Development of Artificial intelligence assisted mobile application for diet counseling and comparing its efficacy with manual approach in children aged 3 -6 years – Randomized control Trial

Phase -1

Artificial Intelligence assisted mobile application for diet counselling will be developed with the help of AI department, R.V Engineering College, Bangalore. The application will be a comprehensive tool that enables patients to track their dietary habits, receive personalized dental hygiene advice, and engage in real time conversations with an AI model to address their dental health queries The source of data to develop the app will be 500 filled diet charts, Diet counselling instructions and frequently asked questions. The app will have the main page with child details to be filled followed by diet diary with the timings and the food score. Once this is done the next option of diet counselling pops up. The diet counselling by AI and manual method will include the following steps:

1. The sugary food in the diet chart will be circled and the suggestions for personalized replacements will be provided.

2. The following instructions will be provided to the parents.

• Ensure children consume a balanced diet that includes all food groups fruits, vegetables, whole grains, lean proteins, and dairy at appropriate portions.
• Provide appropriate portion sizes of food to prevent overeating, which can lead to childhood obesity.
• Encourage diverse food preferences, avoid excessive sugar, and establish regular meal times, discourage skipping meals (especially breakfast), and limit snacking to healthy options like fruits or nuts.
• Encourage adequate water intake throughout the day and limit sugary drinks like soda and juice. Water and milk are preferred choices.
• Discourage constant drinking from a bottle and putting the child to bed with a bottle which contains milk.
• Limit Sugar and Processed Foods: Advise limiting consumption of sugary snacks, sodas, and highly processed foods, which contribute to poor health outcomes.
• Restricting the consumption of sugary drinks to 120 ml (4 oz) per day. Teach children to eat slowly, recognize hunger and fullness cues, and avoid mindless eating in front of screens (TV, tablets).
• Emphasize the role of parents and caregivers in setting examples for healthy eating.
• Shared family meals foster healthy eating habits.
• Address any food allergies or intolerances (e.g., lactose, gluten) and ensure proper nutritional substitutes are provided.
• Recommend supplements only when necessary, such as vitamin D in infancy, or iron in cases of anemia, under healthcare supervision.
• Avoid labelling foods as "bad" or "good" to prevent disordered eating behaviors; promote a balanced and positive approach to eating.
• Non-cariogenic or low-cariogenic snacks must be available at home and provided in school lunchboxes, e.g., dairy products such as cheese, plain milk, fibrous food (vegetables, fruit a) and nuts.
• Replace sugar with alternatives such as:  Raw Honey/Forest Honey. It is one of the oldest known natural sweeteners, sourced directly from the honeycomb. Date Sugar. Dates have long been used as a natural sweetener in a variety of dishes, including traditional sweets. Coconut Sugar. Jaggery. Organic Brown Sugar.
• Ensure the child brushes twice with fluoridated paste and in circular motion. These steps will be fed into the AI application; By clicking on the query option button, they can have a real time interaction with the application and clarify their doubts.

Phase -2

Children aged 3-6 years reporting to department of Pediatric and Preventive Dentistry, M R Ambedkar Dental College and Hospital, Bangalore, Karnataka will be screened and 140 children fulfilling the inclusion and exclusion criteria will be selected. The procedure of restorations and oral prophylaxis will be carried out in all the subjects and randomly divided using computer generated random allocation sequence into two groups of Group -A and Group -B of 70 each.

Level 1:  Parents of Group A patients will be given an AI based android application to install in their phone and will have to update the daily diet the child consumes for duration of 2 weeks, after which the diet score will be calculated by the software and the information will be retrieved by the blinded observer 1and the patient must report to the department for recording of baseline values of S. mutans count, pH of saliva and Oral Hygiene, Gingival and Plaque indices which will be recorded by a blinded observer 2. Following this, diet counselling will be accomplished by the AI application. The diet counselling option will be open tom the patient for a period of 2 weeks and the patient can listen to it how many ever times he wants. In Group-B, the diet diary will be given to the parents to fill the daily diet the child consumes for duration of 2 weeks, after which the diary will be handed back to the blinded observer 3 to calculate the score and the baseline values will be recorded by the blinded observer 2 and diet counselling will be given by the dentist. The handouts of the diet counselling instructions will be given for the parent to carry it home and read it how many ever times he wants.

Level 2: After the diet counselling both the following which the diet score is assessed and diet counselling is reinforced in both the groups.

Level 3: Both the groups will have to record the daily diet of the child for next 2 weeks and the results will be analyzed and compared.

Level 4: After 6 months after provision of diet counselling both the groups will be assessed for all the parameters along with clinically checking for white spot lesion development. The unstimulated saliva sample will be assessed for salivary pH and S. mutans count at baseline, 1month after diet counselling and 6 months by a blinded observer. The oral hygiene status in primary dentition will be determined using simplified Oral hygiene Index by Miglani 9 and in mixed dentition by simplified Oral hygiene index, Gingival index by Loe and Silness10,11 and Turesky -Gilmore -Glickman modification of the Quigley -Hein Plaque Index 12,13,14 at Level 1, Level 2 and Level 3 and Level 4. At Level 4 along with the other parameters the development of new white spot lesions will be assessed.15 The diet score, salivary Ph and S. mutans counts and the indices of Group A and Group B will be compared to check the effectiveness of diet counselling by both the methods. The awareness of parents regarding the association between diet and dental caries before and after the diet counselling will be checked with a questionnaire.