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Development of a Personalized Oral Hygiene Management System: Home-Based Remote Smart Dental Care Platform
J Dent Hyg Sci 2024;24:249-58
Published online December 31, 2024;  https://doi.org/10.17135/jdhs.2024.24.4.249
© 2024 Korean Society of Dental Hygiene Science.

Ji-Na Lim1 and Jae-Young Lee2,†

1Department of Public Health Science, Graduate School of Dankook University, Cheonan 31116, 2Department of Dental Hygiene, College of Health Science, Dankook University, Cheonan 31116, Korea
Correspondence to: Jae-Young Lee, https://orcid.org/0000-0003-2394-5894
Department of Dental Hygiene, College of Health Science, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan 31116, Korea
Tel: +82-41-550-1496, Fax: +82-504-090-7206, E-mail: dentaljy@dankook.ac.kr
Received November 12, 2024; Revised November 24, 2024; Accepted November 29, 2024.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: The COVID-19 pandemic has significantly increased the demand for telemedicine and remote healthcare solutions, highlighting the need for a platform that supports personalized oral health management. In particular, a systematic information technology (IT)-based solution that enables children and adults to effectively perform oral care at home has become essential. To address this need, a smart dental care device and service platform integrating augmented reality (AR) and artificial intelligence (AI) technologies was developed.
Methods: The platform was designed based on an analysis of the oral health management needs of children and adults, leveraging existing smart dental care devices and pre-collected datasets. AR and AI technologies were utilized to provide personalized content and enable real-time monitoring and counseling in remote settings. This study focused on consolidating existing data and technological approaches to establish a foundation for platform development.
Results: The platform development process identified key elements of oral health management and incorporated them into the design, demonstrating the feasibility of personalized oral health services. Additionally, data analysis highlighted differing oral health needs between children and adults, enabling the design of tailored content and services for effective management.
Conclusion: This study highlights the importance of IT-based solutions in oral health management and presents the development process of a personalized platform as a foundational reference. The platform lays the groundwork for future advancements in oral health technology and supports its potential for adaptation and application in various settings.
Keywords : Dental care, Home care dental devices, Oral hygiene, Telemedicine
Introduction

1. Background

Oral diseases, including prevalent conditions such as dental caries and periodontal disease, affect approximately 3.5 billion people worldwide. According to the Global Burden of Disease Study 2017, these diseases significantly impact quality of life. Unmanaged oral health issues can lead to school absences1), reduced workplace productivity, and substantial economic burdens on families and healthcare systems. Oral health is particularly important for children and adolescents, as a lack of preventive care can have serious long-term health consequences2).

The extended COVID-19 pandemic has limited access to medical facilities for many individuals, highlighting the importance of oral healthcare3). This has increased the risk of oral diseases worsening due to lack of preventive care4), especially among vulnerable populations. This situation negatively impacts not only individual health but society as a whole, necessitating the introduction of new digital healthcare solutions. Telemedicine solutions during the pandemic helped reduce patient anxiety and improve preoperative assessments in the dental field. These findings emphasize telemedicine’s critical role in maintaining oral health access during crises5).

The World Health Organization emphasizes digital healthcare solutions incorporating Fourth Industrial Revolution technologies such as artificial intelligence (AI), augmented reality (AR), and Big Data as a future-oriented approach to oral health management6). AI technology, foundational to digital healthcare development, has emerged as a core technology for next-generation healthcare platforms due to advancements in medical information technology (IT), demographic shifts (aging population), rising healthcare costs, smart device popularization, the demand for personalized services, and the rise of digital and non-face-to-face trends. AI-based platforms have been shown to enhance self-management in patients with periodontal diseases, improving clinical outcomes and encouraging better oral hygiene practices7).

Telemedicine includes all healthcare services where patients receive care without direct face-to-face interaction with providers, encompassing digital therapeutics and telemedicine solutions. Various digital therapeutics based on mobile Apps have been developed, with chronic diseases, including those in the dental field, being the primary focus. These technologies can be efficiently utilized in telemedicine and non-face-to-face healthcare environments and have the potential to drive significant innovation in the field of oral health management. Azimi et al.8) found that remote dental screening programs using digital tools helped sustain preventive care among preschool children during the pandemic, highlighting their utility for underserved populations. Consequently, there is a growing need for the development of smart dental care devices and platforms to improve the efficiency of and accessibility to oral health management9).

The need for smart solutions that leverage IT technology for continuous oral health management is growing, especially in modern societies with high smartphone penetration and extensive digital use, making IT integration essential in oral health management.

2. Objectives

The objective of this study is to develop a digital platform that provides personalized oral healthcare services. The system collects data on patients’ oral conditions and delivers customized oral health management solutions. Additionally, the study proposes an integrated management system designed for both individuals and professionals, such as dentists and dental hygienists. Notably, the platform is designed to enable users to efficiently manage their oral health at home, supporting consistent and effective care in non-face-to-face environments. Furthermore, the platform facilitates comprehensive data management and serves as foundational data for the development of future oral healthcare technologies.

This platform can be applied to various oral health management programs, including dental care initiatives for children and students, integrated older adult care projects, and dental programs for individuals with disabilities. Through this innovation, we aim to enhance the efficiency of oral healthcare delivery, provide an environment where users can continuously manage their oral health in daily life, and demonstrate the positive impact of digital healthcare technologies on oral health management.

Materials and Methods

1. Planning process for the smart dental care devices and service platform

With the increasing demand for remote oral health management, the development of a digital platform for oral health education has become essential. In particular, programs integrating smartphones and IT technologies offer a continuous and effective solution for managing oral health. This study is in the development phase of evaluating the “Plaque Removal Effectiveness in Toothbrushing Education Using an Augmented Reality-Based Smart Toothbrush and Gamification Program.” The research protocol has been approved by the Dankook University Research Ethics Committee (Approval No. DKU 2024-05-034-004).

Dennison et al.’s10) research highlights the potential of digital platforms in improving health knowledge, particularly among mothers, and enhancing children’s oral health. This underscores the importance of digital solutions in complementing traditional oral health education and management practices. Based on this background, we designed a smart dental care platform leveraging personalized oral health content and data.

The platform’s primary users are divided into children and adults, each receiving tailored services. The smart dental care device operates using negative pressure sensors to record applied pressure and collects data by analyzing the user’s oral condition. The collected data is managed through a data accumulation App, which connects users with external systems, such as medical institutions and schools, via an application programming interface (API) Gateway and Open API. Through this, users can monitor their oral health status in real time and access appropriate services as needed.

Notably, the AI-powered oral health analysis and recommendation service enables continuous monitoring of user’s health conditions, offering personalized recommendations. Users can utilize this data to establish preventive care and treatment plans while receiving specific guidance from healthcare professionals.

In summary, this platform provides an environment where users can effectively manage their oral health in their daily lives, supported by seamless connections to healthcare professionals. Additionally, it facilitates integrated preventive and therapeutic care. This study demonstrates the potential of digital healthcare technologies to revolutionize oral health management and emphasizes the platform’s role as a foundation for future programs leveraging digital solutions for oral healthcare.

2. Service platform design and big data collection platform development

This study developed a personalized oral health management platform by utilizing existing smart toothbrushes and pre-collected data originally designed for AI training purposes. These tools and datasets were used to identify key oral health trends, user behaviors, and critical gaps in oral health education, forming the foundation for the platform’s development process.

The study designed tailored preventive oral disease programs based on age and health status, establishing a foundation for personalized oral hygiene management services11). To address behavioral gaps and motivate users, a counseling scenario was developed that integrates strategies of empowerment and behavior reinforcement12). This scenario helps users accurately understand their oral health status and create appropriate action plans while providing specific feedback throughout the process. The real-time, customized data provided during counseling serves as a vital tool for driving behavioral changes in users’ oral health management.

This study focuses particularly on oral health management for children and adolescents. For this purpose, a module for counseling on oral health motivation was developed for use by dentists and dental hygienists (Table 1). This module provides personalized counseling based on preventive oral care elements, offering individualized management plans beyond simple information delivery.

Oral Health Monitoring and Feedback System Flow

App-user Web (admin)-expert
  • “Take photo”

    • Capture tooth condition using the Dental Note feature

  • Expert feedback input (admin)

    • Input expert feedback on the requested user’s photo

    [Required data]

    • User account, profile name, photo image

    [Input content]

    • Input feedback on the condition of the oral photo

      Based on pre-stored feedback protocols, the expert selects and combines keywords related to the tooth condition for simplified feedback input

  • “Request expert feedback”

    • Notification of expert feedback within 24 hours

  • “Expert Feedback Notification”

    • Feedback is displayed as a note message next to the captured photo

    • A push notification is sent to alert the user about the feedback



Additionally, a dental care application was developed for use by both children and parents (Fig. 1, 2), enabling the creation of individual profiles for each child to support brushing habit formation and oral hygiene management. AR technology was applied to allow the children to see their faces and follow brushing guides, helping them learn proper brushing techniques. This AR guide synchronizes with a smart toothbrush, accurately analyzing brushed and unbrushed areas and providing real-time feedback. Through this process, users can develop proper brushing habits and gain additional motivation through a reward system upon completion. This gamified approach encourages children to take a more active role in their oral hygiene through an engaging and interactive learning process.

Fig. 1. Children’s dental care goals: preventing dental caries; dental plaque management (5-week management).

Fig. 2. Adult’s dental care goals: preventing periodontal disease; dental plaque management (5-week management).

3. Consultation and review of remote oral health content

The content is categorized into five key areas: cavity prevention, dental treatment, dental trauma, oral hygiene, and teething. Each category delivers essential information in an easily accessible manner13). The content comprises thumbnails, titles, related images, and text, all arranged with an intuitive design that considers user experience, allowing easy access for all users. Children and parents can readily obtain information on oral health, and the content is accessible on various devices, including mobile phones and tablets, enabling information access anytime, anywhere. To enhance visual communication, the content is available in formats such as single images, GIFs, or card news, effectively conveying information visually. These multimedia elements aid intuitive understanding, especially for children, while allowing parents to grasp key points quickly. Future plans include continuous improvement of the content based on user feedback and the implementation of functions to provide personalized information.

Results

1. Development of the measurement device hardware and production of the first prototype

The goal of this project is to develop hardware and software that enables high-resolution imaging diagnostic devices, previously used only in hospitals, to be utilized as home-based oral care devices. Specifically, quantitative light-induced fluorescence technology has been integrated, allowing precise observation of plaque, calculus, and early caries at home. This technology, primarily used in hospital equipment, is being applied to a home-use device for the first time, providing a convenient way to monitor dental health in real-time and detect issues early.

In addition, a 2MP Full HD wireless oral camera was developed to deliver high-quality images, distinguishing it from overseas products with lower resolution and quality. H.264 encoding technology was applied to wirelessly transmit full HD images, enabling real-time streaming via the real-time streaming protocol. Through this technology, users can easily receive wireless video transmissions via user datagram protocol or transmission control protocol, allowing them to monitor their dental conditions anytime, anywhere. This feature focuses on maximizing user convenience beyond simple image transmission. The wireless transmission system is designed to facilitate easy device installation and use, enabling self-diagnosis without the need for a dental visit through high-definition imaging. This technological innovation helps users manage their oral health more easily in daily life, overcoming video quality issues commonly seen in lower-quality products, thereby enabling more accurate assessment of oral conditions.

This technology is anticipated to expand beyond home oral care to applications in telemedicine and oral health education. Building on the success of the prototype, further refinements are planned for commercialization aimed at a broader customer base.

2. Advanced development of the App service and platform

This project established a cooperative system among participating institutions and practitioners to monitor progress in developing customized oral health management components and content for different population groups. Requirements from the supervising ministry (Ministry of Trade, Industry and Energy) were continually integrated, resulting in a system designed and developed to meet user demands. During the platform enhancement process, assessment of user feedback, performance testing, and data analysis were conducted to verify the usability of the smart oral health management service, creating a framework for continuous improvement. Notably, a model for smart oral health management services was developed to enable the platform’s application across various oral health programs, promoting preventive oral health services and improving users’ self-care abilities14).

Additionally, the project explored ways to enhance overall health, including oral health, by using various social tools. Through these social tools, users can share real-time information about oral health, exchange experiences, and develop oral hygiene habits collectively13). Open access to information enables users to exchange knowledge and fosters engagement through interactive communication channels on interesting topics.

The web-based App service, leveraging the high smartphone penetration rates in developing countries, plays a critical role in overcoming social barriers to health promotion. This allows users to participate in a digital environment and access oral health management information, contributing to reducing global disparities in oral health management.

3. Evaluation of diagnostic tool suitability for smart dental devices

In this study, prototypes of diagnostic and management tools for smart dental care devices were developed and evaluated for practicality and usability through expert review. The diagnostic tools were designed to accurately assess each user’s oral condition, and evaluations were conducted based on criteria such as accuracy, efficiency, durability, and ease of use. Particular emphasis was placed on assessing how accurately the diagnostic tools function in diverse user environments15).

The feedback from experts during this process served as valuable data for improving product performance. For instance, suggestions to enhance usability and add features for a more intuitive interpretation of diagnostic results were incorporated (Table 2). Based on this feedback, the prototype was progressively refined, playing a crucial role in the development of the final product16).

Expert Evaluation on Smart Toothbrush Design Development

Toothbrush type Design characteristic Evaluation Recommendation
A type Sleek and stable design Visually sophisticated and stable design -
C type Grip-friendly with anti-slip patterned design Differentiated by its ergonomic and secure grip -
D type Short bristle head Brushing may feel inconvenient due to short bristles Consider extending bristle length for comfort
G type Bright-toned design suitablefor children Excellent grip and appealing to children -
H type Intuitive design with buttons and two-tone colors User-friendly and intuitive -


Additionally, usability assessments incorporating actual user feedback were conducted, ensuring that the device is both user-friendly and capable of providing accurate diagnostics. Ultimately, the diagnostic tools were enhanced through feedback from both experts and users, laying a solid foundation for commercialization17).

Future research will include testing on a broader user group and performance evaluations across various environments. This will improve the device’s reliability and expand its practical applicability in the oral health management market.

4. Development of an oral health synchronization counseling module for a remote dental consultation platform

In this study, an oral health synchronization counseling module was developed for a remote dental consultation platform designed to deliver personalized oral health counseling content. This module incorporates various counseling scenarios aimed at motivating users and facilitating behavioral changes essential for effective oral health management, enabling users to manage their oral health more effectively.

Furthermore, a personalized card news and health information delivery algorithm were developed to provide tailored information in real-time based on the user’s oral health status, emphasizing the importance of preventive oral health management. This algorithm analyzes user data to recommend the most relevant oral health content and delivers counseling information customized to the individual’s health condition, thereby enhancing the effectiveness of personalized oral care.

This counseling module for remote dental consultation supports users in achieving better oral health by motivating and guiding them through customized scenarios. By integrating real-time, personalized card news and health data, the platform highlights the significance of preventive care in managing oral health.

Discussion

1. Interpretation

The smart dental care device and service platform developed in this study offers a personalized oral hygiene management solution that significantly enhances the effectiveness of self-care. In particular, the platform’s AR feature for self-guided oral care education and remote connectivity with dental professionals contribute to user convenience and reliability18), allowing users to receive expert advice anytime, anywhere. This system can be used as a preventive tool in everyday life, promoting awareness of oral health and encouraging preventive oral care as a regular habit. In the long term, it is expected to reduce the incidence of oral diseases through the normalization of preventive care.

2. Comparison to previous studies

Previous studies have primarily focused on self-management systems and basic remote dental health consultations. For example, Huang et al.5) developed a self-management App that allows users to monitor their basic oral health status. However, it lacks the comprehensive approach of this study’s platform, which visualizes oral health using AR and provides personalized education and counseling based on individual risk factors. Additionally, Bokolo Anthony19) proposed the potential use of a remote dental consultation platform; however, unlike this study, which provides a more advanced solution, it lacks real-time connectivity that allows users to instantly consult with oral health professionals. Furthermore, Hartono et al.7) demonstrated that mobile applications could improve clinical outcomes in periodontal disease management; however, they did not incorporate a comprehensive approach, such as using AR to visualize oral health status or providing individualized educational materials, as seen in this study. Lastly, Chen et al.20) analyzed and evaluated mobile applications for dental caries prevention; however, their study lacked a comprehensive approach that included real-time consultation and personalized education for remote dental diagnosis and preventive care, as provided by this study’s platform.

3. Suggestion (in Korea/in other countries)

In Korea, with the growing interest in preventive oral care, it is recommended to introduce this platform in a format that can be used not only at home but also in school oral health rooms. In particular, supporting children and adolescents in managing their oral health in a fun and easy way through features such as AR-based brushing guides in elementary school oral health rooms can make oral health education a regular practice. This would naturally establish preventive oral care as part of daily life. Additionally, it is necessary to reduce regulatory barriers related to telemedicine in Korea and improve accessibility for users by linking dental product sales with clinics.

In other countries, it is essential to develop strategies that align with each country’s healthcare system and regulations. Particularly in developing countries, where it is often challenging to provide oral care services, this platform can contribute to community health by providing basic oral health education and remote consultations. Additionally, collecting and analyzing oral health data compliant with the regulations in various countries will allow the service to expand in ways that match the characteristics of each region. Such strategies can increase the commercialization potential of the platform in the global market and contribute to making preventive oral care a routine practice.

Moreover, in other countries, such as the United States and Indonesia, the scope of telemedicine is gradually expanding. In the United States, telemedicine is already being actively utilized across various medical fields, and this trend is also growing within the dental sector. Similarly, in Indonesia, where telemedicine is actively permitted, the demand for remote oral health management solutions is expected to rise. This platform can align with such market changes by offering remote assessments of oral health and preventive management solutions, thereby enhancing its competitiveness globally.

As part of a strategy for global expansion, it will be important to provide remote dental services that meet each country’s regulatory requirements and develop customized educational content and counseling functions that align with regional needs. Through this, the platform can increase users’ interest in and access to oral health, supporting preventive oral care as an integral part of community health.

Lastly, for global commercialization, it is necessary to ease regulatory barriers in each country while conducting various clinical trials and localized empirical studies to prove the platform’s effectiveness. Remote dental diagnosis and treatment platforms can enhance the feasibility of telemedicine solutions by overcoming temporal and spatial limitations21). A smart home-based dental care solution not only instills greater confidence in patients but also emphasizes the importance of oral hygiene in daily life, creating a positive impact on oral health awareness8). This will enhance the reliability of the oral care platform and expand access to oral health management on a global scale.

4. Limitations

This study demonstrated the effectiveness of the smart dental care device; however, several limitations exist.

First, to systematically and reliably validate the effectiveness of the smart dental care device, long-term cohort-based studies that include diverse age groups and regions are required. The current study focused on school-aged children and adolescents, which limits the generalizability of the findings to other populations. Second, the initial installation and maintenance costs of the smart dental care device can be significant, potentially restricting accessibility for low-income groups and certain user demographics. Economic burdens, particularly for underserved populations, may hinder the dissemination and utilization of the device. Thus, developing cost-reduction models is essential. Third, there are still legal and institutional barriers related to telemedicine. In countries such as Korea, stringent regulations on telemedicine remain a significant obstacle to the widespread commercialization and implementation of this platform. Therefore, establishing a legal framework and securing policy support to alleviate these restrictions are imperative. To address these limitations, future studies should include cohort-based research involving diverse user groups, develop economically accessible models, and explore policy solutions to overcome legal and institutional barriers.

Conclusion

The smart dental care device and platform developed in this study effectively support personalized oral health management and preventive care while contributing to reducing oral health disparities and improving accessibility for underserved populations. Future research should explore the expansion to diverse user groups and the integration with global healthcare systems to establish more sustainable and inclusive oral health management solutions.

Acknowledgements

None.

Notes

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Ethical approval

The research protocol has been approved by the Dankook University Research Ethics Committee (approval number: DKU 2024-05-034-004).

Author contributions

Conceptualization: Ji-Na Lim and Jae-Young Lee. Data acquisition: Ji-Na Lim and Jae-Young Lee. Formal analysis: Ji-Na Lim and Jae-Young Lee. Supervision: Jae-Young Lee. Writing–original draft: Ji-Na Lim and Jae-Young Lee. Writing–review & editing: Ji-Na Lim and Jae-Young Lee.

Funding

This work was supported by the Technology Innovation Program (or Design for AI smart dental care device and service platform) (No. 20019048) funded By Ministry of Trade, Industry & Energy (MOTIE, Korea).

Data availability

Raw data is provided at the request of the corresponding author for reasonable reason.

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