Research Spotlight: Study Finds that Oral Health Text Messages can Improve Dental Caries Behaviors
A parent-targeted oral health text (OHT) messaging program improved preventive dental caries behaviors among a population of underserved children and their caregivers, according to the results of a randomized clinical trial published in JAMA Network Open in January 2025.
The study was led by Drs. Belinda Borrelli, and Michelle Henshaw, both professors at Boston University Henry M. Goldman School of Dental Medicine (GSDM) in the department of health policy & health services research. Borrelli is also director of the GSDM Center for Behavioral Sciences Research, and Dr. Henshaw, is also the GSDM associate dean of global & population health.
“Time constraints often prevent pediatricians from counseling parents to improve their children’s oral health,” the authors wrote. “Because over 95 percent of adults in the U.S. regularly use text messaging, with no disparities in race, ethnicity, or income, text messages can reach populations at highest risk for caries with ongoing and tailored behavior change messages.”
The study investigated whether parent-targeted (OHT) messages outperformed child wellness text (CWT) messages on pediatric caries increment and oral health behaviors among underserved children attending pediatric well-child visits. The parallel randomized clinical trial, Interactive Parent-Targeted Text Messaging in Pediatric Clinics to Reduce Caries Among Urban Children (iSmile), included participants from four pediatric medical clinics in Boston, Massachusetts, that serve low-income, racially, and ethnically diverse populations.
Eligible participants in this randomized clinical trial were English-speaking or Spanish-speaking caregivers of children younger than 7 years with one or more teeth. The study was conducted from March 2018 to February 2022 with a 24-month follow-up. The OHT messages focused on child toothbrushing and preventive dental visits while the CWT messages focused on reading and child safety. The text messages were automated, yet interactive and gamified.
While the intervention had no effect on dental caries, potentially due to the impact of COVID-19 on follow-up dental visits, the study concluded that it does have the potential to reduce caries-related oral health inequities since it increased oral health behaviors known to reduce caries risk. According to the study, earlier pediatric oral health interventions have found changes in oral health knowledge but not in oral health behaviors or caries. Moreover, the text message content and structure of the iSmile program was developed using focus groups and interviews with the target population of English-and Spanish-speaking lower income parents with young children. The authors believe that this tailored approach led to the high satisfaction and retention rates achieved in the trial.
“To our knowledge, this study is the first randomized clinical trial on text messaging to improve oral health in an at-risk population using a fully dose-matched comparison condition, an objective clinical outcome, and a 24-month follow-up,” the authors wrote. “Although there was no treatment effect on new caries, OHT messages outperformed CWT messages on oral health behaviors that are well known to reduce caries, such as toothbrushing, engaging in preventive dental visits, use of fluoride toothpaste, and caregivers’ own brushing behavior.”