Oral Health Promotion Using Technologies Outside the Dental Setting

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  1. Goal
  2. Background
  3. Gaps and Opportunities
  4. Impact
  5. Current Portfolio
  6. Specific Areas of Interest
  7. References

September 2021

Behavioral and Social Sciences Research Branch
Division of Extramural Research

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Goal

The main goal of this initiative is to encourage research that develops, adapts, and/or tests technology-facilitated behavioral, community, and organizational tools for use in oral health promotion outside of the dental clinic.

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Background

Oral health promotion refers to multi-sectoral efforts to achieve oral health and prevent disease, in which equity is a central goal. A set of health promotion principles were codified by the World Health Organization in the Ottawa Charter for Health Promotion (World Health Organization, 1986) and have guided international efforts ever since, including a recent World Health Assembly Resolution focused on oral health promotion (World Health Organization, 2021). The Ottawa Charter principles that serve as an enduring model for oral health promotion include 5 key action areas: 1) build healthy public policy, 2) create supportive environments, 3) strengthen community actions, 4) develop personal skills, and 5) reorient health services from curative to preventive and empowering.

Oral health promotion outside of the dental setting may be a key pathway to reducing oral health disparities. The unequal distribution of oral health professionals and facilities in the United States and worldwide means that there are disparities in access to quality care. Exacerbating the disparities caused by geographical availability are a host of other social and economic challenges that impede access to quality care in the dental setting. Oral health promotion approaches pay particular attention to addressing oral health in the context of these challenges, and tend to involve behavioral, community, and organization-level activities and interventions. These approaches may be especially amenable to being conducted outside the dental setting, and indeed have a long history of doing so. With recent advances in communication and collaboration technologies, oral health promotion seems poised to make use of new tools to increase the reach of services to under-served and under-resourced individuals, families, and communities.

While the use of technologies to support oral health promotion is not new (Jampani et al., 2011), the SARS-CoV2 pandemic has generated new interest in the use of such technologies in dentistry as well as other care sectors (Wosik et al., 2020). Advances in technologies--such as videoconferencing, web-based programs, wearable or device-embedded sensors, and smartphones--provide promising tools for potentially effective oral health promotion outside of the dental clinic.

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Gaps and Opportunities

The availability of smartphone- and web-based programs has skyrocketed, with recent market research estimating tens of thousands of mobile health-promotion programs in the current marketplace. Unfortunately, the development of such programs has outpaced the rigorous empirical testing of these programs. A review of the 33 most popular oral health smartphone applications (apps) noted that none had been empirically tested, and that few conformed to established behavior-change or technology-design principles (Tiffany et al., 2018). A trans-NIH Working Group has identified a need to develop standards for health-promotion digital technologies, given their recent proliferation across health conditions, and largely without empirical support. This proposed initiative would incorporate those standards to guide a more systematic approach to oral health-related tool development and testing.

In addition to web- and smartphone-based programs, oral-health related sensor and remote communication technologies are increasingly available, potentially allowing for patient self-monitoring, and use by clinicians for treatment planning. “Smart” toothbrushes are one example, able to track toothbrushing frequency and duration using a sensor embedded in the toothbrush, with some able to send that information to patients or providers remotely. Current work is extending the smart brush to detect even more features of toothbrushing quality, and to use this technology in “smart games”. Efforts to develop integrated electronic health record systems add to the promise of technology-facilitated oral health promotion, empowering patients to direct their own health care, for example by having access to their health records, scheduling, and other resources. Challenges remain to integrate these technologies into care systems in acceptable and sustainable ways.

While the technology provides opportunities for innovative and virtual communication channels, it does not define clearly the program or intervention content. This initiative would encourage development and testing of oral health promotion interventions that incorporate approaches that move the field forward, both in the use of technologies and in the development of intervention content. Regarding intervention development, there is increasing recognition that health promotion programs—whether or not facilitated by technology--focus too narrowly on a small set of individual health behaviors, rather than on more macro-level social determinants of oral health. This perspective was echoed in the discussions at the 2020 Behavioral and Social Oral Health Sciences Summit, an international effort to build consensus among behavioral and social oral health scientists and clinicians about essential foci and critical next steps in behavioral and social oral health research (Behavioral and Social Oral Health Sciences Summit, 2020). This initiative aligns with these and other expert recommendations about future directions for oral health promotion research.

Perhaps the main potential benefit of technology-based oral health promotion approaches is their ability to increase access to care for individuals and communities who are currently under-served, including communities disproportionately affected by the pandemic. However, if under-served communities do not have access to the technologies required, these approaches could actually increase oral health disparities. A recent study suggested that the majority of people in the U.S. have sufficient access to phone or web connectivity to make use of technology-based approaches (Pew Research Center, 2019), but any study proposing use of technologies will need to ensure that disparities in access do not widen disparities in oral health.

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Impact

Long-standing concerns about oral health disparities exacerbated by limited access to quality care, and new concerns about providing care during the current SARS-CoV2 pandemic, renew the sense of urgency for effective and innovative oral health promotion efforts outside of the dental setting. Oral health promotion approaches have the potential to increase access to quality care for those who are currently under-served, by removing geographical and other social and economic barriers to care. Rigorous testing of technology-facilitated oral health promotion approaches could establish the efficacy of tools, giving stakeholders a foundation for adoption beyond a tool’s intuitive appeal. Given the tens of thousands of web- and smartphone-based programs currently available—with numbers growing rapidly—having an empirical basis for selecting approaches to care seems tremendously important. Also, in the event of another pandemic, natural disaster, or public health threat, being equipped with efficacious oral health promotion approaches that can be conducted virtually is essential planning.

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Current Portfolio

NIDCR has funded the development and testing of a small number of oral health promotion web-based programs and smartphone apps, including those addressing dental fear, smoking cessation, toothbrushing skills, oral hygiene for non-specialty care-providers, and oral health and parenting. This initiative would help guide the systematic development and testing of technology-delivered behavioral interventions focused on improving oral health.

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Specific Areas of Interest

  • Develop and test new web- or smartphone-based oral health promotion strategies that address barriers beyond those attributed to individual behavior.
  • Across individuals, families, or communities, identify features on which an oral health promotion program needs to be tailored to address specific needs or challenges.
  • Develop and test a system that harnesses technology to address an urgent public oral health challenge (e.g., remote monitoring and communication about misuse of prescribed opioids; technology to assess protection from SARS-CoV2 to support treatment-seeking; inter-professional support for prevention and chronic disease management).
  • Support developers of existing web- or smartphone-based oral health promotion interventions to build an empirical basis for outcomes.
  • Develop and test technology that provides new or important functionality for users (e.g., a platform that allows user-friendly tailoring of intervention material for specific individuals, families, or communities; a system that integrates data from different electronic health record sources for use by a patient or provider).
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References

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Last Reviewed
April 2024