Twitter analysis of the orthodontic patient experience with braces vs Invisalign

A longitudinal pilot study examining the influence of the orthodontic system chosen in adult patients (brackets versus aligners) on oral health-related quality of life and anxiety

BACKGROUND

In recent years, the demand for orthodontic treatment with aligners has increased, led by patient need, as aligners typically provide them with improved aesthetics and less physical discomfort. In deciding with the patient on an appropriate orthodontic system, it is important to take into account the potential discomfort and the perceptions that patients have in relation to their treatment. The objective of this study was to analyze the influence of brackets or aligners on oral health-related quality of life (OHRQoL) and anxiety levels in a sample of adult patients during the first month of treatment.

METHODS

The pilot study was carried out at the Dental Clinic of the University of Salamanca between November 2023 and February 2024. Eighty adult patients who initiated orthodontic treatment were selected and divided into two groups: the brackets group (Victory®; 3 M Unitek, California, USA) (n = 40) and the aligners group (Invisalign®; Align Technology, California, USA) (n = 40). OHRQoL was analyzed using the Oral Health Impact Profile-14 (OHIP-14) questionnaire, and anxiety was analyzed using the State-Trait Anxiety Inventory (STAI). The follow-up time was one month, with scores recorded at the beginning (T0) and one month after starting treatment (T1).

RESULTS

The mean patient age was 33.70 (± 5.45) years old. The total sample (n = 80) consisted of 66.2% men and 33.8% women. In the brackets group, one month after starting treatment, the dimension with the highest impact was that of physical pain (5.62 ± 1.51). In the aligners group, where the dimension of psychological disability had the highest score (4.22 ± 1.02). In the brackets group the total OHIP score was higher at one month (T1) (33.98 ± 6.81) than at the start of treatment (T0) (21.80 ± 3.34); this greater impact on OHRQoL one month after starting treatment was not observed in the aligners group (T1 = 27.33 ± 6.83; T0 = 27.33 ± 6.22). The orthodontic system used did not influence participants' anxiety (p > 0.05). Age and sex were not influential factors in either OHRQoL or anxiety.

CONCLUSIONS

The bracket system significantly influenced patients' OHRQoL. In the sample studied, no influence of the orthodontic system (brackets versus aligners) on anxiety was observed.

Orthodontic Elastics: A Multivariable Analysis of YouTubeTM Videos

Background/Purpose

Whether YouTube videos contain precise and adequate information on certain orthodontic procedures remains unclear. This study aimed to investigate the content and quality of YouTube videos on orthodontic elastics and identify the predictors of high-level content YouTube videos.

Materials and Methods

Two hundred YouTube videos were screened for eligibility, and after applying the inclusion criteria, 133 videos were excluded. Student's t-test was used to compare the characteristics, quality parameters, and total content of the low-level and high-level content videos. Chi-square or Fisher's exact tests were implemented to identify the source and content element differences across low-level and high-level content videos. Pearson's correlation coefficients were used to determine the relationship between the total content score, video information and quality index (VIQI), and YouTube characteristics. Stepwise linear multiple regressions with forward selection were used to test the association of the YouTube characteristics and VIQI with the total content score.

Results

Among 67 included videos, only 19.4% of videos were classified as high-level content videos. High-level content videos had significantly higher mean number of likes (MD = 4041.7; SD = 4680.7; P-value=0.0068), VIQI score (MD = 4.17; SD = 4.87; P-value=0.0073), and total content score (MD = 4.04; SD = 1.23; P-value=<0.0001). The adjusted linear regression model demonstrated a significant association between the total content score and VIQI, where 1 unit increase in the VIQI was significantly associated with a 0.16 increase in the total content score (B = 0.16; standard error [SE]=0.04; P = 0.0003). Further, a significant association was observed between the total content score and video duration, where 1 minute increase in the video duration was significantly associated with a 0.15 increase in the total content score (B = 0.15; SE = 0.05; P = 0.008).

Conclusion

This study demonstrated that YouTube content quality concerning orthodontic elastics is poor. Thus, future implementation of online visual content provided by certified orthodontists will ensure accurate and thorough information delivery.

#clearaligners and social media: An in-depth analysis of clear aligners' content on Instagram

BACKGROUND AND OBJECTIVES

Clear aligners-related posts are popularized on social media platforms to educate patients and peers and to market aligners in dental practices. This study aimed to characterize the account credentials and content of the top-performing posts to understand the spread of clear aligners-related information on Instagram.

MATERIALS AND METHODS

This cross-sectional web-based study analysed 13 Instagram clear aligners-related hashtags. Content analysis was performed for the "Top 10 posts" listed under the "Top" section for each hashtag within Instagram, as sorted by Instagram's algorithm. Data were analysed for the poster's background, credentials, role, post format, content, and engagement level ratio. Duplicate posts and those not relevant to clear aligners were excluded. Quantitative and qualitative analyses of the collected data were conducted.

RESULTS

A total of 29 192 596 posts mentioned the selected hashtags, of which 130 posts were screened in this study. Most posts were authored by dentists (n = 84), 79.8% of them were orthodontic specialists. Self-promotional posts comprised 90.2%, while educational posts accounted for only 8.9%. Interestingly, the number of likes and comments received on posts by patients (n = 19, median = 112, IQR = 340) was significantly higher than those posted by dentists (n = 84, median = 93, IQR = 81.75) (P = .004).

CONCLUSION

More than 29 million posts about clear aligners were identified on Instagram. Orthodontists are the leading authors of aligners hashtags. However, the majority of the posts are self-promotional and have nonfactual information. Social media awareness among orthodontic specialists may help provide more evidence-based content about clear aligners and can act as an interactive networking and health communication platform.

[Fixed orthodontic appliances and clear aligner system: a comparative review]

One of the biggest controversies in current orthodontics is determining the appliance to use, since today patients seek better results in shorter times, in addition to putting aesthetics first.

OBJECTIVE

compare the benefits and disadvantages that arise when using fixed orthodontic appliances and transparent aligners.

MATERIALS AND METHODS

An investigation and compilation of specialized bibliographic information on the topic was carried out in scientific search engines such as PubMed, SciElo and Web of Science between the years 1991 to 2023, focused on research work related to the effects of the use of orthodontic appliances. fixed compared to clear aligners.

RESULTS

The review was carried out based on 53 articles found that met the selection criteria.

CONCLUSION

Fixed orthodontic appliances are better in complex cases, they are more precise and less likely to relapse; Transparent aligners are more aesthetic, hygiene is more affective and the bone density of the mandibular condyle decreases.

Evaluation of the Quality and Reliability of YouTubeTM Videos Created by Orthodontists as an Information Source for Clear Aligners

Objective

This study aimed to evaluate the quality, reliability, and content usefulness of videos created by orthodontists on clear orthodontic aligners.

Methods

Videos were screened using YouTubeTM by conducting a search for "Invisalign". After a preliminary evaluation of the first 250 results, 61 videos that met the selection criteria were scored and their length, days since upload, and numbers of views, likes, dislikes, and comments were recorded. These data were used to calculate the interaction index and viewing rate. Video reliability was assessed using a five-item modified DISCERN index, and video quality was assessed using the Video Information and Quality Index. A 10-item content usefulness index was created to determine the usefulness of the video content. Descriptive statistics of the parameters were calculated, and correlation coefficients were calculated to evaluate the relationships between the parameters.

Results

The mean reliability score was 2.75±1.02 (out of 5), and the total quality score was 11.80±3.38 (out of 20). The total content usefulness index was quite low, with a mean score of 2.52±2.14 (out of 10). Interaction index and viewing rate were positively correlated with reliability score (r=0.463, p<0.01; r=0.295, p<0.05) and total quality score (r=0.365, p<0.01; r=0.295, p<0.01, respectively). The reliability score was positively correlated with the total quality score (r=0.842, p<0.01) and total content usefulness index (r=0.346, p<0.01).

Conclusion

Videos about orthodontic aligner treatment have average reliability and quality but largely insufficient content.

Clear aligner therapy versus conventional brackets: Oral impacts over time

Background

The objective is to compare the impact of clear aligner treatment (CAT) versus conventional fixed appliance treatment (FAT) on oral health-related quality of life (OHRQoL) among adults at five-time points: pretreatment (T0), 1 week (T1), 1 month after (T2), and 6 months after (T3) treatment initiation, and in the long-term follow-up (T4).

Materials and Methods

Search terms were based on Medical Subject Headings (MeSH) and non-MeSH. Potentially eligible studies compared OHRQoL in clear aligner (CA) and fixed appliance (FA) patients. In February 2023, Scopus, Web of Science, Cochrane, and PubMed were searched for published studies. Nine out of 94 shortlisted papers were eligible for a systematic review. Of these nine papers, five studies were considered for a meta-analysis.

Results

At T0, CA and FA patients had similar oral health impact profile (OHIP)-14 questionnaire scores with a standard mean difference (SMD) of 0.105 (confidence interval [CI]: -1.029-1.48). The SMD of the OHRQoL related to T1, T2, and T3 was -3.119 (CI: -0.145, 0.355), -1.527 (CI: -5.597, -0.64), and - 2.331 (CI: -1.906, -1.148). T4 showed no difference between groups (SMD = 0.007, CI: CI: -4.286, -0.376). Regarding the OHIP-14 domains, functional limitations remained consistent in both groups across all time intervals. Psychological discomfort exhibited a notable difference only at T2. Throughout the treatment, CAT showed significantly lower levels of physical, psychological, and social disability, as well as handicap, though these differences did not persist beyond T4. Notably, physical pain was the sole domain that remained elevated in the FAT group up to T4.

Conclusion

During the 1st day of the orthodontic treatment, both the CA and FA groups had comparable OHRQoL statuses. However, as time passed, the CA group notably improved their OHRQoL compared to the FA group. Interestingly, after a year or the completion of treatment, both groups eventually reached similar OHRQoL levels. Nevertheless, it is worth noting that FA patients continued to experience more physical pain even a year later.

Assessment of Arabic Web-Based Knowledge About Clear Aligners: An Infodemiologic Study

BACKGROUND

Orthodontic treatments aim to enhance dental aesthetics, functionality, and long-term oral health. Clear aligners have gained popularity as an aesthetic and convenient option for patients seeking orthodontic correction. However, the quality and readability of online Arabic patient-centered information regarding clear aligners has not been studied yet. The aim of our study is to investigate the quality and readability of Arabic patient-centered information about clear aligners.

METHODS

We conducted an extensive evaluation of Arabic web-based content pertaining to clear aligners using three prominent search engines. Eligible websites were categorized based on specialization, organizational affiliation, material type, and presentation style. We assessed website quality and reliability using the DISCERN instrument, Journal of American Medical Association (JAMA) benchmarks, and Health on the Net (HON) code. In addition, we measured readability using the Flesch Reading Ease Score (FRES), Simplified Measure of Gobbledygook (SMOG), and Flesch-Kincaid Grade Level (FKGL).

RESULTS

Out of 600 search results, 195 websites met the inclusion criteria. None of the websites were HON-code accredited. DISCERN assessments revealed low content quality, with none of the websites achieving high-quality status. The JAMA benchmarks showed limited compliance with the four items, with currency being the most frequently achieved. Readability assessments indicated generally high readability, with FKGL scores suggesting easy comprehension for the average readers.

CONCLUSION

While Arabic web-based information on clear aligners is highly readable, its credibility and quality require significant improvement. Websites should adhere to medical information standards, subject content to rigorous assessments, and seek accreditation to ensure reliability. Enhancing the accessibility and comprehensibility of health-related content will empower individuals to make informed health decisions. Addressing limitations, such as social media and video content evaluation, and conducting comparisons with English websites in future research will provide a more comprehensive understanding of the landscape of online orthodontic information.

Effects of different designs of orthodontic clear aligners on the maxillary central incisors in the tooth extraction cases: a biomechanical study

BACKGROUND

Controlling the 3D movement of central incisors during tooth extraction cases with clear aligners is important but challenging in invisible orthodontic treatment. This study aimed to explore the biomechanical effects of central incisors in tooth extraction cases with clear aligners under different power ridge design schemes and propose appropriate advice for orthodontic clinic.

METHODS

A series of Finite Element models was constructed to simulate anterior teeth retraction or no retraction with different power ridge designs. These models all consisted of maxillary dentition with extracted first premolars, alveolar bone, periodontal ligaments and clear aligner. And the biomechanical effects were analysed and compared in each model.

RESULTS

For the model of anterior teeth retraction without power ridge and for the model of anterior teeth no retraction with a single power ridge, the central incisors exhibited crown lingual inclination and relative extrusion. For the model of anterior teeth no retraction with double power ridges, the central incisors tended to have crown labial inclination and relative intrusion. For the model of anterior tooth retraction with double power ridges, the central incisors exhibited a similar trend to the first kind of model, but as the depth of the power ridge increased, there was a gradual decrease in crown retraction value and an increase in crown extrusion value. The simulated results showed that von-Mises stress concentration was observed in the cervical and apical regions of the periodontal ligaments of the central incisors. The clear aligner connection areas of adjacent teeth and power ridge areas also exhibited von-Mises stress concentration and the addition of power ridge caused the clear aligner to spread out on the labial and lingual sides.

CONCLUSIONS

The central incisors are prone to losing torque and extruding in tooth extraction cases. Double power ridges have a certain root torque effect when there are no auxiliary designs, but they still cannot rescue tooth inclination during tooth retraction period. For tooth translation, it may be a better clinical procedure to change the one-step aligner design to two-step process: tilting retraction and root control.

Influence of the use of social media on patients changing dental practice: a web-based questionnaire study

BACKGROUND

Recent years have seen an increase in the use of social media, by the healthcare sector, including dentistry. Indeed, social media may now be important communication tools for dental practices and patients. This work analyzes the influence of patient (male and female) use of dental practice social media on their decision to change practice. The results also provide insight into the factors patients considered important when choosing a dental practice.

METHODS

This study was approved by the Ethics Committee of the Universidad Europea de Madrid (No. CIPI/22.022). Using a web-based questionnaire, a cross-sectional study was undertaken involving a Spanish population that made use of dental services. The questionnaire consisted of four parts covering provision of informed consent, the collection of sociodemographic data, patient use of dental practice social media, and the factors considered important when changing dental practice.

RESULTS

All participants gave their informed consent regarding inclusion. No compensation was provided for participation. 588 people responded to the questionnaire, of whom 503 were eligible for inclusion. Most respondents were female (312/503; 62%). Most (151/503; 30%) last changed dental practice during the previous 2-5 years. 208/503 (41.4%) indicated that they had visited dental practice social media. 118/503 (23.5%) indicated that they had made use of such the last time they changed dental practice; 102 of these 118 (85.6%) reported their experience to have influenced their decision to change. Respondents who had changed practice in the last 5 years had interacted with dental practice social media more than those who changed over 11 years ago (p < .05), and those who changed practice in the present/past year were more influenced by these media (p < .05). The factor considered most important was 'Facilities and technology'. No gender-based differences were seen for any measured variable (p < .05).

CONCLUSIONS

Different factors affect the selection of a new dental practice, but respondents who changed practice in the last few years were more likely to have made use of dental practice social media, which, for some, influenced their final decision to change. Dental practices might do well to consider using social media as communication and marketing tools.

Analysis of the patient’s experiences on the related instagram posts about the orthodontic treatment

Objectives:

The study aimed to comparatively evaluate the patients’ experiences with these treatments by analyzing the contents of the posts shared by the patients with clear aligner and fixed orthodontic treatment (FOT).

Material and Methods:

To reach the treatment methods, the hashtags “braces” for FOT and “aligner” for clear aligner treatment (CAT) were used in the Instagram search engine. To reach objective patient evaluations, clinicians’ posts, company posts, and influencers’ posts containing advertisements and collaborations were eliminated and direct patient posts were considered. Seventy-nine posts were included in the FOT group and 52 posts in the CAT group. The posts were evaluated comparatively in terms of the number of likes, followers of the profiles, comments and content, the gender of the patients, and the treatment stage.

Results:

According to the results of the analysis, although the number of followers, likes, comments, and positive and neutral comments were higher in favor of the aligner group between the FOT and CAT groups, the rate of likes/followers was found to be higher in favor of the fixed treatment group (P < 0.05).

Conclusion:

Considering the literature, although studies on CATs on social media are limited, this media is seen as an effective factor in the treatment decision-making process of patients. While the most negative comments of individuals in fixed treatment were psychological effects, the most criticized issue in CAT was treatment fees.

Oral Health-Related Quality of Life throughout Treatment with Clear Aligners in Comparison to Conventional Metal Fixed Orthodontic Appliances: A Systematic Review

BACKGROUND

Orthodontic clear aligners constitute an alternative and increasingly used orthodontic treatment modality, offering enhanced esthetics with potential consequences regarding patients' oral health-related quality of life (OHRQoL).

OBJECTIVE

Summarize and systematically evaluate existing evidence on the OHRQoL of patients treated with orthodontic clear aligners compared to treatment with conventional metal, fixed appliances.

SEARCH METHODS

We searched without limitations six databases and searched manually the reference lists of relevant studies up to the end of October 2022.

SELECTION CRITERIA

We looked for data from prospective studies that compared OHRQoL, using instruments that had undergone full psychometric validation, between orthodontic patients with clear aligners and labial, fixed, metal orthodontic appliances.

DATA COLLECTION AND ANALYSIS

We extracted the data from the located studies, and we assessed the risk of bias with the Cochrane Collaboration suggested tools. The quality of available evidence was based on the GRADE approach.

RESULTS

Three studies were identified. OHRQoL was impacted less by clear aligners compared to treatment with conventional labially placed, fixed, metal appliances. The exploratory meta-regression, with the time point of assessment as predictor, did not reveal any statistically significant effect. The quality of the available evidence ranged from very low to low.

CONCLUSIONS

According to the exploratory synthesis of the limited available dataset, treatment with clear aligners could be associated with better OHRQoL ratings compared to treatment with conventional labially placed, metal, fixed appliances. However, the quality of the presented evidence renders further high-quality studies warranted to be able to reach safer conclusions.

Orthodontics in an online community: A computational analysis of r/Braces subreddit

BACKROUND

This study aimed to analyze the semantic network and content analyses of the posts published in a subreddit related to orthodontic treatment on Reddit (Advance Publications, Inc., San Francisco, California).

METHODS

The eight threads in the r/Braces subreddit were divided into two categories: 1) "treatment process" (Braces are off!!!, Braces progress, Before and after!, and Day 1!) and 2) "question/problem" (Question, Discussion!, Need advice! and Rant!). For both categories, a semantic network analysis was performed using the Leximancer software (Leximancer Pty Ltd., Brisbane, Australia). In addition, the quality of the posts published in the "question" thread and the usefulness of the replies provided to these questions (useful, misleading, or neutral) were analyzed.

RESULTS

Seven themes (braces, teeth, months, day, worth, started, and result) that mostly emphasized orthodontic treatment and treatment duration were elicited from the "treatment process" category, and seven themes (teeth, orthodontist, braces, week, bands, brush, and extractions) that mostly emphasized orthodontic treatment, orthodontists, and time were elicited from the "question/problem" category. It was also revealed that users voted on the posts related to the "treatment process" category and moved the posts to the list of top posts on the platform. In the "question" thread, 47.79% of the posts asked for advice and 21.11% of them were related to failures. In addition, 69% of the replies were categorized as "useful."

CONCLUSIONS

Reddit is a successful data mining platform, and the users provide highly useful replies to the questions posted on Reddit regarding orthodontic treatment.

How reliable are YouTube videos on laser-assisted surgical treatment of the gummy smile?

Objectives:

Patients frequently use social media platforms to obtain information on dental treatment. This study aimed to evaluate the quality of the content prepared for patients seeking information on laser-assisted surgical treatment of the gummy smile on the YouTube platform.

Material and Methods:

Videos were searched on YouTube using the keyword “fix gummy smile” in Google Trends. Considering the exclusion criteria, 30 out of 119 videos were selected for the study. Videos were analyzed in terms of general characteristics, video uploader, video content quality (VCQ), video information and quality index (VIQI), and Global Quality Scale (GQS). Statistical significance was established at P < 0.05.

Results:

The average VCQ of the videos was 3.07 ± 1.39 out of a maximum of 30. Most videos (46.7%) were uploaded by dentists and 23.3% by healthcare institutions. Considering the video uploader, no significant difference was found in VCQ, VIQI, and GQS (P > 0.05). There was a positive correlation among the interaction index, the number of likes, and the reliability score (P < 0.05). Moreover, reliability score showed a positively directed association with GQS, total VIQI score, and total VCQ score (P < 0.01).

Conclusion:

Clinicians who upload content to YouTube should consider the importance and potential of YouTube to provide information to communities and create videos with more intellectual content to facilitate access to accurate information, especially related to health.

20-Year Change in the Perception of Orthodontic Treatment: A Cross-Sectional Study

OBJECTIVE

To compare the changes in the perception towards orthodontics between the first and second decades over the 20-year period based on a collaborative hypertext dictionary site.

METHODS

The orthodontics-related entries were searched on the EksiSozluk website (http://www.eksisozluk.com). The keyword was determined as "diş teli" ("brace") and a total of 1,028 entries that were contributed between 2001 and 2021 were analyzed. Entries were divided into five general categories based on their content: definition, asking for advice, humor, advertising, and transfer of experience. The transfer of experience category was further divided into four subcategories: procedure, motivation, advice, and complaint. For each entry, the attitude of the contributor was also noted. Entries were compared between the two decades with regard to content and attitude towards orthodontics.

RESULTS

The average number of entries contributed per year was 13.40 ± 10.58 in the first decade and was 89.40 ± 44.67 in the second decade, the increase was statistically significant (P < .05). A significant difference was observed between the two decades in terms of content (P < .05). There was a proportional decrease in the definition and an increase in the transfer of experience. Moreover, the rate of entries containing a complaint decreased and motivation increased in the second decade (P < .05). On the other hand, there was also a significant change between the two decades with regard to the distribution of attitudes, whereby the rate of positive entries increased in the second decade (P < .05).

CONCLUSION

The contributors' attitudes towards orthodontics shifted from negative in the first decade to positive in the second decade.

Public and dental professionals' use of social media to discuss amelogenesis imperfecta

BACKGROUND

Amelogenesis imperfecta (AI) is an inherited disorder of enamel development that is challenging to treat and often associated with negative patient and parental outcomes. Social media provides a valuable perspective on patients' and dental professionals' experience of AI and dental care.

AIM

To explore how the public and dental professionals use social media to discuss AI.

DESIGN

A cross-sectional study involving a systemic search of eight social media platforms using the search term 'amelogenesis imperfecta'. Relevant posts were selected using predefined eligibility criteria. Word content of eligible posts was qualitatively analysed using a thematic framework approach.

RESULTS

A total of 555 posts were identified, of which 144 were eligible for analysis. For dental professionals, the posts included case reports and seeking and sharing of information. For the public, the posts were related to individuals' experience of AI, dental treatment and outcome of treatment.

CONCLUSIONS

Posts from individuals affected by AI suggest a need for better distribution of reliable information and greater support. Case reports indicate that dental professionals find it challenging to recognise AI and determine appropriate treatment options. Social media could potentially be used to inform and support people with AI and allow dental professionals to share information and learning with peers.

Comparison of the psychosocial impact on patients affected by cranio facial anomalies between traditional orthodontic brackets and aligners

OBJECTIVES

Malocclusion affects the psychological wellness and social interaction, impacting negatively on adolescents' quality of life and self-esteem. Facial attractiveness is mostly based on the esthetics of the smile and patients seek orthodontic treatment mainly to improve aesthetics. The aim of this prospective clinical study is to compare the psychosocial impact of aligners (AL) and fixed appliances (FA) as orthodontic treatments in patients affected by craniofacial anomalies (CFA).

METHODS

100 syndromic Caucasian patients with CFA followed in two different hospitals were divided in two groups: 50 patients treated with AL and 50 patients treated with FA. The two groups were matched for gender, age and CFA and filled out a modified psychosocial impact of dental aesthetics questionnaire (mPIDAQ).

RESULTS

Patients affected by CFA treated with AL reported a better psychosocial impact than patients treated with FA, showing higher esthetic self-perception and self-esteem, lower social interaction impairments, and lower physical/practical disturbances.

CONCLUSIONS

The results of this study suggest that AL could be a valid alternative, especially in complex patients with CFA. Since AL application requires more cooperative patients the orthodontist should dedicate more time to motivate the patient to adhere to the treatment schedule.

Public perception of Invisalign® clear aligner treatment: A cross-sectional survey-based study

Objectives:

The demand for clear aligner treatment has increased in recent years. Thus, this study investigated public knowledge regarding Invisalign clear aligner treatment.

Material and Methods:

A web-based survey was administered through different social media platforms covering different aspects of Invisalign treatment, namely: Treatment efficiency, patient discomfort, appliance esthetic attractiveness, oral hygiene maintenance, and treatment aesthetic results. Participants were also asked to outline their perception of Invisalign treatment cost. A Likert-type scale was used to rank the participant responses. Data were analyzed with the Chi-square test and Bonferroni correction for multiple comparisons.

Results:

Out of 934 eligible adult participants, 19.6% were aware of Invisalign. Most of the Invisalign-familiar respondents were unaware of its cost (27.9%) but agree it is generally better (49.7%), requires fewer visits (38.2%), results in shorter treatment duration (39.4%) and reduced teeth discomfort (35%), more esthetically attractive (64%), yields easier oral hygiene maintenance (55.2%), and produces superior esthetic results (43.7%) than traditional braces. In addition, males and average-income participants were more likely to believe that Invisalign treatment produces superior esthetic results than traditional braces (P = 0.0002 and P = 0.002, respectively). Average-income participants also believed that Invisalign treatment was generally better (P < 0.0001). While participants in the age-range 55–64 years strongly believe, it is cheaper (P < 0.0001) than traditional braces.

Conclusion:

This study highlighted the lack of public knowledge about Invisalign treatment. The results also indicated the importance of ensuring public access to reliable information backed up by high-quality evidence.

Predicting Interest in Orthodontic Aligners: A Google Trends Data Analysis

Aligners are an example of how advances in dentistry can develop from innovative combinations of 3D technologies in imaging, planning and printing to provide new treatment modalities. With increasing demand for esthetic orthodontic treatment, aligners have grown in popularity because they are esthetically more pleasing and less obstructive to oral hygiene and other oral functions compared to fixed orthodontic appliances. To observe and estimate aligner treatment interest among Google Search users, Google Trends data were obtained and analyzed for the search term, "Invisalign". A prediction of interest for the year 2022 for three European Union countries with the highest GDP was developed. "Invisalign" was chosen to represent all orthodontic aligners as the most searched term in Google Trends for aligners. This is the first study to predict interest in the query "Invisalign" in a Google search engine. The Prophet algorithm, which depends on advanced statistical analysis methods, positions itself as an automatic prediction procedure and was used to predict Google Trends data. Seasonality modeling was based on the standard Fourier series to provide a flexible model of periodic effects. The results predict an increase in "Invisalign" in Google Trends queries in the coming year, increasing by around 6%, 9% and 13% by the end of 2022 compared to 2021 for France, Italy and Germany, respectively. Forecasting allows practitioners to plan for growing demand for particular treatments, consider taking continuing education, specifically, aligner certification courses, or introduce modern scanning technology into offices. The oral health community can use similar prediction tools and methods to remain alert to future changes in patient demand to improve the responses of professional organizations as a whole, work more effectively with governments if needed, and provide better coordination of care for patients.

A cross-sectional study of exposure across social media platforms for the British Orthodontic Society retention awareness campaign: #HoldthatSmile

OBJECTIVE

The use of media campaigns in health promotion has become more common in recent years. #HoldthatSmile is a British Orthodontic Society life-long retention awareness campaign aimed at the general public and dental profession launched in 2017. This study investigated #HoldthatSmile exposure on social media platforms over a 12-month period following campaign launch.

DESIGN

A cross-sectional content analysis.

SETTING

Public-facing, English-language posts tagged #HoldthatSmile on the Facebook, Instagram and Twitter social media platforms.

METHODS

Data were collected relating to a 12-month period, from September 2017 immediately following campaign launch, to the end of September 2018. The primary outcome was exposure to the #HoldthatSmile campaign on the different platforms through analysis of posts, measurement of audience reached and engagement. Secondary outcomes included demographics of user-types and content analysis of reactive comments on posts.

RESULTS

A total of 205 relevant posts with #HoldthatSmile were identified on Twitter (n=90, 43.9%), Facebook (n=64, 31.2%) and Instagram (n=51, 24.9%) with an overall calculated audience reach of 108,807 individuals. There were 1849 reactions across the three platforms. The percentage of reactions that generated comments was low at 3%, 6.1% and 5.7% for Twitter, Facebook and Instagram, respectively. Just over three-quarters of users were either Dental Surgeries (53%) or Professional Dental Bodies (28%) and the vast majority were from the United Kingdom. Overall, most comments were positive (46%, n=36) or neutral (44%, n=35) with only 10% (n=8) negative. The overriding theme was a person's name, with the user commonly typing a friend's name in order to bring their attention to the post.

CONCLUSION

There were a relatively low number of posts relevant to #HoldthatSmile on Twitter, Facebook and Instagram over the campaign's first 12 months. However, the majority of these did convey positive or neutral messages.

Looking good but tweeting bad? The social perception of orthodontic-related posts on Twitter and Instagram

BACKGROUND

Social media plays a major role in the daily life of adolescents and has become highly interesting for healthcare research as well. The aim of this study was to explore the social perception of orthodontic-related posts on Twitter and Instagram by young adults.

METHODS

401 orthodontic-related posts were collected during a 30-day period and categorized with regard to specific characteristics - their content and the social networking site (SNS) being used as well as the presence or absence of a selfie. In order to investigate the social perception of these posts, 42 young adults rated the emotional states of the SNS users using the Self-Assessment Manikin (SAM)-Tool. A total of 4211 poster-rater observations pertaining to the three SAMs dimensions pleasure, arousal and dominance were analyzed by using linear and multinomial logistic regression analyses.

RESULTS

The investigated characteristics of the collected posts had significant effects on the perceived emotional state of the SNS users. Besides significant SNS-associated differences, there were also effects that were independent of the SNS being used: Receiving orthodontic appliances was more often associated with rather negative emotions (p < 0.001), while users who posted about the removal of such braces were more often perceived as joyful (p < 0.001). Interestingly, users whose posts contained selfies with visible braces were perceived as significantly more positive and stronger in comparison to users who did not post a picture of themselves (p < 0.05).

CONCLUSION

This research gives insights into the social perception of orthodontic-related posts on SNS. While users' emotional states were perceived highly differential on both SNS, orthodontic-related content also revealed significant effects on social perception. Because selfies with visible braces were associated with positive feelings by young adults, a modern and SNS-related way of coping with a temporary supposed impairment like fixed orthodontic appliances might have been revealed through this research.

Grass-roots entrepreneurship complements traditional top-down innovation in lung and breast cancer

The majority of biomedical research is funded by public, governmental, and philanthropic grants. These initiatives often shape the avenues and scope of research across disease areas. However, the prioritization of disease-specific funding is not always reflective of the health and social burden of each disease. We identify a prioritization disparity between lung and breast cancers, whereby lung cancer contributes to a substantially higher socioeconomic cost on society yet receives significantly less funding than breast cancer. Using search engine results and natural language processing (NLP) of Twitter tweets, we show that this disparity correlates with enhanced public awareness and positive sentiment for breast cancer. Interestingly, disease-specific venture activity does not correlate with funding or public opinion. We use outcomes from recent early-stage innovation events focused on lung cancer to highlight the complementary mechanism by which bottom-up "grass-roots" initiatives can identify and tackle under-prioritized conditions.

A comparison of patient testimonials on YouTube of the most common orthodontic treatment modalities: Braces, in-office aligners, and direct-to-consumer aligners

INTRODUCTION

The aims of this study were to (1) investigate and compare the educational value of the most popular YouTube (www.youtube.com; Google, San Bruno, Calif) orthodontic patient testimonials between braces, in-office aligners (IOA), and direct-to-consumer aligners (DTCA), and (2) classify the emotional response of the viewers through sentiment analysis of the video comments.

METHODS

Three different phrases relevant to braces, IOA, and DTCA were searched on YouTube. The 20 most popular patient testimonial videos meeting the criteria for each group were selected for a total of 60 videos. Using the YouTube application program interface for each video, 13 video metrics were extracted. An information completeness score was assigned, and the video comments were analyzed using sentiment analysis software.

RESULTS

The 60 videos included were viewed 34.4 million times by internet users. Braces videos had significantly more likes, comments, and a higher viewer interaction score than the IOA and DTCA videos. IOA videos had a higher median information completeness score than braces and DTCA videos. Of the 5149 video comments with polarity, 53.6% were positive, and 46.4% were negative (P <0.0001). There was no significant association between the treatment modality and positive or negative comments (P = 0.5679).

CONCLUSIONS

There is high user engagement on YouTube with orthodontic patient testimonials. YouTube users interact with braces patient testimonials the most. YouTube viewers' comments on orthodontic patient testimonials express more positive sentiment than negative sentiment. There was no significant difference in positive and negative sentiment between the video comments for the 3 different treatment modalities.

Bullying in individuals with cleft lip and palate: A Twitter analysis

OBJECTIVES

This study aimed to evaluate bullying in individuals with cleft lip and/or palate (CLP) using Twitter analysis.

MATERIALS AND METHODS

By using Twitter's advanced search feature, the four selected keywords; "bully", "bullying", "bullied" and "teased" were searched along with the terms "cleft lip and palate", "cleft lip" and "cleft palate", respectively. A total of 1010 tweets meeting the criteria were selected. The data were evaluated qualitatively using thematic analysis and the determination of the themes were based on this analysis.

RESULTS

Most of the tweets were posted by a layperson (80.8%), while most of the tweets were categorised in the theme "criticism of bullying" (36%). The tweets were distributed according to their uploader status as irrelevant individuals (60.6%), CLP subjects (26.9%), family of CLP subjects' (12.5%). Of the 1010 tweets evaluated, 707 were identified as negative, while 90 were identified as neutral and 213 were identified as positive. No significant differences were detected in retweet and like numbers between negative, neutral and positive comments (P > .05).

CONCLUSIONS

Twitter is an important platform, in which the bullying victims with CLP and their families feel free to share their personal experiences of being bullied and how they feel about it, while the others are standing against bullying and promoting social support for these individuals.

Content analysis and reliability of YouTube™ videos on clear aligner

Objectives:

The aim of the present study is to evaluate the accuracy and reliability of the information provided in the videos about the clear aligner on the Youtube video platform, an internet information source.

Materials and Methods:

A video search was performed on the Youtube video platform using three keywords determined with the Google Trends application. After the videos were ranked based on their view counts, a total of 75 videos were analyzed, 47 being the first for each term. After applying the exclusion criteria (repetitive content, no audio content or title information, irrelevant to the topic, only promotional content, duration over 15 min, and addressing other orthodontic treatments), the remaining 47 videos were evaluated. Regarding the videos, the following parameters were recorded: View count, number of likes, number of dislikes, number of comments, video duration, and days since the uploaded date. A scoring system consisting of seven parameters was used to classify the video content quality as low and high. The video information and quality index were utilized to evaluate the quality of the videos universally. Statistical analyses were performed with Stata/IC computer program using Shapiro–Wilks, Kruskall–Wallis, Mann–Whitney U, and linear regression (Backward method) tests. Statistical significance value was set at P < 0.05.

Results:

Evaluation of the videos based on their upload source revealed that 27 videos were downloaded from individuals, ten videos from doctors and ten videos from commercial sources, and the number of subscribers to these sources varied significantly (P < 0.05). Evaluation of the videos based on the information provided, revealed that 32 videos had poor quality, ten videos had moderate quality and five videos had good quality information content, and the video durations varied significantly (P < 0.05). It was seen that of the 75 videos viewed, only 10 (13.3%) provided information of moderate-good quality. The number of likes was found to be the parameter that significantly affects the view count (P < 0.05).

Conclusion:

YouTube videos prove insufficient as a source of information on orthodontic treatment with clear aligner. Health-care professionals should be aware of online platforms to ensure that patients can access accurate information.

A qualitative twitter analysis of the patient experience with invisible orthodontics; lingual braces versus invisalign

Objectives:

The aim of this qualitative study was to examine orthodontic patients’ thoughts and experiences about the invisible orthodontic treatment options – lingual braces and Invisalign – through the analysis of Twitter posts’ content.

Materials and Methods:

A software program was written for the data collection. The program consecutively collected the tweets posted over an 8-month period from Twitter’s publicly accessible database. Tweets that were written in the English language and contained any of the four keywords “Invisalign,” “lingualorthodontics,” “lingualbraces,” and “invisiblebraces” were collected. The tweets that included irrelevant or incoherent posts, professional advertisements, unclear/not applicable content, and reposts were excluded from the study. Two authors, with different experiences, independently read, and analyzed the tweets. Each applicable tweet was classified into one of the three categories: Positive, negative, and neutral for two study groups (Invisalign and lingual braces). Pearson Chi-square test was used to analyze the negative and positive tweet rates of the groups.

Results:

1176 of 2407 tweets were selected as applicable and analyzed by the authors. There was a statistically significant very good agreement between the two observers (Kappa = 0.933, P < 0.001). The negative comment rate (39%) and neutral comment rate (31.1%) in the lingual group were statistically higher than the Invisalign group (27.2% and 21.7%, respectively; P < 0.001). The positive comment rate in the Invisalign group was significantly higher (51.1%) compared to the lingual group (29.9%, P < 0.001).

Conclusion:

Orthodontic patients use social media to share their experiences and feelings about their treatment process. The applicable Tweet number and the positive Tweet rate in the Invisalign group were higher than the lingual braces group.

What are dental professionals posting on Facebook? A cross-sectional content analysis

OBJECTIVE

To profile the posts on open orthodontic Facebook groups and identify which communication strategies and media modalities generate the most engagement from users.

DESIGN

A cross-sectional content analysis.

SETTING

Facebook Internet-based search.

METHODS

Post data were collected over a one-month period from the 10 largest public orthodontic Facebook groups. Evaluation of group characteristics included membership levels, number of administrators, time each group had been in existence and growth rate of each group. The number of posts, the numbers and types of engagement (likes, emojis, comments, shares) and engagement rate were calculated. The communication strategies (e.g. case presentation, course promotion, etc.) and media modalities (e.g. plain text, photograph, etc.) were recorded.

RESULTS

The study identified 190,268 Facebook members from the 10 largest orthodontic Facebook groups (median 17,811; interquartile range [IQR] 11,977). The median time the groups had existed was six years (median 2175 days; IQR 2311 days) and the median number of new group members in the past month was 1257 (IQR 2773). The median number of new group members in the past month was 1257 (IQR 2773). There were 227 postings during the study period with 2546 engagements. The overall median number of engagements was 196 (IQR 445) and the engagement rate of posts was 1.3% overall. Posts relating to course promotion (n = 63, 28%) followed by product promotion (n = 42, 19%) were the most common. Case presentation style posts accounted for 15% (n = 35). The level of engagement was greater for posts that had a clinical component compared to posts that did not (P < 0.001). For media modality, posts that included a photograph had greater engagement (P < 0.001).

CONCLUSION

There are frequent posts on course and product promotion in orthodontic Facebook groups; however, these are associated with low levels of engagement. Posts that are clinically orientated and include photographs have higher levels of engagement.

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.

Comparison of pain perception, anxiety, and impacts on oral health-related quality of life between patients receiving clear aligners and fixed appliances during the initial stage of orthodontic treatment

BACKGROUND AND OBJECTIVES

Clear aligner is an advanced orthodontic method with benefits of comfort, aesthetics, and convenience. This study aimed to compare pain perception, anxiety, and impacts on oral health-related quality of life (OHRQoL) between adult patients receiving clear aligners and fixed appliances during the initial stage of orthodontic treatments.

MATERIAL AND METHODS

The two groups were well matched by ages, gender, and levels of malocclusion severity. Pain perception, anxiety, and OHRQoL were assessed through visual analogue scale, state-trait anxiety inventory, and oral health impact profile-14 (OHIP-14), respectively. And the comparison of above scores was performed by two-way analysis of variance.

RESULTS

A total of 110 patients (55 pairs) were enrolled in this study. Orthodontic pain levels peaked on the first day and decreased gradually afterwards in both groups, which were significantly higher in the fixed group on the first, second, fourth, and fifth days. Likewise, anxiety levels peaked on the first day and decreased thereafter, with significant difference on the 1st, 3d, 5th, 7th, and 14th days. Moreover, the OHIP-14 scores increased and peaked on the first day and then gradually decreased for both groups, which were also significantly higher in the fixed group on the 1st, 7th, and 14th days.

LIMITATIONS

More malocclusion types should be used for group matching. The effect of exclusion of small groups should be taken into consideration in sample size calculation. Income was significantly unbalanced between two groups due to higher cost of clear aligners, and random assignment of treatment modalities was unfeasible.

CONCLUSIONS

Patients treated with clear aligners experienced lower pain levels, less anxiety, and higher OHRQoL as compared to those receiving fixed appliances.

The Implications of the COVID-19 Pandemic on the Interest in Orthodontic Treatment and Perspectives for the Future. Real-Time Surveillance Using Google Trends

Background: The COVID-19 pandemic outbreak may have a large impact on orthodontic treatment. Regular orthodontic visits were strongly and widely interrupted by the unprecedented epidemiological threat. Methods: The data regarding orthodontic queries were investigated in a real-time surveillance using Google Trends. Search terms “braces”, “invisalign”, “get braces”, “get braces off”, “braces pain” and the phrase “social distancing” were analyzed regarding the year preceding the pandemic outbreak and the time of the pandemic. Moreover, the five-year trend for queries “braces” vs. “invisalign”, as an example of different types of orthodontic appliances, was compared. Results: There was a significant decrease in orthodontics phrase queries in the spring of 2020, connected with the worldwide restrictions and lockdowns announced all over the world. There was a lower interest in the “braces pain” query during the first lockdown in 2020. The number of searches for “invisalign” increased steadily over time, while the number of searches for “braces” was relatively stable across the investigated time period. Conclusions: The course of the COVID-19 pandemic has had a large impact on the orthodontic-related search queries. Orthodontists must be better-prepared for any sudden changes in the possible future in the epidemiological situation that may change accessibility to dental offices.

Invisalign treatment from the patient perspective: A Twitter content analyses

Background

Understanding patient perspective is a key factor in improving treatment satisfaction. The aim of the present study is to qualitatively describe the content of Twitter posts related to the treatment with Invisalign in order to get a better understanding of patient experience.

Material and Methods

Tweets were prospectively collected during a period of four weeks from public available posts on Twitter using Awario™ a bespoke social media monitoring tool. After applying the pertinent inclusion and exclusion criteria the selected posts were analysed by three investigators using thematic analysis. Specific themes and subthemes were developed.

Results

A total of 1564 tweets were analysed; three mayor themes were identified: Pre-treatment related, Treatment related and Patient/clinician relationship. Pre-treatment posts were mainly positive and underlined patients' expectations, while in the treatment phase an almost equal number of positive and negative posts were found. The positive post were about the satisfaction with treatment and the improvement of self-esteem. The negative ones were related to pain, compliance, the impact on diet and pronunciation.

Conclusions

The present study provides a better understanding of patients' experience during clear aligners treatment. Increasing the awareness of the clinicians can improve their ability to face problems related to the orthodontic treatment and to provide to their patients better professional advices and counselling. Key words:Social media, twitter, clear aligners, Invisalign, orthodontics.

The effect of vestibular, lingual, and aligner appliances on the quality of life of adult patients during the initial stages of orthodontic treatment

Background

Patient quality of life (QoL) during orthodontic treatment is an important consideration that requires greater academic investigation as greater focus is placed on enhancing patient experience. Quality of life (QoL) was assessed in three orthodontic appliance groups, i.e., vestibular, lingual, and aligners during the initial stages of treatment. The sample was comprised of 117 adult patient-subjects distributed into 3 groups: vestibular (n = 41), lingual (n = 37), and aligner (n = 39). A WHOQOL-BREF questionnaire surveyed four domains (physical health, psychological health, social relationships, and environment).

Results

Mean scores for domain 1, physical health, showed that the aligner group (28.1) had significantly greater scores than that of the vestibular (22.7) or lingual (22) groups. Domain 2, psychological health, demonstrated significant differences (P < 0.001) between all groups, with the aligner group scoring the highest (23.2), followed by the lingual (18.4) and vestibular (15.2) groups. Domain 3, social relationship, showed that aligner (10.9) and lingual (10.2) scores were significantly greater (P < 0.001) than those of the vestibular group (7.8). Domain 4, environment, displayed significant differences between all groups, with the aligner group scoring highest (32.1), followed by the lingual group (29.3), and lastly the vestibular group (26.4). Overall, the highest mean score was obtained by the aligner group (23.1) and the lowest mean score was by the vestibular group (18). The mean domain scores for all three groups were significantly different (P ≤ 0.005) from each other (Table 2).

Conclusions

Overall, patients undergoing Aligner therapy reported the overall highest QoL scores, followed by lingual and vestibular groups.

Twitter for microblogging in oral health care, research, and academics: Road map and future directions

Current times have seen growing use of social medial tools, including microblogging sites like Twitter as an efficient method to disseminate information related to health amongst patients, students as well as health care workers. This article explores the role of this short, effective messaging platform in oral health care, teaching, research and learning. The concepts of “tweeting the meeting” and aggregation of conversations via “hashtags” is advocated for academic conferences, which will extend the conference reach to give the users better access to the instructors and enhance the related outcomes. Tweeting and retweeting the required research content may increase the academic footprint of the conducted research and researchers. In addition, it has served an immense role in the current COVID-19 pandemic by the regular circulation of information to the public and helped governments in policymaking and showcasing the areas of public concern. However, it still has a huge potential yet to be explored, with collective efforts towards strengthening the aspects of authenticity and standardization of the shared content.

The Impact of the COVID-19 Epidemic on Orthodontic Patients in China: An Analysis of Posts on Weibo

Background: During the COVID-19 pandemic, many dental care services including orthodontic practice were suspended. Orthodontic patients turned to social media platforms to communicate, share experiences, and look for solutions. Our study aimed to investigate the attitudes and perspectives of orthodontic patients during the COVID-19 epidemic in China by analyzing orthodontics-related posts on Sina Weibo (a Chinese counterpart of Twitter). Materials and Methods: Potentially eligible posts on Sina Weibo platform were collected between December 30, 2019, and April 18, 2020. Posts related to both orthodontics and COVID-19 were included and then coded and classified into specific appliances and themes. Geographic and temporal distributions of the included posts were analyzed. In addition, time-lagged cross correlation was performed to explore the association between the number of daily posts and daily new COVID-19 cases/deaths in China. Chi-square tests were employed to compare the differences between fixed appliances and aligners in problems/difficulties and feelings during the epidemic. Results: Of the 28,911 posts identified, 4,484 were included in the analysis. The most frequently mentioned themes were appointments (n = 2,621, 58.5%), negative feelings (n = 2,189, 48.8%), and problems/difficulties (n = 1,155, 25.8%). A majority of posts were tweeted in regions with high levels of economic development and population density in eastern China and from February to March. The number of daily posts had a significantly positive correlation with daily new COVID-19 cases/deaths in China (P < 0.05). Compared with clear aligners, patients with fixed appliances reported more problems/difficulties (P < 0.001) and negative feelings (P < 0.001), but fewer positive feelings (P < 0.001). Conclusions: The analysis of Weibo posts provided a timely understanding of the impact of COVID-19 on orthodontic patients. Delayed appointments were their greatest concern, and negative feelings and untreated orthodontic problems increased during the suspension of dental care services. However, patients with clear aligners reported fewer negative feelings and problems than those with fixed appliances. The findings highlighted the need to consider both treatment- and psychology-related issues of orthodontic patients and how to handle them appropriately during the epidemic.

Analysis of Instagram® Posts Referring to Cleft Lip

Background: Social media has become a source of medical information. Cleft lip and palate is a visible congenital anomaly. The aim of the study was to analyze Instagram^® posts on the topic of cleft lip. Methods: Instagram^® posts with “#cleftlip” from March 2014–March 2017 were accessed. Separate lists of expressions (hashtags, meaningful words, words with emojis or emojis alone) were prepared for primary posts and for replies. Thirty expressions statistically most frequent in primary versus secondary posts and 30 in secondary versus primary posts were identified (Group 1) as well as 30 English words or hashtags (Group 2), non-English words or hashtags (Group 3) and emojis (Group 4). The frequencies of expressions were compared (Z-test for the difference of two population proportions). Results: There were 34,129 posts, (5427 primary posts and 28,702 replies), containing 62,163 expressions, (35,004 in primary posts). The occurrence of all expressions was 454,162, (225,418 in primary posts and 228,744 in replies). Posts with positive expressions such as “beautiful”, “love”, “cute”, “great”, “awesome” occurred more often than these with negative ones. In replies all emojis were positive. Conclusions: Numerous Instagram^® posts referring to cleft lip are published and do provoke discussion. People express their solidarity and sympathize with persons affected by cleft.

Web-based information on orthodontic clear aligners: a qualitative and readability assessment

BACKGROUND

Data regarding the quality of information (QOI) related to orthodontic clear aligners (OCAs) on the internet are lacking. The aim of the present investigation was to assess the quality and readability of websites providing information regarding OCAs to prospective patients.

METHODS

Three search terms were entered separately into three search engines. Four validated QOI instruments were used to determine the QOI and readability of the content contained within the websites that satisfied predetermined criteria. Descriptive statistical analyses and intrarater testing for DISCERN scores were calculated.

RESULTS

Forty-nine websites satisfied inclusion/exclusion criteria. General dentists (44.9%) and specialist orthodontists (26.5%) authored the majority of websites. One website contained the Health on the Net (HON) code seal. Cohen's kappa for DISCERN scores was good (0.87). The overall mean (SD) DISCERN score was 38.55 (8.00)/80, range 26-60. The websites authored by 'Direct-to-consumer' OCA providers recorded the lowest DISCERN mean score (33/80). One website contained all four Journal of the American Medical Association (JAMA) benchmarks. The mean (SD) Flesch Reading Ease score was 53.92 (9.08), range 36-82.5.

CONCLUSIONS

The QOI of the website content related to OCAs is poor and is 'fairly difficult' to read. Website authors should consider using QOI instruments and readability tools to enable the delivery of evidence-based and easily readable information regarding OCAs to prospective patients.

YouTube as a source of information about orthodontic clear aligners

OBJECTIVES

To evaluate the content, reliability, and quality of videos about orthodontic clear aligners on YouTube.

MATERIALS AND METHODS

Researchers used the Google Trends website to determine that the most frequently used search term for orthodontic clear aligners on the Internet was: "Invisalign." A search was then conducted on YouTube using the key word "Invisalign." From the first 140 results, 100 videos were selected for analysis. A 13-point content score was used to classify poor-content and rich-content videos, and the global quality scale (GQS) was used to examine quality of the videos. To evaluate reliability of the information, a five-question scale was used. The Mann-Whitney U-test, χ2 test, and Pearson correlation coefficients were used for statistical evaluations.

RESULTS

Of the YouTube videos, 33 were classified as rich content and 67 as poor content. Most videos (73%) were uploaded by laypeople, and most uploaders (71%) were women. The most commonly discussed content was instructions (65%), followed by procedure (57%) and pain (52%). Regarding the GQS, most of the videos were evaluated as moderate quality (51%). Compared with the poor-content video group, the rich-content video group had a significantly higher GQS score (P = .004). There was no significant difference between the poor-content and rich-content groups regarding information reliability (P > .05).

CONCLUSIONS

Video content on YouTube relating to aligner orthodontics was generally insufficient. The quality of videos was moderate, but the reliability of information was generally poor. Specialists should refer patients to reliable sources of information.

Sentiment Analysis in Health and Well-Being: Systematic Review

Background

Sentiment analysis (SA) is a subfield of natural language processing whose aim is to automatically classify the sentiment expressed in a free text. It has found practical applications across a wide range of societal contexts including marketing, economy, and politics. This review focuses specifically on applications related to health, which is defined as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”

Objective

This study aimed to establish the state of the art in SA related to health and well-being by conducting a systematic review of the recent literature. To capture the perspective of those individuals whose health and well-being are affected, we focused specifically on spontaneously generated content and not necessarily that of health care professionals.

Methods

Our methodology is based on the guidelines for performing systematic reviews. In January 2019, we used PubMed, a multifaceted interface, to perform a literature search against MEDLINE. We identified a total of 86 relevant studies and extracted data about the datasets analyzed, discourse topics, data creators, downstream applications, algorithms used, and their evaluation.

Results

The majority of data were collected from social networking and Web-based retailing platforms. The primary purpose of online conversations is to exchange information and provide social support online. These communities tend to form around health conditions with high severity and chronicity rates. Different treatments and services discussed include medications, vaccination, surgery, orthodontic services, individual physicians, and health care services in general. We identified 5 roles with respect to health and well-being among the authors of the types of spontaneously generated narratives considered in this review: a sufferer, an addict, a patient, a carer, and a suicide victim. Out of 86 studies considered, only 4 reported the demographic characteristics. A wide range of methods were used to perform SA. Most common choices included support vector machines, naïve Bayesian learning, decision trees, logistic regression, and adaptive boosting. In contrast with general trends in SA research, only 1 study used deep learning. The performance lags behind the state of the art achieved in other domains when measured by F-score, which was found to be below 60% on average. In the context of SA, the domain of health and well-being was found to be resource poor: few domain-specific corpora and lexica are shared publicly for research purposes.

Conclusions

SA results in the area of health and well-being lag behind those in other domains. It is yet unclear if this is because of the intrinsic differences between the domains and their respective sublanguages, the size of training datasets, the lack of domain-specific sentiment lexica, or the choice of algorithms.

YouTube™ video content analysis on space maintainers

AIM

Since it is difficult to understand by patients or parents, YouTube™ videos can be used to describe space maintainers. However, the reliability and quality of the information in the YouTube™ videos about space maintainers have not been investigated. Therefore, the purpose of this study was to examine the quality of information provided on YouTube™ about space maintainers.

MATERIALS AND METHODS

Videos were searched on YouTube™ using the key words of "space maintainers" in the Google Trends application. From the first 120 results, after discarding the ones immediately deemed insufficient, 46 videos were selected for analysis. To classify the video content as high or low, a scoring system formed of seven parameters was used. For a global evaluation of the video quality, the video information and quality index were applied. Data obtained were analyzed statistically using the independent t-test, the Mann-Whitney U-test, and the Chi-square test, and the Pearson correlation coefficient was calculated.

RESULTS

The quality of the content of videos was found to be mean 2.89 from a maximum of seven points, with 15 (32.6%) videos determined to be of high quality and 31 (67.4%) of low quality. The "likes" index was higher in the high-quality videos (P < 0.05). No statistically significant difference was determined between the groups responsible for uploading videos to YouTube™ in respect of the quality content (P > 0.05).

CONCLUSION

The content quality of videos on YouTube™ about space maintainers is usually low. High-quality content expected from videos uploaded by specialists/dental practitioners was not provided compared to other groups.

What Do Patients Complain About Online: A Systematic Review and Taxonomy Framework Based on Patient Centeredness

Background

Complaints made online by patients about their health care experiences are becoming prevalent because of widespread worldwide internet connectivity. An a priori framework, based on patient centeredness, may be useful in identifying the types of issues patients complain about online across multiple settings. It may also assist in examining whether the determinants of patient-centered care (PCC) mirror the determinants of patient experiences.

Objective

The objective of our study was to develop a taxonomy framework for patient complaints online based on patient centeredness and to examine whether the determinants of PCC mirror the determinants of patient experiences.

Methods

First, the best fit framework synthesis technique was applied to develop the proposed a priori framework. Second, electronic databases, including Web of Science, Scopus, and PubMed, were searched for articles published between 2000 and June 2018. Studies were only included if they collected primary quantitative data on patients’ online complaints. Third, a deductive and inductive thematic analysis approach was adopted to code the themes of recognized complaints into the framework.

Results

In total, 17 studies from 5 countries were included in this study. Patient complaint online taxonomies and theme terms varied. According to our framework, patients expressed most dissatisfaction with patient-centered processes (101,586/204,363, 49.71%), followed by prerequisites (appropriate skills and knowledge of physicians; 50,563, 24.74%) and the care environment (48,563/204,363, 23.76%). The least dissatisfied theme was expected outcomes (3651/204,363, 1.79%). People expressed little dissatisfaction with expanded PCC dimensions, such as involvement of family and friends (591/204,363, 0.29%). Variation in the concerns across different countries’ patients were also observed.

Conclusions

Online complaints made by patients are of major value to health care providers, regulatory bodies, and patients themselves. Our PCC framework can be applied to analyze them under a wide range of conditions, treatments, and countries. This review has shown significant heterogeneity of patients’ online complaints across different countries.

Comparison of Pain Perception in Patients Affected by Cleft and Cranio Facial Anomalies Treated With Traditional Fixed Appliances or Invisalign

Introduction:

The objective of this prospective study was to compare the difference in pain perception between treatment with aligners (AL) and fixed appliances (FA) in patients affected by cleft and craniofacial anomalies (CFA).

Methods:

The sample consisted of 100 syndromic caucasian patients affected by various CFA from 2 different hospitals. Fifty patients treated with AL were matched for sex, age, and CFA with a control sample of 50 patients treated with FA. A modification of the Mc Gill Pain Questionnaire was adapted to our needs.

Results:

Statistical differences were found. Aligners induced more tightness and tension than FA, while FA induced more pain descriptors and patients reported a higher intake of painkillers.

Conclusions:

The results of this study documented a higher pain perception with FA than with AL in patients affected by CFA. The higher sensitivity to pain in cleft and craniofacial patients with fixed treatment could be related to their higher prior sensitization, given the past surgeries and orthodontic treatments. Thus, this study might suggest that Invisalign treatment might be a further interesting treatment option for patients with cleft in order to reduce their burden of orthodontic pain.

Social media and orthodontic treatment from the patient’s perspective: a systematic review

Background

Social media are one of the most common and easily accessible ways of gaining information about orthodontic treatment.

Objective

The main objective of this study was to systematically search the literature and determine the various aspects of the interrelationship between social media and orthodontics from the patient’s perspective.

Search methods

Electronic database searches of published and unpublished literature were performed. The reference lists of all eligible articles were hand-searched for additional studies.

Selection criteria

Randomized clinical trials (RCTs), prospective, retrospective, and cross-sectional studies were included.

Data collection and analysis

Study selection, data extraction, and risk of bias assessment were performed individually and in duplicate by the first two authors.

Results

One RCT, three retrospective, and four cross-sectional studies were deemed as eligible for inclusion in this review. The studies included patient’s statements in social media or results from questionnaires given to patients. The social media reported were with order of frequency: Twitter, YouTube, Facebook, Google+, Pinterest, and Instagram. The feelings the patients expressed seemed to be more positive than negative: enthusiasm, self-esteem and pleasure, excitement about the aesthetic result, excitement after braces removal but also antipathy, annoyances, reduced self-esteem, and impatience for removing mechanisms. In addition, one study referred to bullying through Twitter.

Limitations

The high amount of heterogeneity precluded a valid interpretation of the results through pooled estimates.

Conclusions and implications

This systematic review demonstrated that information about orthodontics, how the patient feels, and other psychosocial facets are spread through social media. It is intuitive that research relating to the effects and impact of orthodontic interventions should account not only for the physical impacts of treatment but also to encompass patient-centered outcomes.

Registration

The protocol of this study was not registered in publicly assessable database.

Conflicts of interest

None to declare.

Clear aligner treatment: different perspectives between orthodontists and general dentists

Purpose

To evaluate differences between orthodontists and general dentists in experience with clear aligners (CA), patients’ demand and perception, types of patients, and malocclusion treated with CA and to compare the two groups of clinicians not using CA in their practice.

Methods

A Web-based survey was developed and sent to the 129 members of the European Aligner Society and randomly to 200 doctors of dental surgery by e-mail. They responded on demographics and to one of two different parts for clinicians using CA or not using CA. Statistical analysis was performed with SAS EGv.6.1.

Results

The response rate was 74%. Among the total of respondents, the majority reported utilizing CA in their practice with a greater percentage of orthodontists (P = 0.0040). Overall, orthodontists learned more about CA during academic seminars comparing to general dentists, and they treated more class I with crowding (P = 0.0002) and with open bite (P = 0.0462). The majority of patients treated with CA were female and adults with a full-time employment, and the patients’ knowledge about CA treatment was mainly provided by information from external media advertising. For respondents not using CA, orthodontists were more likely to report that CA limit treatment outcomes, whereas general practitioners were reported not having enough experience to use them.

Conclusions

There were some significant differences between orthodontists and general dentists mainly in experience and case selection for clinicians using CA as well as in the reasons provided for not using CA in their practice.

Electronic supplementary material

The online version of this article (10.1186/s40510-019-0263-3) contains supplementary material, which is available to authorized users.

"My Invisalign experience": content, metrics and comment sentiment analysis of the most popular patient testimonials on YouTube

Background

The aim of the study was to investigate the popularity, content of Invisalign patient testimonials on YouTube, as well as the sentiment of the related comments.

Methods

Using the term “Invisalign experience,” the top 100 results on YouTube by view count were screened for English spoken patient videos that attracted comments. Video information (time since video upload, sponsorship), engagement metrics (comments, likes, dislikes, subscriptions), and views were collected. Videos were rated for information completeness (ICS), and comments were classified by origin and content. The emotional loading of the comments was measured using automated sentiment analysis.

Results

The 40 reviewed testimonials scored an average ICS of 3.78 (SD 0.97). ICS, time since upload, and video duration did not appear to significantly influence the number of views, subscriptions, likes, dislikes, and comments. There was a statistically significant difference (P = 0.03) between mean positive (2.01, SD 0.95) and negative sentiment scores (− 1.90, SD 1.14). Commenter’s status and overall comment on video were significantly associated with positive sentiment scores. There was a significant association between sponsorship, commenter’s status, overall comment on video, focus of concern, perceived Invisalign’s disadvantages, and increased negative sentiment scores.

Conclusions

Engagement of audience and views of the most popular Invisalign patient testimonials were not significantly influenced by completeness of information, video duration, and lifespan. The sentiment of viewers’ comments about Invisalign treatment was significantly more positive and was significantly associated with their status, content, and sponsorship of videos. Orthodontic trends on YouTube need to be cautiously monitored for planning interventions that improve patients’ knowledge about orthodontics.

Experiences Of Individuals Concerning Combined Orthodontic and Orthognathic Surgical Treatment: A Qualitative Twitter Analysis

OBJECTIVE

The aim of this qualitative study was to analyze the content of posts on Twitter in order to gain an in-depth understanding of patients' thoughts and experiences surrounding orthognathic surgical treatment.

MATERIALS AND METHODS

Using the Twitter search function, with the keywords "jaw surgery," the 1,000 most recent posts on Twitter with relevance to a combined orthodontic and orthognathic surgical treatment were extracted. After applying relevant inclusion and exclusion criteria, the selected posts were analyzed using thematic analysis by 2 independent investigators. Distinct themes and subthemes were developed.

RESULTS

A total of 689 posts were analyzed; the 3 main themes identified in relation to orthognathic surgery were preoperative engagement, postoperative difficulties, and posttreatment satisfaction. Twelve subthemes were also identified, expressing issues such as anticipation or apprehension of the surgical procedure, postoperative pain and edema, dietary restrictions and weight loss, paresthesia, depression, and satisfaction with improvements in appearance and self-confidence. The 6 terms most frequently used in tweets were "recovery," "braces," "swollen," "eat," "liquid diet," and "pain."

CONCLUSIONS

The findings from the present study can increase the awareness of clinicians involved in the combined orthodontic and orthognathic surgical treatment of patients with dentofacial deformities, allowing them to better educate and counsel their patients throughout the entire treatment process.