Discussion
MCI, weakness, plaque-induced, cognitive impairment
DISEASES, DENTAL PLAQUE, PLAQUE
In the present study, it was demonstrated that despite that the registered values for frequency and duration are lower in the data extracted from the app than the normally recommended use of a toothbrush (brush for 2 min twice a day), the use of a powered toothbrush may improve PI, BOP, and reduction of numbers of pockets PPD ≥ 4 mm in a group of older with MCI.Furthermore, the results show that individuals in group 1 (indicating little or poor dental hygiene routines) also seize the opportunity to develop their ability to use the powered toothbrush. Toothbrushing aims to eliminate dental plaque from the tooth surfaces and the gingival margins to avoid plaque-induced diseases and maintain oral health. A general recommendation is to brush one’s teeth for 2 min in the morning and evening. Powered toothbrushes often have a timer function to facilitate brushing for at least 2 min. However, the profession has no consensus regarding the method, brushing time, or the number of brushing sessions needed [In the present study, only 13.5% of participants regularly brushed twice daily for 2 min or more. This result coincides with another study where 91.7% of participants brushed for less than the prescribed 2 min in all sessions. The participants’ average brushing time was 89 s, and large variations between and within individuals were found [Another strength of the present study is the long observation time and the total sample size. A weakness is that this is not a randomized controlled study. However, since it would not have been possible to record brush data in the same way for a group using only a manual toothbrush, the value of such a comparison is assumed to be low. A further limitation is that the system used is a commercial system not designed for research purposes. The data is transferred between the brush and the app using Bluetooth technology. The Bluetooth module in the brush may break. However, this cannot be investigated. No participants reported problems connecting to their app. We have investigated whether there was any difference in presentation between two randomly chosen brushes, which was not detected. An article from 2020 describes the development of a Remote Oral Behaviors Assessment System (ROBAS). A commercial-powered toothbrush (Oral-B 7000; Procter & Gamble) with the same functions as the one we used in the present study is used and evaluated to collect data for timing, duration, and pressure applied. Bluetooth transmission is used for connection to the mCerebrum data collection app, in contrast to our study, using the Oral-B app. The participants used a stopwatch as a reference during their brushings, and compared to ROBAS, the absolute mean error was 1.8%. They reported connection errors to 6.7% and summarize that based on our study findings, ROBAS has a high criterion validity for measuring oral health behaviors. It can accurately and reliably monitor brushing behaviors in the home setting for extended periods [Despite the fact that 86.5% of the participants in the present study used the powered toothbrush for less than 2 min and less than twice a day, its introduction, together with information and instructions, showed improved values for PI, BOP, and a reduction of the number of pockets ≥ 4 mm. Notable from the results is that at the baseline, the amount of plaque is similar in group 1 and group 3, while BOP and PPD are lower in group 3. An explanation could be that the registration method only registers the presence or absence of dental plaque and ignores the amount of plaque on the tooth surface [As previously noted, no consensus exists on how toothbrushing is best performed. Toothbrushing duration has, however, been reported as the most critical parameter for reducing the amount of plaque [The present study demonstrates the possibility that even limited use of a powered toothbrush, together with information and instruction, leads to reduced plaque among individuals with MCI. The present study’s design does not allow for evaluation of the impact of the information and instruction of the results since all participants have received the same information and instruction.”The difference between the self-reported powered toothbrush uses and the objective user data recorded from the participants’ toothbrushes is extensive. For example, group 1, the participants with the lowest factor based on the frequency of use and brushing time, states that 76.9% use the powered toothbrush daily or several times daily after 12 months, while the data recorded from their toothbrushes shows 0.08 brushings per day with an average brushing time of 0.32 min per month. Corresponding values for group 3 are 95% self-reported use daily or several times daily at M12, while the recorded values show that the brush is used 1.2 times per day for 2.1 min. There are no similar studies to compare with. However, research in other fields states that differences between self-reported and objective data have many causes, such as personal characteristics and the survey context [Objective brush data recorded from powered toothbrushes can be used as a decision basis for preventing impaired oral health, not only for individuals with MCI. Future research is needed to clarify the importance of frequency of use and the brush time compared with other factors when older individuals with cognitive impairment use a powered toothbrush.