Effect of Oral Health Education Using a Mobile App (OHEMA) on the Oral Health and Swallowing-Related Quality of Life in Community-Based Integrated Care of the Elderly: A Randomized Clinical Trial

Navigating Through Innovation in Elderly's Health: A Scoping Review of Digital Health Interventions

Objectives

Comprehensively map and summarize digital health initiatives for the elderly and caregivers.

Methods

Scoping review between April and May 2022 based on Joanna Briggs methodology. Databases used included PubMed, Cochrane Library, CINAHL Plus, and Web of Science, along with grey literature and hand searches. Two reviewers independently conducted screening and eligibility phases, with a third resolving disagreements. Data were thematically analyzed.

Results

The review included 421 documents. Most documents were published between 2013 and 2022, with a recent increase. Most studies, originating from high-income countries, focused on home applications and were mainly in the testing and validation stages. Telephones and computers were the predominant devices. Health objectives included monitoring, prevention, and treatment, with interventions utilizing directed communication and personal health monitoring for individuals, and telemedicine and decision support for healthcare providers.

Conclusion

Increasing integration of technology in older adults' lives, along with their increasing proficiency, is driving a significant rise in digital health interventions. Despite this growth, further research in middle- and low-income countries, for caregivers and evaluating effectiveness and feasibility of these technological interventions is needed.

Effect of Simple Swallowing Training Program on Early Oropharyngeal Dysphagia in Community-Dwelling Older Adults: A Randomized Controlled Study

OBJECTIVES

Oropharyngeal dysphagia (OD) in community-dwelling older adults continues to be a challenge due to its insidious onset. This study developed a simple swallowing training program (SSTP) to address these issues and conducted a randomized controlled trial to explore its effect on swallowing function and quality of life.

DESIGN

Two-arm randomized controlled trial.

SETTING

AND PARTICIPANTS: A total of 248 community-dwelling older adults with OD from were included in 2024 and randomly divided into intervention and control groups.

METHODS

The SSTP was developed through expert consultation. A total of 248 community-dwelling older adults with OD were included in 2024 and randomly divided into intervention and control groups. The intervention group underwent the SSTP twice daily for 21 days, with weekends off, and the control group participants did light physical activities by themselves. The primary outcome was the Gugging Swallowing Screen (GUSS), and the secondary outcomes were the Eating Assessment Tool-10 (EAT-10), Swallowing Quality of Life questionnaire (SWAL-QoL), maximum tongue pressure, masticatory ability, bite force, and meal duration. Assessments were conducted on days 1 and 21, while meal duration was assessed every 3 days for lunch.

RESULTS

Twenty-seven participants withdrew halfway. There were no significant differences in baseline assessments (P > .05). There were significant between-group and interactive effects in the GUSS [(19.07 ± 1.38) vs (17.28 ± 2.17), Fbetween-group = 6.893, Pbetween-group = .009, Finteractive = 59.504, Pinteractive<.001], EAT-10 {[4.00 (3.00, 5.00)] vs [9.00 (7.00, 10.00)], zbetween-group = -3.502, Pbetween-group<.001; zinteractive = -6.252, Pinteractive<.001}, SWAL-QoL {[166.00 (163.00, 171.50)] vs [154.00 (150.00, 158.00)], zbetween-group = 2.681, Pbetween-group = .007; zinteractive = 5.475, Pinteractive<.001}, maximum tongue pressure {[33.10 (26.48, 36.86)] vs [28.85 (19.21, 35.77)], zbetween-group = 3.377, Pbetween-group = .001; zinteractive = -6.208, Pinteractive<.001}, masticatory ability {[176.92 (133.10, 212.91) vs [163.33 (116.66, 189.32)], zbetween-group = 4.801, Pbetween-group<.001; zinteractive = 6.979, Pinteractive<.001}. Between-group, time, and interactive effects were significant in the meal duration [(23.39 ± 4.32) vs (27.64 ± 5.63), Fbetween-group = 8.692, Pbetween-group = .004, Ftime = 138.683, Ptime< 0.001, Pinteractive = 73.196, Pinteractive<.001].

CONCLUSIONS AND IMPLICATIONS

The SSTP can effectively improve early OD and swallowing-related quality of life in community-dwelling older adults.

A Study on the Development of Information and Communication Technology-Based Oral Functional Rehabilitation Exercise Program Content for Elderly People

Background/Objectives: This study was conducted to develop information and communication technology (ICT)-based oral functional rehabilitation exercise (OFRE) program content to effectively improve the oral function of the elderly people. Methods: After selecting evidence-based effective OFRE items through systematic review, the final items were constructed through the validity evaluation of detailed items through an expert Delphi survey. The items were composed in a simple content form that can be performed directly and applied to ICT-based mobile applications. Results: The final content items consisted of an oral functional motor-ability measurement, oral Pilates videos, and games. The first is to measure the maximum opening amount before and after exercise, and the opening amount was designed to be measured by eating the fruit displayed on the screen by opening and closing the lips. The second one consisted of eight exercises in the video, and each exercise was to be performed at least three times a day, with a total of two sets. The third is a salivary secretion function exercise that stimulates the salivary glands to stimulate the user's interest and enable them to perform oral movements on their own. It consists of a lip and respiratory muscle exercise that inflates the cheeks and bursts a balloon, and the image disappears when the word in the image presented on the screen is pronounced correctly. It consists of pronunciation exercises. Conclusions: This content development attempt can be expanded into new convergence research linked to ICT and can be used as basic data when developing related content as part of digital care for the elderly in the future.

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

Background

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

Objective

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

Methods

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

Results

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

Conclusion

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

Validation of the conceptual framework and intervention scope of oral function rehabilitation exercise

OBJECTIVES

This study used a Delphi survey to define the concept of oral function rehabilitation exercise (OFRE) based on the International Classification of Functioning, Disability, and Health (ICF) and to categorise intervention domains for community-dwelling older adults.

BACKGROUND

While numerous studies have been conducted to improve oral function through exercise interventions, the conceptual definition of oral exercise remains unclear and there is a lack of systematic categorisation of oral exercise intervention domains.

METHODS

A preliminary model was developed based on the key findings of 19 papers selected from a prior systematic review. Its validity was confirmed through a Delphi survey conducted twice with eight expert panellists. Consensus was achieved by evaluating the validity of the OFRE conceptual framework, the accuracy of OFRE conceptual definitions, and intervention domains.

RESULTS

Through expert consensus, an ICF-based OFRE conceptual framework was developed that includes 21 factors that affect the oral health status of the older adults. The OFRE intervention domain for improving the health status consisted of oral function rehabilitation warm-up exercise, masticatory function exercise, swallowing function exercise, articulatory function exercise, salivary function exercise, and oral function rehabilitation cool-down exercise, and 11 specific intervention methods were derived.

CONCLUSIONS

The OFRE intervention can be used for planning and applying successful interventions to improve oral function and life function of older adults.

Orofacial and cervical myofunctional intervention programmes for older adults: A scoping review

INTRODUCTION

Senescent stomatognathic systems undergo anatomical changes that are not always compensated by physiology due to associated factors such as poorly fitted dentures, dental changes, and clinical conditions that trigger sarcopenia. When these conditions are not properly addressed, they can lead to nutritional deficiencies. Hence, this study aimed to map orofacial and cervical myofunctional intervention programmes for older adults, evaluate the current research in this area, and formulate suggestions for further investigation.

METHODS

Scoping review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. The EMBASE, LILACS, PubMed/Medline, Scopus, Web of Science, and grey literature databases were systematically searched. Studies addressing therapeutic programmes, myofunctional exercises, and their influence on the stomatognathic system of older adults were included. Studies with populations younger than 60 years, residing in long-term care facilities, homes, or hospital care, and with associated comorbidities were excluded, as well as secondary studies.

RESULTS

A total of 3098 studies were retrieved. After applying the eligibility criteria, nine studies were eligible for this review. The nine studies were published in English between 2008 and 2021 in the United States, Japan, and South Korea. The participants' mean ages ranged from 64 to 81 years, with a preponderance of females. Six of the studies divided the sample into intervention and control groups. Two studies referred to programmes to promote oral function through facial expression and tongue muscle exercises, salivary gland massage, and swallowing biomechanics. Seven studies report the positive influence of myofunctional exercises on the stomatognathic system.

CONCLUSION

The mapping concluded that therapeutic programmes, including educational actions, help prevent orofacial myofunctional disorders, and improve the functionality of the stomatognathic system.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Oral health and healthy ageing: a scoping review

BACKGROUND

Good oral health is an important part of healthy ageing, yet there is limited understanding regarding the status of oral health care for older people globally. This study reviewed evidence (policies, programs, and interventions) regarding oral health care for older people.

METHODS

A systematic search of six databases for published and grey literature in the English language by the end of April 2022 was undertaken utilising Arksey and O'Malley's scoping review framework.

RESULTS

The findings from oral health policy documents (n = 17) indicated a lack of priorities in national health policies regarding oral health care for older people. The most common oral health interventions reported in the published studies (n = 62) included educational sessions and practical demonstrations on oral care for older adults, nurses, and care providers. Other interventions included exercises of facial muscles and the tongue, massage of salivary glands, and application of chemical agents, such as topical fluoride.

CONCLUSION

There is currently a gap in information and research around effective oral health care treatments and programs in geriatric dental care. Efforts must be invested in developing guidelines to assist both dental and medical healthcare professionals in integrating good oral health as part of healthy ageing. Further research is warranted in assessing the effectiveness of interventions in improving the oral health status of the elderly and informing approaches to assist the integration of oral health into geriatric care.

Effectiveness of e-learning to promote oral health education: A systematic review and meta-analysis

BACKGROUND

In recent times during and after the COVID-19 pandemic, e-learning is increasingly being used to give oral health education. However, the efficacy of e-learning in improving and promoting the oral hygiene and oral health knowledge, attitude and practice is unclear. Therefore, this systematic review and meta-analysis aim to clarify the effectiveness of e-learning compared to other conventional education methods for providing oral health.

METHODS

An electronic database search was performed on PubMed-Medline, Scopus, and CENTRAL (Central Register Cochrane of Controlled trials). Randomized controlled trials (RCTs), including cluster or group RCTs, were collected in this study. The risk of bias was assessed with the Cochrane Handbook for Systematic Reviews of Interventions. Five different meta-analyses were conducted for plaque index, gingival index, oral health knowledge, oral health attitude, and oral health practice using a random effects model.

RESULTS

A total of 282 articles were found through the database search; 19 articles were included in the qualitative synthesis and 9 articles in the quantitative synthesis. The meta-analysis found that compared with conventional education, e-learning exhibited no positive effect. However, the use of e-learning was superior to conventional education methods for oral health practice for adults in subgroup analysis.

CONCLUSIONS

This paper could not indicate the effectiveness of e-learning in comparison with conventional education for oral health in total. However, for adults, it may be effective to get the oral health practice compared to the conventional education. Our study limitation is that there are only few studies that have assessed the effectiveness of e-learning. Therefore, numerous further high-quality studies should be conducted regarding the efficacy of e-learning compared with conventional education methods for oral health promotion.

Development and evaluation of the "Toothbrushing Timer with Information on Toothbrushes" application: A prospective cohort pilot study

OBJECTIVES

For people, it is challenging to be conscious of the appropriate toothbrushing time to maintain good oral health in daily life. The aim of this study was to preliminarily examine the utility of an application (app) that combines a toothbrushing timer and information on toothbrushes.

MATERIALS AND METHODS

We developed the "Toothbrushing Timer with Information on Toothbrushes" app to help users ensure appropriate toothbrushing time and learn about the beneficial characteristics of toothbrushes. A total of 18 participants were registered for the study. At baseline (T0) and after 1 month (T1) of app usage, study participants answered a digital questionnaire that comprised three questions on oral health practice, self-efficacy in oral hygiene, and quality of life related to oral health (Oral Health Impact Profile-14 [OHIP-14]).

RESULTS

Five participants were excluded from the analysis as they did not answer the digital questionnaire. Finally, 13 participants completed the survey with a follow-up of 1 month. The 13 participants were grouped into health professionals (n = 8) and non-health professionals (n = 5). The total scores for oral health practice and self-efficacy related to oral hygiene increased after a month of app usage in health professional and non-health professional groups. However, there were no significant differences between T0 and T1 in either group. The total score of OHIP-14 was lower at T1 than at T0 in both groups. Therefore, participants showed better oral health practice, self-efficacy in oral hygiene, and quality of life related to oral health at T1 compared with that at T0.

CONCLUSIONS

Our app showed positive results for the users and is useful in maintaining and promoting oral health awareness and practice. However, our pilot study lacks sufficient power and did not yield significant differences. Therefore, high-quality clinical trials with larger sample sizes are warranted for further improvement and evaluation.

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.

A mobile augmented reality-integrated oral health education for community dwelling older adults: A pilot study

Background/purpose

Providing oral healthcare education can be an optimal strategy for imparting knowledge and developing self-care skills for older adults to enhance their oral health conditions. However, traditional passive lecture-based education programs have several limitations. Integrating mobile augmented reality (MAR) into oral health education can potentially enhance the effectiveness of the education by mitigating those limitations. The objectives of this study are to develop and evaluate the effectiveness of MAR-integrated oral health education. The objectives of this study were to develop and evaluate the effectiveness of MAR-integrated oral health education.

Materials and methods

Twenty-four older adults from community dwellings participated in this study. The participants received MAR-integrated oral health education once at activity centers. Self-report questionnaires were utilized to assess oral healthcare-related knowledge and self-efficacy, and the usability score of the MAR system. The assessment was conducted before and after the educational program. Data were statistically analyzed using descriptive statistics and paired-t test.

Results

The mean scores of oral healthcare-related knowledge and self-efficacy showed a significant increase after the educational program, with P-values of <0.001 and 0.002, respectively. A majority of the participants exhibited a lack of knowledge and self-efficacy regarding the proper selection of toothpaste and interdental brushes. However, there was an improvement after the intervention. The usability score of the system was lower than the average level.

Conclusion

MAR-integrated oral health education effectively increases oral health-related knowledge and self-efficacy among community dwelling older adults. Still, the usability of the MAR system needs to be improved. Further investigation of long-term effects and clinical outcomes, and the inclusion of comparative groups are recommended for the future study.

The impact of health education interventions on oral health promotion among older people: a systematic review

BACKGROUND

One of the most common pathologic changes in older people is oral and dental problems. The oral health of older people is a public health concern. Promotion of good oral health for this cohort will have beneficial impacts on the longer-term quality of life. This study aimed to identify the types of health education interventions for the oral health of older people and to determine their effects on the oral and dental health of older people.

METHODS

Potential articles were retrieved from four electronic databases (PubMed/Medline, Scopus, Web of Sciences, and Embase) up to 31 September 2022 in English without limit of time. Experimental and quasi-experimental interventional studies investigating the impact of educational interventions on oral and dental health among older people over 60 years old in both sexes were considered. The quality assessment tool was the Effective Public Health Practice Project (EPHPP).

RESULTS

In the initial search, 1104 articles were retrieved. Finally, according to the inclusion criteria, 23 studies (seventeen randomized controlled trials (RCT) and six quasi-experimental studies) were reviewed. In this review, educational interventions for older people and their caregivers are classified. Theoretical frameworks were used in only three interventions related to older people. Outcome measures were both self-reported and objective measures. Fifteen of the included studies were of moderate quality.

CONCLUSION

This review provides evidence that the use of oral and dental health educational interventions was effective in improving the oral health of older people. Educational interventions were carried out both among older people and among their caregivers. Although a variety of interventions were used in the reviewed studies, more lectures were used in the interventions related to older people. In the interventions related to caregivers, in addition to lectures, practical education was also used. It is recommended to perform higher quality studies for assessing the effectiveness of interventions in this field.

A Systematic Review of the Use of mHealth in Oral Health Education among Older Adults

Oral diseases are largely preventable. However, as the number of older adults is expected to increase, along with the high cost and various barriers to seeking continuous professional care, a sustainable approach is needed to assist older adults in maintaining their oral health. Mobile health (mHealth) technologies may facilitate oral disease prevention and management through oral health education. This review aims to provide an overview of existing evidence on using mHealth to promote oral health through education among older adults. A literature search was performed across five electronic databases. A total of five studies were identified, which provided low to moderate evidence to support using mHealth among older adults. The selected studies showed that mHealth could improve oral health management, oral health behavior, and oral health knowledge among older adults. However, more quality studies regarding using mHealth technologies in oral health management, oral health behavior, and oral health knowledge among older adults are needed.

Association of Number of Teeth with ADL/IADL in Korean Middle-Aged and Older Adults: An Analysis of the 7th Korean Longitudinal Study of Aging

We determined the association between the number of natural and implant teeth with activities of daily living (ADL) and instrumental ADL (IADL) levels in middle-aged and older adults aged ≥ 55 years. We included 6,925 participants, who underwent a computer-assisted personal interview in the 7th Korean Longitudinal Study of Aging. After controlling for general characteristics, the associations between the number of natural and implant teeth with ADL and IADL levels were examined using multiple regression analysis. The participants had 21.2 natural teeth and 1.08 implant teeth on average. The ADL and IADL levels were 0.61 and 1.56, 0.40 and 1.16, and 1.10 and 0.31 in participants with ≤ 9, 10-19, and ≥ 20 teeth, respectively. There was no significant association between ADL and the number of natural and implant teeth (p > 0.05). However, a one-unit increase in IADL score was associated with a reduced number of natural (β = -0.031, p < 0.001) and implant (β = -0.194, p = 0.006) teeth. Difficulties regarding IADL were associated with fewer natural and implant teeth, suggesting that maintaining and managing the number of teeth is critical to promoting the health of middle-aged and older adults.