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A systematic review to assess interventions delivered by mobile phones in improving adherence to oral hygiene advice for children and adolescents


Background Mobile phones are potentially an invaluable tool in addressing the global challenge associated with dental caries as they may elicit behaviour change by incorporating numerous behaviour change techniques (BCTs) to address an individual's capability, opportunity and motivation.

Methods The methodology for this review is published on the PROSPERO database (CRD42017078414).

Results Two randomised controlled trials were included, both were undertaken with orthodontic patients and both reported significantly reduced plaque scores in the intervention group compared with the control at final follow-up. One study also reported statistically significantly lower gingival bleeding scores and caries in the intervention group at final follow-up. The risk of bias was 'unclear' for both studies and neither study intervention appeared to be based on specific theories of behaviour change. Of 93 BCTs available, only six were utilised across the two trials. The overall strength of evidence for the effectiveness of mobile phones in reducing plaque score was rated as moderate using GRADE, while the effectiveness in reducing bleeding scores was considered to be high.

Conclusion There is some evidence that mobile phones are effective in improving adherence to oral hygiene advice in orthodontic patients. The generalisability of this review is limited due to the small number of trials and the unclear risk of bias of included studies.

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  1. 1.

    Petersen P E. The World Oral Health Report 2003: continuous improvement of oral health in the 21st century - the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2003; 31 (Spec Iss): 3-23.

  2. 2.

    Pitts N, Chadwick B, Anderson T. Children's Dental Health Survey 2013. Report 2: Dental Disease and Damage in Children: England, Wales and Northern Ireland. 2015. Available at (accessed July 2019).

  3. 3.

    NHS Digital. Hospital Admitted Patient Care Activity, 2016-17. 2017. Available at (accessed July 2019).

  4. 4.

    Almeida A G, Roseman M M, Sheff M, Huntington N, Hughes C V. Future caries susceptibility in children with early childhood caries following treatment under general anaesthesia. Pediatr Dent 2000; 22: 302-306.

  5. 5.

    Thomson W M. Day-stay treatment for dental caries at a New Zealand hospital dental unit: a 5-year retrospective audit. N Z Dent J 1994; 90: 139-142.

  6. 6.

    Haworth S, Dudding T, Waylen A, Thomas S J, Timpson N J. Ten years on: Is dental general anaesthesia in childhood a risk factor for caries and anxiety? Br Dent J 2017; 222: 299-304.

  7. 7.

    Royal College of Surgeons of England. Actions for the government to improve oral health. 2015. Available at (accessed July 2019).

  8. 8.

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

  9. 9.

    Michie S, van Stralen M M, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci 2011; 6: 42.

  10. 10.

    Webb T L, Joseph J, Yardley L, Michie S. Using the internet to promote health behaviour change: a systematic review and meta-analysis of the impact of theoretical basis, use of behaviour change techniques, and mode of delivery on efficacy. J Med Internet Res 2010; 12: e4.

  11. 11.

    Michie S, Johnston M. Behaviour change techniques. In Gellman M D, Turner J R (eds) Encyclopaedia of Behavioral Medicine. pp 182-186. New York: Springer, 2013.

  12. 12.

    Michie S, Richardson M, Johnston M et al. The behaviour change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behaviour change interventions. Ann Behav Med 2013; 46: 81-95.

  13. 13.

    Kornstein S. The Rise of Mobile Phones: 20 Years of Global Adoption. 2015. Available at (accessed July 2019).

  14. 14.

    Mohammed H, Rizk M Z, Wafaie K, Ulhaq A, Almuzian M. Reminders improve oral hygiene and adherence to appointments in orthodontic patients: a systematic review and meta-analysis. Eur J Orthod 2019; 41: 204-213.

  15. 15.

    Lima I F P, de Andrade Vieira W, de Macedo Bernardino I et al. Influence of reminder therapy for controlling bacterial plaque in patients undergoing orthodontic treatment: A systematic review and meta-analysis. Angle Orthod 2018; 88: 483-493.

  16. 16.

    Bowen T B, Rinchuse D J, Zullo T, DeMaria M E. The influence of text messaging on oral hygiene effectiveness. Angle Orthod 2015; 85: 543-548.

  17. 17.

    Zotti F, Dalessandri D, Salgarello S et al. Usefulness of an app in improving oral hygiene compliance in adolescent orthodontic patients. Angle Orthod 2016; 86: 101-107.

  18. 18.

    Binkley C, Garrett B, Johnson K W. Increasing dental care utilization by Medicaid-eligible children: a dental care coordinator intervention. J Public Health Dent 2010; 70: 76-84.

  19. 19.

    Eppright M, Shroff B, Best A M, Barcoma E, Lindauer S J. Influence of active reminders on oral hygiene compliance in orthodontic patients. Angle Orthod 2014; 84: 208-213.

  20. 20.

    Brukienė V, Aleksejunien J. Is the authoritative parenting model effective in changing oral hygiene behaviour in adolescents? Health Educ Res 2012; 27: 1081-1090.

  21. 21.

    Vangipuram S, Jha A, Raju R, Bashyam M. Effectiveness of peer group and conventional method (Dentist) of oral health education programme among 12-15 year old school children - A randomized controlled trial. J Clin Diagn Res 2016; 10: ZC125-ZC129.

  22. 22.

    de Farias I A, de Araujo Souza G C, Ferreira M A. A health education programme for Brazilian public schoolchildren: the effects on dental health practice and oral health awareness. J Public Health Dent 2009; 69: 225-230.

  23. 23.

    Li X, Xu Z R, Tang N et al. Effect of intervention using a messaging app on compliance and duration of treatment in orthodontic patients. Clin Oral Investig 2016; 20: 1849-1859.

  24. 24.

    Cozzani M, Ragazzini G, Delucchi A et al. Oral hygiene compliance in orthodontic patients: a randomized controlled study on the effects of a post-treatment communication. Prog Orthod 2016; 17: 41.

  25. 25.

    Scheerman J F M, van Meijel B, van Empelen P et al. Study protocol of a randomized controlled trial to test the effect of a smartphone application on oral-health behaviour and oral hygiene in adolescents with fixed orthodontic appliances. BMC Oral Health 2018; 18: 19.

  26. 26.

    Higgins J P, Green S. Cochrane Handbook for Systematic Reviews of Interventions version 5.1. 2011. Available at (accessed July 2019).

  27. 27.

    Guyatt G H, Oxman A D, Vist G E et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008; 336: 924-926.

  28. 28.

    Mohammed H, Rizk M Z, Wafaie K, Ulhaq A, Almuzian M. Reminders improve oral hygiene and adherence to appointments in orthodontic patients: a systematic review and meta-analysis. Eur J Orthod 2019; 41: 204-213.

  29. 29.

    Parker K, Bharmal R V. Sharif M O. The availability and characteristics of patient focused oral hygiene apps. Br Dent J 2019; 226: 600-604.

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Acknowledgements and Authors contributions


The authors would like to thank Helen Nield, BDA Head of Library and Knowledge Services for her expert advice in the conduct of searches for this review.

Authors contributions

MOS, TN and SJC conceived the study, assisted in its design and developed the original protocol, conducted the review and developed this manuscript. The guarantor of the review is MOS.

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Corresponding author

Correspondence to Mohammad Owaise Sharif.

Ethics declarations

Mohammad Owaise Sharif was awarded the Royal College of Surgeons of England Faculty of Dental Surgery 70th Anniversary Research Fellowship. This funding has supported this project.

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Sharif, M., Newton, T. & Cunningham, S. A systematic review to assess interventions delivered by mobile phones in improving adherence to oral hygiene advice for children and adolescents. Br Dent J 227, 375–382 (2019).

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