Oral Health Buddy: A Novel Texting Program to Improve the Oral Health of Low-Income Groups

This study determined whether a mobile health intervention using text messages and social support/encouragement from an informal caregiver (the “buddy”) were effective in achieving improvements in oral health in 31 patients diagnosed with diabetes in an underserved community dental clinic in Southeast Michigan. Participants were: mean age: 58.4 years, 80.6% female, 45.2% African American, 65.5% at or below poverty level, A1c ≥ 7%: 58.1%. Participants chose one family member, friend, or relative as their “buddy” to provide support during the 4­month intervention. The texting algorithm was designed to encourage brushing and flossing; and to send text messages to the buddy when the patient was non-compliant with respect to proper oral hygiene. Significant improvements were observed in self­reported oral health as “good/very good” from baseline (25.8%) to 4 months (38.7%), p=0.05. Marked decreases in A1c were also observed at 4 months (­0.6%, p=0.03). African American participants experienced a 0.7% reduction in A1c while White participants improved by 0.3%. Additionally, African American participants achieved greater improvements in A1c than their White counterparts. No racial differences were observed in oral health improvement. Analyses of clinical oral health outcomes are ongoing. These data demonstrate that combining text messages with a buddy is effective in helping participants to achieve and maintain glycemic control and improve self­reported oral health. With the growing prevalence of diabetes and periodontitis, leveraging the high penetration of cell-phone ownership in low-income groups through text-messaging is a promising low­cost approach to patient engagement in high­risk, underserved communities.