JMIR Mhealth Uhealth. 2026 Nov 3;14:e91720. doi: 10.2196/91720.
ABSTRACT
BACKGROUND: Early childhood caries (ECC) is a prevalent yet preventable disease that significantly impacts young children’s health and quality of life. The World Health Organization’s Global Strategy and Action Plan on Oral Health 2023-2030 highlights the potential of mobile health programs to enhance engagement and support sustained oral health behavior change.
OBJECTIVE: The aim of this study was to assess the effectiveness of the SmilesUp 12-week SMS text messaging-based education and support program to improve parents’ management of their children’s oral health behaviors compared to standard clinical care.
METHODS: We conducted a multisite, assessor-blinded, parallel-design randomized controlled trial among parents of children aged 0 to 6 years who had an ECC diagnosis and attended 1 of 6 public dental clinics in metropolitan, regional, and rural New South Wales, Australia. Participants were randomly assigned to either an intervention group receiving the fully automated 12-week SmilesUp program (3 SMS text messages weekly) or a control group. Both groups continued to receive usual standard dental clinical treatment. The primary behavioral outcome was parent-reported twice-daily toothbrushing with fluoride toothpaste. Secondary outcomes included adherence to oral health-promoting bedtime routines and child consumption of sugar-sweetened foods and beverages. Oral health self-efficacy was measured using 6 behavioral theory-mapped items across oral hygiene, diet, and bedtime routines.
RESULTS: A total of 154 participants were enrolled and randomized (n=78, 50.6% in the control group; n=76, 49.4% in the intervention group) across 6 sites, with 80.5% (124/154) completing the follow-up assessment. High program adherence was observed, with 96.1% (73/76) of intervention participants completing the program. At 12 weeks, a greater proportion of SmilesUp participants reported brushing their children’s teeth twice daily (45/61, 73.8% vs 42/63, 66.7%; adjusted odds ratio [aOR] 2.45, 95% CI 0.95-6.74; P=.07), though this difference was not statistically significant. Significant improvements were observed in adherence to bedtime routines (54/61, 88.5% vs 45/63, 71.4%; aOR 3.25, 95% CI 1.15-10.18; P=.03) as well as oral health knowledge on toothbrushing (46/50, 92.0% vs 41/52, 78.8%; aOR 5.47, 95% CI 1.48-25.19; P=.02). No statistically significant differences were found in sugar-sweetened food (10/61, 16.4% vs 4/63, 6.3%; aOR 3.72, 95% CI 1.02-17.14; P=.06) or beverage (25/61, 41.0% vs. 27/63, 42.9%; aOR 1.08, 95% CI 0.49-2.30; P=.85) consumption.
CONCLUSIONS: These findings suggest that co-designed SMS text messaging-based programs show promise and may represent a feasible strategy for oral health behavior change. However, larger-scale and longer-term studies are needed to confirm sustained effectiveness using clinical outcomes. Future research should also explore ways mobile health can be scaled and cost-effectively embedded into comprehensive, interdisciplinary primary models of care.
PMID:42976338 | DOI:10.2196/91720
