Incentives for Daily Tooth Brushing to Reduce Gingivitis

Study Overview
=================
Brief Summary
-----------------
In this randomized controlled study, the investigators compare two classes of behavioral approaches to change habits and health outcomes with an application to dental health: cognitive vs. behavioral financial incentives. Under cognitive incentives subjects are paid to correctly answer health-related quizzes. Under behavioral incentives subjects earn money for making healthy choices. The investigators apply these incentives to toothbrushing, a daily health-related behavior critical to the prevention of dental caries and periodontal disease, two high-burden conditions among US adults.

Conditions
-----------------
Gingivitis

Intervention / Treatment
-----------------
* Behavioral: Financial Incentives
* Behavioral: Cognitive Incentives
* Behavioral: Financial and Cognitive Incentives


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Male or female older than 18 years, with at least 10 teeth present. Exclusion Criteria: Pregnancy, uncontrolled diabetes, systemic antibiotics taken within the previous 2 months, need for referral for periodontal treatment.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control<br>36 Participants will be sent a new toothbrush and will be asked to use it in place of their current brush. They also receive twice daily reminders via sms to brush their teeth. | |
| Experimental: Financial Incentives<br>36 Participants will receive a toothbrush and twice daily reminders to brush their teeth. They will also be offered financial incentives twice a day to brush their teeth. | Behavioral: Financial Incentives<br> <br> |
| Experimental: Cognitive Incentives<br>36 Participants will receive a toothbrush and twice daily reminders to brush their teeth. Twice a week, they will receive text messages (SMS) with a short quiz question related to oral hygiene behavior and oral health. Participants will receive a reward if they answer correctly via text message. | Behavioral: Cognitive Incentives<br> <br> |
| Experimental: Financial and Cognitive Incentives<br>36 Participants will receive a toothbrush and twice daily reminders to brush their teeth. Twice daily they receive financial incentives to brush their teeth. Twice a week, they will receive text messages (SMS) with a short quiz question related to oral hygiene behavior and oral health. Participants will receive a reward if they answer correctly via text message. | Behavioral: Financial and Cognitive Incentives<br> <br> |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Follow-up Gingival Index |  | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Frequency and duration of toothbrushing |  | 3 months | 
| End of treatment Gingival Index | Gingival Index at the end of behavioral incentives | 3 months |