The Effectiveness of Smartphone Applications and Active Text Reminders on Oral Hygiene and Periodontal Status of Orthodontic Patients: A Systematic Review and Meta-Analysis

Abstract

INTRODUCTION: This study assessed the effectiveness of smartphone applications and active reminders on orthodontic patients' oral hygiene. METHODS: Clinical trials on smartphone applications or active reminders for orthodontic patients were identified from databases up to January 2025. Primary outcomes-Plaque Index (PI), Gingival Index (GI) and Bleeding Index (BI)-were evaluated over short-term (1 to < 3 months) and long-term (>/= 3 months). Standardized mean differences (SMD) with 95 confidence intervals (CI) were calculated using a random-effects model. RESULTS: Thirty-seven studies (22 reminders and 15 applications) were included. Of these, 20 reminder trials and 11 application trials had low or unclear risk of bias. Reminders significantly reduced PI in both short-term (SMD = -1.02; 95 CI (-2.05 to -0.00)) and long-term (SMD = -1.78; 95 CI (-2.88 to -0.69)). They also reduced GI in both short-term (SMD: -2.46; 95 CI (-4.26 to -0.66)) and long-term (SMD: -2.21; 95 CI (-4.39 to -0.04)). However, reminders did not reduce BI in the short-term. Patients who received weekly reminders and whose parents were recipients had significantly lower long-term PI. Also, GI was significantly lower in patients who received weekly reminders. Applications significantly reduced PI in both the short-term (SMD: -0.47; 95 CI (-0.82 to -0.12)) and long-term (SMD: -0.56; 95 CI (-0.89 to -0.22)). GI did not significantly differ between the two groups both in the short-term and long-term. CONCLUSION: Smartphone applications and active reminders positively impacted orthodontic patients' periodontal health (very low to low quality). The frequency and recipient of reminders impacted the outcomes. Further high-quality clinical trials are needed.