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Maintaining good oral health is critical to healthy aging, as cognitive decline often accelerates the deterioration of oral health. Conversely, poor oral health can exacerbate cognitive decline. The thesis examines if introducing a powered toothbrush could prevent the deterioration of oral health in older individuals with mild cognitive impairment (MCI) and maintain a good quality of life. Another aim was to evaluate the actual use and the possibility of using the powered toothbrush as a carrier for other health sensors. From an interdisciplinary perspective, it examines technology's direct and indirect impact on oral health, which aligns with the World Health Organization's definition of applied health technology. Maintaining oral health is critical in a growing aging population and with the increased incidence of MCI. The thesis includes four sub-studies. A pilot study was conducted on healthy adults, where core body temperature was assessed with a sensor attached to the toothbrush. For study I-III, two hundred and thirteen participants who met specific criteria such as age, memory problems, and cognitive levels were initially recruited. Oral health data with medical, cognitive, and quality of life assessments were collected over two years, with visits scheduled every six months. Ethical considerations followed the Declaration of Helsinki, which emphasized informed consent, participant autonomy, and dignity protection, which are particularly important for vulnerable populations such as individuals with MCI. This thesis shows that it is possible to maintain and improve oral health measured by Plaque Index (PI), Bleeding on Probing (BOP), and Periodontal Pocket depth 4mm or deeper (PPD≥4 mm) in a group of older individuals with MCI for at least 24 months. The results underline the potential of smart toothbrushes as tools for improved oral health and as carriers of sensors for health monitoring.

Objectives: The aim of the study is to investigate whether the use of a powered toothbrush could maintain oral health by reducing the dental plaque (PI), bleeding on probing (BOP), and periodontal pocket depth (PPD) ≥4 mm in a group of individuals with MCI and also if changes in oral health affect various aspects of quality of life. Background: People with cognitive impairment tend to have poor oral hygiene and poorer Quality of life. In the present study, the participants were asked to use a powered toothbrush for at least 2 min morning and evening and no restrictions were given against the use of other oral care products. The participant survey conducted at each examination demonstrated that 61.2% of participants at baseline claimed to have experience of using a powered toothbrush, 95.4% at 6 months and 95% after 12 months. At the same time, the use of manual toothbrushes dropped from 73.3% to 44.7% from baseline to the 12-month check-up. This shows that several participants continue to use the manual toothbrush in parallel with the powered toothbrush, but that there is a shift towards increased use of the powered toothbrush. Removal of dental biofilm is essential for maintaining good oral health. We investigated whether using a powered toothbrush reduces the presence of dental plaque, bleeding on probing and periodontal pockets ≥4 mm in a group of older individuals with mild cognitive impairment. Materials and methods: Two hundred and thirteen individuals with the mean age of 75.3 years living without official home care and with a Mini-Mental State Examination (MMSE) score between 20 and 28 and a history of memory problems in the previous six months were recruited from the Swedish site of a multicenter project, Support Monitoring And Reminder Technology for Mild Dementia (SMART4MD) and screened for the study. The individuals received a powered toothbrush and thorough instructions on how to use it. Clinical oral examinations and MMSE tests were conducted at baseli, CC BY-NC-ND 4.0© 2022 The Authors. Gerodontology published by Gerodontology Association and John Wiley & Sons Ltd.First published: 22 January 2022

BackgroundApplied health technology is a research field that ties together several disciplines to improve and preserve the health and quality of life of individuals and society. Helping especially elderly to meet the above goals is an important and necessary task and assistive technology and collection of health data are part of this work. AimsPaper I aims to investigate whether the use of a powered toothbrush could maintain oral health in a group of individuals with MCI and if changes in oral health affect various aspects of quality of life. Paper II and III aims to examine the capacity of a powered toothbrush as a carrier and mediator of health-related data. MethodsFor papers I and II, the participants were recruited from the Swedish site of the multicenter project Support Monitoring And Reminder Technology for Mild Dementia and for paper III from the Department of Health at Blekinge Institute of Technology. In all three papers, a powered toothbrush has been used as a tool, sensor carrier and transmitter of data. For Quality-of-life assessment two instruments are used, The QoL-AD and OHIP 14. ResultsBy introducing an intelligent powered toothbrush in the group of older individuals with mild cognitive impairment we have showed that they, regardless of cognitive level,improved their scores for plaque index, bleeding index and deepened periodontal pockets ≥ 4mm, over 12 months. The quality-of-life instrument related to oral health improved in parallel with the improvement in oral health. Furthermore, it is possible to use the intelligent powered toothbrush both as a carrier for healt related sensors and to transfer user data via Bluetooth technology to a single-core processor that stores or forwards the data via Wifi to an external computer for processing, analysis and storage. A fesibility study regarding temperature sensor for measuring body temperature during toothbrushing have been evaluated and found to be comparable to traditional oral temperature measurement.

The advent of powered toothbrushes and associated mobile health applications provides an opportunity to collect and monitor the data, however collecting reliable and standardized data from large populations has been associated with efforts from the participants and researchers. Finding a way to collect data autonomously and without the need for cooperation imparts the potential to build large knowledge banks. A solution with Bluetooth low energy technology is designed to pair a powered toothbrush with a single-core processor to collect raw data in a real-time scenario, eliminating the manual transfer of powered toothbrush data with mobile health applications. Associating powered toothbrush with a single-core processor is believed to provide reliable and comprehensible data of toothbrush use and propensities can be a guide to improve individual exhortation and general plans on oral hygiene quantifies that can prompt improved oral wellbeing. The method makes a case for an expanded chance to plan assistant capacities to protect or improve factors that influence oral wellbeing in individuals with mild cognitive impairment. The proposed framework assists with determining various parameters, which makes it adaptable and conceivable to execute in various oral care contexts, open access