A Randomized Controlled Trial: Effectiveness of Smartphone Applications as a Reminder for Improving Oral Hygiene Compliance in Patients Undergoing Orthodontic Treatment

Maintaining optimal oral hygiene during orthodontic treatment is critical to preventing plaque accumulation, gingivitis, and other periodontal complications. Mobile applications have emerged as potential tools to promote oral hygiene compliance. This Randomized Controlled Trial (RCT) aimed to investigate the effectiveness of a mobile application–based intervention in improving oral hygiene compliance among patients undergoing fixed orthodontic treatment.

A parallel randomized controlled trial with a 1:1 allocation ratio was conducted among 60 orthodontic patients at Umm Al-Qura University. Participants were randomly allocated into two groups: a control group (n=30) receiving standard oral hygiene instructions, and an intervention group (n=30) receiving the same instructions plus reminders via two smartphone applications: Brushout and Brush teeth reminder. Plaque Index (PI) and Gingival Index (GI) were measured at baseline and after four weeks for both groups. This trial was retrospectively registered on a public online clinical trials registry (www.clinicaltrials.gov) with registration number (NCT06811688), dated 5^th February 2025.

Both groups exhibited significant reductions in PI and GI scores after 4 weeks. In the control group, the baseline median PI and GI were 0.42 and 0.27, respectively, while at follow-up, the median PI and GI were 0.25 and 0.1, respectively. For the intervention group, the baseline median PI and GI were 0.43 and 0.25, respectively, while at follow-up, the median PI and GI were 0.2 and 0.08, respectively. However, no significant difference was observed between the intervention and control groups in terms of PI (p = 0.86) and GI (p = 0.38) at follow-up.

The findings of the current study contradict previous studies that reported the effectiveness of smartphone applications in improving oral hygiene compliance among orthodontic patients. This discrepancy may be related to several factors, such as user engagement with the application, readiness for behavior change, sample size, follow-up duration, geographical location, and cultural factors. Future research should consider including a larger and more diverse sample, extending the follow-up period, and using applications with interactive elements to better support behavior change.

While both mobile applications and standard verbal instructions improved oral hygiene, using smartphone reminder applications did not lead to better outcomes. Recommendations for future studies include extending the follow-up period and enhancing application features.