A Short-term Evaluation of Oral Hygiene Education Methods in Fixed Orthodontics Patients: A Randomized Clinical Trial Comparing Assistant Training, Software, and Social Media

A Short-term Evaluation of Oral Hygiene Education Methods in Fixed Orthodontics Patients: A Randomized Clinical Trial Comparing Assistant Training, Software, and Social Media | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Short-term Evaluation of Oral Hygiene Education Methods in Fixed Orthodontics Patients: A Randomized Clinical Trial Comparing Assistant Training, Software, and Social Media Hooman Shafaee, Sorour Saeedi, Erfan Bardideh, Mahsa Ghorbani, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4331562/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 23 Oct, 2024 Read the published version in BMC Oral Health → Version 1 posted 4 You are reading this latest preprint version Abstract Objective : To compare the effectiveness of different oral hygiene education strategies on periodontal health in fixed orthodontic patients in a one-month period: assistant-led instruction, social media-based education, and custom-made software. Methods : Sixty orthodontic patients from Mashhad University of Medical Sciences' Dentistry School were randomly assigned into three groups. Each group received oral health education differently: via assistant instruction, educational videos on social media, or a researcher-designed software for Android smartphones. After a month, participants' oral health was evaluated using the plaque index (PI) and the gingival index (GI). Results : Assistant-led education group demonstrated the highest PI (1.26 ± 0.70) and GI (0.92 ± 0.67), while the software group reported the lowest indices (PI = 0.68, GI = 0.46 ± 0.46). The social media group's measurements fell between these extremes (PI = 0.89 ± 0.75, GI = 0.60 ± 0.52). Significant group differences were found for both PI and GI (P = 0.028 and P = 0.047, respectively). Pairwise comparison revealed significantly lower PI and GI in the software group compared to the assistant group. No significant differences were found between the social media and other groups. Conclusion : Our results suggest that the use of specially designed software could be the most effective strategy for improving oral hygiene in orthodontic patients. Meanwhile, traditional assistant-led education showed the least effectiveness. The study supports the potential benefit of utilizing digital tools, such as bespoke software and social media, in oral health education for orthodontic patients. oral health education oral hygiene orthodontic patients educational software social media Figures Figure 1 Introduction Orthodontic treatment is essential for achieving optimal dental aesthetics and functional occlusion. However, maintaining good oral hygiene can be challenging with the presence of fixed orthodontic appliances ( 1 ). Plaque accumulation and gingival inflammation are common issues associated with orthodontic treatment, which, if not addressed effectively, can lead to oral health complications ( 2 ). Therefore, providing patients with proper oral hygiene education and guidance is crucial to ensure successful treatment outcomes and long-term oral health. The objective of this study is to compare the effectiveness of three distinct oral hygiene education methods: education through social media, dental assistant-led training, and specialized software applications. By evaluating these methods, we aim to identify the most effective approach for educating orthodontic patients and promoting optimal oral hygiene practices. Education through social media platforms provides an opportunity to reach a wider audience and engage with patients through interactive content ( 3 ). This method allows for the dissemination of instructional videos, informative posts, and interactive quizzes to educate patients about proper brushing techniques, interdental cleaning, and the importance of regular dental check-ups. Dental assistant-led training has been a conventional approach to providing oral hygiene education to orthodontic patients. Dental assistants offer personalized guidance on brushing techniques, interdental cleaning methods, and the effective use of supplementary oral hygiene devices. Through face-to-face interactions, dental assistants can address patients' concerns, provide individualized advice, and reinforce the importance of oral hygiene practices during orthodontic treatment ( 4 ). Specialized software applications designed for orthodontic patients offer an innovative way to deliver oral hygiene education. These applications provide interactive modules, instructional videos, personalized reminders for oral care routines, and feedback systems to monitor patients' progress. The content is tailored to address the unique challenges and requirements of orthodontic patients, providing them with continuous support and motivation to maintain good oral hygiene habits ( 5 , 6 ). The primary aim of this study was to assess the effectiveness of three oral hygiene education methods in improving oral health over a one-month period. The findings of this study will assist orthodontic practitioners in selecting the most effective oral hygiene education method for their patients. Method Study design This balanced randomized [1:1:1], parallel-designed clinical trial aimed to compare the efficacy of education through social media, education provided by assistants, and education through mobile applications in improving oral health. The clinical procedures were performed at the Orthodontics Department, Mashhad Dental School between 2022 and 2023. The specially designed software for Android smartphones has been developed by researchers using Android Studio (version Arctic Fox, Google, CA, USA). The effectiveness of these education modalities was measured by examining the proportion of patients whose oral health showed improvement compared to their initial condition, using the plaque index ( 7 ), gingival index ( 8 ). Blinding of participants and operators was not possible because of the nature of the interventions. However, outcome evaluators and data analysts remained unaware of the allocation and the type of education provided. Prior to any interventions, every participant provided their informed consent by signing a consent form. The form had been approved by the Vice-Chancellor of Research at Mashhad University of Medical Sciences and included a comprehensive explanation of the study's goals and methods, as well as addressing any questions they had. Approval was granted by the ethical committee at Mashhad University of Medical Sciences, ensuring that all patient information would be kept confidential. The study was registered in the Iranian Registry of Clinical Trials (IRCT) database with the identification code IRCT20200609047705N2. It is important to note that this study was conducted in accordance with the guiding principles outlined in the Declaration of Helsinki. Clinical procedures Sixty patients diagnosed with having moderate crowding without the need for extraction, undergoing fixed orthodontic treatment on both jaws and whose ages ranged from 20 to 35 (mean age: 26.26 ± 3.95) were recruited from Mashhad Dental School referral patients. Table 1 provides comprehensive inclusion and exclusion criteria. The eligibility was verified by the principal orthodontist investigator. Table 1 In- and exclusion criteria Inclusion criteria Exclusion criteria Aged between 20 and 35 years History of periodontal problems Having moderate crowding without the need for extraction Presence of systemic diseases Undergoing fixed orthodontic treatment on both jaws Presence of cavities on the buccal surfaces of the examined teeth Having communication software such as WhatsApp, Telegram, and Instagram installed Presence of white spots on the buccal surfaces of the examined teeth Having an Android operating system on their phones Presence of restorations on the buccal surfaces of the examined teeth Prior to commencing the study, a randomization procedure was implemented using a 1:1:1 allocation with a block size of 3. To begin, a total of 60 opaque and sealed envelopes were prepared, each containing a unique three-digit code. Subsequently, 20 envelopes were assigned to each of the three education groups: assistant education, social media, and software. The assignment was carried out using an online website called randomizer.org. On day 0, measurements of the Plaque Index (PI) and gingival Index (GI) were recorded for all participants. Following this, the participants were randomly distributed into one of the three groups, with each group consisting of 20 individuals. The oral hygiene education included brushing the teeth twice a day followed by flossing once a day. The brushing technique used was the modified Bass technique, involving placing the toothbrush at the gum margin at a 45-degree angle and making small vibratory movements. This process continued along the dental arches until all accessible tooth surfaces were brushed for 2 minutes, with 30 seconds dedicated to each quadrant ( 9 , 10 ). For flossing, super floss was instructed to use by placing the stiffened-end threader under the orthodontic wire or between the teeth. They were then guided to pull the spongy floss through the gap or around the bracket ( 11 ). In the assistant education group, oral hygiene education was provided to patients by an operator using a dental model for at least three minutes at the beginning of orthodontic treatment. In the social media group, oral hygiene education was delivered through instructional videos, similar to the assistant education group, lasting three minutes, and patients were asked to record the number of times they watched the video. In the software group, an Android application was installed on the patients' smartphones. This software, included instructional videos and provided the ability to set multiple reminders for oral hygiene practices and record patients' hygiene habits. After the software education, patients in this group were asked to set a minimum of two reminders for daily oral hygiene in the software and record their hygiene habits in the calendar based on the type (toothbrushing with blue, flossing with red, interdental brushing with yellow). Notably, the same operator who provided education to the assistant education group also instructed the patients on the use of social media and software. The Plaque Index (PI) and gingival Index (GI), as mentioned earlier, were also evaluated after a one-month period, and any changes in these indices were examined across all groups. The assessment of outcomes was carried out by the same group of individuals, which consisted of a dentist and two periodontists. These individuals had their professional qualifications and calibration validated in advance to ensure the accuracy and reliability of the reported results. The measurement of inter-observer reliability yielded a coefficient of 0.91, indicating a high level of consistency among different observers. Statistical analysis In accordance with the findings presented by Alkadhi et al. ( 12 ), an observed difference of 0.7 between groups was noted. With a targeted power of 90%, the minimum required sample size for all groups, maintaining a significance level of α = 0.05, was calculated to be 60 patients, with 20 individuals allocated to each group. The comparison of sample sizes was conducted considering the anticipated difference between two independent groups, and GPOWER v3.0.1 software (Dusseldorf, Germany), were utilized for the sample size calculations. The data obtained from the study were presented using frequency tables and mean values accompanied by their respective standard deviations. To assess the distribution of gender within the study groups, the Chi-squared test was utilized. The normal distribution of the data was evaluated using the Shapiro-Wilk test. If the dependent variable exhibited a normal distribution, a one-way ANOVA followed by the Tukey test was employed to compare the different research groups. Conversely, if the data did not follow a normal distribution, the Kruskal-Wallis test was used, followed by Dun's post hoc test. The level of statistical significance was set at P < 0.05. The statistical analysis was performed using SPSS software (version 23; SPSS Inc., Chicago, IL, USA). Additionally, a 95% confidence interval was calculated for the study. Results Figure 1 illustrates the patient flow through the trial. A total of sixty patients participated in the study, with a mean age of 26.26 ± 3.95 years (ranging from 20 to 35 years). The gender distribution consisted of 35 females (58.3%) and 25 males (41.7%). No participants were excluded from the study, and all sixty patients successfully completed the trial. A detailed breakdown of age and gender distribution can be found in Table 2 . Furthermore, there were no significant differences observed among the study groups regarding the variables of age and gender (P = 0.731 and P = 0.934, respectively). Table 2 Age and gender distribution analyzed by Kruskal-Wallis and Chi-square test, respectively Groups Social media Assistant-based Software Total Gender (N (%)) Male 9 (45) 8 (40) 8 (40) 25 (41.7) Female 11 (55) 12 (60) 12 (60) 35 (58.3) Age (mean ± SD) 27 ± 4.75 25.25 ± 2.93 26.55 ± 3.94 26.26 ± 3.95 Before being evaluated, participants in three groups of 20 received oral hygiene education through either social media, assistant, or software. The assessment was conducted using PI and GI at the following time points: before treatment (T0) and one month (T1) after treatment. First, the Shapiro-Wilk test was used to determine whether the data had a normal distribution. Since an abnormal distribution was detected in each assessment, the Kruskal-Wallis test was employed when analyzing the results. Kruskal-Wallis found no statically significant differences in PI and GI between all groups at baseline (P > 0.05). One month following education, there was no significant difference between social media and software groups, nor between social media and assistant groups regarding both indices, despite the assistant group having a considerably higher PI and GI than software group (P = 0.028 and P = 0.048, respectively). The statistics are displayed in Table 3 below. Table 3 Comparison of mean periodontal indices for each study group at each assessment time point Baseline One month Variables Social media (mean ± SD) Assistant-based (mean ± SD) Software (mean ± SD) P value Social media (mean ± SD) Assistant-based (mean ± SD) Software (mean ± SD) P value PI 0.77 ± 0.70 0.83 ± 0.62 0.75 ± 0.71 0.844 0.89 ± 0.75 ab 1.26 ± 0.70 a 0.68 ± 0.64 b 0.028 GI 0.49 ± 0.44 0.63 ± 0.53 0.50 ± 0.54 0.623 0.60 ± 0.52 ab 0.92 ± 0.67 a 0.46 ± 0.52 b 0.047 A significant difference between groups is indicated by a different superscript letter (p < 0.05). A 95% confidence interval of the mean was estimated in the analysis. Moreover, a significant difference was observed in PI and GI changes across groups one month after education. By the one-month interval, There was a statistically significant difference in PI changes between each pair of groups (P < 0.001). Nevertheless, was no significant difference between social media and software groups, nor between social media and assistant groups regarding GI changes throughout one month. However, it is noticeable that the assistant group had a significantly lower GI reduction than the software after one month (P = 0.001) (Table 4 ). Table 4 Comparison of changes in mean periodontal indices for each study group. Differences Variables Social media (mean ± SD) Assistant-based (mean ± SD) Software (mean ± SD) P value PI 0.12 ± 0.26 a 0.43 ± 0.43 b -0.07 ± 0.26 c < 0.001 GI 0.11 ± 0.25 ab 0.29 ± 0.44 a -0.05 ± 0.20 b = 0.001 A significant difference between groups is indicated by a different superscript letter (p < 0.05). A 95% confidence interval of the mean was estimated in the analysis. Discussion The present study aimed to compare the effectiveness of three different oral hygiene education methods: education through social media, assistant-based education, and software-based education. After conducting eligibility assessments, a total of sixty patients were selected from referrals received from Mashhad dental school to take part in this trial, which lasted for a duration of one month. The results demonstrated significant differences in oral hygiene outcomes among the education groups, highlighting the potential benefits of incorporating technology-based approaches in orthodontic practices. One of the key findings of this study was that the software education group exhibited the lowest plaque and gingival indices, indicating better oral hygiene outcomes compared to the assistant education group. This suggests that software applications specifically designed for oral hygiene education can effectively reduce plaque accumulation and minimize the risk of gingival inflammation during orthodontic treatment. The interactive nature of software programs, coupled with visual aids and educational content, may have contributed to improved patient understanding and adherence to oral hygiene practices. Similarly, the social media education group showed favorable oral hygiene outcomes, although the differences between this group and the software education group were not statistically significant. This implies that social media platforms can also play a valuable role in promoting oral hygiene practices among orthodontic patients. The widespread use of social media and its ability to deliver information in an engaging and accessible manner make it a promising tool for oral health education. The findings of this study align with previous research emphasizing the positive impact of technology-based approaches on oral hygiene outcomes. In a comparable trial, Alkadhi et al. examined the effect of using mobile applications on improving oral hygiene compliance in patients with fixed orthodontic appliances. They concluded that the plaque index (PI) and gingival index (GI) decreased in the group using active reminders of oral hygiene instructions on mobile applications compared to verbal oral hygiene instructions ( 12 ). Similar to this study’s findings, Scheerman et al. conducted a randomized controlled trial to assess the effect of using a mobile application called "WhiteTeeth" on oral health improvement. The results showed that the use of a mobile application containing relevant information and education about oral health alongside regular care in adolescents with fixed orthodontic appliances leads to improved oral hygiene ( 13 ). In another study Zotti et al. (2015) the usefulness of mobile applications in improving oral hygiene compliance in orthodontic patients. They found that orthodontic patients using mobile applications had lower GI, PI, and percentages of caries and white spots ( 2 ). Ross et al. investigated the impact of automated messaging on the oral health of patients undergoing orthodontic treatment and found that the daily reminder group exhibited significant progress in maintaining oral and dental hygiene compared to the weekly reminder group ( 14 ). Al-Moghrabi et al. conducted a systematic review to investigate the effectiveness of mobile applications and social media-based interventions in inducing behavioral changes in orthodontic patients. They concluded that there is limited to moderate evidence supporting the effectiveness of mobile applications and social media-based interventions in promoting positive behavioral changes in orthodontic patients, and further studies in this area are needed ( 15 ). Despite the promising results, it is important to consider the limitations of this study. The short follow-up period of one month may not fully capture the long-term effects of the different education methods on oral hygiene outcomes. Future research should incorporate longer follow-up periods to assess the sustainability of the observed improvements. Additionally, expanding the study to include a more diverse population in terms of age and socioeconomic background would help validate the generalizability of the findings. Another limitation of this study is the reliance on self-reported oral hygiene practices. Self-reporting introduces the possibility of recall bias and may not provide an accurate reflection of actual oral hygiene behaviors. Future studies could incorporate objective measures, such as bacterial plaque analysis. By identifying the most effective methods, orthodontic professionals can optimize patient care and contribute to improved oral health during orthodontic treatment. Conclusion In conclusion, the results of this study suggest that software education and social media platforms have the potential to improve oral hygiene outcomes in orthodontic patients. The use of software applications specifically designed for oral hygiene education demonstrated superior results in terms of plaque control and gingival health compared to traditional assistant-based education. Social media platforms also showed promising results. Declarations Ethics approval and consent to participate Ethics approval was obtained from the ethical committee at Mashhad University of Medical Sciences, ensuring the confidentiality of all patient information. Consent for publication Before participating in any activities, each participant provided their informed consent by signing a consent form. This form had received approval from the Vice-Chancellor of Research at Mashhad University of Medical Sciences and contained a detailed explanation of the study's objectives and procedures, along with addressing any inquiries they may have had. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests Funding The findings of this study were obtained from a student thesis (thesis number IRMUMS990352). Authors' contributions HS : Conceptualization, Methodology, Validation, Supervision, Project administration SS: Investigation, Conceptualization, Writing - Review & Editing. EB: Conceptualization, Methodology, Investigation, Supervision, Writing - Review & Editing. MG: Investigation, Methodology, Visualization, Writing - Original Draft, Writing - Review & Editing. PS: Investigation, Methodology, Visualization, Writing - Original Draft, Writing - Review & Editing. Acknowledgements Not applicable References Anuwongnukroh N, Dechkunakorn S. R K. Oral Hygiene Behavior during Fixed Orthodontic Treatment. Dentistry. 2017;7. Zotti F, Dalessandri D, Salgarello S, Piancino M, Bonetti S, Visconti L, et al. Usefulness of an app in improving oral hygiene compliance in adolescent orthodontic patients. Angle Orthod. 2016;86(1):101–7. Alslakhi M, Oz U, Sin Ç. The powerful effects of social media platforms on orthodontic patient knowledge’s improving, attitude management and it is influence on financial income of the orthodontic clinic. Appl Nanosci. 2022;13. Le Fouler A, Jeanne S, Sorel O, Brézulier D. How effective are three methods of teaching oral hygiene for adolescents undergoing orthodontic treatment? The MAHO protocol: an RCT comparing visual, auditory and kinesthetic methods. Trials. 2021;22(1):144. Deleuse M, Meiffren C, Bruwier A, Maes N, Le Gall M, Charavet C. Smartphone application-assisted oral hygiene of orthodontic patients: a multicentre randomized controlled trial in adolescents. Eur J Orthod. 2020;42(6):605–11. Farhadifard H, Soheilifar S, Farhadian M, Kokabi H, Bakhshaei A. Orthodontic patients’ oral hygiene compliance by utilizing a smartphone application (Brush DJ): a randomized clinical trial. BDJ Open. 2020;6(1):24. Silness J, Loe H. PERIODONTAL DISEASE IN PREGNANCY. II. CORRELATION BETWEEN ORAL HYGIENE AND PERIODONTAL CONDTION. Acta Odontol Scand. 1964;22:121–35. Loe H, Silness J. PERIODONTAL DISEASE IN PREGNANCY. I. PREVALENCE AND SEVERITY. Acta Odontol Scand. 1963;21:533–51. Farook FF, Alrumi A, Aldalaan K, Ababneh K, Alshammari A, Al-Khamees AA, et al. The efficacy of manual toothbrushes in patients with fixed orthodontic appliances: a randomized clinical trial. BMC Oral Health. 2023;23(1):315. Weng L, Wen J, Cui G, Liang J, Pang L, Lin H. Comparison of modified bass, rolling, and current toothbrushing techniques for the efficacy of plaque control – A randomized trial. J Dent. 2023;135:104571. Sawan N, Ben Gassem A, Alkhayyal F, Albakri A, Al-Muhareb N, Alsagob E. Effectiveness of Super Floss and Water Flosser in Plaque Removal for Patients Undergoing Orthodontic Treatment: A Randomized Controlled Trial. Int J Dent. 2022;2022:1344258. Alkadhi OH, Zahid MN, Almanea RS, Althaqeb HK, Alharbi TH, Ajwa NM. The effect of using mobile applications for improving oral hygiene in patients with orthodontic fixed appliances: a randomised controlled trial. J Orthod. 2017;44(3):157–63. Scheerman JFM, van Meijel B, van Empelen P, Verrips GHW, van Loveren C, Twisk JWR, et al. The effect of using a mobile application (WhiteTeeth) on improving oral hygiene: A randomized controlled trial. Int J Dent Hyg. 2020;18(1):73–83. Ross MC, Campbell PM, Tadlock LP, Taylor RW, Buschang PH. Effect of automated messaging on oral hygiene in adolescent orthodontic patients: A randomized controlled trial. Angle Orthod. 2019;89(2):262–7. Al-Moghrabi D, Alkadhimi A, Tsichlaki A, Pandis N, Fleming PS. The influence of mobile applications and social media-based interventions in producing behavior change among orthodontic patients: A systematic review and meta-analysis. Am J Orthod Dentofac Orthop. 2022;161(3):338–54. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 23 Oct, 2024 Read the published version in BMC Oral Health → Version 1 posted Editorial decision: Revision requested 29 May, 2024 Submission checks completed at journal 24 May, 2024 Editor assigned by journal 24 May, 2024 First submitted to journal 26 Apr, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4331562","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":308226014,"identity":"da12f7b4-3452-430a-ac56-f784afb4e801","order_by":0,"name":"Hooman Shafaee","email":"","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Hooman","middleName":"","lastName":"Shafaee","suffix":""},{"id":308226015,"identity":"b24b8a72-4160-498d-afc3-188cf83d102d","order_by":1,"name":"Sorour Saeedi","email":"","orcid":"","institution":"Private Practice, Mashhad, Iran","correspondingAuthor":false,"prefix":"","firstName":"Sorour","middleName":"","lastName":"Saeedi","suffix":""},{"id":308226017,"identity":"fab2ca3b-0e59-40f8-bac5-547c6edb133a","order_by":2,"name":"Erfan Bardideh","email":"","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Erfan","middleName":"","lastName":"Bardideh","suffix":""},{"id":308226018,"identity":"382f4415-5c39-45b3-81af-93f6151a11a9","order_by":3,"name":"Mahsa Ghorbani","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIiWNgGAWjYFACHhBxgIFBAkglGNhAGKRoSSNVCwPDYcJadNvPHv7w49cdOfPZzc8ePCg4n9g/u/ngA4Yam2hcWszO5KVJ9vY9M5a5c8zcIMHgduKMO8eSDRiOpeU24NJyIMeMgbfncOIMiQQzCZCWhhs5ZhKMDYdxazn/xvjjX7CW9G9ALecS5xPUciPHQJrnB0hLDsiWA4kbCGt5YyYt23DYWELmTBlQS7LxxhtpyQYJ+PxyPsf445s/h+UkpNu3Sf74Yyc770bywQcfamxwagEDxjYE2xGsMgGfcjD4g2DaE1Q8CkbBKBgFIw4AAPjzZIq25k6sAAAAAElFTkSuQmCC","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Mahsa","middleName":"","lastName":"Ghorbani","suffix":""},{"id":308226019,"identity":"ddd5e24f-345b-4baf-8186-8934218c7a68","order_by":4,"name":"Pooya Saeedi","email":"","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Pooya","middleName":"","lastName":"Saeedi","suffix":""}],"badges":[],"createdAt":"2024-04-26 20:53:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4331562/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4331562/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12903-024-05014-x","type":"published","date":"2024-10-23T15:57:30+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":58144215,"identity":"a3c7e341-b75a-4532-9616-8301def15197","added_by":"auto","created_at":"2024-06-11 18:23:24","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":40489,"visible":true,"origin":"","legend":"\u003cp\u003eCONSORT diagram showing the flow of patients through the trial.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4331562/v1/9f72e1800fc33caa016d8c5b.png"},{"id":67681833,"identity":"c34d4ea9-c163-4f89-bbcb-c01ae5dee823","added_by":"auto","created_at":"2024-10-28 16:10:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":461816,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4331562/v1/c4bfbe11-5a97-4702-a278-1f07866bb7ff.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Short-term Evaluation of Oral Hygiene Education Methods in Fixed Orthodontics Patients: A Randomized Clinical Trial Comparing Assistant Training, Software, and Social Media","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOrthodontic treatment is essential for achieving optimal dental aesthetics and functional occlusion. However, maintaining good oral hygiene can be challenging with the presence of fixed orthodontic appliances (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Plaque accumulation and gingival inflammation are common issues associated with orthodontic treatment, which, if not addressed effectively, can lead to oral health complications (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Therefore, providing patients with proper oral hygiene education and guidance is crucial to ensure successful treatment outcomes and long-term oral health. The objective of this study is to compare the effectiveness of three distinct oral hygiene education methods: education through social media, dental assistant-led training, and specialized software applications. By evaluating these methods, we aim to identify the most effective approach for educating orthodontic patients and promoting optimal oral hygiene practices.\u003c/p\u003e \u003cp\u003eEducation through social media platforms provides an opportunity to reach a wider audience and engage with patients through interactive content (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). This method allows for the dissemination of instructional videos, informative posts, and interactive quizzes to educate patients about proper brushing techniques, interdental cleaning, and the importance of regular dental check-ups.\u003c/p\u003e \u003cp\u003eDental assistant-led training has been a conventional approach to providing oral hygiene education to orthodontic patients. Dental assistants offer personalized guidance on brushing techniques, interdental cleaning methods, and the effective use of supplementary oral hygiene devices. Through face-to-face interactions, dental assistants can address patients' concerns, provide individualized advice, and reinforce the importance of oral hygiene practices during orthodontic treatment (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSpecialized software applications designed for orthodontic patients offer an innovative way to deliver oral hygiene education. These applications provide interactive modules, instructional videos, personalized reminders for oral care routines, and feedback systems to monitor patients' progress. The content is tailored to address the unique challenges and requirements of orthodontic patients, providing them with continuous support and motivation to maintain good oral hygiene habits (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e The primary aim of this study was to assess the effectiveness of three oral hygiene education methods in improving oral health over a one-month period. The findings of this study will assist orthodontic practitioners in selecting the most effective oral hygiene education method for their patients.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis balanced randomized [1:1:1], parallel-designed clinical trial aimed to compare the efficacy of education through social media, education provided by assistants, and education through mobile applications in improving oral health. The clinical procedures were performed at the Orthodontics Department, Mashhad Dental School between 2022 and 2023. The specially designed software for Android smartphones has been developed by researchers using Android Studio (version Arctic Fox, Google, CA, USA). The effectiveness of these education modalities was measured by examining the proportion of patients whose oral health showed improvement compared to their initial condition, using the plaque index (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), gingival index (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBlinding of participants and operators was not possible because of the nature of the interventions. However, outcome evaluators and data analysts remained unaware of the allocation and the type of education provided. Prior to any interventions, every participant provided their informed consent by signing a consent form. The form had been approved by the Vice-Chancellor of Research at Mashhad University of Medical Sciences and included a comprehensive explanation of the study's goals and methods, as well as addressing any questions they had. Approval was granted by the ethical committee at Mashhad University of Medical Sciences, ensuring that all patient information would be kept confidential. The study was registered in the Iranian Registry of Clinical Trials (IRCT) database with the identification code IRCT20200609047705N2. It is important to note that this study was conducted in accordance with the guiding principles outlined in the Declaration of Helsinki.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eClinical procedures\u003c/h2\u003e \u003cp\u003eSixty patients diagnosed with having moderate crowding without the need for extraction, undergoing fixed orthodontic treatment on both jaws and whose ages ranged from 20 to 35 (mean age: 26.26\u0026thinsp;\u0026plusmn;\u0026thinsp;3.95) were recruited from Mashhad Dental School referral patients. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e provides comprehensive inclusion and exclusion criteria. The eligibility was verified by the principal orthodontist investigator.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIn- and exclusion criteria\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInclusion criteria\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExclusion criteria\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAged between 20 and 35 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHistory of periodontal problems\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaving moderate crowding without the need for extraction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresence of systemic diseases\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUndergoing fixed orthodontic treatment on both jaws\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresence of cavities on the buccal surfaces of the examined teeth\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaving communication software such as WhatsApp, Telegram, and Instagram installed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresence of white spots on the buccal surfaces of the examined teeth\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaving an Android operating system on their phones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresence of restorations on the buccal surfaces of the examined teeth\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePrior to commencing the study, a randomization procedure was implemented using a 1:1:1 allocation with a block size of 3. To begin, a total of 60 opaque and sealed envelopes were prepared, each containing a unique three-digit code. Subsequently, 20 envelopes were assigned to each of the three education groups: assistant education, social media, and software. The assignment was carried out using an online website called randomizer.org. On day 0, measurements of the Plaque Index (PI) and gingival Index (GI) were recorded for all participants. Following this, the participants were randomly distributed into one of the three groups, with each group consisting of 20 individuals.\u003c/p\u003e \u003cp\u003eThe oral hygiene education included brushing the teeth twice a day followed by flossing once a day. The brushing technique used was the modified Bass technique, involving placing the toothbrush at the gum margin at a 45-degree angle and making small vibratory movements. This process continued along the dental arches until all accessible tooth surfaces were brushed for 2 minutes, with 30 seconds dedicated to each quadrant (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). For flossing, super floss was instructed to use by placing the stiffened-end threader under the orthodontic wire or between the teeth. They were then guided to pull the spongy floss through the gap or around the bracket (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the assistant education group, oral hygiene education was provided to patients by an operator using a dental model for at least three minutes at the beginning of orthodontic treatment. In the social media group, oral hygiene education was delivered through instructional videos, similar to the assistant education group, lasting three minutes, and patients were asked to record the number of times they watched the video. In the software group, an Android application was installed on the patients' smartphones. This software, included instructional videos and provided the ability to set multiple reminders for oral hygiene practices and record patients' hygiene habits. After the software education, patients in this group were asked to set a minimum of two reminders for daily oral hygiene in the software and record their hygiene habits in the calendar based on the type (toothbrushing with blue, flossing with red, interdental brushing with yellow). Notably, the same operator who provided education to the assistant education group also instructed the patients on the use of social media and software.\u003c/p\u003e \u003cp\u003eThe Plaque Index (PI) and gingival Index (GI), as mentioned earlier, were also evaluated after a one-month period, and any changes in these indices were examined across all groups. The assessment of outcomes was carried out by the same group of individuals, which consisted of a dentist and two periodontists. These individuals had their professional qualifications and calibration validated in advance to ensure the accuracy and reliability of the reported results. The measurement of inter-observer reliability yielded a coefficient of 0.91, indicating a high level of consistency among different observers.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eIn accordance with the findings presented by Alkadhi et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), an observed difference of 0.7 between groups was noted. With a targeted power of 90%, the minimum required sample size for all groups, maintaining a significance level of α\u0026thinsp;=\u0026thinsp;0.05, was calculated to be 60 patients, with 20 individuals allocated to each group. The comparison of sample sizes was conducted considering the anticipated difference between two independent groups, and GPOWER v3.0.1 software (Dusseldorf, Germany), were utilized for the sample size calculations.\u003c/p\u003e \u003cp\u003eThe data obtained from the study were presented using frequency tables and mean values accompanied by their respective standard deviations. To assess the distribution of gender within the study groups, the Chi-squared test was utilized. The normal distribution of the data was evaluated using the Shapiro-Wilk test. If the dependent variable exhibited a normal distribution, a one-way ANOVA followed by the Tukey test was employed to compare the different research groups. Conversely, if the data did not follow a normal distribution, the Kruskal-Wallis test was used, followed by Dun's post hoc test. The level of statistical significance was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05. The statistical analysis was performed using SPSS software (version 23; SPSS Inc., Chicago, IL, USA). Additionally, a 95% confidence interval was calculated for the study.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the patient flow through the trial. A total of sixty patients participated in the study, with a mean age of 26.26\u0026thinsp;\u0026plusmn;\u0026thinsp;3.95 years (ranging from 20 to 35 years). The gender distribution consisted of 35 females (58.3%) and 25 males (41.7%). No participants were excluded from the study, and all sixty patients successfully completed the trial. A detailed breakdown of age and gender distribution can be found in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Furthermore, there were no significant differences observed among the study groups regarding the variables of age and gender (P\u0026thinsp;=\u0026thinsp;0.731 and P\u0026thinsp;=\u0026thinsp;0.934, respectively).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAge and gender distribution analyzed by Kruskal-Wallis and Chi-square test, respectively\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003eGroups\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eSocial media\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eAssistant-based\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eSoftware\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender (N (%))\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25 (41.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35 (58.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u0026thinsp;\u0026plusmn;\u0026thinsp;4.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.25\u0026thinsp;\u0026plusmn;\u0026thinsp;2.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26.55\u0026thinsp;\u0026plusmn;\u0026thinsp;3.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26.26\u0026thinsp;\u0026plusmn;\u0026thinsp;3.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e Before being evaluated, participants in three groups of 20 received oral hygiene education through either social media, assistant, or software. The assessment was conducted using PI and GI at the following time points: before treatment (T0) and one month (T1) after treatment.\u003c/p\u003e \u003cp\u003eFirst, the Shapiro-Wilk test was used to determine whether the data had a normal distribution. Since an abnormal distribution was detected in each assessment, the Kruskal-Wallis test was employed when analyzing the results.\u003c/p\u003e \u003cp\u003eKruskal-Wallis found no statically significant differences in PI and GI between all groups at baseline (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). One month following education, there was no significant difference between social media and software groups, nor between social media and assistant groups regarding both indices, despite the assistant group having a considerably higher PI and GI than software group (P\u0026thinsp;=\u0026thinsp;0.028 and P\u0026thinsp;=\u0026thinsp;0.048, respectively). The statistics are displayed in Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e below.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of mean periodontal indices for each study group at each assessment time point\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003eOne month\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSocial media\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eAssistant-based\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eSoftware\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eSocial media\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eAssistant-based\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eSoftware\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.844\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.623\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eA significant difference between groups is indicated by a different superscript letter (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eA 95% confidence interval of the mean was estimated in the analysis.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMoreover, a significant difference was observed in PI and GI changes across groups one month after education. By the one-month interval, There was a statistically significant difference in PI changes between each pair of groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Nevertheless, was no significant difference between social media and software groups, nor between social media and assistant groups regarding GI changes throughout one month. However, it is noticeable that the assistant group had a significantly lower GI reduction than the software after one month (P\u0026thinsp;=\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of changes in mean periodontal indices for each study group.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eDifferences\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSocial media\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eAssistant-based\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eSoftware\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e=\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eA significant difference between groups is indicated by a different superscript letter (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eA 95% confidence interval of the mean was estimated in the analysis.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study aimed to compare the effectiveness of three different oral hygiene education methods: education through social media, assistant-based education, and software-based education. After conducting eligibility assessments, a total of sixty patients were selected from referrals received from Mashhad dental school to take part in this trial, which lasted for a duration of one month. The results demonstrated significant differences in oral hygiene outcomes among the education groups, highlighting the potential benefits of incorporating technology-based approaches in orthodontic practices. One of the key findings of this study was that the software education group exhibited the lowest plaque and gingival indices, indicating better oral hygiene outcomes compared to the assistant education group. This suggests that software applications specifically designed for oral hygiene education can effectively reduce plaque accumulation and minimize the risk of gingival inflammation during orthodontic treatment. The interactive nature of software programs, coupled with visual aids and educational content, may have contributed to improved patient understanding and adherence to oral hygiene practices. Similarly, the social media education group showed favorable oral hygiene outcomes, although the differences between this group and the software education group were not statistically significant. This implies that social media platforms can also play a valuable role in promoting oral hygiene practices among orthodontic patients. The widespread use of social media and its ability to deliver information in an engaging and accessible manner make it a promising tool for oral health education.\u003c/p\u003e \u003cp\u003e The findings of this study align with previous research emphasizing the positive impact of technology-based approaches on oral hygiene outcomes. In a comparable trial, Alkadhi et al. examined the effect of using mobile applications on improving oral hygiene compliance in patients with fixed orthodontic appliances. They concluded that the plaque index (PI) and gingival index (GI) decreased in the group using active reminders of oral hygiene instructions on mobile applications compared to verbal oral hygiene instructions (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Similar to this study\u0026rsquo;s findings, Scheerman et al. conducted a randomized controlled trial to assess the effect of using a mobile application called \"WhiteTeeth\" on oral health improvement. The results showed that the use of a mobile application containing relevant information and education about oral health alongside regular care in adolescents with fixed orthodontic appliances leads to improved oral hygiene (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In another study Zotti et al. (2015) the usefulness of mobile applications in improving oral hygiene compliance in orthodontic patients. They found that orthodontic patients using mobile applications had lower GI, PI, and percentages of caries and white spots (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Ross et al. investigated the impact of automated messaging on the oral health of patients undergoing orthodontic treatment and found that the daily reminder group exhibited significant progress in maintaining oral and dental hygiene compared to the weekly reminder group (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Al-Moghrabi et al. conducted a systematic review to investigate the effectiveness of mobile applications and social media-based interventions in inducing behavioral changes in orthodontic patients. They concluded that there is limited to moderate evidence supporting the effectiveness of mobile applications and social media-based interventions in promoting positive behavioral changes in orthodontic patients, and further studies in this area are needed (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the promising results, it is important to consider the limitations of this study. The short follow-up period of one month may not fully capture the long-term effects of the different education methods on oral hygiene outcomes. Future research should incorporate longer follow-up periods to assess the sustainability of the observed improvements. Additionally, expanding the study to include a more diverse population in terms of age and socioeconomic background would help validate the generalizability of the findings. Another limitation of this study is the reliance on self-reported oral hygiene practices. Self-reporting introduces the possibility of recall bias and may not provide an accurate reflection of actual oral hygiene behaviors. Future studies could incorporate objective measures, such as bacterial plaque analysis. By identifying the most effective methods, orthodontic professionals can optimize patient care and contribute to improved oral health during orthodontic treatment.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, the results of this study suggest that software education and social media platforms have the potential to improve oral hygiene outcomes in orthodontic patients. The use of software applications specifically designed for oral hygiene education demonstrated superior results in terms of plaque control and gingival health compared to traditional assistant-based education. Social media platforms also showed promising results.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval was obtained from the ethical committee at Mashhad University of Medical Sciences, ensuring the confidentiality of all patient information.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eBefore participating in any activities, each participant provided their informed consent by signing a consent form. This form had received approval from the Vice-Chancellor of Research at Mashhad University of Medical Sciences and contained a detailed explanation of the study\u0026apos;s objectives and procedures, along with addressing any inquiries they may have had.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe findings of this study were obtained from a student thesis (thesis number IRMUMS990352).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHS\u003c/strong\u003e: Conceptualization, Methodology, Validation, Supervision, Project administration \u003cstrong\u003eSS:\u0026nbsp;\u003c/strong\u003eInvestigation, Conceptualization, Writing - Review \u0026amp; Editing. \u003cstrong\u003eEB:\u0026nbsp;\u003c/strong\u003eConceptualization, Methodology,\u0026nbsp;Investigation, Supervision, Writing - Review \u0026amp; Editing.\u003cstrong\u003e\u0026nbsp;MG:\u0026nbsp;\u003c/strong\u003eInvestigation, Methodology, Visualization, Writing - Original Draft, Writing - Review \u0026amp; Editing. \u003cstrong\u003ePS:\u003c/strong\u003e Investigation, Methodology, Visualization, Writing - Original Draft, Writing - Review \u0026amp; Editing.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAnuwongnukroh N, Dechkunakorn S. R K. Oral Hygiene Behavior during Fixed Orthodontic Treatment. Dentistry. 2017;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZotti F, Dalessandri D, Salgarello S, Piancino M, Bonetti S, Visconti L, et al. Usefulness of an app in improving oral hygiene compliance in adolescent orthodontic patients. Angle Orthod. 2016;86(1):101\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlslakhi M, Oz U, Sin \u0026Ccedil;. The powerful effects of social media platforms on orthodontic patient knowledge\u0026rsquo;s improving, attitude management and it is influence on financial income of the orthodontic clinic. Appl Nanosci. 2022;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLe Fouler A, Jeanne S, Sorel O, Br\u0026eacute;zulier D. How effective are three methods of teaching oral hygiene for adolescents undergoing orthodontic treatment? The MAHO protocol: an RCT comparing visual, auditory and kinesthetic methods. Trials. 2021;22(1):144.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeleuse M, Meiffren C, Bruwier A, Maes N, Le Gall M, Charavet C. Smartphone application-assisted oral hygiene of orthodontic patients: a multicentre randomized controlled trial in adolescents. Eur J Orthod. 2020;42(6):605\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFarhadifard H, Soheilifar S, Farhadian M, Kokabi H, Bakhshaei A. Orthodontic patients\u0026rsquo; oral hygiene compliance by utilizing a smartphone application (Brush DJ): a randomized clinical trial. BDJ Open. 2020;6(1):24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSilness J, Loe H. PERIODONTAL DISEASE IN PREGNANCY. II. CORRELATION BETWEEN ORAL HYGIENE AND PERIODONTAL CONDTION. Acta Odontol Scand. 1964;22:121\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLoe H, Silness J. PERIODONTAL DISEASE IN PREGNANCY. I. PREVALENCE AND SEVERITY. Acta Odontol Scand. 1963;21:533\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFarook FF, Alrumi A, Aldalaan K, Ababneh K, Alshammari A, Al-Khamees AA, et al. The efficacy of manual toothbrushes in patients with fixed orthodontic appliances: a randomized clinical trial. BMC Oral Health. 2023;23(1):315.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeng L, Wen J, Cui G, Liang J, Pang L, Lin H. Comparison of modified bass, rolling, and current toothbrushing techniques for the efficacy of plaque control \u0026ndash; A randomized trial. J Dent. 2023;135:104571.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSawan N, Ben Gassem A, Alkhayyal F, Albakri A, Al-Muhareb N, Alsagob E. Effectiveness of Super Floss and Water Flosser in Plaque Removal for Patients Undergoing Orthodontic Treatment: A Randomized Controlled Trial. Int J Dent. 2022;2022:1344258.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlkadhi OH, Zahid MN, Almanea RS, Althaqeb HK, Alharbi TH, Ajwa NM. The effect of using mobile applications for improving oral hygiene in patients with orthodontic fixed appliances: a randomised controlled trial. J Orthod. 2017;44(3):157\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScheerman JFM, van Meijel B, van Empelen P, Verrips GHW, van Loveren C, Twisk JWR, et al. The effect of using a mobile application (WhiteTeeth) on improving oral hygiene: A randomized controlled trial. Int J Dent Hyg. 2020;18(1):73\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoss MC, Campbell PM, Tadlock LP, Taylor RW, Buschang PH. Effect of automated messaging on oral hygiene in adolescent orthodontic patients: A randomized controlled trial. Angle Orthod. 2019;89(2):262\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Moghrabi D, Alkadhimi A, Tsichlaki A, Pandis N, Fleming PS. The influence of mobile applications and social media-based interventions in producing behavior change among orthodontic patients: A systematic review and meta-analysis. Am J Orthod Dentofac Orthop. 2022;161(3):338\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"oral health education, oral hygiene, orthodontic patients, educational software, social media","lastPublishedDoi":"10.21203/rs.3.rs-4331562/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4331562/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: To compare the effectiveness of different oral hygiene education strategies on periodontal health in fixed orthodontic patients in a one-month period: assistant-led instruction, social media-based education, and custom-made software.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: Sixty orthodontic patients from Mashhad University of Medical Sciences' Dentistry School were randomly assigned into three groups. Each group received oral health education differently: via assistant instruction, educational videos on social media, or a researcher-designed software for Android smartphones. After a month, participants' oral health was evaluated using the plaque index (PI) and the gingival index (GI).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Assistant-led education group demonstrated the highest PI (1.26 ± 0.70) and GI (0.92 ± 0.67), while the software group reported the lowest indices (PI = 0.68, GI = 0.46 ± 0.46). The social media group's measurements fell between these extremes (PI = 0.89 ± 0.75, GI = 0.60 ± 0.52). Significant group differences were found for both PI and GI (P = 0.028 and P = 0.047, respectively). Pairwise comparison revealed significantly lower PI and GI in the software group compared to the assistant group. No significant differences were found between the social media and other groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Our results suggest that the use of specially designed software could be the most effective strategy for improving oral hygiene in orthodontic patients. Meanwhile, traditional assistant-led education showed the least effectiveness. The study supports the potential benefit of utilizing digital tools, such as bespoke software and social media, in oral health education for orthodontic patients.\u003c/p\u003e","manuscriptTitle":"A Short-term Evaluation of Oral Hygiene Education Methods in Fixed Orthodontics Patients: A Randomized Clinical Trial Comparing Assistant Training, Software, and Social Media","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-11 18:23:19","doi":"10.21203/rs.3.rs-4331562/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-05-29T13:07:29+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-25T03:36:38+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-25T03:36:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2024-04-26T20:39:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2ffd0add-ff27-4e0a-afcb-95ed2dd09e00","owner":[],"postedDate":"June 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-28T16:01:17+00:00","versionOfRecord":{"articleIdentity":"rs-4331562","link":"https://doi.org/10.1186/s12903-024-05014-x","journal":{"identity":"bmc-oral-health","isVorOnly":false,"title":"BMC Oral Health"},"publishedOn":"2024-10-23 15:57:30","publishedOnDateReadable":"October 23rd, 2024"},"versionCreatedAt":"2024-06-11 18:23:19","video":"","vorDoi":"10.1186/s12903-024-05014-x","vorDoiUrl":"https://doi.org/10.1186/s12903-024-05014-x","workflowStages":[]},"version":"v1","identity":"rs-4331562","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4331562","identity":"rs-4331562","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}