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Background: Several studies have recently demonstrated that active communication to explain the importance of oral hygiene can improve the oral health of orthodontic patients. The main objective of this study was to evaluate the effects of a structured text message communication on orthodontic patient's oral hygiene compliance for tooth brushing, plaque control and gingival health. This Randomized clinical trial was conducted on 100 patients of both sex with age range between 15-25 years recruited from orthodontics department de,Montmorency College of Dentistry, Lahore. All participants were undergoing fixed orthodontic appliance therapy. Participants were randomized in to text message and control group.

Pre, during and post-trial examinations were carried out by author her-self using blind and calibrated methodology using plaque, bleeding and modified gingival indices. Results showed that text message group expressed a statistically significant (P4 mm, pregnant women.

All 100 patients selected according to inclusion criteria were equally randomized to text message group (50; 35 females and 15 males) and control group (50; 30 females and 20 males). Patients included in both groups were instructed about home care oral hygiene with proper brushing and use of mouth wash. All patients were provided with same brands home care oral prophylaxis kit containing tooth brush, interproximal brush, tooth paste and mouth wash. Patients assigned to the text message group received text message reminder once each week while no text message reminder to control group.19 Patients were called after one month for baseline oral health evaluation. Oral hygiene compliance was evaluated using bleeding index (BI), modified gingival index (MGI), and plaque index (PI), at baseline (T0), 30 days after baseline (T1), and 60 days after baseline (T2). 14 All evaluations were carried out by author her-self using blind and calibrated methodology.

Text message example

It's important to keep ur teeth squeaky clean. Give them a scrub, keep them healthy! TY 4 being so gr8 today! N Oral hygiene alert! How long to brush? 2 min! Did you know the avg toothbrush has over 2500 bristles? Put those bristles to work! N Brush and floss? We want no white spots or cavities. Remember 2 brush after every meal and your results will B fantastic. C U soon! N U can't spend 2 much time brushing those teeth, they're the only 1s you have. After the braces are off their [sic] going to look great. N Remember the 2 F's. Fluoride -Brush W/fluoride toothpaste and Frequency-Remember 2 brush after every meal! Don't forget to brush! N Ur next appt is soon. If uv been slacking on brushing, its not 2 late to get on it b4 your appt. Keep up the good work! C U soon! N YOUR SMILE IS THE FIRST THING PEOPLE SEE!! KEEP THOSE TEETH CLEAN and SHU Orthodontics will get them straight.

Statistical Analysis Data were entered in XPSS 20. Variables of text message group were compared with control group using standard student 't' test. P<0.05 was considered as significant.


Compared to the control group, the text message group showed statistically significant (P0.05

After 30 days (T1)###1.08+-0.52###1.39+-0.41###<0.001

After 60 days (T2)###0.64+-0.54###1.67+-0.53###0.05

After 30 days (T1)###0.69+-0.39###1.07+-0.34###>0.05

After 60 days (T2)###0.37+-0.36###1.32+-0.40###0.05

After 30 days (T1)###1.22+-0.60###1.93+-0.73###<0.001

After 60 days (T2)###0.56+-0.54###2.34+-0.12###<0.001


Time (days)###P1###B1###MG1

Base line (T0)###1.5+-0.55###1.00+-0.39###1.74+-0.59

After 60 days (T2)###0.64+-0.54###0.37+-0.36###0.56+-0.54

P value###<0.001###<0.001###<0.001

In comparison of control group, the text message group showed statistically significant (P<0.001) improvement of B1 score after 30 days (T1) and 60 days (T2) (Table 5). In comparison of control group, the text message group showed statistically significant (P<0.001) improvement of MG1 score after 30 days (T1) and 60 days (T2) (Table 6). For the whole study period (0- 60 days), the text message group showed a statistically significant (P<0.001) improvement in PI, B1 and MGI scores when compared base line value (T0) with the posttrial value (T2) (Table 7).


The primary purpose of this study was to find the effect of messaging instruction on plaque index (PI), bleeding index (BI) and Modified gingival index (MGI) score in a group of orthodontic patients and compare these scores with controls. All subjects including text message and controls completed the 60-day study period. At baseline, there was no significant difference between both the groups for plaque, bleeding and gingivitis.

Dental plaque is the main cause for gingival inflammation and dental caries. Chronic gingival inflammation may lead to tissue damage, and if not treated, may progress into the more destructive stages of periodontitis. Present study observed that at 60 days, both control and text message groups showed 17.96% and 39.75% reduction of bleeding, respectively. Reduction of bleeding was statistically significant in both the groups at 30 days and 60 days (P <0.001).A study found that a tooth paste containing antibacterial agent may be responsible for 18.6% and 15.8% reduction in whole mouth plaque and gingival scores around teeth. Same study also noted that bleeding decreased by 20% around teeth at the end of 3 months and 6 months.16 The paste containing antibacterial agent may be responsible for significant reduction of plaque index, gingival Index and bleeding on probing.

These antibacterial agents may have ability to remove 90% of target micro-organisms including P. melaninogenica, A.actinomycetemcomitans, Solobacterium, C. rectus and T. forsythia.16,17 According to our study there is statistically significant decrease in whole mouth plaque, gingival index and bleeding scores (19.87%, 15.9% and 17.96% respectively) in text message group.

At the completion of 60 days trial, both text message and control group showed 35.6% and 19.87% reduction of plaque, respectively. Reduction of plaque was statistically significant in both the groups at 30 and 60 days (P <0.001). Our study also found that at the end of the study (60 days), both text message and control group showed 38.7% and 15.9% reduction of modified gingival index (MGI) respectively with statistically significant difference at (P <0.001). According to a study conducted by Harish et al, the text message group was found to have statistically significant reduction in plaque when compared to that of the control group with p <0.001 and there was significant improvement in oral health.18 Another study conducted by T.Bent Bowen on 50 orthodontic patients found a significant reduction in plaque as compared to control.19

The study of Matthew Eppright and co-workers showed significant decrease in BI, MGI and PI of text message group as compared to controls.14 Their results are in line with our study in which there was statistically significant decrease in PI, BI, and MGI. Limitations of the study were the small sample size and shorter duration.


A text message reminder system is effective for improving oral hygiene compliance in orthodontic patients. BI, MGI and PI scores were significantly lower in the text message group compared to control group. There is a need of clinical trial with longer duration on large number of subjects in the age range of 15-40. This may improve the effectiveness of tooth brushing to reduce plaque, gingivitis and bleeding in patients undergoing orthodontic treatment.


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Publication:Pakistan Oral and Dental Journal
Article Type:Report
Geographic Code:9PAKI
Date:Jun 30, 2017

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