@Article{info:doi/10.2196/70071,
author="BinHamdan, Hamdan Rahaf
and Alsadhan, Abdulrahman Salwa
and Gazzaz, Zohair Arwa
and AlJameel, Hassan AlBandary",
title="Social Media Use and Oral Health--Related Misconceptions in Saudi Arabia: Cross-Sectional Study",
journal="JMIR Form Res",
year="2025",
month="Feb",
day="10",
volume="9",
pages="e70071",
keywords="social media",
keywords="oral health",
keywords="health misinformation",
keywords="digital health",
keywords="Saudi Arabia",
keywords="public health",
keywords="Instagram",
keywords="Snapchat",
keywords="TikTok",
keywords="Twitter",
abstract="Background: Social media has become a central tool in health communication, offering both opportunities and challenges. In Saudi Arabia, where platforms like WhatsApp, Snapchat, and Instagram are widely used, the quality and credibility of oral health information shared digitally remain critical issues. Misconceptions about oral health can negatively influence individuals' behaviors and oral health outcomes. Objective: This study aimed to describe the patterns of social media use and estimate the prevalence of oral health--related misconceptions among adults in Saudi Arabia. Additionally, it assessed the associations between engagement with oral health information, self-reported oral health, and the presence and count of these misconceptions. Methods: A cross-sectional survey was conducted over 10 weeks, targeting adults aged 15 years and older in Saudi Arabia. Data were collected from a total sample size (n=387) via a questionnaire distributed through targeted advertisements on Instagram, TikTok, Snapchat, and X (Twitter). The prevalence of oral health--related misconceptions was estimated using descriptive statistics, including counts and percentages. Chi-square tests described sociodemographic, social media engagement, and self-reported oral health. Logistic and Poisson regression analyses were used to assess associations between engagement and self-reported oral health with misconceptions. Logistic regression models provided odds ratios and adjusted odds ratios with 95\% CI to assess the presence of oral health misconceptions. Poisson regression was used to calculate mean ratios and adjusted mean ratios (AMRs) for the count of misconceptions. Results: WhatsApp (n=344, 89.8\%) and Instagram (n=304, 78.9\%) were the most frequently used social media platforms daily. Common oral health misconceptions included beliefs that ``Pregnancy causes calcium loss in teeth'' (n=337, 87\%) and ``Dental treatment should be avoided during pregnancy'' (n=245, 63.3\%). Following dental-specific accounts was significantly associated with lower odds of having any misconceptions (adjusted odds ratio 0.41, 95\% CI 0.22-0.78) and a lower count of misconceptions (AMR 0.87, 95\% CI 0.77-0.98). Conversely, trust in social media as a source of oral health information was associated with a higher count of misconceptions (AMR 1.16, 95\% CI 1.02-1.31). Conclusions: Social media platforms are essential yet double-edged tools for oral health information dissemination in Saudi Arabia. Participants who followed dental-specific accounts had significantly lower misconceptions, while trust in social media as a source of information was linked to higher counts of misconceptions. These findings highlight the importance of promoting credible content from verified sources to combat misconceptions. Strategic collaborations with dental professionals are necessary to enhance the dissemination of accurate oral health information and public awareness and reduce the prevalence of oral health--related misconceptions. ",
doi="10.2196/70071",
url="https://formative.jmir.org/2025/1/e70071"
}


@Article{info:doi/10.2196/62738,
author="Pupong, Kittiwara
and Hunsrisakhun, Jaranya
and Pithpornchaiyakul, Samerchit
and Naorungroj, Supawadee",
title="Development of Chatbot-Based Oral Health Care for Young Children and Evaluation of its Effectiveness, Usability, and Acceptability: Mixed Methods Study",
journal="JMIR Pediatr Parent",
year="2025",
month="Feb",
day="3",
volume="8",
pages="e62738",
keywords="chatbot",
keywords="conversational agents",
keywords="tele-dentistry",
keywords="oral health behavior",
keywords="in-person toothbrushing",
keywords="hands-on",
keywords="children",
keywords="covid-19",
keywords="oral health education",
keywords="development.",
abstract="Background: Chatbots are increasingly accepted in public health for their ability to replicate human-like communication and provide scalable, 24/7 services. The high prevalence of dental caries in children underscores the need for early and effective intervention. Objective: This study aimed to develop the 30-Day FunDee chatbot and evaluate its effectiveness, usability, and acceptability in delivering oral health education to caregivers of children aged 6 to 36 months. Methods: The chatbot was created using the artificial intelligence (AI) chatbot behavior change model, integrating behavioral change theories into content designed for 3?5 minutes of daily use over 30 days. A pre-post experimental study was conducted from December 2021 to February 2022 in Hat Yai District, Songkhla Province, and Maelan District, Pattani Province, Thailand. Fifty-eight caregivers completed a web-based structured questionnaire at baseline and 2 months post baseline to evaluate knowledge, protection motivation theory-based perceptions, and tooth-brushing practices. Usability was assessed via chatbot logfiles and a web-based questionnaire at 2 months post baseline. Acceptability was evaluated through three methods: (1) open-ended chatbot interactions on day 30, (2) a web-based structured questionnaire at 2 months post baseline, and (3) semistructured telephone interviews with 15 participants 2 weeks post intervention. Participants for interviews were stratified by adherence levels and randomly selected from Hatyai and Maelan districts. All self-reported variables were measured on a 5-point Likert scale (1=lowest, 5=highest). Results: The chatbot was successfully developed based on the 4 components of the AI chatbot behavior change model. Participants had a mean age of 34.5 (SD 8.6) years. The frequency of tooth brushing among caregivers significantly improved, increasing from 72.4\% at baseline to 93.1\% two months post baseline (P=.006). Protection motivation theory-based perceptions also showed significant improvement, with mean scores rising from 4.0 (SD 0.6) at baseline to 4.5 (SD 0.6) two months post baseline (P<.001). The chatbot received high ratings for satisfaction (4.7/5, SD 0.6) and usability (4.7/5, SD 0.5). Participants engaged with the chatbot for an average of 24.7 (SD 7.2) days out of 30. Caregivers praised the chatbot's content quality, empathetic communication, and multimedia design, but noted the intervention's lengthy duration and messaging system as limitations. Conclusions: The 30-Day FunDee chatbot effectively enhanced caregivers' perceptions of oral health care and improved tooth-brushing practices for children aged 6?36 months. High user satisfaction and engagement demonstrate its potential as an innovative tool for oral health education. These findings warrant further validation through large-scale, randomized controlled trials. Trial Registration: Thai Clinical Trials Registry Tctr20210927004; https://www.thaiclinicaltrials.org/show/Tctr20210927004 ",
doi="10.2196/62738",
url="https://pediatrics.jmir.org/2025/1/e62738"
}


@Article{info:doi/10.2196/53585,
author="Abogazalah, Naif
and Yiannoutsos, Constantin
and Soto-Rojas, E. Armando
and Bindayeld, Naif
and Yepes, F. Juan
and Martinez Mier, Angeles Esperanza",
title="Distal and Proximal Influences on Self-Reported Oral Pain and Self-Rated Oral Health Status in Saudi Arabia: Retrospective Study Using a 2017 Nationwide Database",
journal="JMIR Public Health Surveill",
year="2024",
month="Dec",
day="20",
volume="10",
pages="e53585",
keywords="dental health surveys",
keywords="nationwide database",
keywords="public health dentistry",
keywords="path analysis",
keywords="oral health influences",
keywords="oral pain",
keywords="self-rated oral health",
keywords="cross-sectional study",
keywords="dental health",
keywords="dentistry",
keywords="oral health",
keywords="self-reported",
keywords="retrospective study",
keywords="Saudi Arabia",
keywords="proximal",
keywords="distal",
keywords="adult",
keywords="children",
keywords="youth",
keywords="adolescent",
keywords="teen",
keywords="sociodemographic",
abstract="Background: Oral health significantly influences overall well-being, health care costs, and quality of life. In Saudi Arabia, the burden of oral diseases, such as dental caries and periodontal disease, has increased over recent decades, driven by various lifestyle changes. Objective: To explore the associations between proximal (direct) and distal (indirect) influences that affect oral pain (OP) and self-rated oral health (SROH) status in the Kingdom of Saudi Arabia (KSA) using an adapted conceptual framework. Methods: This retrospective cross-sectional study used data from a national health survey conducted in KSA in 2017. The sample included adults (N=29,274), adolescents (N=9910), and children (N=11,653). Sociodemographic data, health characteristics, and access to oral health services were considered distal influences, while frequency and type of dental visits, tooth brushing frequency, smoking, and consumption of sweets and soft drinks were considered proximal influences. Path analysis modeling was used to estimate the direct, indirect, and total effects of proximal and distal influences on OP and SROH status. Results: The mean age of adult respondents was 42.2 years; adolescents, 20.4 years; and children, 10.58 years. Despite OP reports from 39\% of children, 48.5\% of adolescents, and 47.1\% of adults, over 87\% across all groups rated their oral health as good, very good, or excellent. A higher frequency of tooth brushing showed a strong inverse relationship with OP and a positive correlation with SROH (P<.001). Frequent dental visits were positively associated with OP and negatively with SROH (P<.001). Sweet consumption increased OP in adolescents ($\beta$=0.033, P=.007) and negatively affected SROH in children ($\beta$=--0.086, P<.001), adolescents ($\beta$=--0.079, P<.001), and adults ($\beta$=--0.068, P<.001). Soft drink consumption, however, was associated with lower OP in adolescents ($\beta$=--0.034, P=.005) and improved SROH in adolescents ($\beta$=0.063, P<.001) and adults ($\beta$=0.068, P<.001). Smoking increased OP in adults ($\beta$=0.030, P<.001). Distal influences like higher education were directly linked to better SROH ($\beta$=0.046, P=.003) and less OP (indirectly through tooth brushing, $\beta$=--0.004, P<.001). For children, high household income correlated with less OP ($\beta$=--0.030, P=.02), but indirectly increased OP through other pathways ($\beta$=0.024, P=.003). Lack of access was associated with negative oral health measures (P<.001). Conclusions: Among the KSA population, OP and SROH were directly influenced by many proximal and distal influences that had direct, indirect, or combined influences on OP and SROH status. ",
doi="10.2196/53585",
url="https://publichealth.jmir.org/2024/1/e53585",
url="http://www.ncbi.nlm.nih.gov/pubmed/39706582"
}


@Article{info:doi/10.2196/56370,
author="Attamimi, Sultan
and Marshman, Zoe
and Deery, Christopher
and Radley, Stephen
and Gilchrist, Fiona",
title="A Behavior-Based Model to Validate Electronic Systems Designed to Collect Patient-Reported Outcomes: Model Development and Application",
journal="JMIR Form Res",
year="2024",
month="Sep",
day="17",
volume="8",
pages="e56370",
keywords="patient-reported outcome",
keywords="PRO",
keywords="electronic PRO",
keywords="user acceptance testing",
keywords="system validation",
keywords="patient-reported outcomes",
keywords="electronic PROs",
keywords="user acceptance",
keywords="validation model",
keywords="paediatric dentistry",
abstract="Background: The merits of technology have been adopted in capturing patient-reported outcomes (PROs) by incorporating PROs into electronic systems. Following the development of an electronic system, evaluation of system performance is crucial to ensuring the collection of meaningful data. In contemporary PRO literature, electronic system validation is overlooked, and evidence on validation methods is lacking. Objective: This study aims to introduce a generalized concept to guide electronic patient-reported outcome (ePRO) providers in planning for system-specific validation methods. Methods: Since electronic systems are essentially products of software engineering endeavors, electronic systems used to collect PRO should be viewed from a computer science perspective with consideration to the health care environment. On this basis, a testing model was blueprinted and applied to a newly developed ePRO system designed for clinical use in pediatric dentistry (electronic Personal Assessment Questionnaire-Paediatric Dentistry) to investigate its thoroughness. Results: A behavior-based model of ePRO system validation was developed based on the principles of user acceptance testing and patient-centered care. The model allows systematic inspection of system specifications and identification of technical errors through simulated positive and negative usage pathways in open and closed environments. The model was able to detect 15 positive errors with 1 unfavorable response when applied to electronic Personal Assessment Questionnaire-Paediatric Dentistry system testing. Conclusions: The application of the behavior-based model to a newly developed ePRO system showed a high ability for technical error detection in a systematic fashion. The proposed model will increase confidence in the validity of ePRO systems as data collection tools in future research and clinical practice. ",
doi="10.2196/56370",
url="https://formative.jmir.org/2024/1/e56370"
}


@Article{info:doi/10.2196/50479,
author="Musa, Reem
and Elamin, Dalia
and Barrie, Robert
and Kimmie-Dhansay, Faheema",
title="Effectiveness of Mobile App Interventions to Improve Periodontal Health: Protocol for a Systematic Review and Meta-Analysis",
journal="JMIR Res Protoc",
year="2024",
month="Jul",
day="31",
volume="13",
pages="e50479",
keywords="mobile app",
keywords="periodontal health",
keywords="text messages",
keywords="application",
keywords="effectiveness",
keywords="physical well-being",
keywords="mental well-being",
keywords="social well-being",
keywords="oral hygiene",
keywords="oral disease",
keywords="disease prevention",
keywords="periodontal",
keywords="health education",
keywords="systematic review",
abstract="Background: Periodontal health plays a key role as a shared reference point for evaluating periodontal diseases and identifying significant treatment outcomes. Providing adequate instruction and enhancing the motivation of patients to maintain proper oral hygiene are crucial factors for successful periodontal treatment, with self-performed regular oral hygiene identified as a critical factor in improving the outcomes of treatment for periodontal diseases. Recently, mobile health (mHealth) solutions, especially mobile apps, have emerged as valuable tools for self-management in chronic diseases such as periodontal disease, providing essential health education and monitoring capabilities. However, the use of mHealth apps for periodontal health is complex owing to various interacting components such as patient behavior, socioeconomic status, and adherence to oral hygiene practices. Existing literature has indicated positive effects of mHealth on oral health behaviors, knowledge, attitude, practice, plaque index score, and gingivitis reduction. However, there has been no systematic review of mobile apps specifically targeting patients with periodontal disease. Understanding the design and impact of mHealth apps is crucial for creating high-quality apps. Objective: The aim of this systematic review and meta-analysis is to evaluate the effectiveness of existing mobile apps in promoting periodontal health. Methods: A comprehensive search strategy will be performed in multiple electronic databases (PubMed, EBSCOhost, CINAHL Plus, Dentistry \& Oral Sciences, ScienceDirect, Scopus, and Cochrane Central Register of Controlled Trials) with the following keywords in the title/abstract: ``mobile application,'' ``mobile health,'' ``mHealth,'' ``telemedicine,'' ``periodontal health,'' ``periodontitis,'' and ``text message.'' Only randomized controlled trials will be included that assessed the following outcomes to measure periodontal health improvement: gingival index, bleeding index, periodontal pocket depth, and clinical attachment loss. Covidence will be used for data collection, and a PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) flowchart will be used to describe the selection process of the included, identified, and excluded studies. The Confidence in Network Meta-Analysis approach will be used for meta-analysis of the extracted data from the included studies. Results: This review will not require ethical approval since no primary data will be included. As of July 2024, a total of 83 articles retrieved from various databases have been imported to Covidence with 13 articles deemed eligible for inclusion in the review. The review is currently ongoing and is expected to be complete by the end of 2024 with the results published in early 2025. Conclusions: This systematic review and meta-analysis will contribute to developing mobile apps with enhanced criteria to improve periodontal clinical outcomes. The review emphasizes the importance of mHealth and preventing periodontal disease, which can set the stage for informed global health care strategies. Trial Registration: PROSPERO CRD42022340827; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=340827 International Registered Report Identifier (IRRID): DERR1-10.2196/50479 ",
doi="10.2196/50479",
url="https://www.researchprotocols.org/2024/1/e50479"
}


@Article{info:doi/10.2196/51087,
author="Navaneethan, Praveena
and Mohammed, Pasha Imran
and Shenoy, P. Rekha
and Junaid, Junaid
and Amanna, Supriya
and Alsughier, Zeyad
and Kolarkodi, Hameed Shaul",
title="Evaluation of Staining Propensity of Silver Diamine Fluoride With and Without Potassium Iodide in Children (Project Healthy Smiles): Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Jul",
day="23",
volume="13",
pages="e51087",
keywords="silver diamine fluoride",
keywords="SDF",
keywords="potassium iodide",
keywords="KI",
keywords="tooth discoloration",
keywords="dental caries",
keywords="dental esthetics",
keywords="dental",
keywords="teeth",
keywords="healthy smile",
keywords="staining",
keywords="treatment",
keywords="oral health",
keywords="child",
abstract="Background: Silver diamine fluoride (SDF) is becoming more widely recognized as a simple, cost-effective approach to minimize sensitivity and arrest caries. However, SDF results in caries that are stained black. Potassium iodide (KI) treatment with SDF may minimize or lessen the staining. However, the effectiveness of KI on staining has not been investigated. Studies demonstrating that potassium iodide reduces the black staining are still insufficient. This paper presents the study protocol for Healthy Smiles, a randomized controlled trial implemented to compare the staining propensity of SDF and SDF+KI. Objective: This study, Healthy Smiles, aims to evaluate the staining propensity of SDF and SDF+KI using a Nix Mini color sensor among children aged 4 to 6 years. Another objective of the study is to evaluate the caries-arresting effect of SDF and SDF+KI in the treatment of carious primary teeth. Methods: This study is a randomized controlled trial. A total of 60 children with caries that meet the criteria of the International Caries Detection and Assessment System (code 1 or above) will be randomly assigned to treatment groups, where group 1 will be treated with SDF and group 2 will be treated with SDF+KI. Discoloration of treated lesions will be assessed digitally using a Nix Mini color sensor. Participants will be followed up at 1, 3, and 6 months after treatment to digitally record the ?L and ?E values using the Nix Mini color sensor. Data will be analyzed using SPSS (version 28; IBM Corp). Independent sample t tests and the Mann-Whitney U test will be used to compare the 2 groups. Results: Enrollment started in October 2023. It is estimated that the enrollment period will be 12 months. Data collection is planned to be completed in 2024. Conclusions: The presented paper describes Happy Smiles, a project that provides an opportunity to address the aesthetic inconvenience of patients without compromising the effectiveness of the SDF treatment. The trial findings will contribute to the limited evidence base related to discoloration after SDF intervention to improve aesthetic appearances in child oral health. If the results from the trial are promising, it will lead to the development of a model for child oral health and pave the way for further research in child oral health. International Registered Report Identifier (IRRID): PRR1-10.2196/51087 ",
doi="10.2196/51087",
url="https://www.researchprotocols.org/2024/1/e51087"
}


@Article{info:doi/10.2196/53353,
author="Zhang, Yanan
and Zhang, Xinwen
and Jiang, Jinzhuo
and Xie, Wanhua
and Xiang, Daoman",
title="Factors Associated With Perception of Stigma Among Parents of Children With Cleft Lip and Palate: Cross-Sectional Study",
journal="JMIR Form Res",
year="2024",
month="Mar",
day="4",
volume="8",
pages="e53353",
keywords="stigma",
keywords="social anxiety",
keywords="depression",
keywords="parents of children with cleft lip and palate",
keywords="cleft lip",
keywords="cleft palate",
keywords="cross-sectional study",
abstract="Background: Parents of children with cleft lip with or without cleft palate (CL/P) often face stigmatization, which has a significant impact on their quality of life and mental health. However, to date, there is a lack of comprehensive, multicenter empirical research on parents of children with CL/P in China, particularly those with large-scale samples. Objective: This study aimed to identify major factors that contribute to the perception of stigma experienced by parents of children with CL/P. Methods: A cross-sectional survey was conducted. A total of 104 parents of children diagnosed with CL/P in 2 hospitals were selected by convenience sampling. Demographics and disease information, the Chinese Perception of Stigma Questionnaire, the Center for Epidemiological Studies Depression Scale, and the Social Anxiety Scale were used in this study. Descriptive statistics, t tests, and one-way ANOVA were used to compare the differences between participants' demographic information and perception of stigma. Multivariable linear regression was performed to assess associations between demographic factors, social anxiety, depression, and perception of stigma. Results: The mean scores for the dimensions of perception of stigma, depression, and social anxiety were 22.97 (SD 9.21), 38.34 (SD 8.25), and 22.86 (SD 6.69), respectively. Depression and social anxiety were positively associated with discrimination, while surgery status was a negatively associated variable. Parents with a college education or higher had significantly lower levels of perceived stigma compared to parents with a junior high school education (all P values <.05). These 4 factors explained 40.4\% of the total model variance (F8=9.726; P<.001; R2=0.450; adjusted R2=0.404). Conclusions: Our findings highlight a concerning trend of diminished quality of life among parents of children with CL/P. Factors such as parents' education level, surgery status, depression, and social anxiety are shown to influence the level of stigma experienced. Implementing comprehensive nursing care and providing presurgical support are effective strategies for alleviating parents' social anxiety, reducing perceived stigma, and preventing depression. ",
doi="10.2196/53353",
url="https://formative.jmir.org/2024/1/e53353",
url="http://www.ncbi.nlm.nih.gov/pubmed/38437002"
}


@Article{info:doi/10.2196/35145,
author="Duangthip, Duangporn
and He, Shuyang
and Gao, Shiqian Sherry
and Chu, Hung Chun
and Lo, Man Edward Chin",
title="Effectiveness of Silver Diamine Fluoride for Preventing Occlusal Caries in the Primary Teeth of Preschool Children: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="May",
day="23",
volume="11",
number="5",
pages="e35145",
keywords="silver diamine fluoride",
keywords="sodium fluoride",
keywords="children",
keywords="early childhood caries",
keywords="prevention",
abstract="Background: Tooth decay is a significant public health problem globally. The caries-arrest effectiveness of 38\% silver diamine fluoride (SDF) has been well documented. However, information on the caries-preventive effect of SDF on primary teeth is insufficient. Objective: The aim of this trial is to investigate the effectiveness of semiannual application of 38\% SDF and that of 5\% sodium fluoride (NaF) varnish when compared with placebo control for preventing occlusal caries in the primary molars of preschool children over 30 months. Methods: This 3-arm, parallel design, double-blind, randomized controlled trial involves 791 preschool children. Children are randomly allocated to receive 1 of 3 interventions as follows: Group 1, 38\% SDF; Group 2, 5\% NaF varnish; and Group 3, placebo control (tonic water). The intervention and dental examination will be carried out every 6 months. A parent-administered questionnaire, including the children's demographic background and oral health--related behaviors, has been collected at baseline. Follow-up examinations to detect new caries development will be conducted every 6 months by a masked examiner. Caries development will be diagnosed at the cavitation level. Chi-square tests and logistic regression analyses will be adopted. A 2-level logistic regression analysis will be performed to investigate the effects of the study interventions and other potential confounding factors on the development of occlusal caries. Results: This study was started on September 1, 2020, and the recruitment process ended on September 30, 2021. At present, a total of 791 children are participating in the study. This 30-month clinical trial is expected to be completed in March 2024. Conclusions: If SDF application is more effective than NaF varnish for preventing caries on occlusal surfaces of primary teeth, it can be a preferred choice for caries prevention in a kindergarten-based program. Results of this trial will provide valuable clinical evidence for the development of oral health strategies and policies on the promotion of child oral health. Trial Registration: HKU Clinical Registry HKUCTR-2844, https://tinyurl.com/bdhz9yuk; ClinicalTrials.gov NCT05084001, https://clinicaltrials.gov/ct2/show/NCT05084001 International Registered Report Identifier (IRRID): DERR1-10.2196/35145 ",
doi="10.2196/35145",
url="https://www.researchprotocols.org/2022/5/e35145",
url="http://www.ncbi.nlm.nih.gov/pubmed/35604758"
}


@Article{info:doi/10.2196/35415,
author="Aminabadi, Asl Naser
and Golsanamlou, Ozra
and Halimi, Zohreh
and Jamali, Zahra",
title="Assessing the Different Levels of Virtual Reality That Influence Anxiety, Behavior, and Oral Health Status in Preschool Children: Randomized Controlled Clinical Trial",
journal="JMIR Perioper Med",
year="2022",
month="Apr",
day="18",
volume="5",
number="1",
pages="e35415",
keywords="virtual reality",
keywords="anxiety",
keywords="behavior",
keywords="oral health training",
abstract="Background: Compared with a traditional behavior management strategy and oral health training, virtual reality (VR) integrated with multisensory feedback possesses potential advantages in dentistry. Objective: This study aimed to assess the impact of different levels of VR on anxiety, behavior, and oral health status. Methods: This study was carried out in the Department of Pediatric Dentistry at the Tabriz University of Medical Sciences from December 2020 to June 2021. We randomly assigned 60 healthy children aged 4 years to 6 years to 4 groups, each consisting of 15 children. The study consisted of 2 consecutive sessions. During the first visit, the plaque index was calculated, and oral health education was carried out in all groups using Immersive VR (group I), Semi-immersive VR (group II), Nonimmersive VR (group III), and tell-show-do (TSD; group IV). In the second session, an amalgam restoration was performed in all groups. Participants' anxiety and behavior were recorded using the face version of the Modified Child Dental Anxiety Scale (MCDAS[f]) and Frankl scale. The plaque index was recorded in 2 follow-up sessions. Results: The greatest prevalence of positive behavior (P=.004) and the lowest anxiety (P<.001) were recorded in group I, followed by group II, group III, and group IV. The plaque index scores showed a reduced trend between the first session and follow-up sessions (P<.001), but the values did not differ significantly between the 4 groups during the 3 sessions (P=.28, P=.54, P=.18). Conclusions: The most positive behavior was observed in the Immersive VR group, followed by the Semi-immersive VR, Nonimmersive VR, and TSD groups. Moreover, oral health education using VR resources can improve oral health status in children. Trial Registration: Iranian Registry of Clinical Trials 20210103049926N1; https://www.irct.ir/trial/53475 ",
doi="10.2196/35415",
url="https://periop.jmir.org/2022/1/e35415",
url="http://www.ncbi.nlm.nih.gov/pubmed/35436233"
}


@Article{info:doi/10.2196/25795,
author="Kimmie-Dhansay, Faheema
and Barrie, Robert
and Naidoo, Sudeshni
and Roberts, Sharon Tina",
title="Prevalence of Early Childhood Caries in South Africa: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2021",
month="Aug",
day="3",
volume="10",
number="8",
pages="e25795",
keywords="dmft",
keywords="prevalence",
keywords="dental caries",
keywords="South Africa",
keywords="early childhood caries",
abstract="Background: Young children are at the highest risk of developing dental caries as they have a lack of autonomy over their diet and oral hygiene practices. Dental caries develops over time due to demineralization of tooth substance (enamel), which results from acid production during sugar metabolism by bacteria. Early onset of dental caries often results in asymptomatic presentation, but if left untreated, it can result in severe pain, infection, and dentoalveolar abscesses. Early childhood caries (ECC) is defined as dental caries in children aged 6 years and younger and is a significant public health problem in South Africa. According to the Global Burden of Disease study, untreated dental caries of primary teeth affects 532 million children. Untreated dental caries has many detrimental effects which can affect the physical development and reduce the quality of life of affected children. Furthermore, long-term untreated dental caries can result in school absenteeism, low BMI, and poor educational outcomes. Objective: The purpose of this study was to determine the prevalence and severity of ECC in South Africa in children under the age of 6 years. Methods: All cross-sectional studies documenting the prevalence and severity of dental disease (decayed, missing, and filled teeth scores) will be included. Various databases will be searched for eligible studies. Only studies conducted on South African children aged 6 years and under will be included. There will be no restriction on the time or language of publication. The quality of all eligible studies will be analyzed by a risk of bias tool developed by the Joanna Briggs Institute. The results will be presented narratively, and if possible, a meta-analysis will be conducted. Results: The protocol is registered with PROSPERO. The literature search was initially conducted in November 2018 and was repeated in November 2020. Conclusions: The results of this study will be used to advise stakeholders of the prevalence and severity of dental disease in children under 6 years of age in South Africa. Trial Registration: PROSPERO CRD42018112161;    International Registered Report Identifier (IRRID): DERR1-10.2196/25795 ",
doi="10.2196/25795",
url="https://www.researchprotocols.org/2021/8/e25795",
url="http://www.ncbi.nlm.nih.gov/pubmed/34342587"
}


@Article{info:doi/10.2196/26701,
author="Kimmie-Dhansay, Faheema
and Barrie, Robert
and Roberts, Tina
and Naidoo, Sudeshni",
title="Risk Indicators for Early Childhood Caries in South Africa: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2021",
month="Jun",
day="24",
volume="10",
number="6",
pages="e26701",
keywords="dmft",
keywords="infant",
keywords="risk factors",
keywords="dental caries",
keywords="South Africa",
keywords="early childhood caries",
abstract="Background: Early childhood caries (ECC) is a common disorder characterized by the presence of one or more decayed (non-cavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces of primary teeth in children 71 months old or younger. South Africa has a diverse population in terms of culture, education, income, and occupation. This diversity is due to the consequences of historical racial discrimination, poverty, unemployment, lack of accessibility to health services, and quality of education. These factors make South Africa unique, and the disease and risk profiles for this country differ from those of other countries at similar stages of development. For these reasons, it is important to identify the unique maternal and infant risk factors for ECC in the South African context. Objective: The purpose of this study is to determine the risk factors associated with the incidence and prevalence of ECC in South Africa in children under the age of 6 years. Methods: All cross-sectional and cohort studies documenting risk factors associated with the prevalence and incidence of dental disease and severity (decayed, missing, and filled scores) will be included. We will search 7 databases for eligible studies, and those included will be based on prespecified inclusion criteria. Only studies conducted with South African children who are aged 6 years and younger in which dental caries risk factors are documented will be included. There is no restriction on the time or language of publication. Included articles will be scrutinized for quality by using a risk of bias tool developed by the Joanna Briggs Institute. The results will be presented narratively, and if possible, a meta-analysis will be performed. Results: The literature search was conducted in November 2020. Conclusions: The results of this study will provide a framework to inform medical and dental personnel to highlight mothers and infants at risk of developing ECC. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020216455; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=216455 International Registered Report Identifier (IRRID): DERR1-10.2196/26701 ",
doi="10.2196/26701",
url="https://www.researchprotocols.org/2021/6/e26701/",
url="http://www.ncbi.nlm.nih.gov/pubmed/34170258"
}


@Article{info:doi/10.2196/14247,
author="Borrelli, Belinda
and Henshaw, Michelle
and Endrighi, Romano
and Adams, G. William
and Heeren, Timothy
and Rosen, K. Rochelle
and Bock, Beth
and Werntz, Scott",
title="An Interactive Parent-Targeted Text Messaging Intervention to Improve Oral Health in Children Attending Urban Pediatric Clinics: Feasibility Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Nov",
day="11",
volume="7",
number="11",
pages="e14247",
keywords="oral health",
keywords="mHealth",
keywords="text message",
keywords="dental caries",
keywords="health behavior",
abstract="Background: Effective preventive treatments for dental decay exist, but caries experience among preschoolers has not changed, with marked disparities in untreated decay. Despite near-universal use of SMS text messaging, there are no studies using text messages to improve the oral health of vulnerable children. Objective: This randomized controlled feasibility trial aimed to test the effects of oral health text messages (OHT) versus a control (child wellness text messages or CWT). OHT was hypothesized to outperform CWT on improving pediatric oral health behaviors and parent attitudes. Methods: Parents with a child aged <7 years were recruited at urban clinics during pediatric appointments (79\% [41/52] below poverty line; 66\% [36/55] black) and randomized to OHT (text messages on brushing, dental visits, bottle and sippy cups, healthy eating and sugary beverages, and fluoride) or CWT (text messages on reading, safety, physical activity and development, secondhand smoke, and stress) groups. Automated text messages based on Social Cognitive Theory were sent twice each day for 8-weeks. Groups were equivalent on the basis of the number of text messages sent, personalization, interactivity, and opportunity to earn electronic badges and unlock animated characters. Assessments were conducted at baseline and 8 weeks later. Data were analyzed with linear mixed--effects models. Results: A total of 55 participants were randomized (28 OHT and 27 CWT). Only one participant dropped out during the text message program and 47 (24 OHT and 23 CWT) completed follow up surveys. Response rates exceeded 68.78\% (1040/1512) and overall program satisfaction was high (OHT mean 6.3; CWT mean 6.2; 1-7 scale range). Of the OHT group participants, 84\% (21/25) would recommend the program to others. Overall program likeability scores were high (OHT mean 5.90; CWT mean 6.0; 1-7 scale range). Participants reported high perceived impact of the OHT program on brushing their child's teeth, motivation to address their child's oral health, and knowledge of their child's oral health needs (mean 4.7, 4.6, and 4.6, respectively; 1-5 scale range). At follow up, compared with CWT, OHT group participants were more likely to brush their children's teeth twice per day (odds ratio [OR] 1.37, 95\% CI 0.28-6.50) and demonstrated improved attitudes regarding the use of fluoride (OR 3.82, 95\% CI 0.9-16.8) and toward getting regular dental checkups for their child (OR 4.68, 95\% CI 0.24-91.4). There were modest, but not significant, changes in motivation (F1,53=0.60; P=.45) and self--efficacy (F1,53=0.24; P=.63) to engage in oral health behaviors, favoring OHT (d=0.28 and d=0.16 for motivation and self--efficacy, respectively). Conclusions: The OHT program demonstrated feasibility was well utilized and appealing to the target population and showed promise for efficacy. ",
doi="10.2196/14247",
url="https://mhealth.jmir.org/2019/11/e14247",
url="http://www.ncbi.nlm.nih.gov/pubmed/31710306"
}


@Article{info:doi/10.2196/mhealth.9626,
author="Scheerman, Maria Janneke Francisca
and van Empelen, Pepijn
and van Loveren, Cor
and van Meijel, Berno",
title="A Mobile App (WhiteTeeth) to Promote Good Oral Health Behavior Among Dutch Adolescents with Fixed Orthodontic Appliances: Intervention Mapping Approach",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Aug",
day="17",
volume="6",
number="8",
pages="e163",
keywords="health behavior",
keywords="mHealth",
keywords="oral health",
keywords="oral hygiene",
keywords="dental caries",
keywords="adolescent",
keywords="dental plaque",
keywords="prevention",
keywords="intervention mapping",
abstract="Background: The insertion of fixed orthodontic appliances increases the risk of dental caries, particularly in adolescents. Caries can be prevented through good oral health behavior. To support adolescents with fixed orthodontic appliances and for promoting oral health behavior, we developed a theory- and evidence-based mHealth program, the WhiteTeeth app. Objective: The objective of our paper was to describe the systematic development and content of the WhiteTeeth app. Methods: For systematic development of the program, we used the intervention mapping (IM) approach. In this paper, we present the results of applying the first 5 steps of IM to the design of an mHealth program: (1) identifying target behaviors and determinants through problem analysis, including a literature search, a survey study, and semistructured interviews, to explore adolescent oral health behavior during orthodontic therapy; (2) defining program outcomes and objectives; (3) selecting theoretical methods and translating them into practical strategies for the program design; (4) producing the program, including a pilot test with 28 adolescents testing the acceptability and usability of the WhiteTeeth app; and (5) planning implementation and adoption. Results: On the basis of our literature search, we identified fluoride use and control of dental plaque levels (eg, tooth brushing and proxy brush usage) as target behaviors for preventing caries. Next, we identified important and changeable determinants of oral health behavior that fitted the theoretical concepts of the Health Action Process Approach (HAPA) theory. The HAPA theory, the self-regulation theory, and the results of the semistructured interviews were used to define the program objectives, that is, the performance and change objectives. After defining the objectives, we identified multiple behavior change techniques that could be used to achieve these objectives, such as providing oral health information and feedback, prompting self-monitoring, coaching of set actions and coping plans, and sending reminders. We translated these methods into practical strategies, such as videos and a brushing timer. Next, we combined these strategies into a single program resulting in the WhiteTeeth app (which is available on both iTunes and Google Play stores as ``Witgebit''). Adolescents with fixed orthodontic appliances and dental professionals were included in the development process to increase the success of implementation. The pilot test revealed that the app users appreciated and liked the app. The WhiteTeeth app can be integrated into current orthodontic care. Conclusions: IM allowed us to identify multiple techniques that have been shown to be the most effective in initiating behavior change, but have not yet been incorporated into existing orthodontic apps. The WhiteTeeth app contains all these techniques, which makes it a unique and promising home-based app for promoting oral health in adolescents with fixed orthodontic appliances. ",
doi="10.2196/mhealth.9626",
url="http://mhealth.jmir.org/2018/8/e163/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30120085"
}


@Article{info:doi/10.2196/10322,
author="Arrow, Peter
and McPhee, Rob
and Atkinson, David
and Mackean, Tamara
and Kularatna, Sanjeewa
and Tonmukayakul, Utsana
and Brennan, David
and Palmer, David
and Nanda, Soniya
and Jamieson, Lisa",
title="Minimally Invasive Dentistry Based on Atraumatic Restorative Treatment to Manage Early Childhood Caries in Rural and Remote Aboriginal Communities: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2018",
month="Jul",
day="25",
volume="7",
number="7",
pages="e10322",
keywords="cost-effectiveness analysis",
keywords="early childhood caries",
keywords="health utility",
keywords="health-related quality of life",
abstract="Background: The caries experience of Aboriginal children in Western Australia (WA) and elsewhere in Australia is more than twice that of non-Aboriginal children. Early childhood caries (caries among children <6 years) has a significant impact on the quality of life of children and their caregivers, and its management is demanding and commonly undertaken under general anesthesia. A randomized controlled trial using a minimally invasive dentistry approach based on Atraumatic Restorative Treatment (ART) in metropolitan Perth, WA, has demonstrated a significant reduction in the rate of referral to a dental specialist for dental care among children with early childhood caries, potentially reducing the need for treatment under general anesthesia. The tested approach was clinically successful and was without adverse effects on child dental anxiety. The model of ART-based primary care requires further testing and development if similar outcomes for Aboriginal children in remote and rural settings are to be achieved. Objective: The study aims to develop, implement, and evaluate a remote primary care model to deliver effective primary dental services, encompassing treatment and preventive services, to Aboriginal preschool children (based on minimally invasive approaches including ART). Methods: This is a two-arm parallel cluster randomized controlled study in which a test group will be provided with the intervention treatment at the start of the study and a control group will be provided with the intervention treatment 12 months after study commencement (delayed intervention). Participating communities, stratified by size of community (ie, number of children in the sample frame) and baseline caries experience, will be randomly assigned using a computer-generated block randomized list into immediate (test group) or delayed intervention (control group; provided with standard care). Informed consent will be obtained from all participants. Aboriginal research assistants will explain the study to the parents and assist the parents in completing the questionnaires. Participants in the randomized study will be examined at baseline and at 12 months follow-up by a calibrated examiner. Test group participants will subsequently be contacted and appropriate appointments coordinated for treatment. Control group participants will be provided with standard preventive care by the Aboriginal Health Workers and managed for treatment as per standard procedures. Results: Community consultations have been undertaken and 26 communities have agreed to participate. Fieldwork is in progress to recruit study participants. Conclusions: The significance of the study lies in its holistic approach to testing the model of care. Clinical evaluations as well as oral health?related quality of life evaluations will be undertaken. Cost-effectiveness and cost-utility evaluations will assist in the development of policy options for oral health services for rural and remote communities. The elicitation of caregiver perspectives through focus group interviews will supplement the clinical, psychosocial, and cost-utility evaluations and provide a richer evaluation of the intervention. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616001537448; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371735 (Archived by WebCite at http://www.webcitation.org/70UMxndFZ) Registered Report Identifier: RR1-10.2196/10322 ",
doi="10.2196/10322",
url="http://www.researchprotocols.org/2018/7/e10322/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30045834"
}