Effectiveness of smartphone-based augmented reality for oral health education in students with physical disabilities: A randomized controlled trial

Students with physical disabilities face systemic inequities in accessing quality oral health education, resulting in higher rates of dental plaque and periodontal disease compared to peers without disabilities. This study evaluated the effectiveness of ARGI (Augmented Reality Interactive Dental), a mobile augmented reality-based oral health education intervention, to improve oral hygiene practices among students with mild physical disabilities through a randomized controlled trial. The intervention integrated multimodal learning components including printed modules, AR overlays with step-by-step toothbrushing demonstrations, instructional videos, and educational games with digital rewards to support motor skill development and autonomous practice. Thirty-four students aged 13 to 22 years from two special needs schools in Java, Indonesia, were randomly assigned to either the ARGI intervention group (n = 17) or conventional media control group (n = 17). Oral health behaviors were assessed using the O'Leary Plaque Index at baseline, post-intervention (Day 43), and follow-up (Day 58). The ARGI group demonstrated significantly greater plaque reduction (from a median of 84.82% to 3.57%) compared to the control group (from 92.85% to 40.17%), with the difference remaining statistically significant (Mann-Whitney U, p < 0.001, effect size r = 0.68). These improvements were sustained at follow-up, demonstrating short-term maintenance of oral hygiene gains. This study provides the first RCT evidence, based on a literature search conducted up to November 2025, that smartphone-based mobile AR significantly improves oral hygiene for students with physical disabilities compared to conventional media. The findings demonstrate that accessible technology can address health disparities and support educational equity in inclusive education settings.