A Systematic Review of the Use of mHealth in Oral Health Education among Older Adults

Oral diseases are largely preventable. However, as the number of older adults is expected to increase, along with the high cost and various barriers to seeking continuous professional care, a sustainable approach is needed to assist older adults in maintaining their oral health. Mobile health (mHealth) technologies may facilitate oral disease prevention and management through oral health education. This review aims to provide an overview of existing evidence on using mHealth to promote oral health through education among older adults. A literature search was performed across five electronic databases. A total of five studies were identified, which provided low to moderate evidence to support using mHealth among older adults. The selected studies showed that mHealth could improve oral health management, oral health behavior, and oral health knowledge among older adults. However, more quality studies regarding using mHealth technologies in oral health management, oral health behavior, and oral health knowledge among older adults are needed.


Introduction
According to the United Nations (UN), the number of persons aged 65 years and over is expected to double by 2050 [1].Individuals' oral health tends to decline as their age increases, and such decline has been linked to various systemic diseases [2][3][4].Therefore, as the number of older adults increases, appropriate actions would be needed to maintain their oral health [5].
With advancements in oral healthcare over the past few decades, it is observed that the number of older adults maintaining natural teeth for their lifetime has increased [6].However, natural teeth are susceptible to many dental diseases, such as caries, periodontal disease, and tooth wear, thus leading to increased demand for dental treatments.
It is recognized that many oral diseases are mostly behavioral problems and are, therefore, preventable with appropriate approaches [7,8].Effective self-care oral hygiene measures, such as toothbrushing and interdental cleaning, are essential to oral disease prevention and control.In addition, studies have revealed that older adults who receive regular behavioral instructions tend to have a lower prevalence of caries, gingival inflammation, or tooth loss than their counterparts who rely solely on continuous professional attention [7,[9][10][11].However, given the limited physical functioning of many older adults, their ability to seek professional care is limited.Moreover, it may not be sustainable to send teams of dentists to visit older adults frequently [12,13].
Due to recent technology developments, adopting mobile computing and communication technologies in healthcare and public health is now a possible solution.Mobile health or mHealth is defined by the World Health Organization (WHO) as "the use of mobile devices (mobile phones, patient monitoring devices, and personal digital assistants) for medical and public health practice" [14].In general health areas, clinicians have been testing using mobile electronic devices (MEDs), like wearable sensors, to provide older adults with real-time feedback and personalized recommendations for disease management, as well as to promote long-term behavior change with the aid of guided behavioral approaches [15][16][17].The application of MEDs may allow dentists to provide remote clinical instructions and support oral health behavior change [18][19][20].
The WHO oral health program, headed by Benoit Varenne, has been working on leveraging technology to improve oral health outcomes and promote universal oral health coverage through areas such as oral health promotion, disease prevention, and integrated care [21].There have been studies investigating the adoption of teledentistry, especially mHealth, as clinical tools for promoting oral health and oral health management for patients who could not visit dental facilities [22,23].In addition, several reviews have looked at the evidence to support the use of mHealth technologies as oral health knowledge interventions for the general population [22,24] and children [25].However, there seems to be a lack of summary of evidence regarding using mHealth technologies as oral health knowledge interventions among older adults, and past reviews provided mixed acceptance of mHealth among older adults regarding other health aspects [26,27].
The objectives of this review were to (1) identify the uses of mobile computing and communication technologies by dental professionals in the context of oral health management, oral health behavior, and oral health knowledge of older adults; (2) assess the effectiveness of mHealth regarding different aspects related to oral health, including oral health management, oral health behavior, and oral health knowledge, among older adults; and (3) evaluate the acceptability of mHealth among older adults in oral health management, oral health behavior, and oral health knowledge.

Materials and Methods
This review followed the Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) statement [28].

Review Question and Criteria
This review adopted the Population, Intervention, Control, and Outcomes (PICO) framework to answer the question "Is the application of mHealth tools effective in promoting oral health among older adults?"The population (P) of this review was older adults aged 60 years and older [29], without other restrictions.The intervention (I) was any non-clinical oral health intervention, targeting oral health management, oral health behavior, or oral health knowledge, with MEDs.The comparator (C) was conventional (oral health) education (CE) on oral health management, oral health behavior, and oral health knowledge [30,31].The outcomes (Os) considered in this review were any improvement in terms of oral health management, oral health behavior, or oral health knowledge observed from the cohorts, with or without follow-up assessments [32,33].
Both randomized and quasi-randomized control trials were included.Studies without statistical analysis and studies that did not use mHealth technologies were excluded.Studies that focused on the perspectives of healthcare workers instead of patients were also excluded.The detailed selection criteria are listed in Table 1.

Search Strategy
A literature search was performed across 4 electronic databases, including PubMed, MEDLINE, Scopus, and Web of Science, with no filters applied to include the maximum number of studies.An additional search was performed via Google Scholar from inception until February 2023.The search strategy applied was as follows: "[(Aged) OR (elderly)) OR (old adults)) OR (senior citizen)] AND [(Dental Care for aged) OR (oral health)) OR (dental health)) OR (oral hygiene)) OR (dental health education)) OR (oral health promotion)) OR (oral health education)) OR (oral hygiene instruction)] AND [(telemedicine) OR (teledentistry)) OR (mHealth)) OR (eHealth)) OR (mobile application)) OR (telecommunication)) OR (m-Oral Health)) OR (e-Oral Health)]".

Study Selection
Studies were checked for duplications, and title and abstract screening was performed independently by 2 researchers (R.C.W.C., K.M.T.) using an online platform (Covidence, Australia) [34].Disagreements were solved by discussion.Full-text reading was then performed to select eligible articles by the abovementioned 2 researchers independently using the same online platform.Disagreements were again solved by discussion.

Data Extraction
Data extraction was conducted independently by the abovementioned 2 researchers using the mentioned online platform, and assessment of the risk of bias was performed independently by the 2 researchers using the National Institutes of Health (NIH) study quality assessment tools [35,36].The following study features were extracted: (i) method of delivery [37], (ii) content delivered [37], (iii) length per session of the intervention [38], (iv) clinical outcome(s) [37,38], (v) participant-reported outcome(s) [39], (vi) qualitative usability and acceptability [40], and (vii) oral health knowledge outcome(s) [41].The data extracted were assessed by a third researcher (W.Y.-H.L.) to ensure data quality.In addition, any study's correspondence author(s) with details missing from the publication were contacted.

Search Results
A total of 1949 studies were retrieved through the primary literature search.After removing duplicates, 1698 studies were screened, and of those, 33 studies were shortlisted for full-text assessment based on screening of their titles and abstracts.Next, the full text of the shortlisted studies was assessed for eligibility, and finally, five studies were selected for this review (Figure 1).

Study Characteristics
A total of 422 participants were included in the selected studies (n = 5), where 268 were assigned to receive mHealth interventions (Interventions), and 154 were assigned to control groups (Controls).The mean number of participants per study was 84.4, the median was 75, and the number of participants ranged from 46 to 150.

Study Characteristics
A total of 422 participants were included in the selected studies (n = 5), where 268 were assigned to receive mHealth interventions (Interventions), and 154 were assigned to control groups (Controls).The mean number of participants per study was 84.4, the median was 75, and the number of participants ranged from 46 to 150.

Format and Content Delivery
Four studies adopted audio-visual materials to deliver oral health education messages [42][43][44][45], while one chose text-only delivery through SMS [46].Four selected studies adopted various interactive features when designing the oral health education materials [42][43][44][45], while one was a one-way delivery of educational materials [46].
All five studies covered toothbrushing instructions in their oral health education materials.Three studies provided the participants with information regarding common oral diseases among older adults [42,45,46], while two briefly covered all oral diseases [43,44].Instructions on proper denture maintenance was covered in four out of the five studies [43][44][45][46].Oral motor exercises and mouth massage were included in one study [43].All studies provided evidence-based knowledge with references (Table 3). Lee (2023) [42] Audio-visual materials (mobile APP on smartphones).
-Oral health problems in old adulthood: dental caries and gingival disease; dry mouth and bad breath.
-Oral management: toothbrushing and denture management; diet and smoking cessation; dental scaling and periodic oral check-ups.-Oral health education video on toothbrushing.
-Trot songs (a genre of Korean popular music) [48] adapted with oral health education script.-Oral exercise education consisting of oral gum exercises and tongue exercises.-Intraoral and extraoral massage.
-Customized oral hygiene intervention, including brushing and denture care methods.
-Self-care of oral health.
-Flossing.-Fluoride and mouth rinse to use.

Significant improvement:
-Willingness to use dental floss.
-Improved oral health awareness.
-Improved oral health behaviors.
-Improved oral health perceptions.Not reported.

Clinical Outcomes
Only two studies reported clinical outcomes [42,43].One study reported no significant difference across three clinical indices (the O'Leary Index, tongue coating, and Löe and Silness Index) between the intervention and control groups [42].The other study reported significant improvement in the Plaque Index; however, no significant differences were reported for the number of functional teeth and tongue coating [43].

Participant-Reported Outcomes
Significant decrease in self-reported oral dryness and a significant increase in selfreported swallowing-related quality of life (SWAL-QoL) and tongue pressure after the intervention were reported in one study [43].In another study, participants reported a significant increase in willingness to use dental floss after intervention [46].

Qualitative Outcomes
Two studies reported that the mHealth intervention positively impacted oral health behavior and improved oral health knowledge among participants [45,46].One study reported that participants wanted more than non-individualized oral health education [45].

Oral Health Knowledge Outcomes
Significant improvements in oral health behavior or oral health knowledge after intervention were reported in three studies [42,44,45].There was one study that reported a significant increase in knowledge about preventing dental caries and periodontal diseases [45].

Acceptability of mHealth Intervention(s)
Two studies reported the acceptability of mHealth as an intervention for oral health management, oral health behavior, and oral health knowledge [45,46].One study reported that the older adult participants "showed strong support" and "valued" the mHealth intervention, as the participants recognized "the importance of communicating dental information through an online approach"; the participants were also reported to enjoy, feel comfortable, and feel respected with the mHealth intervention as older learners [45].Another study reported a significantly higher acceptance of mHealth intervention compared to CE; 89% of intervention participants would recommend the mHealth intervention to others, compared to 68% in the control group (p < 0.05) [46].

Assessment of Risk of Bias
The summary of the assessment of the risk of bias in the selected studies is reported in Table 5.None of the five studies was considered "good" (low risk of bias).Two [44][45][46] were considered "poor" (high risk of bias), while three [42,43] were considered "fair" (unclear risk of bias) [35].
For [42], the intervention allocation was not concealed, and the participants and the assessors were not blinded.The dropout rate was higher than 15%.All these factors resulted in "fair".
For [43], the intervention allocation was not concealed, and the participants and the assessors were not blinded.The dropout rate was higher than 15%.The information on participant adherence to interventions was not provided.All these factors resulted in "fair".
For [44], the assessors were not blinded, and participants were changed in the midcourse of the study.The study also failed to adopt an interrupted time-series design, and it was impossible to determine if the statistical analysis was appropriate.Thus, all these factors resulted in "poor".
For [45], the participants' selection criteria were not clearly defined, and non-eligible participants were recruited.The assessors were not blinded, and the study failed to adopt an interrupted time-series design.It was not possible to determine if the statistical analysis was appropriate.In addition, the dropout rate was more than 30% (33%), and according to the NIH quality assessment guidelines, it should be considered a "fatal flaw".Thus, the study was rated as "poor".
For [46], the intervention allocation was not concealed, and the participants and the assessors were not blinded.The information on participant adherence to interventions was not provided.The information on whether a validated and reliable measurement was used consistently throughout the study was also not reported.In addition, the dropout rate was more than 30% (55%), and according to the NIH quality assessment guidelines, it should be considered a "fatal flaw".Thus, the study was rated as "poor".Quality Rating (Score) Lee (2023) [42] Controlled Intervention Studies (Table A1).Fair (10/14) Ki (2021) [43] Controlled Intervention Studies (Table A2).Fair (9/14) Khalil (2020) [44] Before-After (Pre-Post) Studies With No Control Group (Table A3).

Discussion
This study reviewed the evidence that supports the use of mHealth technologies, such as MEDs, to perform oral health education among older adults.The existing evidence suggested that efforts were being made by dental professionals to use mobile computing and communication technologies to facilitate the oral health management, oral health behavior, and oral health knowledge of older adults.The acceptability was high, though the reported effectiveness was mixed.The result of this review aligned with other studies regarding mHealth in other aspects of healthcare in terms of benefits from mHealth interventions and the potential for better disease management [38,40].However, the quality of the evidence was not strong.Most studies reported short and few interactions between the participants and the respective research team, suggesting that the outcomes observed, both clinical and behavioral, may be due to other factors, such as participants' self-care using the provided mHealth tools.
This review widened the scope of existing studies regarding using mHealth technologies to facilitate oral health education, with special emphasis on older adults [22,24,25].Any form of oral health education intervention with mHealth was included in this study, and all were accessible with MEDs.Among all five studies, a certain form of reinforcement of oral health behavior and oral health knowledge was observed, which suggested that mHealth, with stronger interactions between the participants and the clinicians, could be an ideal tool for repetition and reinforcement, aligning with outcomes of previous studies on oral health behavior and oral health knowledge [22,60].
The willingness to use mHealth technologies among the older adult participants was also observed, suggesting an increase in digital literacy among the older adults as reported in other studies (even though their skills might be limited) [61], which might facilitate the autonomy of older adults and encourage self-efficacy [24].
However, the studies included in this review have several limitations.Most studies did not include baseline clinical examinations, and there was a lack of long-term follow-up, so the potential impacts of mHealth on the oral health of older adults were still not investigated.There was also a lack of information about participants' adherence to the full intervention and the recruitment rate.Moreover, most of the included studies reported high dropout rates.These factors impaired the quality of the study outcomes.
There were also other limitations to this review.While the effects and acceptance of mHealth technologies were observed, there was limited information to explain such a phenomenon, thus limiting the possibility of exploring each variable and its roles in the outcomes.In addition, given the complex and non-comparable nature of study designs and measurement, meta-analysis was not possible, which limited the quantitative assessment of the impacts of mHealth technologies on older adults.Furthermore, the studies included in this review had limited generalizability, as they were conducted in only four countries (South Korea, Egypt, Australia, and the United Kingdom).This represents a small portion of the various healthcare systems available worldwide.Therefore, readers should exercise caution when interpreting the results of this study.
Future studies investigating the use of mHealth should consider facilitators and barriers of mHealth and older adults, like oral health education materials that are easy to follow and can capture participants' attention.In addition, investigations of the impact of mHealth on the oral health education of older adults should be paired with adequate clinical assessments, as well as longitudinal follow-ups, to examine short-term and longterm impacts.To improve assessments of the impacts of oral health education interventions, it is recommended to report the baseline information, including the oral health status, the behavioral characteristics of participants, and their oral health knowledge.The dental conditions of the participants such as the degree of edentulism, as well as their prosthetic status, should be reported in future studies.
Advancements in mobile computing and communication technologies have enabled a more personalized approach to oral health management, oral health behavior, and oral health knowledge.One included study reported negative comments from the participants toward non-individualized information [46], which indicated that older adults might require individualized oral health information to feel motivated to adopt mHealth oral health knowledge.Recent studies have demonstrated the use of photographs for site specific gum disease detection [62,63].Therefore, oral health education tailored to individual needs can be delivered.It is anticipated that improvements in smartphone cameras may facilitate the detection and monitoring of oral diseases, allowing early identification among high-risk patient groups and precise management.As newer-generation mobile networks continue to improve, remote consultation and oral health education via teledentistry [64] may also become more accessible, as well as the use of cloud-based AI for providing more personalized oral health management [65].

Conclusions
The existing evidence suggests that mHealth is being used by dental professionals to improve oral health management, oral health behavior, and oral health knowledge among older adults with high acceptability and mixed effectiveness.Such technology may potentially become a valuable tool for promoting oral health.However, the quality of the available studies was fair to poor.More quality studies regarding using mHealth technologies to facilitate oral health management, oral health behavior, and oral health knowledge among older adults are needed.potentially become a valuable tool for promoting oral health.However, the quality of the available studies was fair to poor.More quality studies regarding using mHealth technologies to facilitate oral health management, oral health behavior, and oral health knowledge among older adults are needed.

Appendix A
Appendix A potentially become a valuable tool for promoting oral health.However, the quality of the available studies was fair to poor.More quality studies regarding using mHealth technologies to facilitate oral health management, oral health behavior, and oral health knowledge among older adults are needed.
Appendix A    Institutional Review Board Statement: Not applicable.

Table 1 .
Inclusion/exclusion criteria of this review.

Table 2 .
The characteristics of included studies.
^-O'Leary Index.^-Tongue Coating Index.^-Löe and Silness Index.^ Participant characteristics, age, gender, number of participants recruited/completed the studies, and number of participants per group; ˆOutcomes related to oral health management; + Outcomes related to oral health behavior or oral health knowledge.

Table 3 .
Format and content delivery of selected studies in this review.

Table 4 .
Summary of key outcomes that were reported in included studies.

Table 5 .
Summary of risk of bias in the selected studies.

Table A1 .
[42]et al. (2023)k of bias forLee et al. (2023)[42].availablestudies was fair to poor.More quality studies regarding using mHealth tech ogies to facilitate oral health management, oral health behavior, and oral h knowledge among older adults are needed.potentially become a valuable tool for promoting oral health.However, the quality o available studies was fair to poor.More quality studies regarding using mHealth tech ogies to facilitate oral health management, oral health behavior, and oral h knowledge among older adults are needed.

Table A1 .
[42]et al. (2023)k of bias forLee et al. (2023)[42].Dent.J. 2023, 11, x FOR PEERREVIEW  11potentially become a valuable tool for promoting oral health.However, the quality o available studies was fair to poor.More quality studies regarding using mHealth tech ogies to facilitate oral health management, oral health behavior, and oral h knowledge among older adults are needed.

Table A1 .
[42]et al. (2023)k of bias forLee et al. (2023)[42].Dent.J. 2023, 11, x FOR PEER REVIEW 11 of 18potentially become a valuable tool for promoting oral health.However, the quality of the available studies was fair to poor.More quality studies regarding using mHealth technologies to facilitate oral health management, oral health behavior, and oral health knowledge among older adults are needed.
✓ 11.Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?✓ 7. Was the overall dropout rate from the study at endpoint 20% or lower of the number allocated to treatment?

Table A1 .
[42]et al. (2023)k of bias forLee et al. (2023)[42].Dent.J. 2023, 11, x FOR PEERREVIEW  11potentially become a valuable tool for promoting oral health.However, the quality o available studies was fair to poor.More quality studies regarding using mHealth tech ogies to facilitate oral health management, oral health behavior, and oral h knowledge among older adults are needed.
✓ 10.Were other interventions avoided or similar in the groups (e.g., similar background treatments)?✓ 11.Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?✓ 8. Was the differential dropout rate (between treatment groups) at endpoint 15 percentage points or lower?
✓ 9. Was there high adherence to the intervention protocols for each treatment group?✓ 10.Were other interventions avoided or similar in the groups (e.g., similar background treatments)?✓ 11.Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?✓ 9. Was there high adherence to the intervention protocols for each treatment group?
✓ 9. Was there high adherence to the intervention protocols for each treatment group?✓ 10.Were other interventions avoided or similar in the groups (e.g., similar background treatments)?✓ 11.Were outcomes assessed using valid and reliable measures, implemented consistently ✓ 10.Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
✓ 8. Was the differential dropout rate (between treatment groups) at endpoint 15 percentage points or lower?✓ 9. Was there high adherence to the intervention protocols for each treatment group?✓ 10.Were other interventions avoided or similar in the groups (e.g., similar background treatments)?

Table A1 .
[42]et al. (2023)k of bias forLee et al. (2023)[42].Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
✓ 7. Was the overall dropout rate from the study at endpoint 20% or lower of the number allocated to treatment?✓ 8. Was the differential dropout rate (between treatment groups) at endpoint 15 percentage points or lower?✓ 9. Was there high adherence to the intervention protocols for each treatment group?✓ 10.Were other interventions avoided or similar 12.
✓ 6. Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, comorbid conditions)?✓ 7. Was the overall dropout rate from the study at endpoint 20% or lower of the number allocated to treatment?✓ 8. Was the differential dropout rate (between treatment groups) at endpoint 15 percentage points or lower?
✓ 6. Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, comorbid conditions)?✓7.Was the overall dropout rate from the study at endpoint 20% or lower of the number allocated to treatment?
✓ 6. Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, comorbid conditions)?✓* CD, cannot determine; NA, not applicable; NR, not reported.
1. Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT? Dent.J. 2023, 11, x FOR PEER REVIEW 11 of 18

Table A1 .
[42]et al. (2023)k of bias forLee et al. (2023)[42].No new data were created or analyzed in this study.Data shar not applicable to this article.The authors declare no conflicts of interest.
Funding: This research received no external funding.Institutional Review Board Statement: Not applicable.Data Availability Statement:

Table A1 .
[42]et al. (2023)k of bias forLee et al. (2023)[42].Was the overall dropout rate from the study at endpoint 20% or lower of the number allocated to treatment?ogies to facilitate oral health management, oral health behavior, and oral health knowledge among older adults are needed.

Table A1 .
[42]et al. (2023)k of bias forLee et al. (2023)[42].potentiallybecome a valuable tool for promoting oral health.However, the quality o available studies was fair to poor.More quality studies regarding using mHealth tech ogies to facilitate oral health management, oral health behavior, and oral h knowledge among older adults are needed.

Table A1 .
[42]et al. (2023)k of bias forLee et al. (2023)[42].become a valuable tool for promoting oral health.However, the quality of the available studies was fair to poor.More quality studies regarding using mHealth technologies to facilitate oral health management, oral health behavior, and oral health knowledge among older adults are needed.Dent.J. 2023, 11, x FOR PEER REVIEW 11 of 18potentially become a valuable tool for promoting oral health.However, the quality of the available studies was fair to poor.More quality studies regarding using mHealth technologies to facilitate oral health management, oral health behavior, and oral health knowledge among older adults are needed.
potentially ✓ 9. Was there high adherence to the intervention protocols for each treatment group?✓ 10.Were other interventions avoided or similar in the groups (e.g., similar background treat-✓ * CD, cannot determine; NA, not applicable; NR, not reported.

Table A3 .
[44]il et al. (2020)f bias forKhalil et al. (2020)[44].valuable tool for promoting oral health.However, the quality of the available studies was fair to poor.More quality studies regarding using mHealth technologies to facilitate oral health management, oral health behavior, and oral health knowledge among older adults are needed.
✓5.Were the people assessing the outcomes blinded to the participants' group assignments?✓ 6. Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, comorbid conditions)?
✓ 2. Was the method of randomization adequate (i.e., use of randomly generated assignment)?✓ 3. Was the treatment allocation concealed (so that assignments could not be predicted)?✓ 4. Were study participants and providers blinded to treatment group assignment?✓ 5. Were the people assessing the outcomes blinded to the participants' group assignments?✓ 6. Were the groups similar at baseline on im-

Table A1 .
[42]et al. (2023)k of bias forLee et al. (2023)[42].No new data were created or analyzed in this study.Data shar not applicable to this article.The authors declare no conflicts of interest.

Table A1 .
[42]et al. (2023)orLee et al. (2023)[42].Were outcome measures of interest taken multiple times before the intervention and multiple times after the intervention (i.e., did they use an interrupted time-series design)?potentially become a valuable tool for promoting oral health.However, the quality o available studies was fair to poor.More quality studies regarding using mHealth tech ogies to facilitate oral health management, oral health behavior, and oral h knowledge among older adults are needed.If the intervention was conducted at a group level (e.g., a whole hospital, a community, etc.), did the statistical analysis take into account the use of individual-level data to determine effects at the group level?
CDReason(s) to be considered "Poor" + Changes in participants to keep the same sample size during the study * CD, cannot determine; NA, not applicable; NR, not reported.

Table A4 .
Assessment of risk of bias for Marino et al. (2016) [45].Dent.J. 2023, 11, x FOR PEER REVIEW 11 of 18 potentially become a valuable tool for promoting oral health.However, the quality of the available studies was fair to poor.More quality studies regarding using mHealth technologies to facilitate oral health management, oral health behavior, and oral health knowledge among older adults are needed. .Were the participants in the study representative of those who would be eligible for the test/service/intervention in the general or clinical population of interest?Dent.J. 2023, 11, x FOR PEER REVIEW 11 of 18 potentially become a valuable tool for promoting oral health.However, the quality of the available studies was fair to poor.More quality studies regarding using mHealth technologies to facilitate oral health management, oral health behavior, and oral health knowledge among older adults are needed.Dent.J. 2023, 11, x FOR PEER REVIEW 11 potentially become a valuable tool for promoting oral health.However, the quality o available studies was fair to poor.More quality studies regarding using mHealth tech ogies to facilitate oral health management, oral health behavior, and oral h knowledge among older adults are needed.
✓ 7. Was the overall dropout rate from the study at endpoint 20% or lower of the number allocated to treatment?✓ 8. Was the differential dropout rate (between treatment groups) at endpoint 15 percentage points or lower?✓ 9. Was there high adherence to the intervention protocols for each treatment group?✓ 10.Were other interventions avoided or similar 3✓ 6. Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, comorbid conditions)?✓ 7. Was the overall dropout rate from the study at endpoint 20% or lower of the number allocated to treatment?✓ 8. Was the differential dropout rate (between treatment groups) at endpoint 15 percentage ✓ ✓ 8. Was the differential dropout rate (between treatment groups) at endpoint 15 percentage points or lower?✓ 9. Was there high adherence to the intervention protocols for each treatment group?✓ 10.Were other interventions avoided or similar in the groups (e.g., similar background treatments)?✓ 5. Were the people assessing the outcomes blinded to the participants' group assignments?