Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 2 appraisals
JMIR mHealth and uHealth
WhatsApp-Supported Teledentistry to Reinforce Oral Health Promotion Among Older Adults Residing in Rural and Urban Areas: Randomized Controlled Trial
BACKGROUND: Access to oral health promotion for older adults is globally limited, especially in rural, low- and middle-income settings. Digital research often lacks theoretical foundation and focuses primarily on younger cohorts, yielding few randomized trials evaluating accessible tools for oral health education in older adults. OBJECTIVE: This study aimed to develop a telehealth reinforcement strategy for oral health promotion to improve knowledge, attitudes, and self-efficacy in community-dwelling older adults. METHODS: A single-center, parallel-group randomized controlled trial was conducted in 4 municipalities (2 urban and 2 rural) in La Araucanía, Chile. Eligible participants were functionally independent adults aged ≥60 years with smartphone and internet access; those with cognitive impairment, complete edentulism, or inability to use WhatsApp were excluded. Participants were recruited from regional databases and assessed using the Geriatric Dental Specialties Tele-platform, a teledentistry tool for older adults. Participants were randomized (1:1) to face-to-face instruction (comparator) or the same instruction plus 2 weeks of social cognitive theory-informed telehealth reinforcement (4 validated videos via WhatsApp). Clinicians and statistical advisors were blinded. Primary outcomes (oral health knowledge, attitudes, and self-efficacy) were measured via telephone-administered questionnaires at baseline and 6 weeks post intervention. Secondary outcomes included acceptability and self-reported behaviors. Analyses included hypothesis testing, multiple correspondence analysis, and k-means clustering. RESULTS: A total of 120 older adults were randomized (comparator: n=59; telehealth: n=61), with 103 analyzed (comparator: n=51; telehealth: n=52). Both groups showed substantial within-group improvements in oral health knowledge (comparator: Cohen d=0.93, 95% CI 0.52-1.34; P<.001; telehealth: Cohen d=1.07, 95% CI 0.66-1.48; P<.001) and self-efficacy (comparator: r=0.59, 95% CI 0.38-0.74; P<.001; telehealth: r=0.62, 95% CI 0.43-0.77; P<.001). In per-protocol analysis, telehealth improved dental caries knowledge (P=.03) and attitudes (P=.004), with no between-group differences in other domains (P>.05). In intention-to-treat analysis, telehealth showed a significant between-group difference for attitudes only (adjusted mean difference=0.91, 95% CI 0.34-1.48; P=.002), with no differences for overall oral health knowledge (P=.11) or self-efficacy (P=.59). Exploratory analyses indicated only the rural telehealth subgroup showed significant gains in attitudes (P=.003) and flossing (P<.001). Clustering suggested greater improvements among participants with higher baseline needs, predominantly rural, with fewer teeth. Telehealth demonstrated acceptability across multiple indicators (>80% for most measures) with no clinical adverse events; minor video-access issues occurred. CONCLUSIONS: Telehealth reinforcement provided significant advantages in oral health attitudes compared with face-to-face instruction. The intervention was acceptable and showed benefits among older adults with higher preventive needs, commonly seen in rural settings. By integrating theory-informed strategies into a familiar digital platform, this study adds evidence from rural and urban contexts, extending prior work on mobile oral health. It offers insights to address service gaps in underserved areas and highlights potential for feasible, context-aligned implementation. Future research should evaluate long-term effects, adaptability, and cost-effectiveness. TRIAL REGISTRATION: ClinicalTrials.gov NCT05917548; https://clinicaltrials.gov/study/NCT05917548.
17 May 2026
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A randomized controlled pilot trial comparing peri-implant tissue health beneath CAD/CAM-milled PEEK versus cobalt-chromium telescopic crowns for mandibular overdentures
PURPOSE: This pilot randomized clinical trial compared peri-implant tissue health around milled cobalt-chromium (CoCr) versus polyether ether ketone (PEEK) secondary telescopic crowns in implant-retained mandibular overdentures over 12 months. METHODS: Twelve completely edentulous patients received two implants each. After randomization, secondary crowns were fabricated from milled CoCr (n = 6 patients) or PEEK (n = 6 patients). Assessor-blinded outcome assessments such as marginal bone loss (MBL), probing depth (PD), and plaque index (PI) were performed at baseline, 6, 9, and 12 months post-loading. Statistical analysis used the patient as the unit of analysis. RESULTS: No statistically significant inter-group differences were found at any time point. At 12 months, mean MBL was 0.48 ± 0.15 mm for CoCr and 0.45 ± 0.16 mm for PEEK (p = 0.735). PD increased over time within groups but remained comparable between groups (CoCr: 2.58 ± 0.58 mm, PEEK: 2.33 ± 0.41 mm at 12 months; p = 0.411). PI scores also showed no significant inter-group differences (p > 0.05). CONCLUSIONS: Over 12 months, milled PEEK and CoCr secondary telescopic crowns demonstrated comparable peri-implant tissue health. PEEK presents a viable metal-free alternative for this application. These preliminary findings warrant confirmation in larger, long-term studies.
14 May 2026
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