Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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Clinical oral investigations
Evaluation of a novel dual-headed toothbrush design for periodontal health: split-mouth randomized blind clinical trial
BACKGROUND: Optimal oral health largely depends on the successful removal of plaque through effective brushing, but success typically relies on user technique, time, and adherence. The aim was to compare the effectiveness of a newly introduced dual-headed toothbrush with a conventional single-headed toothbrush in control of plaque and gingival health using a split-mouth design. METHODS: In the study, 37 dental professionals used two types of toothbrushes: a dual-headed toothbrush on one side of the mouth (Test side) and a conventional single-headed toothbrush on the other side (Control side). The study compared plaque removal, gingival status, and brushing time, assessing clinical outcomes using plaque index (PI), gingival index (GI), and modified sulcus bleeding index (mSBI) at baseline, 2 weeks, and 4 weeks. At the end, participants completed a Likert scale questionnaire. RESULTS: Both types of toothbrushes were effective in enhancing oral hygiene over time; however, dual-headed toothbrush group showed significant short-term reductions in plaque accumulation, gingival inflammation, and bleeding, particularly at the 2-week interval. A significant majority of participants (89.2%) rated dual-headed brush as "very easy" to use. Using a dual-headed toothbrush significantly reduces the brushing time (0.54 ± 0.17 vs. 0.99 ± 0.05 min for a conventional single-headed toothbrush), suggesting enhanced time efficiency. CONCLUSION: A dual-headed toothbrush would be more effective, faster, and easier to use than a single-headed brush. It would be a convenient alternative, especially for individuals with time constraints.
21 May 2026
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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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