Smartphone application-assisted oral hygiene of orthodontic patients: a multicentre randomized controlled trial in adolescents

Objective: The aim of this trial was to test whether the use of a smartphone application (app)
connected to a toothbrush improves the oral hygiene compliance of adolescent orthodontic
patients.
Design: The study was designed as a multicentre, randomized, controlled clinical trial.
Setting: Two academic hospitals.
Ethical approval: The study was approved by the ethics committee.
Subjects and methods: This multicentre randomized controlled trial was conducted on 38
adolescents aged 12–18 years with full-fixed orthodontic appliances. Participants were randomly
assigned either to a test group that used an interactive oscillating/rotating electric toothbrush
connected to a brushing aid app or to a control group that used an oscillating/rotating electric
toothbrush alone. At baseline, all patients received verbal and written oral hygiene instructions.
Outcome measurements: Data collection was performed at T1 (baseline), T2 (6 weeks), T3 (12
weeks) and T4 (18 weeks—end of the study). At each time point, the plaque index (PI), gingival
index (GI) and white spot lesion (WSL) score were recorded. Several app-related parameters were
evaluated. Patient-related outcome measures were investigated in the test group.
Results: Test and control groups were similar at baseline except for WSL score. Between T1 and
T4, PI and GI decreased significantly in both groups but evolutions were globally similar in both
groups. Interestingly, at T3 (12 weeks), the PI was significantly lower in the app group than in the
control group (P = 0.014). Data showed a marked decline in the use of the app over time in the test
group.
Conclusions: This trial, conducted over 18 weeks in two academic hospitals, showed no significant
effect of the use of the app in promoting oral hygiene.