Orthodontic treatment modalities: a qualitative assessment of Internet information

The quality of Web-based orthodontic information: A scoping review

INTRODUCTION

Patients seeking health information on the Internet is commonplace. This scoping review aimed to collate and synthesize the evidence regarding the quality of Web-based orthodontic information.

METHODS

A systematic search and independent screening process was conducted by 2 independent reviewers across 4 databases. The review was conducted in alignment with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines.

RESULTS

Of 661 records identified, 30 publications satisfied the inclusion criteria. Reviewed studies included those related to the information contained within Web sites regarding dental and orthodontist practices, orthodontic interventions, appliances and auxiliaries, orthodontic conditions commonly requiring orthodontic therapy, issues related to patient experience, and advice during orthodontic treatment. A total of 5 quality of information (QOI) instruments and 3 readability tools were employed, with the University of Oxford, United Kingdom (DISCERN) instrument and the Flesch Reading Ease Score tool being the most frequently used. Most studies determined that the QOI contained within evaluated Web sites was poor and provided suboptimal information related to treatment risks and Web site reliability. Most studies indicated that the information was more difficult to read than recommended by guidelines.

CONCLUSIONS

The QOI of orthodontic information available on Web sites was low to moderate, with the readability of content at a level that was considered challenging for many readers to understand. A recommendation for greater involvement of the dental and orthodontic specialty in Web site development was commonplace. Research is required for the development of validated tools that can determine the accuracy of information in addition to Web site reliability.

The performance of artificial intelligence models in generating responses to general orthodontic questions: ChatGPT vs Google Bard

INTRODUCTION

This study aimed to evaluate and compare the performance of 2 artificial intelligence (AI) models, Chat Generative Pretrained Transformer-3.5 (ChatGPT-3.5; OpenAI, San Francisco, Calif) and Google Bidirectional Encoder Representations from Transformers (Google Bard; Bard Experiment, Google, Mountain View, Calif), in terms of response accuracy, completeness, generation time, and response length when answering general orthodontic questions.

METHODS

A team of orthodontic specialists developed a set of 100 questions in 10 orthodontic domains. One author submitted the questions to both ChatGPT and Google Bard. The AI-generated responses from both models were randomly assigned into 2 forms and sent to 5 blinded and independent assessors. The quality of AI-generated responses was evaluated using a newly developed tool for accuracy of information and completeness. In addition, response generation time and length were recorded.

RESULTS

The accuracy and completeness of responses were high in both AI models. The median accuracy score was 9 (interquartile range [IQR]: 8-9) for ChatGPT and 8 (IQR: 8-9) for Google Bard (Median difference: 1; P <0.001). The median completeness score was similar in both models, with 8 (IQR: 8-9) for ChatGPT and 8 (IQR: 7-9) for Google Bard. The odds of accuracy and completeness were higher by 31% and 23% in ChatGPT than in Google Bard. Google Bard's response generation time was significantly shorter than that of ChatGPT by 10.4 second/question. However, both models were similar in terms of response length generation.

CONCLUSIONS

Both ChatGPT and Google Bard generated responses were rated with a high level of accuracy and completeness to the posed general orthodontic questions. However, acquiring answers was generally faster using the Google Bard model.

Assessment of the quality and accuracy of information contained within the websites of marketed orthodontic products: a cross-sectional investigation

OBJECTIVES

To assess the quality and accuracy of information contained within the websites of providers of marketed orthodontic products.

MATERIALS AND METHODS

Twenty-one websites of orthodontic appliance and adjunct (product) providers were identified. The website content was assessed via two validated quality-of-information instruments (DISCERN and the Journal of the American Medical Association [JAMA] benchmarks) and an accuracy-of-information instrument. Website content was qualitatively analyzed for themes and subthemes.

RESULTS

More than half (n = 11; 52.3%) of the assessed websites contained clinician testimonials. The mean (SD) DISCERN score was 33.14 (5.44). No website recorded the minimum of three JAMA benchmarks required to indicate reliability. The most common content themes related to quality-of-life impact and treatment duration. Just 8% of the statements within the websites were objectively true. The Pearson correlation coefficient indicated that the DISCERN scores were correlated with the accuracy-of-information scores (r = .83; P < .001).

CONCLUSIONS

The quality and accuracy of information contained within the websites of the providers of marketed orthodontic products was poor. The combined use of DISCERN and the accuracy-of-information instrument may help overcome the shortcomings of each. Clinicians should check the accuracy of information on orthodontic product provider websites before adding links to those websites on their own sites.

Quality assessment of available Internet information on early orthodontic treatment

BACKGROUND

This study aimed to evaluate the content, reliability, quality and readability of information on Internet websites about early orthodontic treatment.

METHODS

The "early orthodontic treatment" search term was individually entered into four web search engines. The content quality and reliability were reviewed with DISCERN, Journal of American Medical Association (JAMA), and Health on the Net code (HONcode) tools using the contents of websites meeting predetermined criteria. The readability of websites was evaluated with Flesch Reading Facilitate Score (FRES) and Flesch-Kincaid Grade Level (FKGL).

RESULTS

Eighty-six websites were suitable for inclusion and scoring of the 200 websites. 80.2% of websites belonged to orthodontists, 15.1% to multidisciplinary dental clinics and 4.7% to professional organizations. The mean DISCERN score of all websites (parts 1 and 2) was 27.98/75, ranging between 19 and 67. Professional organization websites had the highest scores for DISCERN criteria. Moreover, 45.3% of websites were compatible with JAMA's disclosure criterion, 7% with the currency criterion, 5.8% with the authorship criterion and 5.8% with the attribution criterion. Only three websites met all JAMA criteria, and these websites belonged to professional organizations. None of the websites had the HONcode logo. Mean FRES and FKGL were 47.6 and 11.6, respectively.

CONCLUSIONS

The quality of web-based information about early orthodontic treatment is poor, and readability is insufficient. More accurate and higher quality Internet sources are required on the web.

Predicted overbite and overjet changes with the Invisalign appliance: a validation study

OBJECTIVES

To investigate whether the predicted changes in overbite (OB) and overjet (OJ) in Align Technology's (Santa Jose, Calif) digital treatment plan for the prescribed course of treatment with the Invisalign appliance were consistent with those same changes in OB and OJ measured with the Geomagic Control X (Geomagic US, Research, Triangle Park, NC) metrology software system.

MATERIALS AND METHODS

Geomagic Control X software was used to determine OB and OJ differences between the pretreatment and predicted outcome. STL files for patients satisfying inclusion criteria and undergoing nonextraction orthodontic treatment with the Invisalign appliance. The differences were compared, using the Bland-Altman analysis, to the corresponding data provided by Align Technology's digital treatment-planning interface, ClinCheck.

RESULTS

Data regarding 76 adult patients who satisfied strict inclusion criteria were assessed. The Shapiro-Wilks test indicated normality (P > .05). The Bland-Altman analysis showed high levels of agreement between the two measurements, with a bias range of -0.131 to 0.111 for OB and -0.393 to 0.03 for OJ recorded.

CONCLUSIONS

Clinicians and researchers can be confident that measurement data provided by Invisalign's ClinCheck digital treatment-planning facility concerning OB and OJ changes from the initial to the predicted treatment outcome are valid.

Orthodontic patients and the information found on the web: a cross-sectional study

BACKGROUND

In recent years, the Web has become a source of medical information for patients, even though the information available online may be incorrect or qualitatively inadequate. Younger generations, immersed in a digital environment since a very tender age, are more likely to get informed online. This study aims to understand the relevance of online information for prospective orthodontic patients and to investigate the effects of digital research on patients' decision-making process, and it also aims to investigate potential generational differences between digital natives and digital immigrants.

MATERIALS AND METHODS

An anonymous questionnaire was developed to investigate patients' orthodontic-themed Web searches as well as the effects digital material had on their decision-making process. Before submitting the newly designed survey to patients, it was validated in a pilot study. Univariate analysis was applied to analyze the relationship between the demographic characteristics of respondents and their answers on the use of digital research for the decision-making process.

RESULTS

64.6% of the study population searched the Web for orthodontic information prior to their visit. Google was the most used platform regardless of patients' age. The perceived reliability of online sources varied significantly with age. Men displayed more trusting behavior towards their doctor than women. Prospective patients' satisfaction with affected patients' decision-making processes, and the perceived reliability of online sources of information had repercussions on the doctor-patient relationship.

CONCLUSIONS

Orthodontists should be aware that the majority of patients use the Internet as a source for orthodontic information, and that patients who are digital immigrants are more prone to trust the information found online. Patients who perceive the information found on the Web as either useful or reliable don't easily discard it, even if it is inconsistent with the orthodontist's opinion.

The quality and reliability of the Internet as a source of information for hypodontia patients

OBJECTIVES

The aim of this study was to determine the quality, reliability and usability of information on the Internet regarding hypodontia.

METHOD

A survey of patients with hypodontia revealed seven key search terms favoured by patients: Hypodontia; Congenitally missing teeth; Missing teeth; Gaps in teeth; Cure of missing teeth; Information on missing teeth; and Treatment of missing teeth. These were entered into four search engines: Google; Ask; Wikipedia; and NHS Choices. Relevant websites were assessed for their overall demographics, author type, country of origin and rank within the search engine. They were then analysed using five validated assessment tools. Intra-examiner reliability was assessed, and statistical analysis of the data was undertaken.

RESULTS

Good intra-examiner reliability was observed. A total of 48 websites were included for analysis from an initial 1718. There was no relationship between the ranking of a website on a search engine and the quality of information it contained. When medical search terminology was used, it resulted in websites of better quality than layperson search terms. Most websites were produced by general dental or specialist dental practices but the quality of these was poorer than those developed by private companies and medical organisations. The country of origin was primarily the USA and UK; however, this had no relationship to website quality. Overall, the majority of websites scored poorly for the validated tools and none scored well across multiple tools. A statistical analysis showed a positive relationship between the LIDA and DISCERN instruments but no other correlation between other validated tools was found.

CONCLUSION

The quality and reliability of information on the Internet regarding hypodontia is generally poor. There is a need for a reliable online hypodontia resource that can be recommended for patient use.

The quality and content of websites in the UK advertising aligner therapy: are standards being met?

Aims To evaluate the quality of information and compliance with General Dental Council (GDC) ethical advertising guidelines for English-language orthodontic websites providing orthodontic treatment with aligners in the United Kingdom (UK).Materials and methods The term 'orthodontic aligners or braces' was entered into the Google online search engine. The first 100 English language orthodontic websites (practice or company) were pooled. Both the quality (DISCERN instrument) and compliance with GDC ethical advertising guidelines were assessed. Frequency distributions and the overall summative DISCERN score for each website were calculated.Results The overall mean DISCERN score was 42.9 (SD = 9.4). The quality of information was only rated as good-excellent for 16% of websites and only 11% of websites showed full compliance with GDC guidelines on ethical advertising. A link to the GDC/authority website (75%), the date when the website was last updated (72%), and the practice complaints policy (66%) were not commonly provided. The country of qualification, a statement of whether practices provide NHS or private treatment or a combination of both, and the date when the website was last updated, were significant predictors for the overall quality based on DISCERN score.Conclusions The quality of information provided on websites providing aligner therapy and their compliance with GDC guidelines on ethical advertising was suboptimal. An improvement in both areas is required.

Quality assessment of online information on orthodontic Web sites in the United States

INTRODUCTION

The objective of this study was to assess the quality of online information on orthodontic treatment provided by orthodontic Web sites in the United States and investigate their claims.

METHODS

Three hundred and one American orthodontic Web sites were identified after an advanced Google search. Data collection included: the location of the clinic, treatment options offered, quality-of-information assessment using the DISCERN tool, and finally, claims when promoting 1 treatment option against another, as well as the presence of information on relapse risk and retention needs.

RESULTS

All Web sites belonged to private clinics, with more than half (60.5%) in a single location. Invisalign (Align Technology, Santa Clara, Calif) was the most commonly promoted treatment option (94%), followed by the full fixed appliance (FFA) (92%). The mean DISCERN total score was poor (36.78 out of 80.00), whereas the mean reliability (questions 1-8) and quality-of-information (questions 9-15) scores were 17.06 out of 40.00 and 16.85 out of 35.00, respectively. Almost one-third (28%) of the Web sites compared aligners to FFA, whereas 25% claimed that aligners are less painful than FFA, faster than FFA (14%), or give better results than FFA (1%). Almost half of the Web sites (47%) failed to display information on relapse risk and retention needs after orthodontic treatment (41%). The Web sites that displayed such info had higher DISCERN total scores (P <0.001).

CONCLUSIONS

Invisalign seems to be the treatment modality most commonly mentioned online. According to DISCERN, U.S. orthodontic Web sites display poor or fair quality information. On many Web sites, aligner treatment was compared with FFA, with some stating that aligners cause less pain than FFA or are more efficient/faster than FFA. Moreover, almost half of the American orthodontic Web sites failed to display information on the relapse risk or retention need. Display of such information can be an indicator of better-quality Web sites. There is ample room for improvement in the online information American orthodontists provide to potential patients.

Ectopic and impacted maxillary canines: A quality evaluation of online information

OBJECTIVE

To determine the quality of online information regarding ectopic and impacted maxillary canines (EIMCs).

DESIGN

A cross-sectional survey on the Internet.

MATERIAL AND METHODS

An online search using eight terms was carried out using four search engines. The relevant content of websites satisfying the inclusion and exclusion criteria were assessed for quality by applying three quality of information instruments and one readability tool. Statistical analyses were performed through GraphPad Prism 9.0.

RESULTS

In total, 77 websites were evaluated. Most of the assessed content was associated with oral and maxillofacial surgery (49.35%) and orthodontic websites (31.18%). The overall mean DISCERN score was 38.05 ± 9.76/80 with 59.73% of websites recording a poor or very poor score. Three (3.9%) websites contained the HONCode seal. Twelve (15.58%) websites satisfied at least three out of a maximum four JAMA benchmarks and 11 (14.29%) satisfied none. The mean SMOG score was 9.81 ± 1.52 (95% confidence interval = 9.46-10.16; range = 6.7-15.1).

CONCLUSION

The quality of online information related to EIMCs was poor and the content was difficult to read. Professional societies and clinicians should consider the use of quality of information and readability tools to enable the provision for reliable, high-quality and readable online information. This will assist EIMC treatment-related decision-making and management by patients and their families.

The reach, influence and tenor of professional orthodontic societies on social media: A cross-sectional content analysis

BACKGROUND AND OBJECTIVES

Orthodontic societies should support the profession and improve patient awareness. We aimed to investigate the scope and influence of orthodontic societies on social media.

METHOD

A total of 120 orthodontic societies were identified on the World Federation of Orthodontists (WFO) affiliates list. Presence of orthodontic societies on Instagram, Facebook and Twitter was ascertained. All societies with Instagram accounts were included for further analysis of the nature and content of posts as well as user engagement. Pilot coding and thematic analysis were undertaken (n=200 posts). The most recent 20% of the total number of posts for each account were then analysed for content.

RESULTS

Only 10 (8.3%), 34 (28.3%) and 52 (43.3%) orthodontic societies had accounts on Twitter, Instagram and Facebook, respectively. A total of 2124 Instagram posts were analysed. On average, 318 posts were identified per account (range=1 to 1901). The average number of followers was 2337 (range=85 to 11,400) with average user engagement of 1.25% (range=0.0%-7.17%). A total of 6 themes (subthemes; n=28) were identified including "announcements on professional events" (51.6%), "patient education, enlightenment and commendation" (26%), "running and operation of the society" (9.1%), "highlighting research and evidence" (3.1%), "COVID-related advice and updates" (4%) and "observance and commemoration" (10.4%). The posts targeting patients were limited (18.7%).

CONCLUSIONS

The limited reach of the accounts of international orthodontic societies highlights the need to develop a more effective and influential social media presence. Orthodontic societies should involve members, providers and patients in developing more effective social media resources.

Information on the Internet about clear aligner treatment-an assessment of content, quality, and readability

Purpose

The goal was to evaluate the content, quality, and readability of the information available about clear aligner treatment on the Internet.

Materials and methods

The search terms “aligner,” “clear aligner,” and “Invisalign” (Align Technology, Tempe, AZ, USA) were analyzed in three search engines (Google [Google LLC, Mountain View, CA, USA], Bing [Microsoft, Redmond, WA, USA], and Yahoo [Yahoo, Sunnyvale, CA, USA]). The first 50 websites for each keyword in each search engine were screened. Duplicate websites, advertisements, links to scientific articles, videos, and other irrelevant websites were excluded. The quality of the remaining websites was analyzed using the DISCERN and Journal of American Medical Association (JAMA) benchmark instruments together with the Health on the Net code (HONcode, Health On the Net Foundation, Geneva, Switzerland). The readability of the websites was evaluated by the Flesch Reading Ease Score (FRES) and Flesch–Kincaid Grade Level (FKGL). Statistical analyses were performed by one-way analysis of variance, Kruskal–Wallis and Fischer’s exact tests, with p < 0.05 accepted to be statistically significant.

Results

Among 111 evaluated websites, most belonged to multidisciplinary dental clinics (n = 49; 44.2%), followed by aligner companies (n = 26; 23.4%), orthodontists (n = 26; 23.4%), and professional organizations (n = 10; 9%). The mean DISCERN score (sections 1 and 2) for all websites was 29.95/75. The average FRES and FKGL were 55.77 and 9.74, respectively. Professional organization websites had significantly higher DISCERN scores than others (p < 0.001), and together with multidisciplinary dental clinic websites, they showed better compliance with JAMA benchmark criteria. Professional organization websites’ FRES and FKGL were also higher than other websites (p > 0.05).

Conclusions

Overall, the quality of web-based information about clear aligners was poor and the readability of the data was insufficient. Websites presenting high-quality data with better readability are needed for potential aligner patients.

An assessment of the treatment information contained within the websites of direct-to-consumer orthodontic aligner providers

BACKGROUND

The use of direct-to-consumer (DTC) orthodontic aligners is growing. The purpose of this study was to evaluate the quality of information contained within the websites of DTC orthodontic aligner providers.

METHODS

Websites that satisfied inclusion criteria were assessed for the presence of specific treatment-related features. Four validated quality of information instruments and readability tools were used to evaluate the content of the websites. Descriptive statistical analyses and intra-examiner reliability tests were performed.

RESULTS

Twenty-one websites were evaluated. Few websites referred to the need for pre-treatment dental health (38.1%) and indefinite post-treatment retention (23.8%). Most websites (95.2%) were categorized as either 'poor' or 'very poor' according to their DISCERN scores. DISCERN items regarding information bias and treatment risks scored particularly poorly. Cohen's kappa intra-examiner reliability testing for DISCERN scores was 0.81-0.89. Three websites honoured two out of the four Journal of the American Medical Association benchmarks and 18 honoured one benchmark only. The readability scores indicated 'difficult to read' content.

CONCLUSIONS

The quality of information contained within the websites of DTC orthodontic aligner providers is poor. Patient consent for DTC aligner treatment based solely on the information contained within the websites is likely to be invalid.

Orthodontic temporary anchorage devices: A qualitative evaluation of Internet information available to the general public

INTRODUCTION

The evaluation of online information regarding orthodontic temporary anchorage devices (TADs) is lacking despite the increase in their use by orthodontists. This cross-sectional study aimed to investigate the quality of information regarding TADs available on the Internet to the general public.

METHODS

Two search terms ("orthodontic temporary anchorage device" and "orthodontic miniscrew") were entered separately into a total of 5 search engines. The DISCERN instrument, Journal of the American Medical Association (JAMA) benchmarks, and Health on the Net Foundation Code of Conduct were used to evaluate the quality of information contained within Web sites that satisfied the inclusion and/or exclusion criteria. Web site readability was assessed via the Simple Measure of Gobbledygook and Flesch Reading Ease Score tools. Descriptive statistical analyses and Cohen's kappa intrarater reliability tests were performed.

RESULTS

Thirty-one Web sites were evaluated. Most were authored by orthodontists (77.4%) and originated from the U.S. (38.7%). The mean (standard deviation [SD]) DISCERN score was 41.87 (8.45) out of 80, with a range of 27-57. Intrarater reliability testing for DISCERN scores was excellent (0.84). Four Web sites achieved all 4 JAMA benchmarks, and 2 achieved none. Referencing of content sources throughout the Web sites scored least via DISCERN (mean 1.49 out of 5 per Web site [SD, 0.77]) and JAMA (19.35% of Web sites). One Web site contained the Health on the Net Foundation Code of Conduct seal. The mean (SD) Simple Measure of Gobbledygook score was 8.75 (1.25), with a range of 6.5-11.3. The mean (SD) Flesch Reading Ease Score was 59.81 (7.17), with a range of 47.6-73.8.

CONCLUSIONS

The quality of information related to TADs on the Internet is moderate. The usefulness of the information may be further reduced because it was beyond the readability of the average member of the general public. Web site authors should consider the use of additional expertise, quality of information tools, and readability formulas to ensure high-quality and easily readable content.

Evaluation of treatment risks and the quality of information contained within the websites of specialist orthodontists

Objective

To evaluate the treatment risks and the quality of information contained within the websites of specialist orthodontists in Australia.

Methods

The term ‘specialist orthodontic practice’ was entered into three internet search engines. Websites satisfying inclusion and exclusion criteria were evaluated for orthodontic treatment risk information against nine common treatment risks. For website reliability and quality, the DISCERN instrument was used along with the HON (health on the net) seal certification; and for readability, the Flesch Reading Ease (FRE) Test was applied.

Results

Of the 105 websites that met the inclusion and exclusion criteria, 4.8% reported all nine risks. No risks were reported by 17.1%. Relapse (64.8%) was the most common risk recorded on websites, followed by ‘pain/discomfort’ (63.8%). Root resorption was reported by 5.7%. The requirement for life-long retention was indicated by 22.9% of the websites and 57.1% gave advice on sports mouthguard wear. The proposed benefits of orthodontic treatment were outlined by 85.7%. The mean (standard deviation [SD]) overall DISCERN score was 43.78 (SD 6.49; range 17–59). No website displayed the HON Seal certification. The mean FRE Score was 51.71 (SD 10.19; range 30.1–74.7).

Conclusions

Information regarding orthodontic treatment risks contained within specialist orthodontic practice websites appears deficient. Websites were of variable reliability, quality and readability. Further development of specialist orthodontists’ websites is required to ensure the delivery of accessible, reliable and understandable evidence-based information to patients.

Assessing the quality, reliability and readability of online health information regarding systemic lupus erythematosus

Introduction Systemic lupus erythematosus (SLE) has complex pathophysiology and treatments, and patients often use the internet to better understand their condition. This report systematically assesses the quality, reliability and readability of online information. Methods The search term 'systemic lupus erythematosus' was used with Google™, Bing™ and Yahoo™ search engines sequentially. The first 25 websites returned ('hits') for each search engine (total 75 websites) were compiled. The search terms 'SLE' and 'lupus' were used in separate Google searches to assess for commonality. After removal of excluded hits, websites were assessed using the DISCERN instrument, Journal of the American Medical Association benchmarks and Gunning Fog Index for quality, reliability and readability and presence of 'Health on the Net Code' (HoN) standardisation recorded. Results There was a large degree of commonality among hits from the three different search engines using the search term 'systemic lupus erythematosus', as well as hits returned for the three different search terms using Google. The mean DISCERN score was 47.7 (SD 13.2) for 'systemic lupus erythematosus', 46.4 (SD 14.2) for 'SLE' and 45.2 (SD 10.1) for 'lupus', with no statistically significant difference. The mean number of JAMA benchmarks (maximum four) present for the 'systemic lupus erythematosus', 'SLE' and 'lupus' searches was 1.3 (SD 1.2), 1.4 (SD 1.3) and 1.2 (SD 1.0), respectively, with no statistically significance difference. The average readability of hits for the three different search terms was 9.3 (SD 3.4), 10.0 (SD 3.1) and 11.1 (SD 2.7), with no statistically significant difference. Conclusion There was a large degree of commonality of hits among the different search engines and the utilised search terms but they are not synonymous. Regardless of search term, the overall quality of websites was fair, whilst reliability was poor. Websites appearing higher in searches did not score better. Presence of the HoN did not represent better quality. Readability was higher than recommended for near-universal understanding. There was no difference in quality, reliability or readability of websites using the search terms 'systemic lupus erythematosus', 'SLE' or 'lupus', with some high-scoring websites appearing in only one search term result. This study reminds clinicians to direct patients to high-quality websites rather than rely on search engines.