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Randomized Controlled Trial
. 2025 Dec 12;26(1):113.
doi: 10.1186/s12903-025-07423-y.

Effectiveness of mobile oral health intervention on orthodontic patients' oral hygiene and oral health literacy: a randomised controlled clinical trial

Nermine M Balbaa  1 , Maha A Hamza  2 , Wafaa E Abdelaziz  2 , May M Adham  2
Affiliations
Randomized Controlled Trial

Effectiveness of mobile oral health intervention on orthodontic patients' oral hygiene and oral health literacy: a randomised controlled clinical trial

Nermine M Balbaa et al. BMC Oral Health. .

Abstract

Background: Fixed orthodontic appliances pose challenges to maintaining oral hygiene by increasing plaque retention, leading to gingival inflammation. Oral Health Literacy (OHL) is essential for understanding and implementing oral hygiene instructions effectively. Mobile oral health interventions, including smartphone-based programmes, have recently emerged as promising tools to improve oral hygiene behaviours and outcomes. This trial assessed the effectiveness of the World Health Organisation (WHO) mOralHealth programme in improving orthodontic patients' oral hygiene and OHL.

Methods: A randomised controlled trial was conducted involving 60 orthodontic patients aged 16-25 in the orthodontic clinic of Faculty of Dentistry, Alexandria University, Egypt. Oral hygiene was measured using the Silness-Löe Plaque Index (PI). OHL was assessed using the validated Arabic version of the Oral Health Literacy Adult Questionnaire (OHL-AQ) across four domains. Baseline assessments (T0) for both OHL and PI were conducted before randomly assigning participants to either a control group (n = 30), receiving standard oral hygiene instructions, or an intervention group (n = 30), receiving the same instructions in addition to the WHO mOralHealth programme (46 WhatsApp messages delivered over 12 weeks). OHL and PI were reassessed after one month (T1) and three months (T2) and compared to T0 to monitor changes in both outcomes. Data collected were analysed using SPSS. The association between PI and OHL was assessed at all time points.

Results: At T0, no significant differences were observed between groups in demographics, oral hygiene behaviours, or OHL. At T2, the intervention group showed significantly lower median PI scores (1.33, IQR = 1.00-1.63) than the control group (1.83, IQR = 1.50-2.00; p = 0.001). OHL scores were also significantly higher in the intervention group, particularly in the reading and numeracy domains (p < 0.01). Plaque scores were negatively correlated with numeracy (p = 0.012) and decision-making (p = 0.045) within the intervention group.

Conclusion: The mOralHealth programme implemented via WhatsApp significantly improved oral hygiene and OHL among orthodontic patients over three months compared to standard oral hygiene instructions, with potential for integration into orthodontic care as a practical and scalable approach to enhance plaque control, sustain oral hygiene habits, and support long-term behavioural change when reinforced over time.

Trial registration: ClinicalTrials.gov, TRN: NCT06734325, Registration date:11 December 2024, retrospectively registered.

Keywords: Mobile oral health intervention; OHL-AQ; Oral health literacy; Oral hygiene; Orthodontic patients; Plaque index; WhatsApp messages.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical approval for the study was obtained from the Research Ethics Committee of the Faculty of Dentistry, Alexandria University (IRB 00010556–IORG 0008839) prior to any research-related activities and the trial was registered under the protocol ID (NCT06734325) according to the CONSORT statement of the updated guidelines for reporting randomised clinical trials. The study abided by the Declaration of Helsinki [64] and followed the ethical guidelines established by the Research Ethics Committee. Participants were provided with detailed information about the study and were informed that their participation was entirely voluntary, with the right to withdraw at any point without any consequences. Written informed consent was obtained from each participant before enrollment. To protect privacy and confidentiality, all data used for this study were de-identified. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart showing the flow of participants from screening for eligibility to follow-up assessments. A total of 75 orthodontic patients were assessed for eligibility, of whom 60 met the inclusion criteria and were randomly allocated into two equal groups: intervention (n=30) and control (n=30). All participants received the assigned interventions, and follow-up assessments were conducted at one and three months. Two participants in the intervention group were lost to follow-up and two had discontinued their orthodontic treatment. In the control group, four participants were lost to follow-up and two had discontinued their orthodontic treatment. Intention-to-treat analysis was used, with all randomised participants included in the analysis. Missing data were handled using the last observation carried forward
See this image and copyright information in PMC

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