JMIR Publications

ABSTRACT

Background:

For most people, dental visits are unpleasant, usually accompanied by discomfort or pain. Patients seek treatment when the pain becomes intolerable, regardless, we have learned from the novel coronavirus disease 2019 (COVID-19) pandemic, that we must find solutions for times when patients cannot meet their dentist for an extended period. One of the prevalent oral diseases is gingivitis, characterized by red, swollen and bleeding gums. Gingivitis heals within 10 days of professional care and thorough daily oral hygiene practices. Without treatment, it progresses and eventually teeth may become mobile or be lost. There are many m-Health apps in medical fields, unfortunately none deal with the monitoring of gingivitis.

Objective:

The aim of this study is to present a characterization and development of an m-Health application called iGAM, which focuses on periodontal health. An m-Health app which improves the flow of information between dentists and their patients during the intervals between checkups.

Methods:

A quantitative design process based on the the Agile approach was used to develop iGAM and included the following steps: User story, Use Cases, Functional and Non-functional requirements followed by Agile Software Development cycles. A pilot study was conducted with a group of 18 participants aged 18-45, with different levels of health literacy. The participants were given a kit containing toothpaste, toothbrush, mouth wash, toothpicks and dental floss. After installing iGAM the participants were asked to photograph their gums once a week for four weeks.

Results:

The agile software development of iGAM had five cycles and demonstrated the importance of communication between dentists, expert app developers and "everyday people” testing the app. Prior to app the development we convened a focus group. All participants believed in the potential of a mobile app to effectively monitor gingivitis and reduce the severity of gingivitis, some voiced concern about information security and privacy issues. Subsequently, we conducted three semi-structured in-depth interviews on the use of cellphone applications for monitoring gum infections. Two themes emerged from the interviews: 1) What's in it for me? 2) Need for take home message. Qualitative analysis showed that participants: had difficulty using the camera therefore, mouth openers were given, had difficulty operating the phone, therefore we reprogrammed the app to be fully automated and a weekly reminder SMS was added, eventually we added an instructions document. Final interviews showed satisfaction.

Conclusions:

The iGAM was developed to promote oral health and is the first m-Health app for monitoring gingivitis using self-photography. iGAM presents a novel solution to improve the flow of information between dentists and their patients between checkups and may be useful whenever patients cannot meet dentists for a long time like the current COVID-19 pandemic.