Personalized Digital Behavior Change Interventions to Optimize Oral Hygiene Behaviors: Randomized Controlled Trial

This multisite randomized controlled trial is designed to evaluate whether a personalized Digital Oral Health Intervention (DOHI) can improve adherence to recommended oral hygiene behaviors compared to traditional oral hygiene instruction alone. The study addresses the persistent challenge of maintaining long-term oral hygiene habits by utilizing technology-facilitated coaching, adaptive intervention delivery, and reinforcement learning algorithms that respond to each participant's real-time brushing behaviors.

A total of 230 adults (aged 18 years and older) will be recruited from three community dental clinics in California: Dientes Community Dental Care (Santa Cruz County), Petaluma Health Center (Sonoma County), and University of California, Los Angeles (UCLA)Dental Clinics (Los Angeles County). Following baseline education in the recommended 2x2x4 brushing protocol (brushing twice daily for two minutes, covering all four dental quadrants) and a 2-week run-in period to ensure comfort with the electronic toothbrush system and study procedures, eligible participants will be randomized in equal numbers to either the intervention or control group.

Participants in the control group will continue with traditional oral hygiene instruction and receive standard feedback on their brushing patterns over the 19-week intervention period. The intervention group will also receive traditional instruction and standard feedback, but in addition they will be provided with personalized digital coaching through the DOHI platform. The DOHI integrates an electronic toothbrush and the Oralytics mobile application to deliver tailored feedback, educational resources, and motivational strategies such as micro-incentives. The system uses reinforcement learning algorithms to dynamically adjust the timing, frequency, and content of coaching prompts based on each participant's brushing data and engagement patterns, aiming to optimize involvement and support sustainable behavior change.

The primary outcome of the study is the change in participants' adherence to the recommended brushing frequency and duration, objectively measured from baseline through 19 weeks using data collected by the electronic toothbrush system. Secondary outcomes include analyses of individual-level factors-such as demographics, initial oral hygiene behaviors, and patterns of technology use-that may influence the effectiveness of the DOHI for promoting oral self-care.

The results of this trial are expected to provide evidence for the implementation of adaptive digital interventions to support oral health, with the potential for broad application in community dental care settings.