Assessing the effectiveness of text messages as appointment reminders in a pediatric dental setting

BackgroundText messaging is a dominant form of communication in our society. However, little research has been conducted to evaluate its effectiveness as an appointment reminder in the dental setting.MethodsFrom the patient pool of the pediatric dentistry clinic at the University of Washington, Seattle, the authors invited 543 caregiver/child dyads who met eligibility criteria to participate in this study. They randomly assigned 318 pairs (59 percent response) to receive a short message service (SMS) text message (n = 158) or a voice message (control group) (n = 160) as an appointment reminder.ResultsYounger caregivers were more likely to be nonattendees than were older caregivers (P = .02). Participants in the voice message group had a lower no-show attendance (8.2 percent) than did those in the text message group (17.7 percent) (P = .01). The unadjusted odds ratio (OR) for type of appointment reminder and no-show attendance was 2.41 (P = .01). After the authors adjusted for the caregiver's age, the OR was 2.12 (P = .04).ConclusionsSMS text messages were not as effective as voice reminders for patients in a dental school pediatric dentistry clinic. Future studies should investigate the effect of text message reminders when limited to patients who self-select that type of reminder and in patient populations outside the university setting.Clinical ImplicationsText messaging may not be the preferable method of reminding patients about appointments in a university pediatric dental clinic.     

Failed appointments in an orthodontic clinic.

BACKGROUND: The aim of this study was to retest the hypotheses of Reekie and Devlin (1998) by conducting a similar randomized controlled trial in an orthodontic clinic in the Netherlands. It was hypothesized that a reminder would reduce the failed attendance rate and that the form of the reminder would be irrelevant. METHODS: All patients with appointments in the orthodontic clinic at the Academic Centre of Dentistry Amsterdam during a 3-week period were divided into 4 groups. Three groups received a reminder 1 day before the appointment, either by telephone, mail, or short message service (SMS, a service used to send and receive short text messages to and from cell phones). A control group did not receive a reminder. In a follow-up study, random subsamples in each group were interviewed by telephone. Subjects were asked how they felt about receiving a reminder and which reminder they preferred. RESULTS: The hypothesis that a reminder would reduce the failed attendance rate was not confirmed. Also, no differences were found between the 4 conditions, indicating that the form of the reminder is irrelevant. However, most of the interviewed participants felt positive or very positive about receiving a reminder. There was a significant preference for a reminder by mail (56.3%), followed by a telephone reminder (26.0%) and a reminder by SMS (17.7%). No less than 20% of the interviewed participants felt negative or very negative about the reminders and considered them to be a waste of time and money. CONCLUSIONS: The hypothesis that reminders are useful in the prevention of failed appointments was not confirmed. This study underlines the importance of replication studies. It demonstrates that every research result, whether it is generated by evidence-based or tradition-based research, should be interpreted with care and should be replicated in other studies before the results can be generalized.     

The use of postal reminders to reduce non-attendance at an orthodontic clinic: a randomised controlled trial

OBJECTIVES: To evaluate the effect of issuing a patient reminder plus a confirmation slip on the attendance of orthodontic new patients. SETTING: Department of Orthodontics, University Dental Hospital of Manchester. DESIGN: A randomised controlled trial. METHODS: New patients were randomly allocated to:receive a reminder letter and return a confirmation slip ornot receive a reminder. OUTCOME MEASURES: Patient attendance at the clinic. RESULTS: A total of 232 patients were entered into the study between June 18, 2001 and August 29, 2001. These were randomly allocated to 115 (49.8%) in the reminder group and 116 (50.2%) in the no reminder group. If the patient received a reminder and returned the confirmation they were less likely to fail the appointment than if they did not receive a reminder (OR 0.4, 95% CI 0.2 to 0.96) There was an effect of social deprivation, if the patients lived in an area of high social deprivation they were 2.7 (95% CI 1.1 to 6.5) times more likely to fail to attend an appointment than people who were more affluent. CONCLUSIONS: The use of postal reminders for orthodontic consultation appointments appears to result in a useful increase of appointments that are kept or cancelled in advance.     

Effect of automated messaging on oral hygiene in adolescent orthodontic patients: A randomized controlled trial

Objective:To determine whether automated text messages sent daily to adolescent orthodontic patients improves oral hygiene more than weekly reminders.Materials and Methods:A blinded, prospective, randomized controlled trial was designed to evaluate the effects of automated messages on oral hygiene. Subjects were recruited from patients undergoing orthodontic treatment at the Texas A&M University College of Dentistry, Department of Orthodontics. They were being treated with a variety of fixed full appliances in both arches. Subjects were randomly assigned to either a once-a-week text message group or a daily text message group. There were 52 females and 27 males who were 12 to 17 years of age. Oral hygiene was measured at the beginning of the study and again 8.6 ± 0.9 weeks later.Results:The daily reminder group (N = 42) had significantly greater improvements in oral hygiene compliance than the weekly reminder group (N = 37). The daily score decreases were 48%, 21% and 19% for the bleeding index (BI), plaque index (PI), and gingival index (GI), respectively. The weekly score decreases were 27%, 14% and 13% for the BI, PI, and GI. There were no sex differences in hygiene changes during the study. The 42% of patients who completed the survey at the end of the study wanted more frequent messages and reported that messages related to decreasing treatment time were the most effective, while those related to oral hygiene were the least effective.Conclusions:Daily text messages are more effective at improving oral hygiene than weekly text messages.     

The influence of text messaging on oral hygiene effectiveness

Objective:To investigate whether text message reminders regarding oral hygiene have an effect on plaque removal in orthodontic patients.Materials and Methods:In this randomized, controlled clinical trial, 50 orthodontic patients were assigned to either a text message or control group. Patients in the text message group received 12 text messages over the course of 4 weeks and one text message for 8 weeks thereafter. Photos were taken at baseline (T0), at 4 weeks after baseline (T1), and at 12 weeks after baseline (T2). For each subject, photos of eight teeth were taken and then the area of the tooth and amount of plaque were measured using planimetry.Results:There was a statistically significant difference in plaque coverage between baseline and both T1 and T2 in the text message group as measured using planimetry. This was demonstrated by comparing the average measurements of the control group and the treatment group.Conclusion:This study demonstrated that the use of automated text message reminders sent from an orthodontic office was effective in improving oral hygiene compliance in orthodontic patients.     

Can text messages encourage flossing among orthodontic patients?

ObjectivesTo assess the extent to which text messages on WhatsApp play a role in patient awareness of the importance of proper oral hygiene and flossing on a daily basis and to test the null hypothesis that daily text messages do not influence the flossing habits of orthodontics patients.Materials and MethodsForty-four patients wearing fixed orthodontic appliances with a mean age of 14.3 years participated in the study. Patients (male and female) were randomly assigned to two groups (n = 22): group 1, text messages sent via WhatsApp daily during the study period, and group 2 (control), no text messages received. Plaque index, gingival bleeding index, and halitosis were assessed at baseline and after 30 days. The results were analyzed and subjected to normality test, McNemar test, Fisher exact test, Mann-Whitney test, and Wilcoxon signed-rank test.ResultsThere was a significant influence on flossing habits (P < .05) and a significant reduction in plaque and gingival bleeding indices in group 1 (P < .05). Group 1 had a significant reduction in halitosis (P < .05).ConclusionsDaily text messages seem to influence patient awareness of the importance of proper oral hygiene and flossing. The null hypothesis was rejected because those patients who received text messages every day changed their flossing habits.     

Influence of active reminders on oral hygiene compliance in orthodontic patients

Objective: To determine if text message reminders regarding oral hygiene compliance have an influence on the level of compliance within an orthodontic population.Materials and Methods:In this prospective, randomized, controlled clinical trial, 42 orthodontic patients were assigned to a text message or control group. Parents of patients assigned to the text message group received a reminder text message one weekday each week. Oral hygiene compliance was measured using bleeding index (BI), modified gingival index (MGI), and plaque index (PI), and visual examination of white spot lesion (WSL) development at baseline (T0), two appointments after baseline (T1), and four appointments after baseline (T2).Results:BI, MGI, and PI scores were significantly lower in the text message group than in the control group at T2.Conclusion:A text message reminder system is effective for improving oral hygiene compliance in orthodontic patients.     

The influence of text messages on the cooperation of Class II patients regarding the use of intermaxillary elastics

Objectives:To evaluate the influence of text messages on cooperation of Class II patients with the use of intermaxillary elastics.Materials and Methods:The sample consisted of 42 orthodontic patients (20 males and 22 females) aged between 14 and 34 years. They were randomly divided into one of the following two groups: a control group with 21 patients who did not receive messages and an experimental group with 21 patients who received motivational and reminder text messages. Messages were sent twice a week for a period of 3 months. The patients were instructed to wear the elastics all day, removing them only during meals and replacing them daily. All patients were instructed regarding the importance of cooperation. Measurements were performed with a digital caliper on plaster models at the beginning of elastics wear (T1) and 3 months later (T2). For intragroup and intergroup comparisons between T1 and T2, paired and unpaired t-tests, respectively, were used with a significance level of 5%.Results:Statistically significant differences were observed in the intra- and intergroup comparisons between T1 and T2. Both groups showed a decrease in the sagittal distance between upper and lower arches from T1 to T2, demonstrating the effective use of elastics. However, the experimental group showed a Class II correction that was 3.7 times greater than the control group (P = .001).Conclusions:Text messages had a positive influence on the cooperation of patients regarding the use of intermaxillary elastics in the orthodontic treatment of Class II malocclusion.     

Effectiveness of metronidazole gel and mobile telephone short-message service reminders on gingivitis in orthodontic patients:: A double-blind randomized controlled trial

ObjectivesTo compare the effectiveness of metronidazole gel and mobile telephone short-message service (SMS) reminders on gingivitis in patients undergoing fixed orthodontic treatment.Materials and MethodsThe trial was double blinded (patient and investigator), and only the clinical trial unit pharmacist was unblinded. Data were collected from patients undergoing fixed orthodontic treatment for at least 6 months. A total of 66 patients were randomly assigned to either 0.8% metronidazole gel (n = 22), SMS reminder and placebo gel (n = 22), or placebo (control) group only (n = 22). Gingival index (GI), bleeding index (BI), and orthodontic plaque index (OPI) were evaluated on several teeth at baseline (T₀) and after 4 weeks (T₁). Paired-sample t-tests were used to compare mean differences of indexes at T₀ and T₁ in the groups, and independent-sample t-tests were used to determine the effects of interventions compared with the controls.ResultsData from 64 patients were analyzed; there were 2 dropouts. There were statistically significant (P < .05) reductions in GI, BI, and OPI scores from T₀ to T₁ for each intervention. However, there were no significant differences between each intervention and the control group. There were no adverse effects.ConclusionsThe null hypothesis could not be rejected. There is no difference between interventions (application of 0.8% metronidazole gel and SMS reminder for reinforcing oral hygiene) in reducing gingival inflammation in orthodontic patients.     

Effect of text message follow-up on patient's self-reported level of pain and anxiety

Objectives:To determine whether a text message reduces the severity of patient self-reported levels of pain and anxiety following initial placement of orthodontic appliances.Materials and Methods:Thirty-nine orthodontic patients were randomly assigned to one of two groups and matched for age, gender, and bracket type (self-ligating vs conventional). The subjects completed baseline questionnaires to ascertain their levels of pain and anxiety before initiating orthodontic treatment. Following the initial appointment, subjects completed the pain questionnaire and anxiety inventory at the same time daily for 1 week. One group received a structured text message showing concern and reassurance, while the second group served as a control and received no postprocedural communication.Results:There was a statistically significant difference in pain in relation to time between the text message group and the control group as it was demonstrated that demonstrated that compared with the text message group, mean pain intensity increased and selfreported discomfort was longer in the control group. Anxiety was determined to be at its peak the day following initial orthodontic appliance placement and gradually tapered off from that time point. No intergroup difference was noted when analyzing anxiety.Conclusions:This study demonstrated that a text message sent from an orthodontic office following initial appliance placement resulted in a lower level of patient''s self-reported pain. Additionally, patient anxiety is at its peak the day following the initial appointment and decreases from that point forward.     

A controlled trial of the impact of exposure to positive images of dentistry on anticipatory dental fear in children

OBJECTIVES: Dental anxiety is common in children. This study sought to determine the impact of viewing positive images of dentistry prior to a dental appointment on the anticipatory dental anxiety levels of children attending for dental treatment. METHODS: Controlled trial. Assessment of anxiety and analysis of data were conducted blind to experimental condition. Assessment of anxiety was carried out in the waiting room postintervention but before the patient entered the dental surgery for treatment. PARTICIPANTS: Thirty-eight children and young adults attending a dental clinic in South West England. INTERVENTION: Participants were randomly assigned to one of two conditions. In both conditions the participant was asked to look at photographs for 2 min in the waiting area prior to their appointment. The intervention consisted of viewing positive images of dentistry and dental treatment, the control condition consisted of dentally neutral images. Positive and neutral images were validated independently by four paediatric dentists. The assessment of anticipatory dental anxiety was made blind to experimental condition and statistical analysis was conducted blind to group membership. OUTCOME MEASURE: Anticipatory anxiety assessed by the Venham Picture Test. FINDINGS: A significant difference in anticipatory dental anxiety was found between the two groups (median-positive images = 0, median-neutral images = 3; P < 0.001). Anticipatory anxiety was not correlated to age (rho = 0.04 P > 0.05), there was no difference between male and female participants in their level of anticipatory anxiety (median-males = 0.5, median-females = 1 P > 0.05). CONCLUSIONS: Viewing positive images of dentistry and dentists results in short-term reductions in anticipatory anxiety in children.     

Attitudes to conscious sedation in patients attending an emergency dental clinic.

INTRODUCTION: Anxiety and fear in relation to dentistry are long-standing problems and the incidence of dental fear does not appear to be decreasing. It can result in poor dental health and wastage of clinical time. Conscious sedation is one method of allaying anxiety in dental patients and enables such patients to accept dental treatment. AIMS, MATERIALS AND METHODS: A questionnaire survey was undertaken among patients attending an emergency dental clinic. Its aims were to assess the levels of dental anxiety in these subjects, the impact on their attendance for dental treatment, and their knowledge of and desire to have conscious sedation, should it be available. RESULTS: The results indicated that in the 72 patients who responded, levels of anxiety regarding dental treatment were high, with 49 (68%) claiming some nervousness or worse. Thirty-one (43%) cited fear/nervousness as a reason for delaying making a dental appointment. Twenty-seven (38%) were not aware of the existence of conscious sedation for dental treatment, of whom half reported that they were in the highly anxious group. Forty (56%) respondents said they would like to have sedation if it were available. Twenty-five (35%) claimed to have received sedation for dental treatment in the past. CONCLUSION: It was concluded that the availability of dental sedation was currently not matching the needs and demands of several patients who took part in the survey. Increased availability of dental sedation could remove a barrier to dental care for many highly anxious dental patients.     

Testing the effect of including oral health in general health checks for elderly patients in medical practice--a randomized controlled trial

AIM: To test the feasibility and effectiveness of an oral health referral process for elderly patients (aged 75 years or over) attending a preventive health check (PHC) with their general medical practitioner. OBJECTIVES: To evaluate the effectiveness of the process in increasing dental attendance at baseline and 6 months after the intervention. To identify key characteristics of those who accepted an oral health visit (OHV). To determine the proportion of people attending the OHV who required treatment and subsequently attended a dentist. Setting: Three general medical practices in east Cheshire, UK. DESIGN: A randomized controlled trial. METHOD: Elderly patients attending their general medical practice for PHCs were randomly assigned to a test group, who were invited to attend for an OHV, and to a control group, who received no intervention. Six months after the PHC the effectiveness of the process was measured. RESULTS: Some 50% of those invited for an OHV accepted. Those accepting were more likely to be edentulous, wear dentures or have a current oral health problem, than those declining. Regression analysis showed the best predictors of acceptance to be having a current dental problem or pain and not having a regular dentist. The mean time since their last dental visit was 8.1 years which was significantly longer than those declining the OHV. 63% of individuals attending the OHV were assessed as having a realistic treatment need and 70% of those referred went on to complete the course of treatment. In the test group a highly significant increase in reported dental visiting was found at sixth month evaluation. The primary care staff were happy to include the dental checklist and felt it was a valuable addition to the PHC. CONCLUSIONS: The offer of an OHV was taken up most readily by those with current oral problems, or pain and those with no regular dentist. The inclusion of a dental checklist within the PHC for elderly patients together with help with arranging a dental appointment shows promise as a way of ensuring the dental needs of this group are met.     

Patient perceptions of costs in the NHS: an evaluation

The cost of the NHS, wastage within it and how much trusts have overspent is a national obsession. Despite these widespread opinions, the costs of individual treatments and impacts of non-attendance appear to be little understood. There is a paucity of literature with regards to patients’ awareness of costs associated with services provided by the NHS. The authors aim to ascertain whether patients are aware of the costs associated with care services provided, and if these data could aid educating patients on NHS costs to reduce missed appointments.A questionnaire was randomly distributed to new and review patients in our Oral and Maxillofacial outpatient and emergency departments from November-December 2017 asking them to estimate the cost of common services they may encounter, such as an outpatient appointment, an orthopantomogram (OPT), a CT head, and a full blood count test (FBC). The results demonstrate that 81% of patients surveyed underestimated the cost of their new patient appointment, with 34% underestimating the cost of their review appointment. The cost of an overnight stay in hospital was underestimated by 65% of patients, with 89% of patients underestimating the cost of an hours’s operating. The costs of a full blood count, an OPT and a CT head have been mostly overestimated by 89%, 77%, and 54% of patients respectively. The results show there is a wide variation in patients’ estimates of costs, with over 50% of patients overestimating the costs of investigations but underestimating the cost of their appointment/A&E attendance.     

Comparison of patient satisfaction measures between in-person and telemedicine postoperative appointments following third molar surgery

The goal of this study was to compare key aspects of patient satisfaction in patients who underwent in-person and telemedicine postoperative appointments following third molar surgery. A total of 69 patients undergoing the removal of third molars were randomized to receive their postoperative care either in person or via telemedicine appointments. Following the postoperative visit, patients were asked to complete a survey that assessed elements of patient satisfaction using a visual analog scale. Forty-seven patients (37 female, 10 male) completed the study (in-person n = 24, telemedicine n = 23). The mean total patient satisfaction score (maximum 50) was 46.46 for the in-person group and 48.78 for the telemedicine group; the difference was not statistically significant (P = 0.11). There were no statistically significant differences in patient satisfaction scores between the two groups with regards to the ease of scheduling the appointment, ease of attending the appointment, perceived usefulness of the appointment, or the quality of patient education received at the appointment. However, the perceived cost-effectiveness was higher for patients in the telemedicine group (P = 0.01). The results of this study suggest that for third molar extraction surgery, telemedicine and in-office postoperative visits produce similar patient satisfaction experiences, but patient perceived cost-effectiveness was greater for telemedicine visits.     

Dental caries prevalence and dental health behaviour in HIV infected children

Objectives . To determine dental caries prevalence in a group of HIV positive children and their reported dental health behaviour.
Design . Standardized epidemiological dental examination and structured interview.
Setting . Paediatric HIV outpatient department in a South London hospital.
Study population . HIV-positive children attending the above outpatient clinic over a 6-month period (30 subjects) and parents (20 informants).
Methods . Epidemiological examination of children was undertaken by one trained and calibrated examiner to determine caries prevalence using dmft/DMFT. Parents were interviewed to obtain information on their children's dental health behaviour: tooth-brushing, diet, fluoride; oral medication and dental attendance were explored.
Results . Sixty-three per cent ( n  = 19) of children had dental caries experience, much of it untreated. Mean dmft/DMFT was 4·4. Sixty per cent ( n  = 18) of all children presented with active or untreated caries and the care index for those at/under age 5 years was low (10%). Unfavourable dental health behaviour included: consumption of nonmilk extrinsic sugars at night, use of sugar-based medications, low fluoride intake, late commencement of toothbrushing and poor dental attendance. Dental health was not considered a priority for many of these children. Parents did not necessarily disclose their child's HIV status on dental attendance.
Conclusion . Caries prevalence was high, much of the disease untreated, and unfavourable dental health behaviour, including the use of sugar-based medicines was common. HIV infected children should be considered a high caries risk and receive appropriate dental care, in terms of both treatment and preventive services, following confirmation of seropositivity.     

Effect of intervention using a messaging app on compliance and duration of treatment in orthodontic patients

Objectives

This study aims to determine the effectiveness of a messaging app (WeChat) in improving patients’ compliance and reducing the duration of orthodontic treatment (DOT).

Materials and methods

A randomized controlled trial was performed in a dental hospital and a clinic from August 2012 to May 2015. Orthodontic patients were included at the beginning of treatment. Patients with multiphase treatment or braceless technique were excluded. Participants were randomized to WeChat group (received regular reminders and educational messages) or control group (received conventional management) and were followed up until the treatment was completed. Primary outcome measure was DOT. Others were late and failed attendance, bracket bond failure, and oral hygiene condition.

Results

One hundred twelve patients in each group participated and completed the trial. DOT in WeChat group were 7.3 weeks shorter (P = 0.007). There were less failed attendance (3.1 vs. 10.9 %, P < 0.001), late attendance (20.1 vs. 29.9 %, P < 0.001), and bracket bond failure (11.8 vs. 16.1 %, P < 0.001) in WeChat group than control. There was no difference in orthodontic plaque index nor modified gingivitis index between the two groups before and after treatment. Number of failed attendances was identified as an independent factor affecting DOT (P = 0.004; HR = 0.89, 95 % CI 0.84 to 0.95).

Conclusions

The intervention with WeChat is effective in reducing the treatment duration and bracket bond failure, and improving the attendance in orthodontic patients.

Clinical relevance

DOT can be reduced by improving patient’s compliance. The messaging app is useful for outpatient education and management.

     

Update on dental graduates entering medicine 1986-1991

In a previous publication we reviewed the future career plans of 169 dental graduates who entered medical school from 1986 to 1991 inclusive. The aim of the present study was to find out what happened to this group after qualification from medical school.The 169 individuals were traced and a questionnaire was sent to them by mail. A reminder was sent and some data for non-respondents were obtained from public sources such as registers and directories.In the original study, 120 of the 154 respondents (78%) intended to become oral and maxillofacial surgeons. We found in this follow up survey that the overall return rate to oral and maxillofacial surgery (OMFS) had dropped to 66%. For those not returning to the speciality, a wide range of alternative specialities had been chosen, with general medical practice (n=9) and oral medicine (n=8) being the most popular.Amongst those returning to OMFS, most undertook basic surgical training in general surgery and trauma. Two thirds of those eligible possessed the FRCS, with 43 (83%) holding the FRCS (Clinical Surgery in General) and six (12%) having the FRCS Ed (oral and maxillofacial surgery).Within the group, opinions were mixed about the changes caused by 'Hospital doctors: training for the future' (Calman Report) [Working Group on Specialist Medical Training. Hospital doctors: training for the future. London: Department of Health, 1993]. Concerns were voiced about the potential reduction in clinical experience, comparatively longer training for OMFS, and particularly the abrupt end of training with no protection whilst seeking a consultant appointment. Half thought that OMFS will become concentrated in supraregional centres, or head and neck units with related specialities.