Non-Cochrane · intervention · PM41187330
The Application of Gamification in Children's Oral Health Management: Systematic Review.
Chen Jinsong, Ying Ying, Pang Mingli, et al. · Journal of medical Internet research · 2025 · PubMed · doi:10.2196/75541
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
11
current version
GRADE rated
0
No studies
0
Included studies
41
linked below
No studies 0 · 0%Ungraded 11 · 100%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Children and adolescents aged <=18 years | Children (predominantly aged 3-15 years); sample sizes from N=30 to N>=500 (n=41 studies) |
| Intervention | Gamification strategies for oral health management (game design elements delivered via digital and non-digital platforms) | Gamified interventions, 59% (24/41) digital (mobile apps [most common], serious games, augmented reality) plus non-digital formats (card/board games, storytelling); common game elements were rewards, progress tracking, interactive/real-time feedback, and quizzes |
| Comparison | Conventional/non-gamified oral health approaches (a comparator was not required for inclusion) | Conventional/traditional oral health education or non-gamified interventions; many studies were single-arm/uncontrolled (app evaluations, usability, development studies) |
| Outcomes | Measurable outcomes related to oral hygiene knowledge, behavior, and adherence to oral hygiene practices | Oral health knowledge; oral hygiene behavior/brushing habits; plaque index/plaque control; engagement/adherence; preventive dental visits |
| Study designs | Randomized controlled trials, quasi-experimental studies, cohort studies, systematic reviews, and qualitative studies with measurable outcomes (English-language only) | 41 studies: 24 experimental (RCTs [predominant], usability studies, cohort studies) and 17 non-experimental (systematic reviews, app evaluations, R&D studies); no qualitative studies met eligibility |
| Timing | Studies published January 1, 2014 to February 9, 2025; no restriction on follow-up duration | Predominantly short-term outcomes; 24% (10/41) lacked long-term follow-up |
Search date: January 1, 2014 to February 9, 2025. Databases: PubMed; MEDLINE; Embase; Cochrane Library; Scopus; Web of Science; PsycINFO
Questions and results
Gamified oral health interventions (mobile apps, serious games, augmented reality, game-based education) vs Conventional or traditional oral health education, or non-gamified interventions (comparator varied; several studies were single-arm/uncontrolled)
Population: Children and adolescents aged <=18 years
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Engagement / adherence to oral hygiene routines Post-intervention (predominantly short-term; long-term follow-up in a minority of studies) Gamified interventions appear to increase children's engagement and adherence to oral hygiene routines, but the evidence is narrative and ungraded. Source: Results (Narrative Summary of Key Findings, experimental and non-experimental); Discussion (Principal Findings); Abstract · same question in other reviews | The regular use rate was significantly higher (72.4%) in the gamified mobile health app group than in the nongamified intervention group (48.3%) [Zolfaghari 2021]; quiz-based challenges in mobile apps encouraged higher… | NR | Ungraded |
Oral health knowledge Post-intervention (predominantly short-term; long-term follow-up in a minority of studies) Gamified interventions appear to improve children's oral health knowledge compared with conventional education, but the evidence is narrative and ungraded. Source: Results (Synthesis of Results; Narrative Summary of Key Findings); Discussion (Principal Findings); Abstract · same question in other reviews | The effectiveness of digital-based interventions was generally positive, with 38% (9/24) of the experimental studies reporting improvements in oral health knowledge and behaviors; game-based teaching significantly… | 9 studies | Ungraded |
Plaque control / oral hygiene clinical status (plaque index) Post-intervention (predominantly short-term; long-term follow-up in a minority of studies) Gamified interventions appear to improve plaque control and oral hygiene status in children versus conventional methods, but the evidence is narrative and ungraded (individual-study P values only). Source: Results (Narrative Summary of Key Findings, experimental); Discussion (Principal Findings; Interpretation) · same question in other reviews | In the gamified mobile health app group, plaque control was superior (P<.05) compared with the conventional method group [Zolfaghari 2021]; a gamified/reminder sticker-book group showed a significant improvement in… | NR | Ungraded |
Plaque control Population: Children and adolescents aged 18 years or younger One RCT reported superior plaque control with a gamified mobile health app versus a conventional method; no effect estimate or GRADE assessment was reported. Source: Discussion, Principal Findings · same question in other reviews | In the gamified app group in one study, plaque control was superior (P<.05) compared to the conventional method group. | 1 study | Ungraded |
Oral hygiene behavior (brushing habits, preventive dental visits, dietary choices) Post-intervention (predominantly short-term; long-term follow-up in a minority of studies) Gamified interventions appear to improve oral hygiene behaviors (brushing habits, preventive dental visits) in children, but the evidence is narrative and ungraded. Source: Results (Narrative Summary of Key Findings, experimental and non-experimental); Discussion (Principal Findings); Abstract · same question in other reviews | A gesture-based motion-capture game enhanced brushing independence and skill retention (P<.001) [Kang 2021]; 58.8% of caregivers reported their children brushed more often when using gamified applications [France… | NR | Ungraded |
Gamified mobile health app vs Nongamified intervention
Population: Children and adolescents aged 18 years or younger
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Regular use rate Digital mobile app One RCT reported a 72.4% regular-use rate with a gamified mobile health app versus 48.3% with a nongamified intervention; no GRADE assessment was reported. Source: Results, Narrative Summary of Key Findings in the Experimental Studies · same question in other reviews | Regular use rate 72.4% (gamified mobile app) vs 48.3% (nongamified) | 1 study · In one study, the regular use rate was significantly higher (72.4%) in the gamified mobile health app group than in the nongamified intervention group (48.3%). participants | Ungraded |
Long-term behavior change and overall oral health outcomes Long-term follow-up (sustained behavior change) Population: Children and adolescents aged <=18 years Digital gamified interventions appear more effective than non-digital alternatives for long-term behavior change and oral health outcomes, but the evidence is narrative and ungraded. Source: Results (Narrative Summary of Key Findings, experimental); Discussion (Principal Findings; Abstract) · same question in other reviews | Digital-based interventions were more effective in fostering long-term behavior change compared with nondigital alternatives and consistently outperformed nondigital alternatives in improving oral health outcomes;… | NR | Ungraded |
Comparison
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Oral hygiene improvement Gamified group (reminder sticker book, rewards and visual aids) | Narrative (P value) Significant improvement in oral hygiene in gamified group (P<.001) | 1 study | Ungraded |
Bacterial count reduction AR-assisted toothbrush vs manual toothbrushing | Narrative (P value) Significant reduction in bacterial count with AR-assisted toothbrush (P<.05) | 1 study | Ungraded |
Brushing independence and skill retention Gesture-based motion capture game | Narrative (P value) Enhanced brushing independence and skill retention after gesture-based motion capture game (P<.001) | 1 study | Ungraded |
Caregiver-reported child brushing frequency Gamified applications (nonexperimental studies) | Proportion (caregiver report) 58.8% of caregivers reported their children brushed more often when using gamified applications | 1 study | Ungraded |
AMSTAR 2 appraisal
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | Yes | No | no |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Yes | No | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Yes | NRSI: Yes · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: N/A · NRSI: N/A | NRSI: N/A · RCT: N/A | no |
| 12Impact of risk of bias on the pooled results | N/A | N/A | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | No | no |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | N/A | N/A | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Low | Critically Low | no |
Included primary studies 41
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Shirahmadi 2024 Effectiveness of theory-based educational interventions of promoting oral health among elementary school students. PMID:38195494 | 1 other review | not stated | not extracted yet | not extracted yet |
| Ajay 2023 App-based oral health promotion interventions on modifiable risk factors associated with early childhood caries: A systematic review. PMID:36968137 | this review only | not stated | not extracted yet | not extracted yet |
| Aljafari 2015 An oral health education video game for high caries risk children: study protocol for a randomized controlled trial. PMID:26016586 | this review only | not stated | not extracted yet | not extracted yet |
| Aljafari 2022 A Video-Game-Based Oral Health Intervention in Primary Schools-A Randomised Controlled Trial. PMID:35621543 | this review only | not stated | not extracted yet | not extracted yet |
| Amantini 2020 Using Augmented Reality to Motivate Oral Hygiene Practice in Children: Protocol for the Development of a Serious Game. PMID:31951216 | this review only | not stated | not extracted yet | not extracted yet |
| Borrelli 2025 Parent-Targeted Oral Health Text Messaging for Underserved Children Attending Pediatric Clinics: A Randomized Clinical Trial. PMID:39745701 | this review only | not stated | not extracted yet | not extracted yet |
| Campos 2019 Development and Evaluation of a Mobile Oral Health Application for Preschoolers DOI:10.1089/tmj.2018.0034 | this review only | not stated | not extracted yet | not extracted yet |
| Chang 2024 The gamification and development of a chatbot to promote oral self-care by adopting behavior change wheel for Taiwanese children. PMID:38798886 | this review only | not stated | not extracted yet | not extracted yet |
| Chuko 2020 Design of Interactive Aids for Children’s Teeth Cleaning Habits DOI:10.25046/aj050263 | this review only | not stated | not extracted yet | not extracted yet |
| Deshpande 2022 Effectiveness of a Visual Interactive Game on Oral Hygiene Knowledge, Practices, and Clinical Parameters among Adolescents: A Randomized… PMID:36553272 | this review only | not stated | not extracted yet | not extracted yet |
| Dey 2023 Fluorescence-based Evaluation of the Efficacy of Augmented Reality-assisted Toothbrush on Oral Hygiene Practices Among 6–8 Years Old… DOI:10.1177/23202068231193772 | this review only | not stated | not extracted yet | not extracted yet |
| Effendi 2021 Effectiveness of reminder sticker books at increasing dental health knowledge and oral hygiene DOI:10.20473/j.djmkg.v54.i1.p5-10 | this review only | not stated | not extracted yet | not extracted yet |
| Fegan 2023 Is the answer to reducing early childhood caries in your pocket? DOI:10.1038/s41432-023-00922-3 | this review only | not stated | not extracted yet | not extracted yet |
| Fijacko 2020 The Effects of Gamification and Oral Self-Care on Oral Hygiene in Children: Systematic Search in App Stores and Evaluation of Apps. PMID:32673235 | this review only | not stated | not extracted yet | not extracted yet |
| France 2024 A Pilot Study Exploring Caregivers' Experiences Related to the Use of a Smart Toothbrush by Children with Autism Spectrum Disorder. PMID:38671677 | this review only | not stated | not extracted yet | not extracted yet |
| Gayatri 2023 Smart Oral Health: A Mobile Application for Dental Caries and Oral Hygiene Self-examination DOI:10.1177/10105395231204987 | this review only | not stated | not extracted yet | not extracted yet |
| Kang 2021 Using a kinect‐based game to teach oral hygiene in four elementary students with intellectual disabilities DOI:10.1111/jar.12828 | this review only | not stated | not extracted yet | not extracted yet |
| Karkoutly 2024 Effectiveness of a dental simulation game on reducing pain and anxiety during primary molars pulpotomy compared with tell-show-do… PMID:39174937 | this review only | not stated | not extracted yet | not extracted yet |
| Kashyap 2022 Effectiveness of Game-Based Oral Health Education Method on Oral Hygiene Performance of 12-Year-Old Private School Children in Lucknow City DOI:10.4103/jiaphd.jiaphd_26_21 | this review only | not stated | not extracted yet | not extracted yet |
| Kumar 2015 Effect of Conventional and Game-based Teaching on Oral Health Status of Children: A Randomized Controlled Trial. PMID:26379380 | this review only | not stated | not extracted yet | not extracted yet |
| Mahesh 2023 Effect of game based education in extension of oral health knowledge among 10–12-year-old school children – an interventional study DOI:10.34172/johoe.2023.28 | this review only | not stated | not extracted yet | not extracted yet |
| Malik 2017 Implementation of Game-based Oral Health Education vs Conventional Oral Health Education on Children's Oral Health-related Knowledge and… PMID:29104385 | this review only | not stated | not extracted yet | not extracted yet |
| Mendonca 2024 Oral Health Education for Children: Development of a Serious Game with a User-Centered Design Approach DOI:10.1089/g4h.2023.0055 | this review only | not stated | not extracted yet | not extracted yet |
| Meric 2024 Evaluation of the quality of oral hygiene mobile apps for children using the mobile app rating scale DOI:10.1016/j.ijmedinf.2024.105612 | this review only | not stated | not extracted yet | not extracted yet |
| Mohammadzadeh 2023 Mobile health applications for children's oral health improvement: A systematic review DOI:10.1016/j.imu.2023.101189 | this review only | not stated | not extracted yet | not extracted yet |
| Moreira 2024 Gamification and Oral Health in Children and Adolescents: Scoping Review. PMID:38573750 | this review only | not stated | not extracted yet | not extracted yet |
| Padmanabhan 2024 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Panic 2014 Promoting Dental Hygiene to Children: Comparing Traditional and Interactive Media Following Threat Appeals DOI:10.1080/10810730.2013.821551 | this review only | not stated | not extracted yet | not extracted yet |
| Patil 2024 Effect of game-based teaching on the oral health of children: a systematic review of randomised control trials DOI:10.22514/jocpd.2024.075 | this review only | not stated | not extracted yet | not extracted yet |
| Peerbhay 2025 Effectiveness of oral health promotion in children and adolescents through behaviour change interventions: A scoping review. PMID:39792864 | this review only | not stated | not extracted yet | not extracted yet |
| Reynolds 2018 How families prepare their children for tooth extraction under general anaesthesia: Family and clinical predictors of non‐compliance with… DOI:10.1111/ipd.12450 | this review only | not stated | not extracted yet | not extracted yet |
| Rizany 2023 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Santhosh 2024 Effectiveness of a toothbrushing intervention utilizing puzzle-solving game assisted with visual aids among adolescents: A single-blind… DOI:10.32394/pe/195139 | this review only | not stated | not extracted yet | not extracted yet |
| Saraf 2023 Comparison of “My Tooth the Happiest” educational game with standard dietary counseling for preference toward non-cariogenic food items in… DOI:10.4103/jisppd.jisppd_93_23 | this review only | not stated | not extracted yet | not extracted yet |
| Sharififard 2020 A music- and game-based oral health education for visually impaired school children; multilevel analysis of a cluster randomized… PMID:32423446 | this review only | not stated | not extracted yet | not extracted yet |
| Sharma 2021 Comparison between Conventional, Game-based, and Self-made Storybook-based Oral Health Education on Children's Oral Hygiene Status: A… PMID:34413606 | this review only | not stated | not extracted yet | not extracted yet |
| Shi 2023 Effect of Conventional and “Dental Truth or Dare” Board Game on Oral Hygiene Knowledge and Oral Hygiene Status of Preschool Children DOI:10.1089/g4h.2022.0059 | this review only | not stated | not extracted yet | not extracted yet |
| Shruti 2021 Incorporation of Storytelling as a Method of Oral Health Education among 3-6-year-old Preschool Children. PMID:34720505 | this review only | not stated | not extracted yet | not extracted yet |
| Widodorini 2023 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Zaror 2021 Current State of Serious Games in Dentistry: A Scoping Review DOI:10.1089/g4h.2020.0042 | this review only | not stated | not extracted yet | not extracted yet |
| Zolfaghari 2021 Development and evaluation of a gamified smart phone mobile health application for oral health promotion in early childhood: a randomized… PMID:33413304 | this review only | not stated | not extracted yet | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match).
| Review | Shared studies | Jaccard |
|---|---|---|
| Health promotion theory-based educational interventions for improving oral health in children and adolescents: a systematic review and… (2025) | 1 | 0.01 |