Impact of connected toothbrushes on patient perceptions of brushing skills and oral health: results from a randomized clinical trial and a single-arm intervention study

Connected toothbrushes, where an electric toothbrush connects wirelessly to a smartphone app that provides feedback and guidance to the user, can improve clinical indicators of oral health. However, the impact of the connected brush on user perceptions of brushing skills, behaviors, "everyday" oral health (e.g., breath odor, how clean teeth feel), and user perceptions of the smartphone app are also important. In this study, a novel PRO measure - the Everyday Oral Health and Brushing (EOHAB) Questionnaire - was implemented to capture these important views. The EOHAB was administered in: (1) a randomized controlled clinical trial (RCT; N = 80) comparing a connected toothbrush to an unconnected electric brush over 6 weeks and (2) a single-arm study (N = 159), where participants used an electric brush alone for 1 week and then a connected brush for 3-4 weeks. EOHAB scores addressing perceptions of brushing behaviors/skills, oral health, and the usefulness and ease of use of the app were calculated. Impression of change items that directly asked users about changes in their perceptions were scored separately. In the single-arm study, perceptions of brushing skills and behaviors were very positive prior to using the unconnected or connected brush and then became incrementally more positive after using the electric brush alone and then the connected brush before decreasing at the last assessment interval. In both studies, cross-sectional correlations between the EOHAB scores and objective measures of brushing behavior and clinical measures were close to zero. Increased brushing duration and coverage over time were observed when participants reported improved perceptions on impression of change items and positive ratings of app utility, but not other EOHAB scores. In the RCT, the connected brush significantly improved several impression of change items, but not other EOHAB items asking about current perspectives. In sum, use of a connected toothbrush was associated with improved brushing and oral health perceptions when EOHAB questions asked directly about changes since starting use of the toothbrush. Brushing metrics improved as views on the app became more positive. Although not uniform, the results support previous studies indicating that connected brush systems can improve patient-reported outcomes.