Oral Hygiene Reminders in Orthodontic Patients

Study Overview
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Brief Summary
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Objective: To determine the effect of WhatsApp and Email reminders on oral hygiene compliance of orthodontic patients. Methods: A Randomized, parallel group, double blinded study was conducted on 54 patients undergoing orthodontic treatment at MAHSA University. They were randomized to 3 groups, namely WhatsApp (W) group, Email (E) group and Control (C) group with 18 subjects in each group. Group (W) and Group (E) received oral health messages once a week through WhatsApp and E-mail reminders respectively, while Group (C) did not receive any reminders. Plaque was measured at baseline (T0), after 4 weeks (T1), and after 8 weeks (T2). For each subject, two intraoral photographs were taken after application of plaque disclosing agent; and the area covered by plaque was measured on 12, 13, 43, 22, 23 and 33 teeth by planimetry.

Detailed Description
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Fifty-four patients undergoing orthodontic treatment were recruited from the dental clinic of MAHSA University between Jan 2018 to April 2018. Voluntary written informed consent was obtained from all the subjects before the start of the study. They were randomly assigned into 3 groups namely WhatsApp (W) group, Email (E) group and Control (C) group with 18 subjects in each group. Oral hygiene messages through WhatsApp and Email were sent once a week for 8 weeks.

Official Title
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Influence of WhatsApp and Electronic Mail Reminders on Oral Hygiene Compliance of Orthodontic Patients Using Planimetry

Conditions
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Compliance, Treatment

Intervention / Treatment
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* Behavioral: WhatsApp reminder
* Behavioral: Email reminder
* Behavioral: Control


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients having fixed maxillary and mandibular orthodontic appliances with 0.022 AO conventional metal brackets, Aged ≥ 15 years, Undergone 3 months of orthodontic treatment, No significant medical or dental history Have access to cellular telephone and are online daily Exclusion Criteria: Patients undergoing single arch treatment Missing maxillary lateral incisor, maxillary canine and mandibular canine Patients' orthodontic treatment duration < 3 months and > 4 months.

Ages Eligible for Study
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Minimum Age: 15 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: WhatsApp<br>WhatsApp reminders | Behavioral: WhatsApp reminder<br>* The WhatsApp group received oral health messages once a week for four weeks (totaling 4 messages) as a reminder to practice good oral hygiene The reminder included an image reminding them to maintain their oral hygiene.<br>* Other names: Reminders;|
| Experimental: Email<br>Email reminders | Behavioral: Email reminder<br>* The Email group received oral health messages once a week for four weeks (totaling 4 messages) as a reminder to practice good oral hygiene The reminder included an image reminding them to maintain their oral hygiene.<br>* Other names: Reminder;|
| Other: Control<br>No reminder | Behavioral: Control<br>* No messages sent.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in plaque from baseline to 4 weeks | Plaque disclosing solution was applied to the pre-selected teeth (12,13,43, 22, 23, 33) followed by measurement of plaque using planimetry. All photographs were taken using a Canon Electro-Optical System (EOS) 550D (camera specifications). Plaque was analyzed using Image J software. Change in plaque score is assessed from baseline to 4 weeks in all the three groups. In the photo, region of interest targeted by the study was manually outlined using Polygon selection tool, the total pixel present in this region is calculated by tracing tool. The pixel of the plaque area is determined by adjusting the color threshold to desirable range of value. The plaque sore was calculated in the form of percent covering tooth structure and the value of plaque on each tooth was determined and mean plaque was calculated. | baseline (T0) to end of 4 weeks (T1) | 
| Change in plaque from baseline to 8 weeks | Plaque disclosing solution was applied to the pre-selected teeth (12,13,43, 22, 23, 33) followed by measurement of plaque using planimetry. All photographs were taken using a Canon EOS 550D (camera specifications). Plaque was analyzed using Image J software. Change in plaque score is assessed from baseline to 8 weeks in all the three groups. In the photo, region of interest targeted by the study was manually outlined using Polygon selection tool, the total pixel present in this region is calculated by tracing tool. The pixel of the plaque area is determined by adjusting the color threshold to desirable range of value. The plaque sore was calculated in the form of percent covering tooth structure and the value of plaque on each tooth was determined and mean plaque was calculated. | Baseline (T0) to end of 8 weeks (T2) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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WhatsApp, Email, Oral hygiene, Compliance, Orthodontics, Planimetry, Reminders