes social cognitive constructs related to behaviour change. A validated questionnaire is needed to measure these constructs in paediatric dentistry. The aim of this study was to improve an existing HAPA-based questionnaire for parents regarding brushing their children's teeth and to assess its validity and reliability in a population of parents of high caries risk children.

METHODS

Parents of high caries risk children of 3-10 years filled out the adjusted HAPA-based questionnaire. Mokken scale analysis, graded response model analyses, factor analyses and reliability analyses were performed according to the protocol of Dima. Discriminant validity was assessed by comparing the mean scores of the HAPA constructs between two groups of participants, based on different levels of caries experience, brushing frequency and education level of the mother.

RESULTS

The Mokken scale analysis and factor analyses indicated a multidimensional eight factor scale. The graded response model did not fit our data. The subscale action control could be identified as a two-factor subscale. Reliability indices from the Dima protocol varied, for instance Cronbach alpha ranged from 0.73 to 0.96. The constructs coping self-efficacy, action planning and action control discriminated between brushing frequencies.

CONCLUSIONS

The adjusted HAPA-based questionnaire is an improved, valid and reliable instrument that could be used to evaluate HAPA-based interventions to improve children's oral health.

Evaluating and improving the usability of a mHealth platform to assess postoperative dental pain

Objectives

The use of interactive mobile health (mHealth) applications to monitor patient-reported postoperative pain outcomes is an emerging area in dentistry that requires further exploration. This study aimed to evaluate and improve the usability of an existing mHealth application.

Materials and methods

The usability of the application was assessed iteratively using a 3-phase approach, including a rapid cognitive walkthrough (Phase I), lab-based usability testing (Phase II), and in situ pilot testing (Phase III). The study team conducted Phase I, while providers and patients participated in Phase II and III.

Results

The rapid cognitive walkthrough identified 23 potential issues that could negatively impact user experience, with the majority classified as system issues. The lab-based usability testing yielded 141 usability issues.; 43% encountered by patients and 57% by dentists. Usability problems encountered during pilot testing included undelivered messages due to mobile phone carrier and service-related issues, errors in patients' phone number data entry, and problems in provider training.

Discussion

Through collaborative and iterative work with the vendor, usability issues were addressed before launching a trial to assess its efficacy.

Conclusion

The usability of the mHealth application for postoperative dental pain was remarkably improved by the iterative analysis and interdisciplinary collaboration.

Design and evaluation of mobile application for adolescents' self-care: protocol for a randomized controlled field trial

BACKGROUND

Adolescence is a critical stage for the development of self-care. Many adolescents use mobile apps to monitor and improve their health. Health information technology plays a significant role in the field of self-care. This article provides a protocol for a study to design and evaluate mobile applications for adolescent self-care.

METHODS

The present research is a combination of applied development study, methodological, and intervention experimental. This study will be done in three stages: The first stage is the design and evaluation of a mobile application for adolescent self-care. The second stage is, designing and evaluating the psychometric properties of the "Questionnaire for Measuring Adolescent Self-Care Performance." This questionnaire will be used before and after using the application in the third stage. The third stage is determining the effectiveness of self-care interventions based on mobile applications among adolescents. The target group will be adolescents aged 10-19 from the schools of Amol City. In the first stage, the opinions of 30 people adolescents, parents, and experts will be used. In the second stage, the number of samples will be 10 times the number of items in the questionnaire. In the third stage, 50 people will be in the intervention group and 50 people will be in the control group. Descriptive statistics will be used for data analysis. Between-group and intra-group comparisons will be calculated about quantitative variables, independent t-test and paired t-test, and analysis of variance. The chi-square test and Fisher's exact test will be used in SPSS 16 software to test the homogeneity of qualitative variables between the two groups.

DISCUSSION

In the first stage, based on the opinions received from the target group, a user-centered educational application for self-care of adolescents will be designed. In the second stage, after determining the validity and reliability, a questionnaire will be designed to measure the self-care performance of adolescents. In the third stage, using an intervention study for 3 months, the effectiveness of the training will be determined through the designed application. Our findings are scheduled for a full analysis, with expectations that analyses will be completed by September 2023.

Understanding Whether and How a Digital Health Intervention Improves Transition Care for Emerging Adults Living With Type 1 Diabetes: Protocol for a Mixed Methods Realist Evaluation

BACKGROUND

Emerging adults living with type 1 diabetes (T1D) face a series of challenges with self-management and decreased health system engagement, leading to an increased risk of acute complications and hospital admissions. Effective and scalable strategies are needed to support this population to transfer seamlessly from pediatric to adult care with sufficient self-management capability. While digital health interventions for T1D self-management are a promising strategy, it remains unclear which elements work, how, and for which groups of individuals.

OBJECTIVE

This study aims to evaluate the design and implementation of a multicomponent SMS text message-based digital health intervention to support emerging adults living with T1D in real-world settings. The objectives are to identify the intervention components and associated mechanisms that support user engagement and T1D health care transition experiences and determine the individual characteristics that influence the implementation process.

METHODS

We used a realist evaluation embedded alongside a randomized controlled trial, which uses a sequential mixed methods design to analyze data from multiple sources, including intervention usage data, patient-reported outcomes, and realist interviews. In step 1, we conducted a document analysis to develop a program theory that outlines the hypothesized relationships among "individual-level contextual factors, intervention components and features, mechanisms, and outcomes," with special attention paid to user engagement. Among them, intervention components and features depict 10 core characteristics such as transition support information, problem-solving information, and real-time interactivity. The proximal outcomes of interest include user engagement, self-efficacy, and negative emotions, whereas the distal outcomes of interest include transition readiness, self-blood glucose monitoring behaviors, and blood glucose. In step 2, we plan to conduct semistructured realist interviews with the randomized controlled trial's intervention-arm participants to test the hypothesized "context-intervention-mechanism-outcome" configurations. In step 3, we plan to triangulate all sources of data using a coincidence analysis to identify the necessary combinations of factors that determine whether and how the desired outcomes are achieved and use these insights to consolidate the program theory.

RESULTS

For step 1 analysis, we have developed the initial program theory and the corresponding data collection plan. For step 2 analysis, participant enrollment for the randomized controlled trial started in January 2023. Participant enrollment for this realist evaluation was anticipated to start in July 2023 and continue until we reached thematic saturation or achieved informational power.

CONCLUSIONS

Beyond contributing to knowledge on the multiple pathways that lead to successful engagement with a digital health intervention as well as target outcomes in T1D care transitions, embedding the realist evaluation alongside the trial may inform real-time intervention refinement to improve user engagement and transition experiences. The knowledge gained from this study may inform the design, implementation, and evaluation of future digital health interventions that aim to improve transition experiences.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/46115.

Development of a mobile application based on the salutogenic model for self-management in adolescents with Moyamoya disease

PURPOSE

Moyamoya disease (MMD) is a rare disease which has a high incidence of onset in adolescence. Disease self-management skills are imperative for adolescents with MMD. This study aimed to describe the systematic development, content, and usability of the Moyamoya Healthy Youth application (app), which was developed to enhance self-management skills for adolescents with MMD.

DESIGN AND METHODS

The theoretical grounding for the app was salutogenic model and the development process of the app was guided by the intervention mapping (IM) protocol. Results of each IM step were applied to the next step leading to the design of the app. Additionally, a pilot test was conducted to determine the usability of the app.

RESULTS

Following the salutogenic model, we identified the stressors, behaviors, and resources regarding managing symptoms of MMD by interviewing adolescents with MMD, their parents, and healthcare providers. Based on the findings of the interviews, we determined the program outcomes and performance objectives to improve the self-management of MMD in adolescents. The app was developed by translating the theoretical methods to achieve the performance objectives into practical strategies for delivering the program. A pilot test with eight participants showed satisfaction with the app in terms of its usefulness and ease of use.

CONCLUSION

We delineated the development process of the Moyamoya Healthy Youth. Additionally, we presented the positive outcomes regarding the usability of the app.

PRACTICE IMPLICATIONS

The Moyamoya Healthy Youth app could benefit adolescents with MMD, by improving their self-management skills which are crucial for their health.

An Evidence-Based Digital Prevention Program to Improve Oral Health Literacy of People With a Migration Background: Intervention Mapping Approach

BACKGROUND

Studies in Germany have shown that susceptible groups, such as people with a migration background, have poorer oral health than the majority of the population. Limited oral health literacy (OHL) appears to be an important factor that affects the oral health of these groups. To increase OHL and to promote prevention-oriented oral health behavior, we developed an evidence-based prevention program in the form of an app for smartphones or tablets, the Förderung der Mundgesundheitskompetenz und Mundgesundheit von Menschen mit Migrationshintergrund (MuMi) app.

OBJECTIVE

This study aims to describe the development process of the MuMi app.

METHODS

For the description and analysis of the systematic development process of the MuMi app, we used the intervention mapping approach. The approach was implemented in 6 steps: needs assessment, formulation of intervention goals, selection of evidence-based methods and practical strategies for behavior change, planning and designing the intervention, planning the implementation and delivery of the intervention, and planning the evaluation.

RESULTS

On the basis of our literature search, expert interviews, and a focus group with the target population, we identified limited knowledge of behavioral risk factors or proper oral hygiene procedures, limited proficiency of the German language, and differing health care socialization as the main barriers to good oral health. Afterward, we selected modifiable determinants of oral health behavior that were in line with behavior change theories. On this basis, performance objectives and change objectives for the relevant population at risk were formalized. Appropriate behavior change techniques to achieve the program objectives, such as the provision of health information, encouragement of self-control and self-monitoring, and sending reminders, were identified. Subsequently, these were translated into practical strategies, such as multiple-choice quizzes or videos. The resulting program, the MuMi app, is available in the Apple app store and Android app store. The effectiveness of the app was evaluated in the MuMi intervention study. The analyses showed that users of the MuMi app had a substantial increase in their OHL and improved oral hygiene (as measured by clinical parameters) after 6 months compared with the control group.

CONCLUSIONS

The intervention mapping approach provided a transparent, structured, and evidence-based process for the development of our prevention program. It allowed us to identify the most appropriate and effective techniques to initiate behavior change in the target population. The MuMi app takes into account the cultural and specific determinants of people with a migration background in Germany. To our knowledge, it is the first evidence-based app that addresses OHL among people with a migration background.

An individualized mobile health intervention to promote physical activity in adults with obstructive sleep apnea: An intervention mapping approach

Objective

Combining continuous positive airway pressure with physical activity (PA) might be a promising strategy to treat obstructive sleep apnea (OSA). This article describes how intervention mapping (IM) can guide the development, content, and mechanisms of action of a mobile application to promote PA in adults with OSA.

Methods

To develop the program, the IM approach was followed. This article presents the first three steps of IM to develop a mixed intervention (with interventionists and a digital application) aiming to: (1) assess patients' health problems and needs in a literature review to determine their expectations and perceived facilitators and barriers to PA behavior change and thus select the determinants of behavior; (2) formulate the expected intervention outcomes and objectives to be met to achieve the overall program goals; and (3) select and implement the behavior change techniques (BCTs) to achieve the change objectives.

Results

The literature review identified the relevant determinants (e.g., self-efficacy, coping, planning, and habit) of PA behavior using the health action process approach and multiprocess action control. These results were used to specify the program outcomes for PA adapted to physical, psychological, and social parameters. Overall, 11 performance objectives and 30 change objectives were defined. Lastly, BCTs and practical applications were identified.

Conclusions

The study provides a theoretical and methodological basis for researchers and practitioners given the current paucity of evidence-based PA interventions for adults with OSA. It addresses the lack of BCTs (framing and prompts/cue techniques) and meaningful behavioral determinants (identity and habit) in most interventions.

Selfie Dental Plaque Index: A New Tool for Dental Plaque Assessment

BACKGROUND

Plaque quantification indices are frequently used to evaluate personal oral hygiene. Education in self-care and self-diagnosis is effective in prevention and control of both dental and periodontal disease. Mobile technology has become a ubiquitous technology and can be particularly useful in the self-monitoring of health promotion. To evaluate the selfie dental plaque index compared with O´Leary index (DPI) and visible plaque index (VPI). The secondary outcome was to compare full-mouth and anterior teeth plaque index analysis.

MATERIAL AND METHODS

A sample of 47 adults were evaluated using a four-stage protocol. All teeth (except third molars) were analyzed for VPI and DPI. A selfie Digital Camera captured the image of the patient's smile (without and with disclosing solution), which was analyzed using Image J software (ImageJ 1.52a, National Institutes of Health). Adobe Photoshop software (Copyright © 2020 Adobe) was used for individual segmentation. The calculation of the selfie index of visible plaque (SVPI) and disclosed (SDPI) was done through the area with plaque of each image in relation to the total teeth area.

RESULTS

Spearman's correlation test showed a moderate correlation between VPI and SVPI (rho = 0.6, p<0.001), whereas between DPI and SDPI the correlation was weak (rho = 0.2, p = 0.13). The correlation between the plaque index using all the teeth present, showed a strong correlation with the analysis only of the anterior teeth (rho = 0.8, p<0.001).

CONCLUSIONS

Our results showed the potential of smiling images as a new tool for quantitative measurements and showed moderate correlation when compared with the visible plaque index. Anterior teeth provided reliable plaque indexes when compared with full mouth analysis. Key words:Dental Plaque Index, dental hygiene, mHealth, health Promotion, oral Health.

Behavioral strategies for periodontal health

The impact of lifestyle factors has been increasingly studied and discussed in oral healthcare. Positive lifestyle factors are important in maintaining oral health or controlling disease, but they are not easy to adopt over the long term. Along with public health initiatives within communities and groups, there is a role for behavior change interventions delivered in dental practice settings to improve the periodontal health of individuals. Behavior management is now seen as a part of both prevention and therapy of periodontal diseases. This article summarizes the evidence on behavioral strategies for periodontal health to inform and assist oral healthcare professionals in implementing behavior change in their practice. In addition, strategies for education and training in communication and behavior change techniques are considered.

Management of white spot lesions induced during orthodontic treatment with multibracket appliance: a national-based survey

OBJECTIVES

The study aimed to survey current strategies against enamel demineralization during multibracket therapy (MBT) and guide a prevention concept based on existing scientific evidence.

MATERIALS AND METHODS

The survey comprised questions on the prevention and management of white spot lesions (WSL). The questionnaire was sent via email to orthodontists working in practices and universities throughout Germany. The analysis involved descriptive statistics using the chi-square test (p < 0.05).

RESULTS

A prevention protocol was used before MBT by 80.6% of the participants. Less than a quarter of the participants regularly applied topical fluoride (gel or varnish) during MBT. According to the respondents' assessment, the prevalence of WSL during MBT is 11.6%, mainly observed in 12- to 15-year-old male patients. Orthodontists graduating after 2000 tended to recommend and apply fluoride-containing materials more often than their senior colleagues (p = 0.039). Participants from private practices applied fluoride varnish or gel more frequently than those from university clinics (p = 0.013). Fluoridation was the most common (70.7%) treatment for WSL after MBT, followed by resin infiltration (21.2%). The majority (80.9%) of the participants favor a guideline for preventing WSL.

CONCLUSIONS

WSL prevention during MBT is challenging. Males in puberty are predominantly affected. Younger orthodontists are more concerned about the prevention of WSL during MBT.

CLINICAL RELEVANCE

The non-negligible prevalence of individuals with WSL emphasizes the need for dental education and health care reform. This would help to implement standardized procedures and establish innovative applications.

Primary Tooth Decay Prevention Program in Children: Application of Intervention Mapping Approach

Background. As the most common diseases globally, oral and dental diseases are closely related to people’s behavior. The present study is aimed at developing a program to prevent primary teeth decay in children using the intervention mapping approach. Methods. This study protocol is aimed at using the intervention mapping approach as the planning framework. The study consists of six steps of intervention mapping, including needs assessment based on the relevant literature review, development of an objectives matrix for changing people’s behaviors and environmental factors, program preparation, program implementation, and program evaluation to develop a family-centered program. Results. The use of the intervention mapping approach helped us identify the outcomes and functional objectives, develop an appropriate intervention program, and evaluate the program. Conclusions. The intervention mapping approach is an appropriate guide to developing a systematic and evidence-based program.

Health belief model for empowering parental toothbrushing and sugar intake control in reducing early childhood caries among young children-study protocol for a cluster randomized controlled trial

Background

It has been recognized that oral health education for parents is critical for preventing early childhood caries (ECC). Few parents practiced caries prevention procedures for their children in daily life, though. A novel intervention scheme using mobile messages will be developed in this study under the framework of the health belief model (HBM). The objective of the present randomized clinical trial (RCT) is to evaluate the effectiveness of the new scheme in promoting oral health of young children by reducing dental caries.

Methods

This RCT will involve 26–36 child care centers or kindergartens with nursery classes (clusters) located in Hong Kong. A total of 518–628 child-parent dyads (child age 18–30 months) will be recruited and randomly allocated at the cluster level into the test or control group with a 1:1 ratio. For parents in the test group, the intervention will consist of a set of HBM-based text messages sent regularly in 48 weeks. A standard text message will be sent to the parents in the control group in the first week. The primary outcome will be dental caries measured by dmft/dmfs of the children after 2 years (around 4 years of age). The secondary outcomes will be toothbtushing and sugar intake.

Discussion

HBM-based intervention via a low-cost text messaging vehicle may serve as a viable way to empower parents to establish proper oral health behaviors for their children and safeguard the oral health of children in Hong Kong.

Trial registration

ClinicalTrials.govNCT04665219. Registered on 11 December 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06208-w.

Development and validation of a progressive web application to educate partial denture wearers

Effective delivery of post-insertion instructions is essential for denture care and oral health. This study aimed to develop a progressive web application (PWA) to educate patients' chairside and serve as a reference material. A need analysis was conducted before prototype development. Subsequently, the prototype was subjected to content verification, design appraisal and usability testing. The results of usability testing revealed a user task success rate of 94.4%, with an adjusted Wald 95% confidence interval of 83-100%. User satisfaction assessed using the Single Ease Questionnaire and System Usability Score reported a mean score of 6.13 (95% CI: 5.69-6.55) and 85.9 (95% CI: 82.2-89.6), respectively, indicating good usability. This study highlights the systematic approach of developing an evidence-based educational PWA to meet the usability standards for mobile applications. This PWA is useful in clinical studies to explore mobile technologies' potential in educating denture wearers, especially in the older population.

Changes in Distribution of Dental Biofilm after Insertion of Fixed Orthodontic Appliances

Good oral hygiene is an important factor in oral and general health, especially in orthodontic patients, because fixed appliances might impede effective oral hygiene and thus increase the risks of tooth decay, periodontal disease and general health complications. This study investigated the impact of fixed orthodontic appliances on the distribution of dental biofilm in teenagers. Supragingival plaque was assessed at T0, T1 and T2. The distribution of the biofilm was analyzed. Approximal Plaque Index (API) and Bonded Bracket Index (BBI) were used to measure the presence of dental plaque. After insertion of the fixed appliance, the dental plaque indices values in the orthodontically treated group were significantly higher (p < 0.05) than in the control group. Fixed orthodontic appliances caused significant changes in the distribution of the biofilm. This was characterized by the change of location of the dental plaque. In the orthodontic group, we observed an increase in the amount of the supragingival plaque on the vestibular surface of the teeth.

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.

Using the Intervention Mapping Approach to Develop a Mental Health Intervention: A Case Study on Improving the Reporting Standards for Developing Psychological Interventions

Replicating or distilling information from psychological interventions reported in the scientific literature is hindered by inadequate reporting, despite the existence of various methodologies to guide study reporting and intervention development. This article provides an in-depth explanation of the scientific development process for a mental health intervention, and by doing so illustrates how intervention development methodologies can be used to improve development reporting standards of interventions. Intervention development was guided by the Intervention Mapping approach and the Theoretical Domains Framework. It relied on an extensive literature review, input from a multi-disciplinary group of stakeholders and the learnings from projects on similar psychological interventions. The developed programme, called the “Be Well Plan”, focuses on self-exploration to determine key motivators, resources and challenges to improve mental health outcomes. The programme contains an online assessment to build awareness about one’s mental health status. In combination with the exploration of different evidence-based mental health activities from various therapeutic backgrounds, the programme teaches individuals to create a personalised mental health and wellbeing plan. The use of best-practice intervention development frameworks and evidence-based behavioural change techniques aims to ensure optimal intervention impact, while reporting on the development process provides researchers and other stakeholders with an ability to scientifically interrogate and replicate similar psychological interventions.

An App-Based Parenting Program to Promote Healthy Energy Balance-Related Parenting Practices to Prevent Childhood Obesity: Protocol Using the Intervention Mapping Framework

BACKGROUND

The family environment plays an important role in the development of children's energy balance-related behaviors. As a result, parents' energy balance-related parenting practices are important targets of preventive childhood obesity programs. Families with a lower socioeconomic position (SEP) may benefit from participating in such programs but are generally less well reached than families with a higher SEP.

OBJECTIVE

This paper describes the application of the Intervention Mapping Protocol (IMP) for the development of an app-based preventive intervention program to promote healthy energy balance-related parenting practices among parents of children (aged 0-4 years) with a lower SEP.

METHODS

The 6 steps of the IMP were used as a theory- and evidence-based framework to guide the development of an app-based preventive intervention program.

RESULTS

In step 1, behavioral outcomes for the app-based program (ie, children have a healthy dietary intake, sufficient sleep, and restricted screen time and sufficient physical activity) and sociocognitive (ie, knowledge, attitudes, and self-efficacy) and automatic (ie, habitual behaviors) determinants of energy balance-related parenting were identified through a needs assessment. In step 2, the behavioral outcomes were translated into performance objectives. To influence these objectives, in step 3, theory-based intervention methods were selected for each of the determinants. In step 4, the knowledge derived from the previous steps allowed for the development of the app-based program Samen Happie! through a process of continuous cocreation with parents and health professionals. In step 5, community health services were identified as potential adopters for the app. Finally, in step 6, 2 randomized controlled trials were designed to evaluate the process and effects of the app among Dutch parents of infants (trial 1) and preschoolers (trial 2). These trials were completed in November 2019 (trial 1) and February 2020 (trial 2).

CONCLUSIONS

The IMP allowed for the effective development of the app-based parenting program Samen Happie! to promote healthy energy balance-related parenting practices among parents of infants and preschoolers. Through the integration of theory, empirical evidence, and data from the target population, as well as the process of continued cocreation, the program specifically addresses parents with a lower SEP. This increases the potential of the program to prevent the development of obesity in early childhood among families with a lower SEP.

TRIAL REGISTRATION

Netherlands Trial Register NL6727, https://www.trialregister.nl/trial/6727; Netherlands Trial Register NL7371, https://www.trialregister.nl/trial/7371.

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.

Comparative evaluation of webinar, powerpoint presentation and lecture as oral health educational interventions among school children: a randomized controlled trial

The study compared the effectiveness of three teaching methods on the oral health status of high school children. The study population of 791 school children selected from three different schools was randomly allocated to one of three intervention groups: (i) Webinar group (Online presentation)-260 subjects, (ii) Face to Face lecture using PowerPoint presentation (F2F PP group)-261 subjects and (iii) Control group (Only lecture)-270 subjects. Subjects from the Webinar group and F2F PP group received oral health education at an interval of 15 days starting from baseline. Subjects from the control group received oral health education only at baseline. Oral Hygiene Index (OHI) and Gingival Index (GI) were measured at baseline, at 1 month, 2 months' and 3 months' interval. OHI and GI showed a significant reduction (P = 0.001) in the Webinar group and F2F PP group; However, in the control group, OHI and GI reduced from baseline till second month and showed an increase at 3 months' interval. F2F PP group showed a maximum reduction in OHI and GI followed by the Webinar group. It can be concluded that F2F PowerPoint-based oral health education was most effective followed by the webinar method.

The Effect of Chairside Verbal Instructions Matched with Instagram Social Media on Oral Hygiene of Young Orthodontic Patients: A Randomized Clinical Trial

Objective: To investigate the effectiveness of Instagram in improving oral hygiene compliance and knowledge in young orthodontic patients compared to traditional chairside verbal instructions. Design: Single-center, parallel, randomized controlled trial. Setting: Section of Dentistry of University of Pavia. Participants: 40 patients having fixed appliances in both arches were recruited and randomly divided into an intervention (n = 20) and a control group (n = 20). Intervention: At a first appointment, both groups were given verbal instructions and motivated to oral hygiene. In addition, multimedia contents on Instagram were sent weekly to trial participants for six months. Main outcome measures: For all participants, the bleeding index (BI), modified gingival index (MGI), and plaque index (PI) were assessed at baseline (T0), after one (T1), three (T2), and six months (T3). A questionnaire was administered at the beginning (T0) and at the end of the study (T3) to assess participants’ knowledge. Results: In both groups, BI, MGI, and PI significantly decreased (p < 0.05) at T1 (means control group: BI 0.26 ± 0.22, MGI 0.77 ± 0.36, PI 0.53 ± 0.20; means test group: BI 0.24 ± 0.22, MGI 0.65 ± 0.46, PI 0.49 ± 0.21) compared to baseline (means control group: BI 0.56 ± 0.27, MGI 1.23 ± 0.41, PI 0.87 ± 0.23; means test group: BI 0.54 ± 0.26, MGI 1.18 ± 0.39, PI 0.93 ± 0.20) but no significant differences in clinical measures were showed between T1, T2, and T3 (p > 0.05) (intragroup differences). Trial patients demonstrated significant improvements in knowledge with respect to controls comparing scores at T0 and T3 (p < 0.05) but despite this result in the test group clinical outcomes did not report significant intergroup differences at any time (p > 0.05). Conclusions: Presenting multimedia information through Instagram resulted in a significant improvement in knowledge. Therefore, this social media represents an aid to the standard verbal motivation performed by orthodontists towards young patients under an orthodontic treatment.

Mobile Apps for Dental Caries Prevention: Systematic Search and Quality Evaluation

Background

Dental caries is the most common multifactorial oral disease; it affects 60% to 90% of the global population. Dental caries is highly preventable through prevention behaviors aimed at improving oral hygiene, adequate fluoride usage, and dietary intake. Mobile apps have the potential to support patients with dental caries; however, little is known about the availability, target audience, quality, and features of these apps.

Objective

This review aims to systematically examine dental caries prevention apps; to describe their content, availability, target audience, and features; and to assess their quality.

Methods

We systematically identified and evaluated apps in a process paralleling a systematic review. This included a search strategy using search terms; an eligibility assessment using inclusion and exclusion criteria focused on accessibility and dental caries self-management behaviors, including oral hygiene, dietary intake, and fluoride usage; data extraction on app characteristics, including app store metrics; prevention behavior categorization; feature identification and description; a quality appraisal of all apps using the validated Mobile App Rating Scale (MARS) assessment tool; and data comparison and analysis.

Results

Using our search strategy, we retrieved 562 apps from the Google Play Store and iTunes available in Australia. Of these, 7.1% (40/562) of the apps fit our eligibility criteria, of which 55% (22/40) targeted adults, 93% (37/40) were free to download, and 65% (26/40) were recently updated. Oral hygiene was the most common dental caries prevention behavior domain, addressed in 93% (37/40) of the apps, while dietary intake was addressed in 45% (18/40) of the apps and fluoride usage was addressed in 42% (17/40) of the apps. Overall, 50% (20/40) of the apps addressed only 1 behavior, and 38% (15/40) of the apps addressed all 3 behaviors. The mean MARS score was 2.9 (SD 0.7; range 1.8-4.4), with 45% (18/40) of the apps categorized as high quality, with a rating above 3.0 out of 5.0. We identified 21 distinctive features across all dental caries prevention behaviors; however, the top 5 most common features focused on oral hygiene. The highest-ranking app was the Brush DJ app, with an overall MARS score of 4.4 and with the highest number of features (n=13). We did not find any apps that adequately addressed dental caries prevention behaviors in very young children.

Conclusions

Apps addressing dental caries prevention commonly focus on oral hygiene and target young adults; however, many are not of high quality. These apps use a range of features to support consumer engagement, and some of these features may be helpful for specific patient populations. However, it remains unclear how effective these apps are in improving dental caries outcomes, and further evaluation is required before they are widely recommended.

Teaching adults how to prevent COVID-19 infection by health workers: The application of intervention mapping approach

INTRODUCTION

Education is one of the most important approaches to preventing infectious diseases at the time of the pandemic. The purpose of the study was to develop an intervention-training program using an intervention mapping approach (IMA) to prevent COVID-19 infection in adults at the time of the pandemic by health workers.

MATERIALS AND METHODS

The present study was a study protocol where IMA was used as a planning framework for developing an intervention-training program to prevent COVID-19 infection in adults at the time of the pandemic by health workers in Ardabil city. Six intervention mapping (IM) steps have been described in this protocol. As the first step, needs assessment was performed by reviewing the studies, qualitative evaluation, and interviews. In the second step, the matrix of change objectives was designed from the intersection of performance goals and determinants. Later on, after designing the program and planning the program implementation, the program evaluation plan was developed.

RESULTS

IMA guided us in designing and implementing a control-oriented training program with the participation of the participants along with the definition of outcomes, performance goals and determinants, theoretical methods and practical applications, intervention program, implementation, and step by step assessment.

CONCLUSION

IM is a control-oriented, systematic, participation-based approach to design and implement targeted and on-going health promotion programs based on the needs of the target group at the time of the pandemic by health workers.

Smartphone applications used in orthodontics: A scoping review of scholarly literature

Mobile applications (apps) play an increasingly important role in day to day life. With the number of orthodontic-related apps continuing to increase, and the rapid development of artificial intelligence, the potential to yield tremendous benefits to both clinicians and patients is apparent. However, if orthodontic apps are to become mainstream and obtain greater acceptance, scientific validation and investigation of these apps are to be undertaken. This scoping review aimed to determine the scope and extent of the published literature on mobile apps in orthodontics, as well as identify the types of studies published, and summarize the outcomes studied- thus also giving direction for future research in a rapidly evolving subject area.

Study of Adolescents' Puberty, Adolescence Training Program: The Application of Intervention Mapping Approach

BACKGROUND

Adolescence is a significant period of life which is crucial for life long health. The purpose of the study was to develop a puberty intervention-training program using an intervention mapping approach (IMA).

METHODS

The present study was a study protocol where IMA was used as a planning framework for developing a puberty intervention-training program (PITP). Six intervention mapping steps have been described in this protocol. As the first step, needs assessment was performed by reviewing the studies, qualitative evaluation, and interviews. In the second step, the matrix of change objectives was designed from the intersection of performance goals and determinants. Later on, after designing the program and planning the program implementation, the program evaluation plan was developed.

RESULTS

IMA guided us in designing and implementing a control-oriented training program with the participation of the participants along with the definition of outcomes, performance goals and determinants, theoretical methods and practical applications, intervention program, implementation and step by step assessment.

CONCLUSION

Intervention mapping is a control-oriented, systematic, participation-based approach to design and implement targeted and on-going health promotion programs.

Deep learning-based dental plaque detection on primary teeth: a comparison with clinical assessments

BACKGROUND

Dental plaque causes many common oral diseases (e.g., caries, gingivitis, and periodontitis). Therefore, plaque detection and control are extremely important for children's oral health. The objectives of this study were to design a deep learning-based artificial intelligence (AI) model to detect plaque on primary teeth and to evaluate the diagnostic accuracy of the model.

METHODS

A conventional neural network (CNN) framework was adopted, and 886 intraoral photos of primary teeth were used for training. To validate clinical feasibility, 98 intraoral photos of primary teeth were assessed by the AI model. Additionally, tooth photos were acquired using a digital camera. One experienced pediatric dentist examined the photos and marked the regions containing plaque. Then, a plaque-disclosing agent was applied, and the areas with plaque were identified. After 1 week, the dentist drew the plaque area on the 98 photos taken by the digital camera again to evaluate the consistency of manual diagnosis. Additionally, 102 intraoral photos of primary teeth were marked to denote the plaque areas obtained by the AI model and the dentist to evaluate the diagnostic capacity of each approach based on lower-resolution photos. The mean intersection-over-union (MIoU) metric was employed to indicate detection accuracy.

RESULTS

The MIoU for detecting plaque on the tested tooth photos was 0.726 ± 0.165. The dentist's MIoU was 0.695 ± 0.269 when first diagnosing the 98 photos taken by the digital camera and 0.689 ± 0.253 after 1 week. Compared to the dentist, the AI model demonstrated a higher MIoU (0.736 ± 0.174), and the results did not change after 1 week. When the dentist and the AI model assessed the 102 intraoral photos, the MIoU was 0.652 ± 0.195 for the dentist and 0.724 ± 0.159 for the model. The results of a paired t-test found no significant difference between the AI model and human specialist (P > .05) in diagnosing dental plaque on primary teeth.

CONCLUSIONS

The AI model showed clinically acceptable performance in detecting dental plaque on primary teeth compared with an experienced pediatric dentist. This finding illustrates the potential of such AI technology to help improve pediatric oral health.

A theory-based intervention delivered by an online social media platform to promote oral health among Iranian adolescents: a cluster randomized controlled trial

Objective: Based on the Health Action Process Approach, we tested the efficacy of a theory-based program using an online social media platform (Telegram) to promote good oral hygiene behaviour among Iranian adolescents.Design: A three-arm randomized-controlled trial design was used, consisting of an adolescent only intervention group (A group; n = 253), an adolescent and mother intervention group (A + M group; n = 260), and a control group (n = 278).Main outcome measures: Psychosocial variables, toothbrushing behaviour, Visual Plaque Index, and Community Periodontal Index.Results: Increases in adolescent toothbrushing at the one- and six-month follow-ups in both intervention groups compared to the control group were observed. Adolescents in the A + M group showed significant greater improvements in their toothbrushing behaviour, Visual Plaque Index, and Community Periodontal Index scores than adolescents in the A group. Improvements to toothbrushing social cognitions were also observed.Conclusions: Current results support the use of the theory-based program delivered by Telegram in improving good oral hygiene behaviour and oral health outcomes among Iranian adolescents. Involving mothers in an intervention can confer additional benefits for adolescent oral health.

The effect of using a mobile application ("WhiteTeeth") on improving oral hygiene: A randomized controlled trial

Objective

To evaluate the effectiveness of the WhiteTeeth mobile app, a theory‐based mobile health (mHealth) program for promoting oral hygiene in adolescent orthodontic patients.

Methods

In this parallel randomized controlled trial, the data of 132 adolescents were collected during three orthodontic check‐ups: at baseline (T0), at 6‐week follow‐up (T1) and at 12‐week follow‐up (T2). The intervention group was given access to the WhiteTeeth app in addition to usual care (n = 67). The control group received usual care only (n = 65). The oral hygiene outcomes were the presence and the amount of dental plaque (Al‐Anezi and Harradine plaque index), and the total number of sites with gingival bleeding (Bleeding on Marginal Probing Index). Oral health behaviour and its psychosocial factors were measured through a digital questionnaire. We performed linear mixed‐model analyses to determine the intervention effects.

Results

At 6‐week follow‐up, the intervention led to a significant 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 12‐week follow‐up, dental plaque accumulation (B = −11.32; 95% CI −20.57 to −2.07) and the number of sites covered with plaque (B = −6.77; 95% CI −11.67 to −1.87) had been reduced significantly more in the intervention group than in the control group.

Conclusions

The results show that adolescents with fixed orthodontic appliances can be helped to improve their oral hygiene when usual care is combined with a mobile app that provides oral health education and automatic coaching. Netherlands Trial Registry Identifier: NTR6206: 20 February 2017.