Oral Health Promotion Mediated by Teledentistry in Community-dwelling Older Adults of La Araucanía Region, Chile

Development and Pilot Implementation of an Oral Health Promotion Strategy Mediated by Teledentistry Focused on Community-dwelling Older Adults of the La Araucanía Region of Chile

The goal of this randomized clinical trial is to compare the knowledge, attitudes, and oral health self-efficacy in self-sufficient elders aged over 60 years of 4 cities of La Araucanía región, Chile.

The main questions it aims to answer are:

• Can the development and implementation of a teledentistry strategy focused on community-dwelling older adults of the La Araucanía region improve participants' knowledge, attitudes, and self-efficacy in oral health?
• Could this teledentistry strategy have acceptability greater than 80%?

Participants will receive a dental-medical-geriatric diagnosis in a mobile dental clinic supported by a web platform called Teleplatform of Geriatric Dental Specialties (TEGO) and individual oral health education.

The researchers will compare a comparison group that will receive face-to-face individual oral health education with an intervention group, called tele-education group, that will receive educational reinforcement through a teledentistry strategy mediated by oral health educational videos sent via WhatsApp; to see if there are differences in the knowledge, attitudes, and oral health self-efficacy between the groups.

Study Overview

• Status: Completed
• Conditions: Oral Health Knowledge; Oral Health Attitudes; Oral Health Self-efficacy
• Intervention / Treatment: Device: Teledentistry oral health promotion; Behavioral: Face-to-Face oral health promotion

Detailed Description

Access to oral health promotion for the elderly has been limited during their lifetime. The purpose of this study is the development and pilot implementation of an oral health promotion strategy mediated by teledentistry focused on community-dwelling older adults of the La Araucanía region. To this end, a randomized clinical trial is proposed with pre- and post-intervention tests to be carried out in a sample (n:120) of people over 60 years of age from 4 cities in this region. Both groups will undergo a dental-medical-geriatric diagnosis in a mobile dental clinic supported by a web platform called Teleplatform of Geriatric Dental Specialties (TEGO) and individual oral health education. The intervention group will also receive educational reinforcement through oral health videos sent via WhatsApp (Tele-education). The strategy will be evaluated through a questionnaire of knowledge, attitudes and self-efficacy in oral health that will be applied before and after the interventions received by both groups. The acceptability of the tele-educational strategy will be assessed. The statistical analysis contemplates the description of the sociodemographic profiles of the participants and the acceptability perceived by those who make up the tele-education group. The average of the scores obtained in the pre and post-test of the questionnaire will be compared within each group through the T-test for related samples and the average of the final scores will be compared between both groups through the T-test for independent samples. Likewise, the relationship between the post-test results, sociodemographic variables, and clinical variables will be evaluated through the Pearson Correlation Coefficient. A value of p < 0.05 was chosen as the threshold for significance.

• Study Type: Interventional
• Enrollment (Actual): 117
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Chile
  • La Araucanía
    • Temuco, La Araucanía, Chile
      • Clinica Dental Móvil TEGO-UFRO

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Adults over 60 years of age residing in La Araucanía Region
• Self-valent (Barthel index ≥ 90)
• With access to a smartphone and internet
• Ability to follow instructions and adequate mobility to go up to a mobile dental clinic.

Exclusion Criteria:

• Subjects with cognitive impairment (Folstein Mini-Mental ≤ 24)
• Totally edentulous
• Those who do not use WhatsApp

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Tele-education; The tele-education group will receive the same intervention as the comparison group with an educational reinforcement mediated by teledentistry. This intervention consists of 4 educational videos, designed for the elderly, promoting correct toothbrushing and flossing, detection, and prevention of dental caries, periodontal disease, and oral cancer. These four videos were sent via WhatsApp.	Device: Teledentistry oral health promotion; Educational videos specially designed and validated for elderly (duration 4 to 6 minutes each one); Behavioral: Face-to-Face oral health promotion; Standardized PowerPoint presentation of 15 minutes about the most common or dangerous oral diseases (dental caries, periodontal disease and oral cancer), and toothbrushing and flossing practice in dental models
Active Comparator: Comparison; The comparison group receive a medical-dental-geriatric diagnosis and face-to-face standardized education via powerpoint presentation and use of dental models for the promotion of correct toothbrushing and flossing, detection, and prevention of dental caries, periodontal disease, and oral cancer.	Behavioral: Face-to-Face oral health promotion; Standardized PowerPoint presentation of 15 minutes about the most common or dangerous oral diseases (dental caries, periodontal disease and oral cancer), and toothbrushing and flossing practice in dental models

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in oral health knowledge	Questionnaire of 38 items focused on identifying signs and symptoms of dental caries, periodontal disease, and oral cancer, as well as preventive measures for each condition. The responses for signs and symptoms were quantified using a 'Yes' , 'I don't know' or 'No' scale, while preventive measures were ranked on a 5-point scale ranging from 'Very important to 'Not at all important	Change from baseline oral health knowledges at 6 weeks
Change in oral health attitudes	Attitudes were measured via a 5-point scale, which evaluated seven items associated with the inevitability of oral disease in the elderly, the value of keeping natural teeth, and the effectiveness of preventive behaviors	Change from baseline oral health attitudes at 6 weeks
Change in oral health self-efficacy	Oral Health self-efficacy scale to assess the individual's confidence in their ability to prevent oral diseases. This survey has 8 items under the subordinate categories of oral and general health self-efficacy, six and two questions respectively. All of the eight items had to be rated along a five-point Likert scale comprising Not at all Confident, Not confident, Neither confident nor unconfident, Confident, and Strongly Confident ratings.	Change from baseline oral health self-efficacy at 6 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Acceptability: Utility of the teledentistry intervention	The utility of each video was assesed via a 4-point scale	2 days after sending each video
Acceptability: Dropout rate	Percentage withdrawal of study participants	Change from baseline up to 6 weeks
Acceptability: Recomendation	Binary question with a yes or no answer on whether you would recommend this type of care and promotion of oral health to friends and/or family	After 6 weeks

Collaborators and Investigators

• Sponsor: Fernanda Muñoz Sepúlveda
• Collaborators: Subvención Presidencial, Ministerio de Hacienda, Chile; Centro Interuniversitario de Envejecimiento Saludable (CIES); Beca de Postgrado Magíster Nacional, ANID

Publications and helpful links

General Publications

• Beltran V, Flores M, Sanzana C, Munoz-Sepulveda F, Alvarado E, Venegas B, Molina JC, Rueda-Velasquez S, von Marttens A. Tooth Loss and Caries Experience of Elderly Chileans in the Context of the COVID-19 Pandemic in Five Regions of Chile. Int J Environ Res Public Health. 2023 Feb 9;20(4):3001. doi: 10.3390/ijerph20043001.
• Beltran V, von Marttens A, Acuna-Mardones P, Sanzana-Luengo C, Rueda-Velasquez SJ, Alvarado E, Flores M, Cerda A, Venegas B. Implementation of a Teledentistry Platform for Dental Emergencies for the Elderly in the Context of the COVID-19 Pandemic in Chile. Biomed Res Int. 2022 Mar 22;2022:6889285. doi: 10.1155/2022/6889285. eCollection 2022.

Study record dates

Study Major Dates

• Study Start (Actual): March 3, 2023
• Primary Completion (Actual): August 30, 2023
• Study Completion (Actual): October 14, 2023

Study Registration Dates

• First Submitted: June 6, 2023
• First Submitted That Met QC Criteria: June 14, 2023
• First Posted (Actual): June 26, 2023

Study Record Updates

• Last Update Posted (Estimated): January 3, 2024
• Last Update Submitted That Met QC Criteria: January 2, 2024
• Last Verified: January 1, 2024

More Information

Terms related to this study

• Keywords: Elderly; Oral health promotion; Teledentistry
• Other Study ID Numbers: 082/22

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: All IPD underlying the results will be shared in one publication
• IPD Sharing Time Frame: When summary data are published
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No