JMIR Publications

ABSTRACT

Background:

Dental disease (dental caries, periodontal disease) is largely preventable and closely linked to inadequate oral health behaviors. Digital health technologies have great potential for unobtrusively monitoring brushing behaviors in home settings and promoting optimal oral self-care routines at scale.

Objective:

To leverage the ubiquity of electronic toothbrushes and smartphones through the development of a Remote Oral Behaviors Assessment System (ROBAS) and to evaluate its feasibility for passively tracking brushing behaviors in real-world settings.

Methods:

We developed ROBAS by linking inertial sensors contained within consumer electronic toothbrushes to a scalable software platform comprising of a smartphone-app linked to a cloud platform First, the criterion validity of ROBAS for accurately capturing brushing details (timing and duration) was established in a laboratory setting. Next, real-world performance and usability were evaluated in a stratified community sample of 34 subjects who used ROBAS daily for one month and maintained a diary of their brushing episodes. Semi-structured interviews at baseline and exit captured the user experience. We used regression models and Bland-Altman analyses to assess criterion validity, functionality, accuracy, and consistency of ROBAS.

Results:

Using a stopwatch as criterion reference, ROBAS showed a mean absolute percent error (MAPE) of 1.8%, an estimated bias of 0.64 seconds that was not statistically distinguishable from zero (95% CI: -0.93 – +2.22 seconds), and a connection failure rate of 6.7% (95% CI: 0.8% – 22.1%). In real world testing, ROBAS showed close agreement with the daily dairy recordings of brushing episodes; estimated average discrepancies (diary – ROBAS) were 0.13 sessions per day (95% CI: 0.01-0.26), 8.0 seconds per brushing session (95% CI: 1.4 – 14.7), and 30 seconds of brushing per day (95% CI: 9.3 – 50.1). Retrospective self-reports produced substantially higher estimates of brushing frequency and duration compared to ROBAS measurements. Participants reported ROBAS as easy to use and revealed an interest in receiving ROBAS-delivered feedback on their brushing behaviors. Most participants were bothered by the use of an additional study phone, and some reported problems with the connectivity-related issues.

Conclusions:

ROBAS has a high criterion validity for measuring oral health behaviors. It can accurately and reliably monitor brushing patterns in home settings for extended periods. Unobtrusive data collection through ROBAS sets the stage for automated coaching and optimization of oral self-care practices at the individual and population level.