Self-reported Oral Health Behaviors Research Articles

Simplifying Oral health evaluation: a novel approach through single-item surveys

BackgroundThis study adopts a novel approach of using single-item surveys to simplify the assessment of oral health status and behaviors among Japanese private sector employees. We aimed to establish the validity of self-reported oral health in relation to clinical dental examinations, and to elucidate the relationship between oral diseases, health behaviors, and self-assessments. A secondary aim was to explore the association of self-rated oral health with oral health behaviors.Materials and methodsSelf-administered questionnaires and dental examinations were obtained from 2262 Japanese private sector employees. Workers self-rated their overall oral health status according to five choices: “very good,” “good,” “fair,” “poor,” or “bad.” Self-reports were then compared with the results of clinical dental examinations, which included measuring the oral hygiene index (DI-S), the number of decayed teeth, periodontal status (Community Periodontal Index) and number of missing teeth. Convergent validity was also tested by examining the correlations of self-reported oral health status with oral health behaviors.ResultsOverall, 30.8% of workers reported their oral health as “poor” or “bad.” “Poor” or “bad” oral health status was significantly correlated with missing teeth, periodontitis, and decayed teeth. However, lower correlations were found for gingivitis and the oral hygiene index. Most self-reported oral health behaviors were correlated with self-rated oral health; exceptions were “tooth brushing instructions received in a dental clinic,” “having a primary-care dentist,” and “habitual snacking between meals.”ConclusionsSelf-rated oral health provides reasonably valid data, and correlated well with clinically assessed oral health status, including dental caries, periodontal status, and tooth loss. Convergent validity was also found for oral health behaviors.Trial registrationClinical trial registration number: UMIN000023011 (UMIN-CTR).Date of clinical trial registration: 06/07/2016.

Self-reported oral health attitudes and behavior of dentistry students

Objectives: Dentistry students in the Philippines undergo 6 years of undergraduate dental education as their foundation to acquire the skills necessary to prevent, diagnose, and treat oral diseases, and educate their future patients. One of the learning outcomes of the entire course is to make them effective role models in the maintenance and improvement of their patient’s oral health. Throughout their undergraduate years, oral health attitudes and behaviors are formed and may be modified. This study aimed to compare 4th-year preclinical and 5th-year clinical dentistry students in terms of their oral health attitudes and behavior. Materials and Methods: The research employed a descriptive cross-sectional research design. Purposive sampling was done using the Hiroshima University-dental behavioral Inventory (HU-DBI) questionnaire. The questionnaire contains 20 questions, which focus on oral health attitudes and behavior, with a dichotomous response format of “Agree” or “Disagree,” giving one point in favor of good oral health attitudes and behavior for a maximum score of 12. Data was collected via an online survey using Google Forms shared in the appropriate year levels’ official social groups. Higher mean scores indicate good oral health attitudes and behavior. The HU-DBI scores of the two groups were compared using the Mann–Whitney U-test. Results: A total of 225 dentistry students in a Philippine private dental college answered the survey, with 119 responses from the 4th year (41% response rate) and 106 responses from the 5th year (77% response rate). The overall mean score of answers favoring good oral hygiene was marginally higher in 4th-year preclinical students (M = 7.17, Standard deviation [SD] = 1.37) than in 5th-year clinical students (M = 7.15, SD = 1.24) but showed no statistical significance in their difference, z = −0.412, P = 0.681. Conclusion: There is no significant difference in the oral health attitudes and behavior between the 4th-year preclinical students and 5th-year clinical dental students. Future researchers can look into increasing the sample size and having respondents from other dental universities to provide a wider picture at a national level. Reinforcing oral health education for clinical students may be beneficial.

Adults' estimated prevalence of healthy behavior in society and self-reported oral health status and behaviors.

To assess Mashhad residents' self-perceived oral health level (OHL) and behaviors in relation to their perceptions of those of their fellow citizens. Cross-sectional telephone survey of 384 individuals recruited from communication centers. The interviews followed a validated Persian schedule with three main sections: 1) background information, 2) questions regarding self-reported OHL, and 3) questions regarding respondents' perceptions of the OHL of their fellow citizens. Participants' mean self-rated OHL and tooth brushing frequency were higher than those of their fellow citizens. The correlation between self-reported and the estimated decayed and missing (DMT) was highest in the middle and lowest in the upper classes. Perceptions of the self- and others' OHL and DMT were positively correlated, with the latter being more so. Education level, age, and tooth brushing frequency affected self-perceived OHL and DMT. Participants' perceived OHL could be explained by their estimation of the general population's oral health. These findings suggest that social norm interventions could nudge improving oral health behaviors.

Evaluation of Self-Reported Oral Health Attitudes and Behavior of Dental Students in Antalya, Turkey.

Background Dental students are expected to play a critical role in the oral health education of society as future providers of dental care, and their attitudes on this subject have a possible impact on the awareness of patients regarding the importance of preventing oral diseases and improving oral health. This study aimed to evaluate the oral health attitudes and behavior of dental students. Methodology The Turkish version of the Hiroshima University Dental Behavior Inventory (HU-DBI) questionnaire regarding oral health attitudes and behaviors with an additional nine questions was distributed among 250 native Turkish-speaking dental students at the Faculty of Dentistry in Antalya, Turkey. The validity of the nine questions added to the original questionnaire was evaluated by expert opinion and a pretest method. A self-administered questionnaire was used for data collection. The Mann-Whitney U test and chi-square test were used for statistical analysis, and the statistical significance level was set at p-values <0.05. Results The mean age of the 250 students in the study was 20.96 ± 1.66 years. In total, 157 (62.8%) students were preclinical (first, second, and third year) dentistry students, and 93 (37.2%) students were clinical (fourth and fifth year) dentistry students. The mean HU-DBI score of all students was 5.95 ± 1.65, and the mean HU-DBI score of clinical students (6.42 ± 1.65) was significantly (p < 0.05) higher than that of preclinical students (5.67 ± 1.59). The mean HU-DBI score of male and female students was 5.63 ± 1.55 and 6.24 ± 1.69, respectively, and this difference was statistically significant (p < 0.05). The study showed significant improvement in the behavior and attitude regarding the oral health of the clinical dental students compared with the preclinical dental students. Conclusions Among dental students, clinical students and female students had generally better attitudes and behaviors about oral health self-care compared to preclinical students and male students, respectively.

Self-reported oral health behavior and dental attendance pattern between smokers and non-smokers in Saudi Arabia: A cross-sectional study

Self-reported oral health behavior and dental attendance pattern between smokers and non-smokers in Saudi Arabia: A cross-sectional study

Food insecurity is associated with self-reported oral health in school-age Ecuadorian children and is mediated by dietary and non-dietary factors.

The main objective was to investigate the association of household food insecurity (HFI) with child oral health. A secondary objective was to explore potential dietary and non-dietary mediators of the HFI-child oral health relationship. Cross-sectional data from the nationally representative Ecuadorian National Health and Nutrition Survey (2018) were analysed. The data included self-reported child oral health, HFI (Food Insecurity Experience Scale), diet (FFQ) and oral care behaviours (toothbrushing frequency, toothpaste use). The association of HFI with the reported number of oral health problems was examined with stereotype logistic regression. Parallel mediation analysis was used to explore potential dietary (highly fermentable carbohydrate foods, plain water) and non-dietary (toothbrushing) mediators of the HFI-oral health relationship. Bias-corrected standard errors and 95 % CI were obtained using non-parametric bootstrapping (10 000 repetitions). Effect size was measured by percent mediation (PM). Ecuador. 5-17-year-old children (n 23 261). HFI affected 23 % of child households. 38·5 % of children have at least one oral health problem. HFI was associated with a greater number of oral health problems: 1-2 problems (adjusted odds ratio (AOR) = 1·37; 95 % CI (1·15, 1·58); P = 0·0001), 3-4 problems (AOR = 2·21; 95 % CI (1·98, 2·44); P = 0·0001), 5-6 problems (AOR = 2·57; 95 % CI (2·27, 2·88); P = 0·0001). The HFI-oral health relationship was partially mediated by highly fermentable carbohydrate foods (PM = 4·3 %), plain water (PM = 1·8 %) and toothbrushing frequency (PM = 3·3 %). HFI was associated with poorer child oral health. The HFI-oral health relationship was partially mediated by dietary and non-dietary factors. Longitudinal studies are needed to replicate our findings and investigate the role of other potential mediators.

Radiographically screened periodontitis is associated with deteriorated oral-health quality of life: A cross-sectional study.

Periodontitis is greatly related to worse perceived oral health-related quality of life (OHRQoL), yet this association has never been explored using radiographically screened periodontal bone loss. Here we have radiographically screened patients for periodontitis via a validated method and assessed its association with measures of OHRQoL. From a total of 10,267 participants (6,112 females and 4,155 males), self-reported general health questionnaire, body mass index, self-reported oral health behaviours, panoramic x-rays and the oral health impact profile (OHIP-14) were gathered. Radiographically screened periodontitis was measured through a radiographic-based periodontal bone loss (R-PBL) approach. We compared the respective variables according to the R-PBL status and explored using multiple logistic regression adjusted for the significant variables. Overall, patients with periodontitis shown significantly different sociodemographic, health measures and oral hygiene characteristics. All domains of the OHIP-14 were significantly worsened in the periodontitis group, and further confirmed through adjusted logistic regression (p<0.001). Active smoking, number of missing teeth, sex and age were the most impactful variables in this relationship. Our results demonstrate the existence of a link between radiographically screened periodontitis and OHRQoL, mostly upheld by active smoking, number of missing teeth, sex and age.

Oral health attitudes and behavior among undergraduate students

IntroductionOral health behavior is based on an acquired experience and cultural traditions. University education may smooth out cultural differences in oral health practice.ObjectivesOur goal is to study self-reported oral health attitudes and behavior of university students and the cultural basis for it.MethodsWe used the English version of the Hiroshima University Dental Behavioral Inventory to carry out an online survey of 136 university students of Morocco and Russia.ResultsOver half of the students (60.3%) do not feel anxious when visiting a dentist. Most of them take care of their gums (41.2%), teeth color (49.3%) and the degree of their cleanness (38.2%). The overwhelming majority of the students brush their each tooth very thoroughly (62.5%), they regularly examine their teeth in the mirror after brushing them (90.4%). They are well aware that tooth brushing alone cannot prevent a gum disease (63.2%), and they feel concerned about the possibility of having bad breath (73.6%). At the same time, over half of the students (61.7%) put off their visit to a dentist until they have a toothache, which is a negative behavioral factor. We did not reveal any gender or cultural differences between the students of the two countries, which can be regarded as a universalization factor of oral health behavior in young people who get higher education in universities.ConclusionsThe majority of the surveyed Russian and Moroccan university students have similar patterns of oral health attitudes and behavior. This assumption needs verification on a larger sample of students.DisclosureNo significant relationships.

Association Between Caries Experience and School Performance in an Island Community: Full-Time versus Part-Time Public Schools

Objective: To investigate the association between caries experience and school performance among children and adolescents living in an island community without fluoridated water supply and to compare data according to the type of attended school (full-time or part-time). Material and Methods: A cross-sectional oral health survey in a convenience sample of students (n=147) attending four public schools was performed. Students were examined by one calibrated dentist in the school environment to the obtain prevalence of dental caries (DMFT/dmft) and its consequences using the PUFA/pufa index. Self-reported oral health behavior was also accessed. Data from each student’s school performance and absenteeism were extracted from official sources and the school performance was classified into “good” and “fair”. The final sample consisted of 120 students. Descriptive statistics, Mann-Whitney, Kruskal-Wallis, chi-square tests and binary logistic regression were performed to evaluate collected data. Results: Students´ age ranged between 5 to 19 years (10±4.3). DMFT/dmft mean were 1.3 (±2.3) and 3.05 (±3.4), respectively. Conclusion: Participants from the full-time school presented better oral health status than their peers in the part-time schools (p<0.05). A significant association was found between the prevalence of caries-free participants and good school performance when the factor age range was controlled (OR=2.87). Moreover, attendance to full-time schools appeared to be a protective factor for good oral health conditions.

Oral Health Status, Knowledge, and Behaviours of People with Diabetes in Sydney, Australia.

This study assessed self-reported oral health status, knowledge, and behaviours of people living with diabetes along with barriers and facilitators in accessing dental care. A cross sectional survey of 260 patients from four public diabetes clinics in Sydney, Australia was undertaken using a 35-item questionnaire. Data were analysed using SPSS software with descriptive and logistic regression analyses. More than half (53.1%) of respondents reported having dental problems which negatively impacted their related quality of life. Less than half (45%) had adequate oral health knowledge. Only 10.8% reported receiving any oral health information in diabetes care settings, which had higher odds of demonstrating adequate oral health knowledge (AOR, 2.60; 95% CI, 1.06–6.34). Similarly, 62.7% reported seeing a dentist in the last 12 months. Having private health insurance (AOR, 3.70; 95% CI, 1.85–7.40) had higher odds of seeing a dentist in the past 12 months. Dental costs were a major contributor to avoiding or delaying dental visit. Patients living with diabetes have unmet oral health needs particularly around the awareness of its importance and access to affordable dental services. Diabetes care providers can play a crucial role in this area by promoting oral health to their patients.

Self-Reported Oral Health Attitudes and Behaviors, and Gingival Status of Dental Students.

AimThe aim of this study was to assess self-reported oral health attitudes and behaviors of the Iraqi dental students and compare the variations in these attitudes and behaviors that linked to dental education level and gender.Materials and MethodsA self-administered questionnaire depended on the English version of the Hiroshima University Dental Behavioral Inventory (HU-DBI) was prepared, the questionnaire given to 198 dental students.ResultsAbout 91.4% of the dental students were worried about the teeth colour, and merely minor percentage of them (18.8%) thought it is not crucial to seek dental advice until they acquire a tooth pain; however, 26.3% of the students were disturbed because of their gum colour, and 75.3% of them examined their teeth after brushing. Besides, 72.2% of the students replied that gum disease could not be prevented by tooth brushing only, 60.1% of the students do not give visiting the dentist such concern, and 14.1% of dental students were smokers. The plaque and gingival indices were significantly higher in preclinical students than clinical students.ConclusionIraqi dental students had somewhat good oral health behavior and attitudes; however, extra concentrating is required on the anticipatory and behavioral aspects of oral self-care practices. Female dental students displayed better oral health behavior and attitudes than male colleagues on some issues.

A comparative study of oral health attitude and behavior of dental and public health students in Ardabil, Iran using the Hiroshima University-Dental Behavioral Inventory

Aim: This study aimed to evaluate the self-reported oral health attitude and behavior of undergraduate dental and public health students, in Ardabil city, Iran to analyze the differences based on the field of education, gender, and level of education. Materials and Methods: This descriptive, cross-sectional study was performed on 195 (119 dental and 76 public health) students using Hiroshima University Dental-Behavioral Inventory (HU-DBI). Demographic questions including gender, educational field, and level of education were added to the questionnaire. The frequency of responses to the questions in the questionnaire was separately analyzed, tabulated, and reported. The effect of educational field and gender and level of education of students on their oral health attitude and behavior was analyzed using the chi-square test and Pearson correlation coefficient. The value of P < 0.05 was considered statistically significant. Results: There were some differences in oral health behavior between dental and public health students. Public health students showed more frequent use of hard toothbrush (P = 0.05) and hard strokes (P = 0.02). Overall, there were no statistically significant differences between female and male students (P > 0.05). No change in attitude occurred by an increase in the level of education (P > 0.05). Conclusion: There were some differences in dental health attitude and behavior of dental and public health students.

Self-reported oral health knowledge, Behavior and Attitude among students of a dental institution in a neo-capital region, Andhra Pradesh.

Aim: To compare the oral health knowledge, attitude and behavior among pre-clinical and clinical undergraduate dental students. Methodology: A questionnaire based cross-sectional study was conducted among pre-clinical and clinical undergraduate students at a teaching dental institution in Andhra Pradesh.A total of 357students were selected using non- probability purposive sampling technique. Modified English version of Hiroshima University Dental Behavior Inventory (HU-DBI) Questionnaire consisting of 31 closed ended questions has been implemented in this study after performing appropriate psychometric analysis. Results:Knowledge, attitude and behavior differences between preclinical and clinical students were analyzed by Student’s t-testand statistically significant difference was obtained with p value of 0.004.Chi- square test was employed for dichotomous datai.e. to find the differences in the distribution of "yes" among students from the different academic year as well as between male and female students.Majority of females (86.3%) have responded that they don’t use tooth brush with hard bristles for cleaning their teeth which is high when compared to males (73.4%) and the difference is statistically significant (p=0.01). There is also a statistically significant difference with respect to smoking habits between males and females (p=0.003). CONCLUSION: The outcome of this study shows clinical students having higher oral health knowledge, attitude and behavior scoresthan preclinical students and also the self-reported quality of overall oral health behavior was more pronounced in clinical students.Specific educational and awarenessprograms should be planned for the preclinical students. Keywords: Dental students, Oral health knowledge, Oral health behavior,Oral health education.

Oral health of high-cost patients and evaluation of oral health measures as predictors for high-cost patients in South Korea: a population-based cohort study

ObjectiveTo examine the oral health conditions and oral health behaviour of high-cost patients and evaluate oral health measures as predictors of future high-cost patients.DesignA retrospective, population-based cohort study using administrative...

Relationship Between Dental Students' Personality Profiles and Self-reported Oral Health Behaviour.

The objective of this study was to investigate the relationships between oral health behaviour and personality profiles among dental students. One hundred six consecutive (pre-)clinical dental students (58 females and 48 males) were recruited for this observational study. Participants' oral health behaviour was evaluated using the Hiroshima University-Dental Behavioral Inventory (HU-DBI). The NEO Five Factor Inventory (NEO-FFI) was used to assess the participants' personality profiles. Main outcome measures were personality dimensions measured by NEO-FFI (neuroticism, extraversion, openness, agreeableness, and conscientiousness) and oral health behaviours measured by HU-DBI (dental visits, toothbrushing, oral health awareness, and oral hygiene practices). Statistical significance was set at p < 0.05. All participants were completely analysed. The students' level of education and age had no relationship to the HU-DBI and NEO-FFI scores (p > 0.05). The conscientiousness personality scores were associated with better oral health attitude and behaviour (p = 0.018). Higher scores of the conscientiousness personality dimension were associated with better oral health attitudes and behaviour. Therefore, it is recommended to consider assessment of personality dimensions when oral health attitudes and behaviours are evaluated. Personality profiles might affect oral health behaviour and attitudes of dental care providers. This interaction should be considered as it might potentially impact professionals' capacities to offer oral health care, and this would influence patients' oral health.

Factors related to dental caries in 10-year-old Vietnamese schoolchildren

In Vietnam, research is required to provide a clearer understanding of the factors associated with dental caries. This will allow paediatric dentists and physicians to provide appropriate care to children. To determine the factors related to dental caries and to evaluate the association between dental caries and nutritional status in 10-year-old schoolchildren. In 2015, 1,079 10-year-old children were randomly selected from 16 public schools in Ho Chi Minh City. Information on self-reported oral health, dental habits, eating, drinking and physical activity behaviours was obtained via a questionnaire. Anthropometric measurements (height and weight) were also taken. Body mass index (BMI) was calculated, and nutritional classification of children was conducted using the BMI-for-age percentile. Dental plaque and dental caries (decayed and filled teeth) were recorded for both primary and permanent teeth. Dental caries was experienced on primary and permanent teeth by 60.7% and 39.6%, respectively, of subjects. The factors significantly related to primary tooth decay were school location [odds ratio (OR)=1.78], self-reported dental caries (OR=1.36), frequency of tooth self-checking (OR=1.32), toothbrushing habits (OR=1.31) and nutritional status (OR=1.77); however, the factors associated with permanent tooth decay were school location (OR=2.66), self-reported dental caries (OR=1.34), frequency of tooth self-checking (OR=1.37), frequency of dental check-ups (OR=1.35), toothbrushing habits (OR=1.31) and nutritional status (OR=1.39 and 1.74) (P<0.05). Dental caries was associated with school location, dental-related behaviours and nutritional status in 10-year-old schoolchildren in Ho Chi Minh City, Vietnam.

A storytelling intervention reduces childhood caries risk behaviors among American Indian and Alaska Native mothers in Northern California.

To evaluate a storytelling intervention targeting the oral health beliefs, knowledge, and behaviors of AIAN pregnant women and mothers. Fifty-three adult AIAN women from three tribal communities in Northern California participated. The intervention story delivered oral health messaging using a traditional storytelling format. The effect of the intervention on self-reported oral health behaviors, dental knowledge, and beliefs was assessed using a pretest-posttest design, with an additional six-month follow-up. Tests of repeated measures using Generalized Linear Models were conducted to assess changes in oral health knowledge, beliefs, and behaviors. Knowledge and beliefs significantly increased as a result of the intervention and persisted after six months. A consistent, significant increase in positive oral health behaviors from baseline to six-months was also observed. The results of this intervention study suggest promise for traditional storytelling to increase oral health-related knowledge, beliefs, and behaviors among self-identified AIAN pregnant women and mothers.

Effectiveness of oral health education intervention among female primary school children in Riyadh, Saudi Arabia

ObjectiveThis study aimed to examine the effectiveness of oral health intervention on the improvement in knowledge and self-reported oral health behavior among 6–8 year old female primary school children in Riyadh, Saudi Arabia. Materials and methodsThe sample consisted of 1661 girls in primary schools who are 6 to 8-year-olds (first, second and third graders). The children’s level of knowledge was assessed by a self-administered questionnaire that was formulated for this specific age and divided into two parts; oral health knowledge and self-reported oral health behavior. There were seven multiple choice questions and one true/false question with five underlying parts in the questionnaire which contained basic information about oral health knowledge, oral hygiene practices and certain habits that affect teeth. The questionnaires were distributed before and six weeks after implementation of the oral health educational program to measure the level improvement of knowledge regarding oral health among these children. ResultsAll the questions showed statistically significant improvement in knowledge and self-reported behavior in the post intervention group. There was a significant increase in the level of knowledge by 11.24% and level of self-reported behavior by 25% after intervention (P < 0.001). The highest net change in the knowledge due to intervention was noted among third graders (13.3%), whereas for self-reported oral health behavior, it was noted among first graders (28.3%). ConclusionThe results of this study showed that an easy-to-organize and inexpensive school-based intervention can, on a short-term basis, be effective in improving the knowledge and self-reported oral health behavior of children.

Complex interrelations between self-reported oral health attitudes and behaviors, the oral health status, and oral health-related quality of life.

PurposeThe purpose of this study was to develop and test a moderated mediation model that was able to describe the relationships between oral health-related attitudes and behaviors, oral health status (OHS), and oral health-related quality of life. The hypothesized relations corresponded to research questions such as “is a person’s oral health predicted by the actions that person takes in order to prevent oral health conditions?” and “do individuals with better oral health also have higher levels of oral health-related quality of life?”.Materials and methodsA cross-sectional correlational study with selected predictor variables was conducted in Cluj-Napoca, Romania, among 191 participants, enrolled in the fourth and sixth years of study at the Dentistry School of the Medicine and Pharmacology, University of Cluj-Napoca. Participants completed the Hiroshima University Dental Behavior Inventory (HUDBI) questionnaire targeting specific behavior and attitude with respect to their dental self-care, Oral Health Impact Profile (OHIP) short questionnaire for measuring oral health-related quality of life, and the current OHS was assessed objectively using Decayed, Missing, Filled Teeth/Surfaces (DMFT) index. Statistical analyses were done using structural equation modeling software.ResultsOur research showed relevant associations between HUDBI, DMFT, and OHIP. The relationship between HUDBI and OHIP was mediated by DMFT. Furthermore, HUDBI worked as a moderator between DMFT and OHIP. Thus, our study revealed a case for moderated mediation, which is usually ignored in similar research.ConclusionThe “straightforward” causality between oral health-related behavior and the actual OHS must be considered with caution, as well as their impact on the oral health-related quality of life. Further research is needed to investigate the interaction between variables, the strength of the interrelations and the magnitude of their interactions, and the confidence that can be placed in these measurements, with respect to the general population and/or those lacking domain-specific education.

Study protocol of a randomized controlled trial to test the effect of a smartphone application on oral-health behavior and oral hygiene in adolescents with fixed orthodontic appliances

BackgroundAdolescents with fixed orthodontic appliances are at high risk of developing dental caries. To date, new smartphone technologies have seldom been used to support them in the preventive behavior that can help prevent dental caries. After an intervention-mapping process, we developed a smartphone application (the WhiteTeeth app) for preventing dental caries through improved oral-health behavior and oral hygiene. The app, which is intended to be used at home, will help adolescents with fixed orthodontic appliances perform their oral self-care behavior. The app is based on the Health Action Process Approach (HAPA) theory, and incorporates several behavior-change techniques that target the psychosocial factors of oral-health behavior. This article describes the protocol of a randomized controlled trial (RCT) to evaluate the effects of the WhiteTeeth app on oral-health behavior and oral-hygiene outcomes (presence of dental plaque and gingival bleeding) compared with those of care as usual, in patients aged 12–16 with fixed orthodontic appliances.Methods/designThe RCT has two conditions: an experimental group that will receive the WhiteTeeth app in addition to care as usual, and a control group that will only receive care as usual. Care as usual will include routine oral-health education and instruction at orthodontic check-ups. In the western part of the Netherlands 146 participants will be recruited from four orthodontic clinics. Data will be collected during three orthodontic check-ups: baseline (T0), 6 weeks of follow-up (T1) and 12 weeks of follow-up (T2). The primary study outcomes are the presence of dental plaque (measured with a modified Silness and Loë Plaque Index); and gingival bleeding (measured with the Bleeding on Marginal Probing Index). Secondary outcomes include changes in self-reported oral-health behaviors and its psychosocial factors identified by the HAPA theory, such as outcome expectancies, intention, action self-efficacy, coping planning and action control.DiscussionSince the intervention was designed to target psychosocial factors in the motivational and volitional components of the behavior-change process, we hypothesize that the app will cause greater improvements in oral-health behavior and oral hygiene more than traditional oral-health-promotion programs (i.e., care as usual).Trial registration.The trial has been registered with the Dutch Trial Register (NTR6206: 20 February 2017).