Digital surveillance: The interests in toothache-related information after the outbreak of COVID-19

Uncovering a pseudoscience: an analysis of 'biological dentistry' Instagram posts

OBJECTIVE

This infodemiology study aimed to analyze characteristics of English-language Instagram posts on 'Biological Dentistry'.

MATERIALS AND METHODS

Using CrowdTangle, we analyzed 500 'Biological Dentistry' posts published on Instagram from May 2017 to May 2022. Two researchers assessed each post for facticity, motivation, author's profile, sentiment, and interaction metrics. Statistical analysis was employed to compare interaction metrics between dichotomized categories of posts' characteristics and determine predictors of misinformation and user engagement.

RESULTS

Over half of the posts (58.4%) were from health-related authors, and a considerable number contained misinformation (68.2%) or were financially motivated (52%). Sentiment was mostly negative or neutral (59.8%). Misinformation was associated with financial motivation (OR = 2.12) and health-related authors (OR = 5.56), while non-health-related authors' posts associated with higher engagement (OR = 1.98). Reliable content, non-health-related authorship, and positive sentiment were associated with increased user interaction.

CONCLUSION

Misinformation about 'Biological Dentistry' on Instagram is mainly spread by financially incentivized health-related authors. Yet, non-health-related authors' posts resonate more with audiences, highlighting a nuanced relationship between content facticity, authorship, and engagement.

The most common types of nontraumatic dental conditions among emergency department visits in North Carolina before and during the COVID-19 pandemic

BACKGROUND

This study aimed to identify the most common types of nontraumatic dental conditions (NTDCs) before and during the COVID-19 pandemic and assess the variations in the most common NTDCs by patient age groups and rural or urban locations and the impact of COVID-19 on emergency department (ED) visits for NTDCs in North Carolina.

METHODS

The authors conducted a retrospective data analysis of ED data from the North Carolina Disease Event Tracking and Epidemiology Collection Tool. The authors estimated the proportions of NTDCs of all ED visits in 2019 and 2021 and ranked the proportions of the major categories of NTDCs by age groups and rural or urban locations. They used a multiple logistic regression model to assess the impact of COVID-19 on NTDCs.

RESULTS

By the first diagnosis, the proportion of NTDCs dropped from 1.1% in 2019 to 0.99% in 2021 (P < .001). Caries was specified as the third most common NTDC. Oral infection was the top NTDC among young (≤ 17 years) and older patients (≥ 65 years). No significant differences were found in NTDCs between rural and urban areas (P = .68). Children younger than 2 years (adjusted odds ratio, 4.36) and adults aged 18 through 44 years (adjusted odds ratio, 4.54) were more likely to visit the ED for NTDCs than those 75 years and older.

CONCLUSIONS

The proportion of NTDCs seen at the ED was lower during the COVID-19 pandemic in 2021 than in 2019. The common NTDCs varied by age group but were similar in rural and urban areas. The most common NTDCs were related to toothache, oral infection, and caries.

PRACTICAL IMPLICATIONS

More efforts are needed to reduce ED visits for NTDCs.

Are Social Media Platforms Appropriate Sources of Information for Patients Regarding the Topic of Facial Trauma?

BACKGROUND

Internet technologies have made a wide variety of information available to the public. Social media platforms (SMPs) can also be used as a source of information for patients seeking health care information. However, the quality of health information on SMPs is not clear and standardized.

PURPOSE

To evaluate the content, reliability, and quality levels of videos reporting on facial trauma on a SMP (YouTube [Google LLC, San Bruno, California]) regarding patients' information.

STUDY DESIGN, SETTING, SAMPLE

This was a cross-sectional study, and the sample is composed of videos found on a SMP based on searching the keyword "facial trauma." English-language videos with acceptable audiovisual quality and content related to facial trauma were included in the study.

PREDICTOR VARIABLE

The descriptive features such as number of views, number of likes, number of comments, video duration, date of uploading, and the demographic features such as source and uploader were recorded.

MAIN OUTCOME VARIABLES

The primary outcome variable was content level. Secondary outcome variables were reliability and quality levels measured by DISCERN and Global Quality Scale.

COVARIATES

The name and uniform resource locator of the videos were recorded as additional data.

ANALYSES

The Mann-Whitney U test was used to compare low-content and high-content videos with a significance level of P < .05. The Kappa test was used to assess the inter-rater reliability.

RESULTS

The sample was composed of 50 videos that met study's inclusion. The mean total content score for the videos was 2.87 (range: 0 to 7), with 64% of all videos (n = 32) classified as low-content. The reliability and quality levels of videos classified as high-content were significantly superior (P < .001). In addition, the video duration was significantly higher in the high-content videos (P = .045). High-content videos were uploaded by health care professionals with a ratio of 39%, and the sources of these videos were predominantly oral and maxillofacial surgeons; however, low-content videos were mostly uploaded by clinics (75%), with the sources of these videos predominantly laypersons.

CONCLUSION AND RELEVANCE

Given the generally low content, reliability, and quality of online videos regarding facial trauma, clinicians should be cautious in recommending or referring patients to SMPs.

Analysis of Fluoride-Free Content on Twitter: Topic Modeling Study

BACKGROUND

Although social media has the potential to spread misinformation, it can also be a valuable tool for elucidating the social factors that contribute to the onset of negative beliefs. As a result, data mining has become a widely used technique in infodemiology and infoveillance research to combat misinformation effects. On the other hand, there is a lack of studies that specifically aim to investigate misinformation about fluoride on Twitter. Web-based individual concerns on the side effects of fluoridated oral care products and tap water stimulate the emergence and propagation of convictions that boost antifluoridation activism. In this sense, a previous content analysis-driven study demonstrated that the term fluoride-free was frequently associated with antifluoridation interests.

OBJECTIVE

This study aimed to analyze "fluoride-free" tweets regarding their topics and frequency of publication over time.

METHODS

A total of 21,169 tweets published in English between May 2016 and May 2022 that included the keyword "fluoride-free" were retrieved by the Twitter application programming interface. Latent Dirichlet allocation (LDA) topic modeling was applied to identify the salient terms and topics. The similarity between topics was calculated through an intertopic distance map. Moreover, an investigator manually assessed a sample of tweets depicting each of the most representative word groups that determined specific issues. Lastly, additional data visualization was performed regarding the total count of each topic of fluoride-free record and its relevance over time, using Elastic Stack software.

RESULTS

We identified 3 issues by applying the LDA topic modeling: "healthy lifestyle" (topic 1), "consumption of natural/organic oral care products" (topic 2), and "recommendations for using fluoride-free products/measures" (topic 3). Topic 1 was related to users' concerns about leading a healthier lifestyle and the potential impacts of fluoride consumption, including its hypothetical toxicity. Complementarily, topic 2 was associated with users' personal interests and perceptions of consuming natural and organic fluoride-free oral care products, whereas topic 3 was linked to users' recommendations for using fluoride-free products (eg, switching from fluoridated toothpaste to fluoride-free alternatives) and measures (eg, consuming unfluoridated bottled water instead of fluoridated tap water), comprising the propaganda of dental products. Additionally, the count of tweets on fluoride-free content decreased between 2016 and 2019 but increased again from 2020 onward.

CONCLUSIONS

Public concerns toward a healthy lifestyle, including the adoption of natural and organic cosmetics, seem to be the main motivation of the recent increase of "fluoride-free" tweets, which can be boosted by the propagation of fluoride falsehoods on the web. Therefore, public health authorities, health professionals, and legislators should be aware of the spread of fluoride-free content on social media to create and implement strategies against their potential health damage for the population.

Exploring online oral health misinformation: a content analysis

Considering the unfavorable implications of health falsehoods and the lack of dental research into information disorder, this study aimed to identify and characterize online oral health misinformation. A total of 410 websites published in English were retrieved using Google Advanced Search and screened by two independent investigators to compile falsehoods through thematic content analysis. Afterward, 318 pieces of misinformation were consensually divided into four groups concerning their informational interest (G1), financial, psychological, and social interests produced/disseminated by non-dental professionals (G2) or by dental professionals (G3), and political interests (G4). Social media (Facebook and Instagram) and fact-checking tool (Snopes) were also screened to determine the spread of falsehoods by identifying corresponding posts and warnings. As a result, misinformation was mainly associated with gum diseases (12.0%), root canal treatment (11.6%), toothache (10.4%), fluoride (10.4%), and dental caries (9.8%), with a special highlight on recommendations for the usage of natural products, toxicity concerns, and anti-fluoridation propaganda. Additionally, most misinformation was allocated in G3 (41.9%), which presented a statistically higher frequency of financial interests than G4. Finally, falsehoods were considerably identified on Facebook (62.9%) and Instagram (49.4%), especially G3 and G4. Nevertheless, Snopes has debunked only 5.9% of these content items. Therefore, misinformation was predominantly produced or disseminated by dental professionals mainly motivated by financial interests and usually linked to alternative/natural treatments. Although these items were shared on social media, fact-checking agencies seemed to have limited knowledge about their dissemination.

Is Teledentistry a Method for Optimizing Dental Practice, Even in the Post-Pandemic Period? An Integrative Review

Background: For the past two and half years, dentists all across the world, along with their patients, have faced numerous challenges. In this context, the aim of this integrative review was to assess if dentists’ and patients’ attitudes regarding teledentistry (TD) have changed since the COVID-19 outbreak, and if the use of TD will continue to rise, even in the post-pandemic period; (2) Methods: A literature search was performed between August 2021 and January 2022. The PubMed, Scopus, and Science Direct databases were searched for articles published between 2012 and 2022 using a combination of the following Mesh terms: “COVID-19”, “pandemic”, “oral telemedicine”, “teledentistry”; (3) Results: Among the 52 included papers, nine papers were published between 2011 and 2019, and 43 articles were published after 2020 (12 were published in 2020, 29 papers were published in 2021, and two in 2022). Among the articles published before 2020, seven out of nine included papers were reviews, and two were original research. Among the 43 papers published after 2020, 18 were reviews and 25 original research. (4) Conclusions: Based on the results of this integrative review, there is clear evidence that the interest in teledentistry and teleassistance in the dental field has increased rapidly, especially in the context of the COVID-19 pandemic. Therefore, while dental practitioners should be encouraged to keep themselves updated about new technologies, patients should also be constantly informed about their options for receiving special oral health care.

Effect of the COVID-19 Mitigation Measure on Dental Care Needs in 17 Countries: A Regression Discontinuity Analysis

Objectives

The effect of COVID-19 mitigation measures on different oral health care needs is unclear. This study aimed to estimate the effect of COVID-19 mitigation measures on different types of oral health care utilization needs and explore the heterogeneity of such effects in different countries by using real-time Internet search data.

Methods

Data were obtained from Google Trends and other public databases. The monthly relative search volume (RSV) of the search topics "toothache," "gingivitis," "dentures," "orthodontics," and "mouth ulcer" from January 2004 to June 2021 was collected for analysis. The RSV value of each topics before and after COVID-19 was the primary outcome, which was estimated by regression discontinuity analysis (RD). The effect bandwidth time after the COVID-19 outbreak was estimated by the data-driven optimal mean square error bandwidth method. Effect heterogeneity of COVID-19 on dental care was also evaluated in different dental care categories and in countries with different human development index (HDI) rankings, dentist densities, and population age structures.

Results

A total of 17,850 monthly RSV from 17 countries were used for analysis. The RD results indicated that advanced dental care was significantly decreased (OR: 0.63, 95% CI: 0.47-0.85) after the COVID-19 outbreak, while emergency dental care toothache was significantly increased (OR: 1.54, 95% CI: 0.99-2.37) 4 months after the COVID-19 outbreak. Compared to the countries with low HDI and low dentist density, the effect was much more evident in countries with high HDI and high dentist density.

Conclusions

COVID-19 mitigation measures have different effects on people with various dental care needs worldwide. Dental care services should be defined into essential care and advanced care according to specific socioeconomic status in different countries. Targeted health strategies should be conducted to satisfy different dental care needs in countries.

Characterization of misleading fluoride information on Instagram: An infodemiology study (Preprint)

Background

Online false or misleading oral health–related content has been propagated on social media to deceive people against fluoride’s economic and health benefits to prevent dental caries.

Objective

The aim of this study was to characterize the false or misleading fluoride-related content on Instagram.

Methods

A total of 3863 posts ranked by users’ total interaction and published between August 2016 and August 2021 were retrieved by CrowdTangle, of which 641 were screened to obtain 500 final posts. Subsequently, two independent investigators analyzed posts qualitatively to define their authors’ interests, profile characteristics, content type, and sentiment. Latent Dirichlet allocation analysis topic modeling was then applied to find salient terms and topics related to false or misleading content, and their similarity was calculated through an intertopic distance map. Data were evaluated by descriptive analysis, the Mann-Whitney U test, the Cramer V test, and multiple logistic regression models.

Results

Most of the posts were categorized as misinformation and political misinformation. The overperforming score was positively associated with older messages (odds ratio [OR]=3.293, P<.001) and professional/political misinformation (OR=1.944, P=.05). In this context, time from publication, negative/neutral sentiment, author’s profile linked to business/dental office/news agency, and social and political interests were related to the increment of performance of messages. Although political misinformation with negative/neutral sentiments was typically published by regular users, misinformation was linked to positive commercial posts. Overall messages focused on improving oral health habits, side effects, dentifrice containing natural ingredients, and fluoride-free products propaganda.

Conclusions

False or misleading fluoride-related content found on Instagram was predominantly produced by regular users motivated by social, psychological, and/or financial interests. However, higher engagement and spreading metrics were associated with political misinformation. Most of the posts were related to the toxicity of fluoridated water and products frequently motivated by financial interests.

Digital surveillance: The interests in toothache-related information after the outbreak of COVID-19

Objectives

The aim of this ecological study was to analyze the relationship of social restriction measures and people's interest in searching toothache‐related information on the Internet.

Materials and Methods

The following indicators Stringency Index (SI), Years Lived with Disability (YLDs) for untreated caries in permanent teeth, Google market share, Internet penetration, and relative search volume (RSV) for the Topic "Toothache" in Google Trends were determined for 21 countries with available data, from April 2018 to May 2020. Statistical analysis was performed using Mann–Whitney U test, t‐Student test, Pearson's Chi‐square test, and Spearman and Pearson's cross‐correlation tests (α = 0.05).

Results

Relative search volume values increased significantly after restriction measures in all countries, except for Japan. Higher RSV values were found among 11 countries that presented a cross‐correlation between RSV and SI with r≥│0.6│. The most common queries were linked to the treatment and self‐resolution of toothache, with a sudden increase of searches that combined the symptom with COVID‐19.

Conclusions

The interests in toothache‐related digital information were associated with social restriction measures. These results allow the identification of dental demands of distinct populations, contributing to the planning of specific public health policies during and after the pandemic period.