A randomised controlled trial of a smartphone application for improving oral hygiene

A Correction to this article was published on 24 January 2020

This article has been updated


Aim The study aimed to test the effectiveness and acceptability of a smartphone application used in conjunction with a movement sensor toothbrushing attachment for promoting plaque control.

Method One hundred and eight dental practice patients were recruited to the study from two general dental practices. Participants were randomised to test and control groups, and both groups offered oral hygiene instruction according to a single protocol. Test participants were given the smartphone device and toothbrush attachment. Control patients were not. After two and four weeks, full mouth plaque scores of the mouths of both test and control participants were measured. A comprehensive questionnaire administered to the test group assessed participants' views about the acceptability of the smartphone device and application.

Results Full mouth plaque scores declined from 40.1 to 11.7, a reduction of 70% in the test group compared to a reduction from 29.1 to 20.5 (30%) in the control group. The device was found to be very well accepted. Participants were conscious of improving their brushing and improving their knowledge of how to brush well. They also reported enjoyment and fun being derived from use of the device and found it simple to use.

Conclusion Providing immediate day-to-day feedback to dental patients about their brushing results in dramatic improvements in oral hygiene and highly significant reductions in plaque levels, in at least the short-term; beyond that seen in previous toothbrushing interventions with adult patients.

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Change history

  • 24 January 2020

    Author's correction note: The authors here provide a note to further explain some sections of the paper that may have caused confusion. A decision was made that as this was a trial to compare the effectiveness of two interventions (oral health advice, with and without the Brushlink device) in pro...


  1. 1.

    Kressin N R, Boetimar V, Nunn M E, Spiro A 3rd. Increased preventive practices lead to greater tooth retention. J Dent Res 2003; 82: 223-227.

  2. 2.

    Al-Shammar K F, Al khabbaz A K, Al-Ansari J M, Neiva R, Wang H L. Risk indicators for tooth loss due to periodontal disease.J Periodontol 2005; 76: 1910-1918.

  3. 3.

    Axelsson P, Nystrom B, Lindhe J. The long-term effect of a plaque control program on tooth mortality, caries and periodontal disease in adults. Results after 30 years of maintenance.J Clin Periodontol 2004; 31: 749-757.

  4. 4.

    van der Weijden F, Slot D E. Oral hygiene in the prevention of periodontal diseases: the evidence.Periodontology 2000 2011; 55: 104-123.

  5. 5.

    Walsh T, Worthington H V, Glenny A M, Appelbe P, Marinho V, Shi X. Flouride toothpastes of different concentrations for preventing dental caries in children and adolescents.Cochrane Database Syst Rev 2010; 20: CD007868.

  6. 6.

    dos Santos A P, Nadanovsky P, de Oliviera B H. A systematic review and meta-analysis of the effects of fluoride toothpastes on the prevention of dental caries in the primary dentition of preschool children.Community Dent Oral Epidemiol 2013; 41: 1-12.

  7. 7.

    Godin G, Kok G. The theory of planned behaviour: a review of its applications to health-related behaviours.Am J Health Promot 1996; 11: 87-98.

  8. 8.

    Public Health England. Delivering better oral health: an evidence based toolkit. 2014. Available at https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-preventiona (accessed March 2019).

  9. 9.

    National Institute for Clinical and Healthcare Excellence. Oral Health: local authority and partners: public health guideline [PH55]. 2014. Available at https://www.nice.org.uk/guidance/ph55 (accessed March 2019).

  10. 10.

    National institute for Clinical and Healthcare Excellence. Oral health promotion: general dental practice. NICE guideline [NG30]. 2015. Available at https://www.nice.org.uk/guidance/ng30 (accessed March 2019).

  11. 11.

    Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 1977; 84: 191-215.

  12. 12.

    Tedesco L A, Keffer M A, Fleck-Kandath C. Self-efficacy, reasoned action, and oral health behaviour reports: a social cognitive approach to complianceJ Behav Med 1991; 14: 341-355.

  13. 13.

    Anagnostopoulos F, Buchanan H, Frousiounioti S, Niakas D, Potamianos G. Self-efficacy and oral hygiene beliefs about toothbrusing in dental patients a model-guided study.Behav Med 2011; 37: 132-139.

  14. 14.

    Miller W R, Rollnick S. Motivational Interviewing: Preparing People for Change. New York: Guildford Press, 2002.

  15. 15.

    Rollnick S, Miller W R. What is motivational interviewing. Behav Cogn Psychother 1995; 23: 325-334.

  16. 16.

    Zimmerman M A. Resistency theory: a strengths-based approach to research and practice for adolescent health.Health Educ Behav 2013; 40: 381-383.

  17. 17.

    Payne H E, Lister C, West J H, Bernhardt J M. Behavioural functionality of mobile apps in heath interventions: a systematic review of the literature.JMIR Mhealth Uhealth 2015; 3: e20.

  18. 18.

    Kay E J, Locker D. Is dental health education effective? A systematic review of current evidence.Community Dent Oral Epidemiol 1996; 24: 231-235.

  19. 19.

    Kay E, Vascott D, Hocking A, Nield H, Dorr C, Barrett H. A review of approaches for dental practice teams for promoting health.Community Dent Oral Epidemiol 2016; 44: 313-330.

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Conflict of interests

Elizabeth Kay is a member of the Brushlink Scientific Committee but has no financial or commercial connection with, or interest in, the company.

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Correspondence to Elizabeth Kay.

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Kay, E., Shou, L. A randomised controlled trial of a smartphone application for improving oral hygiene. Br Dent J 226, 508–511 (2019). https://doi.org/10.1038/s41415-019-0202-1

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