Smartphone-Based Telemonitoring for Better Oral Health With Toothbrushes: 6-Month Randomized Controlled Trial
Authors: Kim Jaeyeon , Choi Yiseul , Song Yoolbin , Park Wonse 
Published: December 2024

Background
A toothbrush device that telemonitors toothbrushing is a technologically advanced solution providing personalized feedback on toothbrushing habits and oral hygiene. These devices integrate smartphone apps to enhance oral health compliance through dental professional feedback.

Objective
This 6-month prospective randomized controlled trial aimed to compare the clinical effectiveness, defined as improved oral hygiene measured by plaque reduction and halitosis control, of an interactive telemonitoring toothbrush (ITT), an oscillating-rotating power toothbrush (ORT), and a manual toothbrush (MT).

Methods
Participants were recruited offline from the Department of Advanced General Dentistry at Yonsei University Dental Hospital, South Korea. A total of 150 participants were randomly assigned to 3 groups (50 participants each): (1) an ITT connected to a smartphone app providing real-time feedback and weekly dental professional reviews, (2) an ORT with smartphone-based guidance requiring participants to send weekly brushing records via screenshots, and (3) an MT with a brushing diary for review. Data collection occurred in clinical settings. Primary outcomes included plaque reduction measured using the Simple Hygiene Score (SHS), while secondary outcomes included plaque reduction measured using the Turesky modification of the Quigley-Hein plaque index (QHI), reductions in halitosis, and changes in oral microbiota. All outcomes were assessed at baseline and 1 month, 3 months, and 6 months.

Results
A total of 150 participants completed the study. Over 6 months, the SHS increased in the MT group (mean 3.16, SD 4.86 to mean 5.66, SD 5.20) but significantly decreased in the ITT group (mean 3.47, SD 5.50 to mean 2.27, SD 3.82; P=.004). Similarly, QHI decreased more in the ITT group (mean 1.79, SD 0.72 to mean 0.85, SD 0.63) than in the ORT (P<.001) and MT (P<.001) groups. Regarding microbiota, there were no significant differences in high-risk periodontal microbiota or the ratio of caries-risk to anticaries microbiota between the ITT and ORT groups. However, in the MT group, the ratio of caries-risk microbiota was significantly higher at the 3-month (P<.001) and 6-month (P=.005) recalls than at baseline and at the 3-month (P=.048) and 6-month (P=.03) recalls than at the 1-month recall. Poststudy questionnaires indicated that 45 of 50 ITT participants (92%) and 37 of 50 ORT participants (76%) reported improved brushing ability. The most effective feature in the ITT group was brushing training, while participants in the ORT group cited the brushing guide as most useful (P<.001). Satisfaction scores were higher in the ORT group (mean 7.90, SD 1.21) than in the ITT group (mean 7.15, SD 1.66; P=.004). The number of brushing events decreased significantly in the ORT group (P=.02), while brushing duration increased in the MT group (P=.01).

Conclusions
ITTs enable better oral hygiene management than MTs through dental professional feedback. However, further studies are needed to optimize feedback intervals and improve long-term adherence.

Trial Registration
Clinical Research Information Service (CRIS), Republic of Korea, KCT0009094; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=26110&search_page=L