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Toothbrushing compliance tracking in a nursing home setting using telemonitoring-enabled powered toothbrushes


Introduction Nursing home residents with cognitive and physical disabilities often depend on assistance from caregivers to perform personal hygiene tasks including toothbrushing. Only a minority receives the care needed and toothbrushing compliance levels are not registered.

Aims To describe toothbrushing compliance levels in a nursing home setting and investigate the relevance and practicality of using telemonitoring-enabled powered toothbrushes for automated compliance tracking. Furthermore, to investigate changes in plaque and bleeding scores.

Materials and methods Nursing home residents were provided with powered toothbrushes and telemonitoring gateways. Toothbrushing frequency and duration were automatically recorded by the telemonitoring gateways, and an email report was sent once a week to the nursing home manager. Plaque index and bleeding index were assessed by dentists at baseline, at the end of the intervention and at three months post-intervention.

Results Data from 20 participants for 100 days (3,920 measurements) were collected and used to evaluate toothbrushing compliance. A minority of toothbrushings (5%) were in compliance with the two-minute toothbrushing duration recommendation, while around 30% achieved the one-minute toothbrushing minimum duration recommendation. Around 25% of participants would get only one toothbrushing per day, while 40% would get none. Both plaque and bleeding scores improved significantly during the project, but all progress was lost three months after the project's end.

Conclusions It is relevant and practical to monitor toothbrushing compliance in the nursing home setting using telemonitoring-enabled powered toothbrushes. Despite finding limited compliance levels, a significant improvement in the plaque and bleeding index was found after the intervention, which was lost again three months after the telemonitoring gateways had been removed.

Key points

  • In a typical Danish public nursing home setting, toothbrushing levels were generally found to be suboptimal for the majority of the residents.

  • After introducing telemonitoring-enabled powered toothbrushes, plaque and bleeding scores improved significantly, but improvements were lost three months after the study.

  • It is relevant and practical to automatically measure the compliance level of daily toothbrushing activities in the nursing home setting using telemonitoring-enabled powered toothbrushes.

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We would like to thank the participating nursing home residents and the caregiving and management staff. Also, we would like to acknowledge Aliviate Development, Denmark for lending us 20 CARIOT telehealth gateways including a LoraWAN gateway for the project, free of charge.

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Correspondence to Stefan Rahr Wagner.

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Wagner, S., Eriksen, C., Hede, B. et al. Toothbrushing compliance tracking in a nursing home setting using telemonitoring-enabled powered toothbrushes. Br Dent J (2021).

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