Methods
Dementia
For this study, 213 individuals were recruited from the Swedish site of the European multicenter study Support Monitoring And Reminder Technology For Mild Dementia (SMART4MD) [The inclusion criteria for this study were the same as for the Swedish site of SMART4MD [Participants have an informal carer. Participants who take prescribed medication are responsible for their medication use.The participants have no specific conditions that reduce their physical ability to use the application to a point that makes their participation in the project impossible, as evaluated by the responsible investigator.The location where the participant normally resides has sufficient wireless or telephone network connectivity for them to use SMART4MD daily. For this substudy to SMART4MD, the requirement of at least ten own teeth was also added.The present study lasted from June 2018 to October 2020 and included a screening, a baseline examination, and additional reexaminations at 6 and 12 months. All examinations were performed at a university research clinic, including oral, medical, and cognitive examinations. During the study, all participants received their usual medical and dental care.Forty-three participants were excluded from the final analysis. Nine because they did not meet the inclusion criteria of having ten teeth, and 34 participants did not present for follow-up. All participants provided written informed consent before entering the study. During the Baseline examination, each Participant received a powered toothbrush (Oral-B Genius 9000, Proctor & Gamble, The Oral-B application was installed on the participant’s mobile phones or computer tablets. Participants were instructed verbally and in writing on transferring data from the powered toothbrush to the application. They were encouraged to do this every fortnight as the brush can store data from a maximum of 30 brushing sessions. The application registers the number of brush sessions per day and the average brushing time per session. On ten occasions, two randomly chosen toothbrushes from the test battery were tested against an external timer. The measurements were carried out with operating sessions from 20 to 200 s. The apps’ presentations noted no significant difference between the brushes and the external timer. To investigate the function of the Bluetooth transmission, an electrical fault was simulated by the battery in one brush being disconnected during an ongoing brushing session. The app then interrupted the registration of brushing time. Registration of the brushing session takes place if the operation has been longer than 30 s.Oral, medical, and cognitive examinations were carried out during the revisits. All brush data was photographed in the Oral-B application of the participant’s mobile phones and tablet computers. If the participant did not use the application, data was transferred from the powered toothbrush to devices in the clinic to investigate whether the brush had been used in the last month. If data was available, it was photographed for registration. At the 6-month visit, the toothbrush and operation of the application were reinformed and re-instructed, and after the 12-month visit, the collected brush data were registered.The collected data were processed, and the formula (number of brushes X average brushing time/number of observation days) was used for the periods between baseline and 6 months (M6) and between M6 and 12 months (M12). The number of observation days was set at 180 for each period. The calculations result in a value, a factor, for each participant, reflecting their diligence in brushing their teeth and using the powered toothbrush. If the powered toothbrush is used for 2 min twice daily, it gives a factor value of 48. Similarly, a factor value of 24 corresponds to, for example, using the brush for 1 min twice a day or brushing for 2 min once a day. The sample was divided into three groups. Group 1 consisted of 25% of individuals with the lowest factor, and group 3 of 25% of individuals with the highest factor. Group 2 consisted of 50% with factors in between. Eight individuals had never used the brush and were excluded from the analysis. The participants who used the powered toothbrush but not the application had their last 30 brush sessions registered at the 6- and 12-month visits. Thirteen participants had on all occasions brushed twice or more per day and at least 2 min per occasion and were therefore interpolated to a factor value of 48.01.