The Effects of Mobile Health Applications on Pediatric Dentists' Use of Fluoride Varnish for High-Caries Risk Patients

Abstract

Purpose: To assess the effects of mobile health (mHealth) applications (apps) on the behaviors of pediatric dentists (PDs) regarding the use of 5% sodium fluoride varnish (FV) for the caries management of high-risk pediatric patients. Methods: An instructional dental mHealth app was developed as the intervention in this cross-sectional study. Two hundred and thirty licensed and actively practicing PDs were solicited to participate in a survey including questions regarding caries management protocols for high caries-risk patients under various scenarios involving at-home FV (AHFV) application. Responding PDs were divided in two randomized groups; one group was exposed to the mHealth app while the control group was not exposed. Results: A total of 116 PDs who fully completed the survey (50.4% response rate) were included in the study; n=57 for control group, and n=59 for the intervention group. The two groups showed no statistically significant differences regarding distribution by demographics for time in practice (age), gender, nor primary place of practice. For the age-based scenarios the distribution of PDs willing to give AHFV between control and intervention groups was not statistically significant for any scenario, nor significant overall. However, there was a trend regarding increasing willingness to give AHFV with increasing child age: a) child less than six years old, control n=17, intervention n=18 (p = 0.94), b) child between six to 12 years old, control n=20, intervention n=26 (p = 0.32), and c) child over 12 years old in braces, control n=26, intervention n=34 (p = 0.20). Overall 98.3% of PDs reported using FV on a regular basis, 22.4% stated they had previously given FV for at-home use, and between 29.8-57.6% reported that they would consider dispensing AHFV under various conditions. Additionally, PDs from both groups with a previous history of giving AHFV, male providers, and PDs working part or full-time in private practice were more likely to recommend at-home FV than their corresponding counterparts of no history of at-home FV (p < 0.001), female providers (p = 0.002), and PDs working 100% of their time in non-private settings, respectively (p = 0.026). Time in practice, and previous use of mHealth apps with patients did not show any significance between groups, nor overall. Conclusions: The results suggest that the presence of technology, such as mHealth apps, have no statistically significant influence on PDs to endorse a protocol outside of their regular routine to manage high-caries risk patients. However, one-fifth of respondents overall have already engaged in providing at-home use FV, and even more are willing to recommend the non-standard therapy. This suggests that PDs may be seeking newer medical model modalities. Ultimately, this study’s outcomes are encouraging for the expansion of teledentistry efforts since many PDs are willing to provide alternative, interactive therapies, and gave positive feedback about mHealth patient education efforts. These observations are promising for the addition of new technologies, and for expansion of the medical model within dentistry to treat the disease, not just the symptoms.