The Effect of Using a Mobile Application ("WhiteTeeth") on Improving Oral Hygiene: A Randomized Controlled Trial

Overview

Journal Int J Dent Hyg

Specialty Dentistry

Date 2019 Jul 11

PMID 31291683

Citations 37

Authors

Janneke F M Scheerman

Berno van Meijel

Pepijn van Empelen

Gijsbert H W Verrips

Cor van Loveren

Jos W R Twisk

Amir H Pakpour

Matheus C T van den Braak

Gem J C Kramer

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

Smartphone-Based Telemonitoring for Better Oral Health With Toothbrushes: 6-Month Randomized Controlled Trial.

Kim J, Choi Y, Song Y, Park W J Med Internet Res. 2025; 27:e65128.

PMID: 39928944 PMC: 11851029. DOI: 10.2196/65128.

Development of Chatbot-Based Oral Health Care for Young Children and Evaluation of its Effectiveness, Usability, and Acceptability: Mixed Methods Study.

Pupong K, Hunsrisakhun J, Pithpornchaiyakul S, Naorungroj S JMIR Pediatr Parent. 2025; 8:e62738.

PMID: 39899732 PMC: 11809939. DOI: 10.2196/62738.

A short-term evaluation of oral hygiene education methods in fixed orthodontics patients: a randomized clinical trial comparing assistant training, software, and social media.

Shafaee H, Saeedi S, Bardideh E, Ghorbani M, Saeedi P BMC Oral Health. 2024; 24(1):1266.

PMID: 39443943 PMC: 11515671. DOI: 10.1186/s12903-024-05014-x.

SmilesUp text message intervention for early childhood dental caries prevention: A protocol for a randomised controlled trial.

Chen R, Irving M, Christian B, Prabhu N, Kumar H, Sohn W PLoS One. 2024; 19(9):e0310561.

PMID: 39348422 PMC: 11441676. DOI: 10.1371/journal.pone.0310561.

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

Nzabonimana E, Malele-Kolisa Y, Hlongwa P Clin Cosmet Investig Dent. 2024; 16:359-369.

PMID: 39323577 PMC: 11423828. DOI: 10.2147/CCIDE.S481599.

References

Garnett C, Crane D, West R, Brown J, Michie S . Identification of Behavior Change Techniques and Engagement Strategies to Design a Smartphone App to Reduce Alcohol Consumption Using a Formal Consensus Method. JMIR Mhealth Uhealth. 2015; 3(2):e73. PMC: 4526967. DOI: 10.2196/mhealth.3895. View

Cozzani M, Ragazzini G, Delucchi A, Mutinelli S, Barreca C, Rinchuse D . Oral hygiene compliance in orthodontic patients: a randomized controlled study on the effects of a post-treatment communication. Prog Orthod. 2016; 17(1):41. PMC: 5165014. DOI: 10.1186/s40510-016-0154-9. View

Rosenbloom R, Tinanoff N . Salivary Streptococcus mutans levels in patients before, during, and after orthodontic treatment. Am J Orthod Dentofacial Orthop. 1991; 100(1):35-7. DOI: 10.1016/0889-5406(91)70046-Y. View

Scheerman J, van Meijel B, van Empelen P, Verrips G, van Loveren C, Twisk J . The effect of using a mobile application ("WhiteTeeth") on improving oral hygiene: A randomized controlled trial. Int J Dent Hyg. 2019; 18(1):73-83. PMC: 7004072. DOI: 10.1111/idh.12415. View

Lara-Carrillo E, Montiel-Bastida N, Sanchez-Perez L, Alanis-Tavira J . Effect of orthodontic treatment on saliva, plaque and the levels of Streptococcus mutans and Lactobacillus. Med Oral Patol Oral Cir Bucal. 2010; 15(6):e924-9. DOI: 10.4317/medoral.15.e924. View

Lin C, Scheerman J, Yaseri M, Pakpour A, Webb T . A cluster randomised controlled trial of an intervention based on the Health Action Process Approach for increasing fruit and vegetable consumption in Iranian adolescents. Psychol Health. 2017; 32(12):1449-1468. DOI: 10.1080/08870446.2017.1341516. View

Toniazzo M, Nodari D, Muniz F, Weidlich P . Effect of mHealth in improving oral hygiene: A systematic review with meta-analysis. J Clin Periodontol. 2019; 46(3):297-309. DOI: 10.1111/jcpe.13083. View

OReilly M, Featherstone J . Demineralization and remineralization around orthodontic appliances: an in vivo study. Am J Orthod Dentofacial Orthop. 1987; 92(1):33-40. DOI: 10.1016/0889-5406(87)90293-9. View

Kok G, Gottlieb N, Peters G, Mullen P, Parcel G, Ruiter R . A taxonomy of behaviour change methods: an Intervention Mapping approach. Health Psychol Rev. 2015; 10(3):297-312. PMC: 4975080. DOI: 10.1080/17437199.2015.1077155. View

10.

Michie S, Abraham C, Whittington C, McAteer J, Gupta S . Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychol. 2009; 28(6):690-701. DOI: 10.1037/a0016136. View

11.

Schulz K, Altman D, Moher D . CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials. J Pharmacol Pharmacother. 2011; 1(2):100-7. PMC: 3043330. DOI: 10.4103/0976-500X.72352. View

12.

Acharya S, Goyal A, Utreja A, Mohanty U . Effect of three different motivational techniques on oral hygiene and gingival health of patients undergoing multibracketed orthodontics. Angle Orthod. 2011; 81(5):884-8. PMC: 8916188. DOI: 10.2319/112210-680.1. View

13.

Dusseldorp E, van Genugten L, van Buuren S, Verheijden M, van Empelen P . Combinations of techniques that effectively change health behavior: evidence from Meta-CART analysis. Health Psychol. 2013; 33(12):1530-40. DOI: 10.1037/hea0000018. View

14.

Al-Anezi S, Harradine N . Quantifying plaque during orthodontic treatment:. Angle Orthod. 2011; 82(4):748-53. PMC: 8845533. DOI: 10.2319/050111-312.1. View

15.

Zotti F, Dalessandri D, Salgarello S, Piancino M, Bonetti S, Visconti L . Usefulness of an app in improving oral hygiene compliance in adolescent orthodontic patients. Angle Orthod. 2015; 86(1):101-7. PMC: 8603968. DOI: 10.2319/010915-19.1. View

16.

Scheerman J, van Empelen P, van Loveren C, Pakpour A, van Meijel B, Gholami M . An application of the Health Action Process Approach model to oral hygiene behaviour and dental plaque in adolescents with fixed orthodontic appliances. Int J Paediatr Dent. 2017; 27(6):486-495. DOI: 10.1111/ipd.12287. View

17.

Tavakol M, Dennick R . Making sense of Cronbach's alpha. Int J Med Educ. 2016; 2:53-55. PMC: 4205511. DOI: 10.5116/ijme.4dfb.8dfd. View

18.

Scheerman J, van Empelen P, van Loveren C, van Meijel B . A Mobile App (WhiteTeeth) to Promote Good Oral Health Behavior Among Dutch Adolescents with Fixed Orthodontic Appliances: Intervention Mapping Approach. JMIR Mhealth Uhealth. 2018; 6(8):e163. PMC: 6119215. DOI: 10.2196/mhealth.9626. View

19.

Alkadhi O, Zahid M, Almanea R, Althaqeb H, Alharbi T, Ajwa N . The effect of using mobile applications for improving oral hygiene in patients with orthodontic fixed appliances: a randomised controlled trial. J Orthod. 2017; 44(3):157-163. DOI: 10.1080/14653125.2017.1346746. View

20.

Boyd R . Longitudinal evaluation of a system for self-monitoring plaque control effectiveness in orthodontic patients. J Clin Periodontol. 1983; 10(4):380-8. DOI: 10.1111/j.1600-051x.1983.tb01287.x. View