Text messaging program improves oral health awareness

BOSTON, U.S.: Effective preventive treatments for dental caries exist; yet caries experience among preschoolers has not changed significantly.

Children from socially disadvantaged families are particularly affected by it. For young children, the role of the primary caregiver is especially important in reducing caries risk. Now, researchers at Boston University have taken advantage of a tool that is already part of everyday life: the cellphone. In a recent study, they used text messaging to improve the oral health of children—with promising results.

For the study, 55 participants with children younger than 7 years were recruited, three-quarters of whom live below the poverty line. Participants in the study were parents or caregivers of children who were patients of pediatric clinics in two community health centers in an urban and underserved area of Boston.

The research team divided the participants randomly into two groups. One group received oral health text messages (OHT) including information on topics such as brushing, dental visits and fluoride, and the control group received child wellness messages (CWT) with material on the general well-being of children, such as safety and physical activity.

The program provided participants with two text messages per day for eight weeks. The messages for both groups were designed to be of an interactive nature and to present opportunities to earn badges and unlock animated characters.

“Ours is the first text message study focusing on oral health and measuring outcomes in a randomized trial with prospective outcomes. It is also the first oral health text messaging program that is customized to the patient, automated yet interactive, and involves gamification,” lead author Dr. Belinda Borrelli, professor in the Department of Health Policy and Health Services Research at the Henry M. Goldman School of Dental Medicine at the university, told Dental Tribune International.

Evaluation of the follow-up clearly showed that this form of communication was received very positively—84% of the OHT group said that they would recommend the program to others. The participants reported a high perceived impact of the OHT program on brushing their children’s teeth, motivating them to address their children’s oral health, and expanding their knowledge of their children’s oral health needs. At follow-up, compared with CWT, the OHT group participants were more likely to brush their children’s teeth twice per day and demonstrated improved attitudes regarding the use of fluoride and toward getting regular dental checkups for their children.

In response to a question about what the greatest advantages of the text messaging program are, Borrelli said: “Through text messaging, we can target previously unreachable populations with evidence-based information that they can access in real time—most people carry their cellphones throughout the day—wherever they happen to be when the text comes in.”

Based on the study results, the researchers secured funding from the National Institute of Dental and Craniofacial Research in order to conduct a larger trial on the text message intervention; currently, 650 families are enrolled in the study.

“This study demonstrates the potential of text message interventions and provides evidence that a larger, fully powered randomized controlled trial is needed,” added Borrelli. “This is the type of program that, if proved effective, could be disseminated nationally to other federally qualified pediatric clinics and ultimately make a real difference in the oral health of at-risk children.”

The study, titled “An interactive parent-targeted text messaging intervention to improve oral health in children attending urban pediatric clinics: Feasibility randomized controlled trial,” was published in the November 2019 issue of JMIR mHealth and uHealth.