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.

ConclusionsAn intelligent powered toothbrush is a well-functioning tool for maintaining oral health in older people with mild cognitive impairment as well as for collecting and transferring brush and health data to external units for storage and analysis. 

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.