The quality of oral care among frail elderly people in nursing homes is low. Due to reduced mobility or cognitive functioning, elderly people fail to complete the oral care ritual sufficiently. Once this happens, caregivers are obliged to take over this task. Unfortunately, in many cases this does not happen due to the difficulty of the task, the uncomfortable feeling of intimacy for both the elderly person and the caregiver, and the high time pressure caregivers experience during the morning care ritual.
Dental Robotics aims to improve the quality of care among frail elderly by developing an automatic toothbrush that takes away these pains. The Dental Robotics toothbrush simply requires the elderly person to bite in a mouthpiece. This enables the caregiver to brush all teeth at the same time while applying the right pressure and angle without skipping any teeth. The toothbrush completes this task in only 10 seconds, helping to reduce the total amount of time of the oral care ritual.
However, for people with dementia such a product, bringing along new and different interactions, is difficult to comprehend. This lack of understanding can lead to problematic behaviour. This can be apathic, anxious, aggressive or agitated behaviour, all of which is difficult to overcome by the caregiver. Currently, the most common solution that caregivers use to overcome problematic behaviour is skipping the oral care altogether. When this happens, the care ritual cannot be completed. This is a major challenge for Dental Robotics, leading to the following design goal:
Increase the acceptance of the Dental Robotics toothbrush among people with dementia and their caregivers, by creating a more pleasant experience for both.
Person-centred care is a way to avoid problematic behaviour in the long term. This is an approach that puts the client with dementia in the centre of their own care, and uses the preferences and habits of the client during the care ritual. Since everyone has a different history, the way in which care should be approached should be different for everyone as well. In addition, the symptoms and severity of all clients are different. In order to apply this person-centred care, it is important to have a good understanding of the person in question.

Blink is an app that aims to enable caregivers to apply the person-centred approach over the entire care ritual. This is supported by the theory that, when the entire care ritual is executed without any problematic behaviour, the client with dementia will be put at ease and be more prone to accept such a difficult product as the toothbrush.
Every time Blink is used for a specific client, the content changes. It will adapt based on the connection between the client and the caregiver, the severity of the dementia and the specific tool preferences for both the caregiver and the client. This helps to keep the use of Blink engaging. Over time, the connection between the caregiver and the client will grow. At the same time, the dementia gets more severe, making it increasingly difficult to connect and have conversations. The focus of the app will be on establishing a connection in the beginning, and slowly shifting towards more active help, such as an easy way to turn on music or videos.
Together, this will help to create a more pleasant care moment for both the client and the caregiver, ensuring an increased acceptance of the automatic toothbrush developed by Dental Robotics.

There are currently no technological options in the market for the oral care of edentulous population. Dental Robotics, a company already involved in the production of dental care devices for elderlies, is interested in new technological solutions to attend this sector. The design is challenging as it has to meet several requirements: 1) be built upon an existing platform (the Air 1 handle), 2) to demonstrate potential for efficiently clean different mouth morphologies, 3) to use an actuator that requires minimal maneuver and is easily accepted by patients and be practical for nurses, and all these while showing manufacturing feasibility and production scalability. The methodology followed a combination of design thinking and lean startup, meaning a human centered, technology-based iterative and integrative process of prototyping and test. Through this progressive development, diverse strategies were applied, including literature research, field work observations and empathizing with the problem, comparison of market-available alternatives, exploration of materials and prototyping processes, evaluation of effectiveness and acceptance of different design versions, image analyses to evaluate cleaning capacity, manufacturing process, etc. The result is a validated prototype that meets the technical requirements and represents the optimal solution within the explored options; however, future progress could result from optimizing the motion of the Actuator, improve design features to make the assembly easier, explore different arrangements of tufts textures to increase comfort, increase the sample of mouth morphologies to better represent the edentulous elderly population in The Netherlands, to test the effect of the gum cleaner with Laser Doppler Flowmetry to find out if it could stimulate blood flow (Irrigation) on the gingiva, and for how long, and evaluate the long-term impact of this device in the reduction of Residual Ridge Resorption clinical tests. If proven, this could be an added value offered by the company. The proposal for oral care in edentulous elder patients developed in this work proved promising as market product after further performance and manufacturing process refinements.