UCSF

Purpose: This randomized, prospective cohort study evaluated the long-term effects of text messaging oral health information and appointment scheduling reminders to parents of new patients at the University of California, San Francisco (UCSF) Pediatric Dentistry Clinic. Six months after cessation of receiving the text messages, periodic oral exam (POE) appointment attendance, parental dental knowledge retention and behavior were compared to a control group who did not receive text messages. Furthermore, this study performed a program evaluation of the UCSF Pediatric Dentistry Clinic to identify factors influencing patients to not return for their POE appointments.

Methods: Upon presenting for a new patient examination at the UCSF Pediatric Dentistry clinic, a convenience sample of 95 parent/child pairs was recruited. To qualify, patients needed to be aged between 1 and 6 years and be generally healthy with an American Society of Anesthesiologists (ASA) classification of 1 or 2, and the parents had to be able to read and give consent in either English or Spanish. The parent-child pairs were randomized into two groups based upon order of presentation. The experimental group parents received text messages with oral health information every 3 weeks for one year and reminders to schedule 6-month POE appointments as well as (per clinic policy) a postcard reminding them to schedule 6-month POEs. The control group did not receive text messages with educational information or appointment reminders and instead only received the standard clinic policy postcard reminding them to schedule 6-month POE appointments. Data was collected regarding appointment attendance, oral health knowledge, and oral health behaviors at baseline, 6-month, 12-month, and 18-month appointments. Those who did not return for their 18-month appointments were sent an anonymous, single question survey via text message to determine what factors influenced their not returning for a POE appointment.

Results: A significant difference in parent knowledge about when a child can brush his/her teeth by him/herself was noted over time in longitudinal models run within each group, but no significant difference was detected between the control and experimental groups over time. A longitudinal analysis of the behavioral data collected over time was not appropriate due to the low number of responses in multiple categories, but a trend toward more parental supervision when brushing was noted in the experimental group with statistically significant results reported between the two groups at both 6 months and 18 months. The factors found to most frequently influence POE appointment non-attendance were being unable to get through to the clinic phone to schedule an appointment, leaving a voice message and not receiving a return phone call, and moving away from the area.

Conclusions: Although text messaging has become a common mode of communication in society today, text messaging oral health information did not result in significant differences in parental oral health knowledge or behavior over time. To improve patient POE appointment return rate, clinic telephone response protocols should be examined further to ensure that parents can easily schedule appointments over the phone directly or with a voicemail message. Further research must be completed using a larger sample size and higher study participant retention rate to determine if significant long-term differences exist between those who receive oral health text messages and appointment reminders versus those who do not.