Effect of Pre-treatment Photographs on Oral Hygiene Maintenance in Orthodontic Patients
Condition: Oral Hygiene; Photographs
Study type: Interventional

Summary: 
      Dental photography is an essential component of orthodontic treatment. Photographs enable the
      clinician to keep record of different stages of treatment. Other uses are for treatment
      planning, communicating with the patients and other specialists, comparison of pre-treatment
      and post-treatment changes, for research purpose and also for patient's motivation. Images
      captured before, during and after treatment provide legal protection when necessary. In the
      orthodontic discipline, at least three extra-oral and five intra-oral photographs are
      recommended. Extra-oral photographs should correctly reflect patient's appearance and
      intra-oral photographs should show complete dentition and occlusion.

      Oral hygiene is controlled by the patient during orthodontic treatment which requires proper
      motivation. Motivational methods are classified as chair-side education, message reminders,
      behavioral modification and Hawthorne effect. Patients' motivation plays an important role in
      maintaining favorable oral hygiene. A number of studies have shown the effect of motivational
      methods on oral hygiene improvement. In one of these studies, 80 patients who needed
      orthodontic treatment were selected and randomly distributed into two equal groups as control
      group and study group. The study group patients were included in a Whatsapp where they shared
      their own photographs (selfies) and received text messages, while the control group patients
      were not included in any Whatsapp group. Baseline PI scoring was 0.48(0.34) in control group
      and 0.41(0.32) in study group, After 3 months PI scoring was 1.72(0.33) in control group and
      1.68(0.40) in study group. Results showed that sharing of selfies improves oral hygiene
      compliance in Orthodontic patients.

      The purpose of this study was to determine probable effect of pre-treatment photographs on
      oral hygiene maintenance in orthodontic patients. To our knowledge no such study has been
      done previously. This would help us in making patients understand the importance of oral
      hygiene maintenance. The results will also be used by other practitioners.
    

Detailed description: 
      Randomized Controlled Trial Design:

        1. Participants:

           Orthodontic patients.

        2. Intervention:

           Patients' own pre-treatment dental photographs.

        3. Study group:

           Orthodontic patients who are shown dental photographs.

        4. Comparison group:

           Orthodontic patients who are not shown dental photographs.

        5. Outcome:

           Good oral hygiene measured by plaque index.

        6. Block randomization:

           To decrease selection or accidental bias patients were assigned group A or B using block
           randomization technique. Blocks were created, size of each block was 4 with 2 'A's and 2
           'B's. For 2 groups there were 6 possible blocks. From random number table a random
           sequence of blocks was generated. Patients were then assigned groups according to
           blocks.

        7. Subjects:

      I. Group 1:

      Included 30 patients and these patients were shown full extra-oral and intra-oral
      photographs.

      II. Group 2:

      Included 30 patients and these patients were not shown any photographs. All subjects received
      similar oral hygiene instructions. Those in group A were shown their photographs while those
      in B were not shown any photographs.
    

Intervention name(s): Showing Pre-treatment photographs of the patient
Intervention type(s): Device
Intervention description(s): Extra-oral and intra-oral dental photographs of patients were taken before starting Orthodontic treatment. Experimental group were shown their photographs while control group were not shown their photographs.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Prevention
Keywords: Oral hygiene; Photographs; Dental; Orthodontics; Periodontitis; Gingivitis; Index