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A Content Analysis of Orthodontic Treatment Information Contained within the Websites of General Dental Practices
Abstract
The purpose of this investigation was to evaluate the content, quality, and readability of orthodontic information contained on the websites of general dental practices located in Australia. An online search strategy was adopted to identify practice websites for evaluation. Websites satisfying inclusion/exclusion criteria were checked for the presence of pre-determined orthodontic treatment-related items. Three validated quality of health information and readability tools were applied for website content assessment. A total of 231 websites satisfied inclusion/exclusion criteria. The mean overall [SD] DISCERN score was 29.87 (6.03)/80, [95%CI: 29.09–30.65]. The majority of the websites (88.3%) recorded poor or very poor DISCERN quality of information scores. Most websites described orthodontic clear aligner treatment (91.3%). Information regarding Invisalign® was provided by 69.3% and myofunctional therapy by 22.5%. Only 7 (3%) websites indicated that orthodontic retention was indefinite. The mean [SD] Simple Measure of Gobbledygook (SMOG) score was 10.10 [1.31], (95%CI: 9.95–10.25). The SMOG and Flesch Reading Ease scores were closely correlated (r = −0.9041; 95%CI: −0.93 to −0.88; p < 0.0001) and signified difficult-to-read information. The content authors should consider the use of quality information and readability tools to ensure that readers access high-quality and readable information.
... Two studies 6,41 used 4 QOI instruments, whereas 19 of the studies [2][3][4]6,25,26,28,30,[34][35][36][37][38][39]41,43,[46][47][48] included readability evaluation of Web site content, and 2 28,46 used 3 readability tools. ...
... The DISCERN instrument was the most employed QOI instrument in this review-being used in 24 studies. 1,2,4,6,[24][25][26][27][28][29][30][31][32][33][35][36][37][38][39][40][41][42]45,46 The DISCERN rating system for quality was described in 19 studies 1,2,[24][25][26][27][28][29][30]32,33,[35][36][37][38][39][40]42,46 whereas the results for each DISCERN item or question were contained within 15 studies. 1,2,[25][26][27][28]32,33,[35][36][37]39,40,42,46 The LIDA instrument was used in 11 studies. ...
... The DISCERN instrument was the most employed QOI instrument in this review-being used in 24 studies. 1,2,4,6,[24][25][26][27][28][29][30][31][32][33][35][36][37][38][39][40][41][42]45,46 The DISCERN rating system for quality was described in 19 studies 1,2,[24][25][26][27][28][29][30]32,33,[35][36][37][38][39][40]42,46 whereas the results for each DISCERN item or question were contained within 15 studies. 1,2,[25][26][27][28]32,33,[35][36][37]39,40,42,46 The LIDA instrument was used in 11 studies. ...
Introduction: Patients seeking health information on the Internet is commonplace. This scoping review aimed to
collate and synthesize the evidence regarding the quality of Web-based orthodontic information. Methods: A
systematic search and independent screening process was conducted by 2 independent reviewers across 4 databases.
The review was conducted in alignment with the PRISMA-ScR (Preferred Reporting Items for
Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Results: Of 661 records
identified, 30 publications satisfied the inclusion criteria. Reviewed studies included those related to the information
contained within Web sites regarding dental and orthodontist practices, orthodontic interventions, appliances
and auxiliaries, orthodontic conditions commonly requiring orthodontic therapy, issues related to
patient experience, and advice during orthodontic treatment. A total of 5 quality of information (QOI) instruments
and 3 readability tools were employed, with the University of Oxford, United Kingdom (DISCERN) instrument and
the Flesch Reading Ease Score tool being the most frequently used. Most studies determined that the QOI contained
within evaluated Web sites was poor and provided suboptimal information related to treatment risks and
Web site reliability. Most studies indicated that the information was more difficult to read than recommended by
guidelines. Conclusions: The QOI of orthodontic information available on Web sites was low to moderate, with
the readability of content at a level that was considered challenging for many readers to understand. A recommendation
for greater involvement of the dental and orthodontic specialty in Web site development was
commonplace. Research is required for the development of validated tools that can determine the accuracy
of information in addition to Web site reliability.
... 2,[4][5][6][7] In addition, the quality of orthodontic information provided by dental professionals, including orthodontists, has been shown to be suboptimal. 8,9 Global studies have indicated that orthodontic and dental practice websites are generally not compliant with regulatory requirements regarding advertising. [10][11][12][13] The interaction of the orthodontic profession with commercial interests is essential as it enables the development and incorporation of new products and services into practice. ...
... 14,16,17 The content of commercial orthodontic provider websites is of additional relevance, as recent investigations have shown that the presence of names of products and links to commercial orthodontic providers are present within the websites of up to 90% of dental and orthodontic practices. 9,10 In 2022, a study found that most marketing claims made about six orthodontic products on Instagram were inaccurate. 18 Data, however, are lacking regarding the quality and accuracy of content related to products within the websites of orthodontic product providers. ...
... The websites of orthodontic product providers were chosen for analysis on June 1, 2023, based on their presence in the orthodontic literature and popularity of use among clinicians. 9,10,[18][19][20][21][22] Inclusion criteria related to the requirement that the information was present on the provider's website and written in the English language. Website content presented in video format was excluded. ...
Objectives
To assess the quality and accuracy of information contained within the websites of providers of marketed orthodontic products.
Materials and Methods
Twenty-one websites of orthodontic appliance and adjunct (product) providers were identified. The website content was assessed via two validated quality-of-information instruments (DISCERN and the Journal of the American Medical Association [JAMA] benchmarks) and an accuracy-of-information instrument. Website content was qualitatively analyzed for themes and subthemes.
Results
More than half (n = 11; 52.3%) of the assessed websites contained clinician testimonials. The mean (SD) DISCERN score was 33.14 (5.44). No website recorded the minimum of three JAMA benchmarks required to indicate reliability. The most common content themes related to quality-of-life impact and treatment duration. Just 8% of the statements within the websites were objectively true. The Pearson correlation coefficient indicated that the DISCERN scores were correlated with the accuracy-of-information scores (r = .83; P < .001).
Conclusions
The quality and accuracy of information contained within the websites of the providers of marketed orthodontic products was poor. The combined use of DISCERN and the accuracy-of-information instrument may help overcome the shortcomings of each. Clinicians should check the accuracy of information on orthodontic product provider websites before adding links to those websites on their own sites.
... Although some information about general dentist CAT provision can be elicited from a study investigating the content of general dental practice websites, a detailed evaluation of CAT practices by general dentists is lacking (Meade and Dreyer 2022). The aim of the current cross-sectional survey was to determine CAT practices among general dentists in Australia. ...
... At 61.2%, it was very close to the 60.6% reported by respondents in the survey reporting CAT practices among orthodontists in Australia (Meade and Weir 2022). Interestingly, the findings of a study of 231 Australian general dental practice websites indicated that 69.3% of the websites contained information and/or links to the Invisalign appliance (Meade and Dreyer 2022). Brand identity was reported to be a major or moderate influence for 42% of the respondents in their decision to use a particular aligner in the present survey. ...
Objectives
The primary aim of the investigation was to survey clear aligner therapy (CAT) use among general dentists in Australia. A secondary aim was to evaluate the factors that influenced general dentists in Australia not to provide CAT.
Material and Methods
General dentists registered with the Australian Health Practitioner Regulation Agency were invited to participate in a structured cross‐sectional electronic survey. The survey covered demographics, preferred CAT systems and practices, relevant treatment planning and retention protocols, patient‐reported CAT issues, pertinent respondent opinions, and reasons for not providing CAT. Descriptive statistics were computed via GraphPad Prism v10 (GraphPad Software Inc., La Jolla, CA, USA).
Results
Most of the 264 (n = 172; 65.2%) respondents indicated that they provided CAT. The majority (n = 82; 58.6%) reported that they treated between 1 and 20 patients with CAT annually. Invisalign was the most used system (n = 83; 61.2%), with 55 (41.7%), indicating that they used more than one system. Most (n = 124; 98.4%) were comfortable using CAT for mild crowding, whereas 73.4% (n = 94) were not comfortable in treating severe crowding with CAT. The median (IQR) number of patients per respondent treated with extraction of a permanent incisor or premolar was 0 (0). Issues regarding tooth positions were reportedly always or mostly in need of change in the initial treatment plan by 68.7%. Problems regarding patient compliance with CAT wear protocols (n = 67; 45.6%) and the predictability of treatment outcomes (n = 31; 21.1%) were the most identified themes of the free‐text comments. Over 80% of those who did not provide CAT indicated that they preferred to refer to an orthodontist for management.
Conclusion
Almost two‐thirds of the respondents provided CAT. Invisalign was the most used system. The majority use CAT combined with nonextraction treatment. Most of those who did not provide CAT preferred to refer to an orthodontist for patient management.
... T he provision of clear aligner therapy (CAT) for the treatment of malocclusion is increasing among orthodontists, with recent studies indicating that the use of the Invisalign (Align Technology, San Jose, Calif) appliance is commonplace globally. [1][2][3][4] In 2017, Align Technology introduced Invisalign with mandibular advancement appliance (MAA) to aid Class II correction in growing patients. 5 The MAA uses buccally positioned inclined planes (precision wings), which are built into the maxillary and mandibular aligners to posture the mandible forward. ...
... 20,21 The most used CAT system by the respondents was the Invisalign appliance which corresponded to previous findings. [19][20][21]25 The 70.3% who most commonly reported that they used Invisalign in the present survey was greater than the 60.6% recorded in Australia but was less than the 81.2% of the U.K./ ROI and U.S.A./Canada respondents. 20,21 A curious finding, however, was that the recently introduced uLab appliance was the second most prescribed CAT system used in NZ. ...
Objective
To survey clear aligner therapy (CAT) procedures and protocols of orthodontists in New Zealand.
Methods
One hundred and ten full members of the New Zealand Association of Orthodontists were invited to complete an e-survey. The questions related to respondent demographics, aligner choice and use, CAT planning and treatment protocols, case selection, patient-reported CAT problems and relevant respondent opinions. The reasons for respondents not providing CAT were also surveyed.
Results
The response rate was 70%. Most respondents (88.3%; N = 68) reported that they used CAT as a treatment modality with 43.15% ( N = 29) treating between 1 and 20 patients per year. The predominant CAT system was the Invisalign appliance (70.3%; N = 45) with 49.2% ( N = 32) stating that they used more than one CAT system. The respondents reported the areas which were always or mostly in need of amendment prior to acceptance of the CAT treatment plan were attachments (75.6%; N = 50) and final tooth positions (62.1%; N = 41). A median of 0% (IQR: 0, 1) of initial digital treatment plans were approved without changes according to the respondents with a median of 90% (IQR: 80, 99) of CAT patients requiring an additional aligner phase. Almost 80% (78.1%; N = 50) indicated that they were not comfortable in treating cases with increased overbite and 66.7% ( N = 44) rarely or never carried out premolar extractions when using CAT. A remote monitoring system was mostly or always used by 32.4% ( N = 21) of respondents in conjunction with CAT. Concern regarding patient compliance with CAT protocols was expressed by 43.5% ( N = 22). That fixed appliances provided better treatment outcomes was a moderate or major influence on the decision of all respondents ( N = 8) who did not provide CAT.
Conclusion
Although CAT provision by orthodontists is commonplace among orthodontists in New Zealand, there is wide variation in its usage and procedures.
... 1 Frequently cited advantages include less chair time, fewer office visits, easier oral hygiene, and an esthetic alternative to fixed appliance therapy (FAT). 2 Recent studies have indicated that Invisalign is one of the most used CAT appliances globally. 1,3,4 Invisalign (Align Technology, San Jose, Calif) uses three-dimensional technology to facilitate treatment planning and aligner fabrication processes. 2 Align provides a digital interface, Clin-Check Pro, which enables the clinician to formulate a digital treatment plan (DTP). ...
ABSTRACT
Objectives: To determine whether achieved outcome regarding overjet and overbite matched the predicted outcome following treatment with Invisalign (Align Technology, San Jose, Calif)aligner appliances.
Materials and Methods: Data including pretreatment, predicted and achieved overjet, and over-bite measurements provided by Align’s digital treatment facility, ClinCheck Pro, were evaluated.Descriptive statistics, Mann-Whitney U-test, and Wilcoxon rank-sum intraclass correlation (ICC)test results were calculated.
Results: From an initial sample of 600, 355 adult patients satisfied the inclusion and exclusion criteria. ICC scores for data input were excellent. Median (interquartile range [IQR]) age was30.14 (23.33, 39.92) years and most (n ¼ 259; 72.95%) were women. Almost one-third (n ¼ 101;28.45%) had undergone extraction as part of their treatment. More aligners were prescribed in the initial digital treatment plan for patients (median, 44; IQR: 35, 51.5; minimum, 17; maximum,92) undergoing extractions as part of their orthodontic treatment than those who were not(median, 24; IQR: 18.25, 32; minimum, 13; maximum, 85) (P , .0001). Planned changes in over-jet differed significantly from achieved outcomes (P , .001). Planned increases in overbite resulted in up to more than twice (222.72%) as much increase than predicted. Planned reduction of overbite achieved 8.69% of its predicted reduction in extraction cases.
Conclusions: Achieved overjet and overbite measurements differed significantly from the predicted outcomes at the end of an initial sequence of aligners. Planned increases in overbite resulted in greater overbite correction than predicted, particularly in extraction cases. Planned overbite reduction was challenging, especially in patients with extractions.
... Clear aligner therapy (CAT) is commonly used to address malocclusion, with the Invisalign (Align Technology, San Jose, Calif) appliance being among the most frequently prescribed CAT appliances globally. [1][2][3][4] One of the proposed advantages of CAT is the use of three-dimensional (3D) technology for treatment planning and the manufacture of aligners. 5 Align Technology uses an online facility called Clin-Check that enables the orthodontist to modify tooth position and plan treatment procedures virtually, such as interproximal reduction, until an acceptable digital treatment plan (DTP) is finalized. ...
Objectives:
To investigate whether the predicted changes in overbite (OB) and overjet (OJ) in Align Technology's (Santa Jose, Calif) digital treatment plan for the prescribed course of treatment with the Invisalign appliance were consistent with those same changes in OB and OJ measured with the Geomagic Control X (Geomagic US, Research, Triangle Park, NC) metrology software system.
Materials and methods:
Geomagic Control X software was used to determine OB and OJ differences between the pretreatment and predicted outcome. STL files for patients satisfying inclusion criteria and undergoing nonextraction orthodontic treatment with the Invisalign appliance. The differences were compared, using the Bland-Altman analysis, to the corresponding data provided by Align Technology's digital treatment-planning interface, ClinCheck.
Results:
Data regarding 76 adult patients who satisfied strict inclusion criteria were assessed. The Shapiro-Wilks test indicated normality (P > .05). The Bland-Altman analysis showed high levels of agreement between the two measurements, with a bias range of -0.131 to 0.111 for OB and -0.393 to 0.03 for OJ recorded.
Conclusions:
Clinicians and researchers can be confident that measurement data provided by Invisalign's ClinCheck digital treatment-planning facility concerning OB and OJ changes from the initial to the predicted treatment outcome are valid.
... [1][2][3] The provision of CAT has become increasingly popular, particularly for the treatment of mild malocclusions. 4,5 Align Technology provides a system called Invisalign® Lite which is intended to address minor crowding and/or spacing within a maximum of 14 aligners. 6 Enabling the required tooth movements to be prescribed, most CAT manufacturers use digital treatment planning software to communicate between the treating doctor and the manufacturer. ...
Objective
To investigate the relationship between pre-treatment, predicted post-treatment, and clinically achieved numbers and locations of occlusal contact in cases treated using the Invisalign® Lite appliance (Align Technology, San Jose, California, USA).
Materials and Methods
Following the application of exclusion and inclusion criteria, 34 patients treated with the Invisalign® Lite appliance were selected. Occlusal contacts were measured at the initial, predicted, and achieved stages on amiga disc file (.adf file) files using the imaging software ImageJ (National Institutes of Health, Bethesda, MD, USA). Descriptive statistics were calculated. Predicted values were provided by Align Technology’s treatment planning software interface, ClinCheck®.
Results
Most patients were female ( n = 29; 85.3%) and the mean (standard deviation) age of the sample was 33.4 (10.72) years. There were significant differences between the initial pre-treatment number of maxillary premolar and molar occlusal contacts and the achieved (a reduction of 58.97%; P < 0.0001), and the total initial pre-treatment number of premolar and molar occlusal mandibular contacts and the achieved (a reduction of 52.5%; P < 0.0001). A significant reduction in the number of posterior occlusal contacts was observed when the achieved number of posterior occlusal contacts was compared to the numbers predicted via ClinCheck® ( p <0.0001).
Conclusions
For minor tooth movement treatment with Invisalign® Lite, more than 50% loss of posterior contact was observed in the achieved outcome when compared to either the initial or predicted number of occlusal contacts.
Objective
To investigate clear aligner therapy (CAT) practice among orthodontists in the British Orthodontic Society (BOS).
Design
A cross-sectional online survey.
Methods
An electronic survey was distributed to members of the BOS in 2022. The survey comprised questions regarding respondent demographics, general use of CAT, the choice of proprietary CAT appliances, CAT planning, case selection, treatment protocols and orthodontist-reported CAT problems.
Results
Overall, 233 (19.5%) responses were received with the majority (n = 121, 53.1%) being female. Most respondents reported practising in England (n = 171, 74.7%). The majority (n = 177, 77.3%) indicated that they used CAT in their practice, with 48.1% (n = 81) treating 1–20 patients with CAT annually. The most frequently prescribed CAT system was Invisalign (n = 138, 81.2%). One to three changes to the initial digital treatment plan were made by 72.9% (n = 121) with final tooth positions being the most common reason for adjustment (64.4%). Most (n = 97, 60.3%) rarely or never performed premolar extractions with CAT. Of the respondents, 23 12.7%) reported that they always or mostly used a remote monitoring system in conjunction with CAT, with a wide range of aligner change protocols reported. The median number of months required to complete non-extraction CAT reported by the respondents was 12. Most respondents (n = 77, 51.7%) did not feel that CAT provides superior outcomes compared with fixed appliance therapy.
Conclusion
CAT practice varied widely among the surveyed orthodontists. A predilection for the use of Invisalign and utility in less severe cases was noted.
Objectives: To scrutinize claims contained within Instagram posts related to six popular marketed orthodontic products.
Materials and Methods: Three hundred publicly available Instagram posts were identified using the following Instagram hashtags: #carrieremotion, #damonbraces, #invisalign, #acceledent, #propelorthodontics, and #myobrace. Pilot coding was undertaken on a subset of claims (n ¼ 50) and a coding guide was developed. The associated claims were categorized under 24 recognized themes and their accuracy assessed on a five-point scale.
Results: Of 1730 posts screened, 300 were included for analysis. The majority of posts were based on photographs (n¼244, 81.3%) with the remainder (n¼56, 18.7%) including videos. Half of the posts involved a picture of the product in isolation (n ¼ 150, 50%), with clinical cases presented in a minority (n ¼ 99, 33%). Overall, 472 claims were included with treatment duration being the most frequent theme (n ¼ 125, 26.5%). In terms of accuracy, most of the claims were judged to be ‘‘false’’ (n ¼ 283, 60%) with less than 2% considered ‘‘objectively true.’’
Conclusions: Most of the claims relating to six popular marketed orthodontic products concerned treatment duration. The vast majority of these claims were not supported by evidence and were judged to be false. Efforts should be made to promote the provision of accurate orthodontic information and to verify marketing claims on social media platforms.
In view of the diversity of orthodontic presentations, a single optimal retention protocol does not exist, with approaches tailored based on pre-treatment characteristics, treatment-induced changes and general patient characteristics. However, orthodontic practitioners should be responsive to the best available evidence to formulate optimal retention protocols in terms of appliance type, design and regimen, in particular. Based on a comprehensive search strategy, we discuss fundamental aspects concerning orthodontic retention of particular interest both to orthodontists and general dentists. These include stability and periodontal outcomes, cost-effectiveness, patient experiences, survival and failure rates of retainers, and the duration of retention.
Introduction
Long-term follow-up and management of orthodontic bonded retainers require a strong collaboration between orthodontists and general dental practitioners (GDPs). This study aimed to evaluate if Eastern French GDPs were aware of bonded retainers’ complications and side effects and if they were willing to take part in their long-term follow-up.
Methods
Two-hundred and eighteen randomly selected GDPs were invited to answer an online questionnaire. The initial sections covered their experience and management with bonded retainers. In the final sections, GDPs were asked their opinion on the responsibility for long-term follow-up of patients wearing fixed retainers and on the mutual communication between orthodontists and GDPs. Statistical analysis involved descriptive statistics and Fisher exact tests.
Results
Response rate was 32.6% (n = 71). The vast majority of GDPs were familiar with loose retainers, but only 45.2% were willing to repair them. Respondents offering orthodontic services on a regular basis were more likely to insert retainers and repair loose or broken retainers (P < 0.001). Approximately 18.6% of GDPs were aware of third-order side effects encountered with unintentionally active retainers bonded to all 6 anterior teeth. For 88.8% of GDPs, permanent retention was justified, whereas 90% of the dentists refused to be responsible for long-term supervision of fixed retainers. In addition, 67.1% were interested in further training on orthodontic retention, and 92.9% would appreciate clinical guidelines.
Conclusions
Knowledge about the harmful side effects of bonded retainers was evaluated as insufficient among surveyed GDPs. Long-term follow-up of patients wearing bonded retainers raises issues that should be addressed globally by enhancing mutual communication, practitioners’ education, and patients’ involvement.
Background
The use of direct‐to‐consumer (DTC) orthodontic aligners is growing. The purpose of this study was to evaluate the quality of information contained within the websites of DTC orthodontic aligner providers.
Methods
Websites that satisfied inclusion criteria were assessed for the presence of specific treatment‐related features. Four validated quality of information instruments and readability tools were used to evaluate the content of the websites. Descriptive statistical analyses and intra‐examiner reliability tests were performed.
Results
Twenty‐one websites were evaluated. Few websites referred to the need for pre‐treatment dental health (38.1%) and indefinite post‐treatment retention (23.8%). Most websites (95.2%) were categorised as either “poor” or “very poor” according to their DISCERN scores. DISCERN items regarding information bias and treatment risks scored particularly poorly. Cohen’s kappa intra‐examiner reliability testing for DISCERN scores was 0.81‐0.89. Three websites honoured 2 out of the 4 Journal of the American Medical Association benchmarks and 18 honoured one benchmark only. The readability scores indicated ‘difficult to read’ content.
Conclusions
The quality of information contained within the websites of DTC orthodontic aligner providers is poor. Patient consent for DTC aligner treatment based solely on the information contained within the websites is likely to be invalid.
Background:
The COVID-19 pandemic has powerfully shaped people's lives. The current work investigated the emotional and behavioral reactions people experience in response to COVID-19 through their internet searches. We hypothesised that when the prevalence rates of COVID-19 increase, people would experience more fear, which in turn would predict more searches for protective behaviors, health-related knowledge, and panic buying.
Methods:
Prevalence rates of COVID-19 in the United States, the United Kingdom, Canada, and Australia were used as predictors. Fear-related emotions, protective behaviors, seeking health-related knowledge, and panic buying were measured using internet search volumes in Google Trends.
Results:
We found that increased prevalence rates of COVID-19 were associated with more searches for protective behaviors, health knowledge, and panic buying. This pattern was consistent across four countries, the United States, the United Kingdom, Canada, and Australia. Fear-related emotions explained the associations between COVID-19 and the content of their internet searches.
Conclusions:
Findings suggest that exposure to COVID-19 prevalence and fear-related emotions may motivate people to search for relevant health-related information so as to protect themselves from the pandemic.
Introduction Shared decision-making (SDM) is a process by which patients and clinicians work collaboratively to make decisions about healthcare. Previously, research has shown that patients want to be more involved in decisions about their care, but more recent evidence suggests that some patients may not wish to have the level of involvement that is now expected of them.
Aims This study therefore investigated adult orthodontic patients' preferred and perceived roles in treatment decision-making.
Methods This cross-sectional study was carried out in a teaching hospital using the Control Preferences Scale (CPS). This involved asking patients to choose one of five cards relating, firstly, to their preferred role in orthodontic decision-making, and then their perceived role in their current orthodontic treatment decision-making, and these were compared.
Results One hundred patients were recruited and perceived roles in decision-making tended to be more passive than those patients said they preferred. Males were significantly more likely to select a passive role than females (p = 0.018).
Conclusions Adult orthodontic patients perceived a more passive role in their current treatment decisions than they would have preferred. This highlights the importance of clinicians asking patients about their preferred role in treatment decision-making from the outset.
Valid patient consent is a legal and ethical principle that is fundamental to healthcare provision. Oral health practitioners (OHPs) must understand the principles that need to be addressed to ensure that the consent given by a patient is valid. Failure to obtain consent may result in a negligence claim or a complaint of professional misconduct against the OHP. Orthodontic treatment is mostly elective but is not without risk to the patient. Obtaining and maintaining valid consent for orthodontic treatment presents additional challenges in comparison with other dental procedures as the treatment lasts over a longer time and is most commonly performed in adolescents. In addition, prospective patients need to be informed regarding 'lifelong' management in the retention phase to minimise the risk of relapse. The present paper outlines the principles of valid consent with particular regard to orthodontic treatment in the adolescent patient. OHPs must ensure that they are satisfied that the competent patient has the capacity to voluntarily consent. Clinicians must also recognise that valid consent is not a one-off 'tick the box' procedural exercise but an ongoing process of effective information sharing in light of changing laws and an ever-changing scientific evidence base within a patient-centred model of healthcare.
Objective: To evaluate the treatment risks and the quality of information contained within the websites of specialist orthodontists in Australia.
Methods: The term 'specialist orthodontic practice' was entered into three internet search engines. Websites satisfying inclusion and exclusion criteria were evaluated for orthodontic treatment risk information against nine common treatment risks. For website reliability and quality, the DISCERN instrument was used along with the HON (health on the net) seal certification; and for readability, the Flesch Reading Ease (FRE) Test was applied.
Results: Of the 105 websites that met the inclusion and exclusion criteria, 4.8% reported all nine risks. No risks were reported by 17.1%. Relapse (64.8%) was the most common risk recorded on websites, followed by 'pain/discomfort' (63.8%). Root resorption was reported by 5.7%. The requirement for life-long retention was indicated by 22.9% of the websites and 57.1% gave advice on sports mouthguard wear. The proposed benefits of orthodontic treatment were outlined by 85.7%. The mean (standard deviation [SD]) overall DISCERN score was 43.78 (SD 6.49; range 17-59). No website displayed the HON Seal certification. The mean FRE Score was 51.71 (SD 10.19; range 30.1-74.7).
Conclusions: Information regarding orthodontic treatment risks contained within specialist orthodontic practice websites appears deficient. Websites were of variable reliability, quality and readability. Further development of specialist orthodontists' websites is required to ensure the delivery of accessible, reliable and understandable evidence-based information to patients.
Introduction The practice of dentistry has become increasingly commercialised and commodified. Conflicts between the commercial and professional obligations that dental practitioners face have been discussed in the academic literature. This review collates the available information and discusses how the area of commercialism and professionalism has developed.
Methods A scoping review was carried out to assess the current literature in this area. Several databases were searched using relevant terms. Following collection of literature sources these were initially screened for duplication.
Results Of the total of 141 sources which were reviewed by title, abstract and keywords, 47 sources were selected for full text review. Qualitative synthesis revealed the three overarching themes of: (1) preserving professional values; (2) the realities of dental practice; and (3) contrasting and conflicting priorities.
Conclusion The interaction between commercialism and professionalism presented in the reviewed literature suggested that commercial interests in dentistry are a direct threat to professional values. Accompanying this discussion was a relative dearth of pragmatic exploration of how this conflict might be managed. There was also a lack of consideration of how the corporatisation of dental businesses might affect - whether positively or negatively - the nexus between commercial and professional obligations in dentistry.
Background:
User-friendly information at the point of care should be well structured, rapidly accessible, and comprehensive. Also, this information should be trustworthy, as it will be used by health care practitioners to practice evidence-based medicine. Therefore, a standard, validated tool to evaluate the trustworthiness of such point-of-care information resources is needed.
Objective:
This systematic review sought to search for tools to assess the trustworthiness of point-of-care resources and to describe and analyze the content of these tools.
Methods:
A systematic search was performed on three sources: (1) we searched online for initiatives that worked off of the trustworthiness of medical information; (2) we searched Medline (PubMed) until June 2019 for relevant literature; and (3) we scanned reference lists and lists of citing papers via Web of Science for each retrieved paper. We included all studies, reports, websites, or methodologies that reported on tools that assessed the trustworthiness of medical information for professionals. From the selected studies, we extracted information on the general characteristics of the tools. As no standard, risk-of-bias assessment instruments are available for these types of studies, we described how each tool was developed, including any assessments on reliability and validity. We analyzed the criteria used in the different tools and divided them into five categories: (1) author-related information; (2) evidence-based methodology; (3) website quality; (4) website design and usability; and (5) website interactivity. The percentage of tools in compliance with these categories and the different criteria were calculated.
Results:
Included in this review was a total of 17 tools, all published between 1997 and 2018. The tools were developed for different purposes, from a general quality assessment of medical information to very detailed analyses, all specifically for point-of-care resources. However, the development process of the tools was poorly described. Overall, seven tools had a scoring system implemented, two were assessed for reliability only, and two other tools were assessed for both validity and reliability. The content analysis showed that all the tools assessed criteria related to an evidence-based methodology: 82% of the tools assessed author-related information, 71% assessed criteria related to website quality, 71% assessed criteria related to website design and usability, and 47% of the tools assessed criteria related to website interactivity. There was significant variability in criteria used, as some were very detailed while others were more broadly defined.
Conclusions:
The 17 included tools encompass a variety of items important for the assessment of the trustworthiness of point-of-care information. Overall, two tools were assessed for both reliability and validity, but they lacked some essential criteria for the assessment of the trustworthiness of medical information for use at the point-of-care. Currently, a standard, validated tool does not exist. The results of this review may contribute to the development of such an instrument, which may enhance the quality of point-of-care information in the long term.
Trial registration:
PROSPERO CRD42019122565; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=122565.
Commercialisation and consumerism have had lasting and profound effects upon the nature of oral health and how dental services are provided. The stigma of a spoiled dental appearance, along with the attraction of the smile as a symbol of status and prestige, places the mouth and teeth as an object and product to be bought and sold. How the dental profession interacts with this acquired status of the mouth has direct implications for the professional status of dentistry and the relationship between the profession and society. This essay examines the mouth’s developing position as a symbol of status and prestige and how the dental profession’s interaction and response to this may have important effects on the nature of dentistry’s social contract with society. As rates of dental disease reduce in higher socioeconomic groups, dentistry is experiencing a reorientation from being positioned within a therapeutic context, to be increasingly viewed as body work. This is not in of itself problematic; as a discipline dentistry places a very high value upon the provision of enhanced or improved aesthetics. This position changes when the symbolic exchange value of an aesthetic smile becomes the main motivation for treatment, encouraging a shift towards a commercialised model of practice that attenuates professional altruism. The dental profession should not welcome the association of the mouth as a status and prestige symbol lightly; this article examines how this paradigm shift might impact upon the social contract and dentistry’s professional status.
Objectives
The aim of this study was to evaluate the quality, readability, and popularity of patient-oriented online information about peri-implantitis. Materials and methodsThe term “peri-implantitis” was searched in Google® and in Yahoo!®. The first 100 websites of each search engine were considered for further analysis. Quality was measured by DISCERN tool, and JAMA benchmarks. Readability was analyzed by Flesch Reading Ease Score (FRES), Flesch-Kinkaid Reading Grade (FKRG), Gunning Fog index (GFI), and Simple Measure of Gobbledygook (SMOG) index. Popularity was assessed by Alexa Popularity Rank (APR). ResultsOnly 28 websites remained after applying the exclusion criteria. The median overall DISCERN rating was 2.0 [2.0–3.0], which demonstrates the low quality of the information related to peri-implantitis. None of the websites achieved all the four JAMA benchmarks. Legibility indices showed ranges within the scores of difficult to read (FRES, 37.3 [26.9–53.9]; FKRGL, 12.8 [10.5–15.4]; GFI, 15.3 [12.5–18.0]; and SMOG, 11.1 [8.8–13.0]). Median APR was 2,228,599.0 [302,352.0–8,125,885.5]. Conclusions
Available English-written e-health information on peri-implantitis is poor in terms of quality and the analyzed websites are beyond the reading level recommended for comprehension. The popularity measurement showed great divergences between different Web pages. Clinical relevanceInformation about peri-implantitis on the Internet is difficult to read by patients, which they are not capable of understand.
Abstract Readability formulas are being increasingly used to measure the understandability of written information in clinical and health settings. This paper examines the most commonly used formulas (Dale-Chall Formula, Flesch Reading Ease, Flesch-Kincaid Formula, Fog Index, Fry Readability Graph, and SMOG Grading). Their reliability and validity when used in health-related areas are discussed, and findings resulting from their use are described. These findings show that much of the material written for patients and clients, in the areas of informed consent, illnesses and their investigation and treatment, and lifestyle advice, is too difficult for many of them to understand. It is also concluded that increasing readability usually leads to improvement in understanding and occasionally in co-operation with treatment. Finally, methods for supplementing the information gained from readability formulas are described.
Introduction
The purpose of this cross-sectional study was to survey orthodontic clear aligner therapy (CAT) practices among orthodontists in Australia.
Methods
A pilot-tested electronic questionnaire was distributed to 434 full members of the Australian Society of Orthodontists. Questions were related to demographics, use and choice of aligners, digital treatment planning, patient selection, treatment protocols, refinements/finishing, retention, and patient-reported aligner issues. Factors regarding the decision not to provide CAT were also surveyed.
Results
The response rate was 54.6%. Most orthodontists (93.13%) provided CAT, which made up 24.17% of their annual orthodontic caseload. The median percentage of initial digital treatment plans (DTP) approved without changes was 0, with 4-6 changes reported by 24.14%. Orthodontists reported a mean of 2.02 ± 1.76 refinements per patient. Orthodontists were least comfortable treating patients with bilateral crossbite (71.28%) and deep overbite (62.56%). DTP challenges regarding tooth attachments and tooth positions and issues regarding patient compliance with CAT wear protocols were commonly reported. More than 1 CAT system was used by most (63.92%), with in-house systems used by 21.63%. Orthodontists rarely or never (63.68%) performed premolar extraction treatment with CAT. Adjunctive interproximal reduction was reportedly mostly carried out to relieve crowding and reduce open gingival embrasures. The view that fixed appliances provide better outcomes was a major influence (71.43%) on the decision for those who did not provide any CAT.
Conclusions
CAT practices among orthodontists varied. Further research is required to investigate the challenges in effective CAT provision highlighted in this survey.
Objective
To evaluate the quality of information and readability of online content regarding medication-related osteonecrosis of the jaw (MRONJ).
Study design
Three search engines were used to identify websites containing information regarding MRONJ. The content was assessed with five quality of information and readability tools. Statistical analyses were performed via GraphPad Software (GraphPad Software Inc.,La Jolla, CA, US).
Results
The HonCode SEAL was present in two of the 21websites that satisfied inclusion/exclusion criteria. The mean JAMA benchmark satisfied per website was 1.619 out of 4 (SD = 1.2; 95% CI 1.07 to 2.17). The mean overall QUEST score was 15.29 out of a maximum 28 (SD = 6.174; 95% CI: 12.48 to 18.1). The QUEST scores of those websites that satisfied ⩾ 3 JAMA criteria were significantly higher than those that did not (p=0.01; 95% CI: -11.41 to -1.79). The readability levels of all content ranged from fairly difficult to very difficult.
Conclusions
The information related to MRONJ on the Internet is unreliable and too difficult for the general public to read. Authors of online MRONJ information should consider use of quality of information and readability tools to ensure reliable information is understood by those with poor health literacy skills.
Objective
To evaluate the readability of orthodontic treatment informed consent forms (ICFs).
Design
A cross-sectional observational investigation.
Methods
An online search strategy was adopted to identify ICFs for orthodontic treatment. The text of each form that satisfied inclusion criteria was modified to a standardised protocol. The readability was evaluated using three validated instruments. GraphPad Software (GraphPad Software Inc., La Jolla, CA, USA) was used for statistical analyses.
Results
A total of 59 ICFs were evaluated. The majority were available on the websites of orthodontists (66.1%) and general dentists (27.1%). The scores recorded from the three instruments indicated that the content of 93.2%–98.3% of ICFs was difficult to read. A strong correlation was observed between the Simple Measure of Gobbledegook (SMOG) and the Flesch Kincaid Grade level (FKGL) instruments (r = 0.9782; P < 0.0001). The mean SMOG score for all assessed forms was 11.19 (95% confidence interval [CI] 10.85−11.54). The ICFs authored by the manufacturers of orthodontic appliances provided by clinicians recorded a mean Flesch Reading (FRE) score of 40.14 (95% CI 33.91−46.37) out of a maximum 100. An analysis of the SMOG scores indicated that the content of ICFs authored by national orthodontic societies was more difficult to read than those written by all other authors ( P=0.01; 95% CI −1.6 to −0.2)
Conclusion
The readability of the ICFs was too difficult for a significant number of the population. Many patients will be unable to validly consent to treatment based solely on reading of the content of the evaluated ICFs. A greater effort is required to improve the readability of ICFs to help ensure patient autonomy regarding orthodontic treatment decision-making and management.
Introduction Dental implants are a popular option for replacing missing teeth. When searching for information regarding dental implants, patients may first look to their dental practice website. The aim of this study was to assess the variance of patient information provided regarding implant complications on dental implant practice websites.
Materials and methods Inclusion criteria for this study were dental practices within the Greater Glasgow & Clyde health board and practices with an active website. Completeness was assessed using a six-point score based on the British Association of Oral Surgeons 'Information for patients' leaflet and Association of Dental Implantology 'Considering dental implants? - A patient's guide to dental implant treatment' leaflet.
Results In total, 90.7% (n = 107) of practices provided accessible implant information on their websites. However, only 37.3% (n = 44) mentioned one or more specified dental implant complications. Pain/discomfort was the most frequently stated complication (n = 41/118); implant failure was only mentioned by 19 practices (16%). The mean number of complications mentioned by the 118 practices offering dental implants was 1.1.
Discussion As implant dentistry grows, there may be concerns over patient expectations. To overcome lack of quality assurance on the internet, dentists can provide factual information on their websites. They should be aware of their duty to provide material that is accurate, honest, informative and not potentially misleading.
Aim
To assess the content quality of Danish dental websites on orthodontic treatment (OT) using the DISCERN quality assessment tool, estimate the percentage of general dental practices offering OT, investigate the kinds of OT offered and appraise claims made when recommending one treatment modality over another.
Materials & Methods
A list of registered dental clinics was downloaded from a Danish dental register index (n=1,640). Sequence randomization was performed and 536 websites were randomly selected for review (33%).
Results
We reviewed 536 websites 97.8% (n=524) of which were from general dental practices (GPs) of whom 70% did not offer OT. The DISCERN mean Reliability (Q1-8) and Quality-of-Information (Q9-15) scores were 16.8/40.0 and 13.0/35.0, respectively. The mean Total score was 31.9/80.0. The quality of information on OT was “very poor” or “poor” in 77% of the websites. Of GPs offering OT (30%), 54% provided Invisalign®, 23% Inman Aligner®, 15% LiteWire® and 11% “other”. Only 24% of websites describing OT had information on relapse. In 41%, aligners were compared with full-fixed appliance (FFA) with some websites claiming that aligners are less painful (22%), faster (13%), less harmful (3%) or give better results (2%). Websites offering only one type of OT had lower DISCERN score compared with those offering more than one type (p < .001). Additionally, clinics offering Invisalign® compared aligners to FFA more often (p < .04), claiming they are less painful (p < .004) while their websites scored higher in DISCERN compared with those not offering Invisalign® (p < .002).
Conclusion
Danish dental websites provide “very poor” to “poor” quality of information on OT. According to their websites, 30% of Danish GPs offer OT. Only 24% provide information on relapse, while some claim that aligners yield better results, are faster and less harmful or painful than FFA. Invisalign® providers more often compare aligners to FFA and claim that aligners have less pain or discomfort. Also, they display information of higher quality based on DISCERN on their websites.
Introduction:
This study evaluated the trends in orthodontic practitioner choice over the past 15 years and explored the lay public's understanding of different orthodontic practitioner options in the U.S., specifically, orthodontists compared with general dentists.
Methods:
A survey was distributed to a representative sample of laypersons in the U.S. The response rate was 90.2%, and 727 completed responses were analyzed.
Results:
A 28.2% shift away from orthodontists toward general dentists over the last 15 years was significant (P <0.001). The 2 most frequently endorsed ways respondents found their orthodontic practitioners were a recommendation from another dentist (54.2%) and their family's general dentist who offered orthodontic treatment in-house (22.9%). Respondents' knowledge of orthodontists was limited; 85.0% believed that dentists who perform orthodontic treatment are also orthodontic specialists. Only 17.1% of respondents disagreed with the statement that "a dentist who advertises orthodontic treatment is an orthodontic specialist." In addition, 89.7% were not aware that a dentist could not be called an orthodontist without separate training from an accredited residency program. Finally, 64.2% of respondents did not know that an orthodontist must complete more education than a general dentist.
Conclusions:
Over the past 15 years, the percentage of orthodontic patients treated by general dentists has increased significantly. The public's ability to differentiate between different types of orthodontic practitioners is poor, showing substantial confusion about orthodontists' qualifications. Most respondents believed that orthodontists are best suited for their orthodontic treatment, but they rely heavily on their general dentists for orthodontic practitioner decisions.
ABSTRACT
Objective
To evaluate and compare the content of posts placed on Instagram by orthodontic treatment providers (OTP) and patients regarding orthodontic retention and retainers.
Materials and Methods
Six “hashtag” terms related to orthodontic retention were searched on the social media Web site, Instagram. Relevant uploaded posts were evaluated for the presence of nine retainer and retention-related domains. Patient posts were also qualitatively evaluated for themes via discourse analysis. Descriptive and univariate statistical analyses were carried out. Cohen's kappa intrarater reliability testing was performed.
Results
Most of the 144 posts that satisfied inclusion criteria were uploaded by OTPs (81.9%). Text and image(s) comprised 86.8% of posts. The most frequently included domain posted by OTPs related to “what is a retainer” and “the importance of wearing a retainer” (49.2%). Posts by OTPs referred to a greater number of domains ( P = 0.028), whereas posts by patients recorded comparatively more “quality-of-life”–related content ( P = 0.027). Most patient posts were positive (53.8%). The main negative theme within patient posts related to retainer discomfort and the unhappiness associated with the requirement for indefinite retainer wear. The intrarater score was 0.89 for the presence of domains.
Conclusions
OTPs appear to use Instagram for posting orthodontic retention–related information more often than patients. The content of Instagram posts differed between OTPs and patients. OTPs must ensure that the content of their Instagram posts is relevant to the concerns articulated in posts uploaded by patients.
Introduction
The evaluation of the quality of information (QOI) contained within oral health-related videos on the video-streaming Web site YouTube has been limited. This study aimed to determine the QOI regarding orthodontic retention and retainers contained within videos uploaded by dental professionals (DPs) to YouTube.
Methods
YouTube was systematically searched using 4 terms. The top 50 videos per search term by “number of times viewed” were stored in a specially created account. Following the application of inclusion/exclusion criteria, the videos were assessed for viewing characteristics, and a 4-point scoring system (0-3) was applied to evaluate QOI in 10 predetermined domains. Descriptive statistical analyses, intrarater, and interrater reliability tests were performed.
Results
Strong intrarater and interrater reliability scores were observed. Sixty-two videos from the top 50 most-viewed DPs were viewed a total of 1,367,810 times (range 77- 529,543). Most DPs originated from the United States (68%), and orthodontists (88%) uploaded most videos. The mean number (standard deviation [SD]) of reported domains was 5.5 out of 10 (SD, 2.2). The mean overall QOI score per domain was 1.14 out of 3 (SD, 0.64). The “importance of retention” domain scored highest (2.18; SD, 1.2). “The need for retention reviews” domain scored the lowest (0.3; SD, 0.65). The mean overall QOI score per DP was 11.72 out of 30.00 (SD, 5.85).
Conclusions
The QOI related to orthodontic retention and retainers contained within videos provided by DPs through the YouTube Web site is deficient, particularly the need for retainer review. Orthodontists should be aware of the importance of YouTube as an information resource and ensure that videos related to orthodontic retention and retainers contain relevant, high-quality, and evidence-based information.
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 pre‐determined criteria. Descriptive statistical analyses and intra‐rater 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 HONcode 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 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.
Background Healthcare information is increasingly being sought on the Internet. Ischaemic heart disease (IHD) poses a significant health burden. Concern often arises for patients with IHD when undergoing dental treatment, leading to online searching for relevant healthcare information.
Objective To evaluate the readability and quality of webpages regarding IHD and dental treatment.
Materials and methods Three searches were performed on the Google search engine. The first hundred results of each search were collated and exclusion criteria applied. The remaining 66 webpages were categorised. Readability was assessed using the FRES and SMOG readability tools. Quality was assessed using the PEMAT questionnaire, the JAMA benchmarks and the Health On the Net (HON) seal.
Results Most examined webpages were commercial. Readability of 90.1% of webpages was deemed fairly to very difficult. Understandability and actionability scores were generally below the comprehension level of the general population. Less than 50% of websites achieved the authorship, attribution and disclosure JAMA benchmarks. Only 12.1% of websites displayed the HON seal.
Conclusions Online health information related to IHD and dental treatment is generally too difficult for the average individual to read, understand, or act upon, and may be of questionable quality. Given the low health literacy rates among the general population, future revisions of educational materials by non-commercial sources regarding IHD and dental treatment are warranted, in order to ensure online health information is understandable and of genuine benefit to patients and/or their carers.
Aim Evaluate the content and quality of internet information for patients regarding intravenous sedation in dentistry.
Methodology Google was queried with predefined search terms that might be chosen by patients wishing to seek information: 'dental IV sedation OR dental intravenous sedation OR dental sedation'. The first hundred search results were identified. Invalid hyperlinks and duplicates were excluded. Providers, format and location of information were extracted. For webpages detailing treatment options, the DISCERN instrument and JAMA benchmark were used to determine the quality of the information provided.
Results Of the first hundred search results, 89 webpages met the initial inclusion criteria. A majority (79%) originated from dental providers. Information was commonly presented as patient information leaflets. Of the 78 webpages detailing treatment options, 3% of webpages received a maximum DISCERN score of 5 and 64% a score of 1. No webpages fulfilled all JAMA criteria and 89% met only one criterion. Secondary care providers scored higher in both scales; however, this represents only 5% of the information available.
Conclusion The internet is a commonly accessed information resource for patients. The quality of internet information available regarding intravenous sedation in dentistry is suboptimal. There is a need for more high-quality information resources.
Objectives: This study investigated the quality of Internet information in the English language about lingual orthodontics.
Design: A cross-sectional study
Materials and Methods: An Internet search using the keywords ‘lingual orthodontics’, ‘lingual braces’, ‘lingual treatment’ and ‘lingual brackets’ was conducted on the four most popular search engines (Google, Yahoo, Bing and AOL) on
4 February 2017. The first 10 websites for each keyword and search engine were screened. After excluding duplicates
and irrelevant websites, the remaining were assessed using the DISCERN tool and JAMA benchmarks.
Results: Of the original 160 websites found, 132 were excluded (102 duplicates, 30 unrelated). The authors of the
remaining 28 websites were orthodontists (39.2%), professional organisations (21%), unspecified (17.8%), dentists (7.1%),
dental hygienists (7.1%) and patients (7.1%). The mean overall DISCERN score for the 28 websites was poor (36.3).
Only 1/28 websites met all four principles of JAMA, four websites met three criteria, 10 websites met two criteria and
13 websites met one criterion.
Conclusion: Online information on lingual orthodontics was of poor quality; moreover, unbiased and balanced information was rare. Orthodontists should be aware that the average quality of information on the Internet about lingual
orthodontics might be inadequate and should direct patients to higher-quality websites.
Introduction
“Upstream” decisions by patients are important in determining whether they seek orthodontic care for their children and for themselves and whether they seek care from general dentists or from orthodontists. Classic marketing theory suggests that purchase decisions naturally progress through a sequence beginning with awareness and proceeding to information, emotional preferences, and final purchase commitment.
Methods
A survey was used to assess patient demographics and care history, motives for seeking care for themselves and their children, perceived barriers to care, trust in various sources of information, and preference for treatment by a general dentist or by an orthodontist. Three hundred fifty-two responses were received from patients in all states in the United Sates attending their general dentists.
Results
Care for children was most often initiated in response to a suggestion from the family dentist, and traditional treatment with braces was expected. Adults were slightly more likely to make a decision for care themselves and for appearance reasons, often with “invisible” braces. Cost was the principal barrier to seeking care for either functional or appearance reasons. More personal and individualized sources of information, such as the family dentist or referral to a specialist were strongly more influential, with indirect sources, such as dentist Web pages or advertisements, being least influential. There was a preference for care by orthodontists compared with general dentists for functional reasons and when complications were anticipated. Orthodontists were seen as being better at identifying complications, managing complications, and delivering reliable results. Orthodontic care provided by general dentists was favored for convenience and based on established relationships. Patients with more education, higher incomes, and more preventive oral habits preferred treatment by orthodontists. Although it was expected that orthodontists would charge more, income and cost were not factors among those considering treatment.
Conclusions
This study suggests that orthodontists should focus on educating potential patients about the functional health features of treatment for malocclusions, especially for children. Furthermore, orthodontists would benefit from working with general dentists, given their role as gatekeepers in the sequential process of reaching an upstream decision about seeking orthodontic care.
Objectives: The present study aimed to determine the quality, accuracy, reliability and usability of Internet information, regarding different orthodontic treatment modalities.
Method: Google AdWords identified five popular keywords: Cosmetic braces, fixed braces, Removable braces, Quick braces and risks. These were entered in five search engines, with the resultant websites analysed using five validated assessment tools. Intra-examiner reliability was assessed, descriptive and inferential analysis of the data undertaken.
Results: Good intra-examiner reliability and consistency was observed. A total of 119 websites were included for analysis, with the keywords cosmetic and fixed braces accounting for 55% of identified websites. Invisalign was the most offered treatment (80%). Specialist orthodontists produced the highest, whilst general dentists advertising short-term options produced the lowest quality scoring websites. LIDA provided the most accurate assessment of quality (mean 62.02, SD 7.48). Regression analysis found a significant relationship between author type and a questions and answer sections with both Discern (P < 0.001) and LIDA (P = 0.002) scores, respectively.
Conclusions: Quality of Information regarding orthodontic treatment was variable, with the highest scoring websites were produced by orthodontic specialists and Invisalign the most offered treatment. There is a clear need for valid and reliable websites to better guide patients.
The increase in primary care dentists who are providing their own orthodontic care has caused orthodontic specialists to change their marketing strategy. Recently, a paradigm shift in marketing has occurred from dentist-based referrals to direct-to-consumer advertising. Orthodontists are now choosing to advertise to patients directly, rather than solicit primary care dentists to refer patients when they deem ready. In essence, primary care dentists have forced the orthodontist's proverbial hand to become independent. The reach of this independence will likely extend well beyond current direct-to-consumer methods to orthodontists soon owning pediatric and general dental offices in the future. The purpose of this paper is to review current and future trends in orthodontic marketing.
Background
Massive use of the Internet for health issues has raised concerns about the quality of the information available and about consumers' ability to tell “good” from “bad” information.PurposeTo assess the quality of patient-addressed, dental implants-related websites in terms of reliability, accessibility, usability and readability.Materials and Methods
Two search engines (Google and Yahoo) were used in this study. The first 100 sites, as listed by each engine, were considered for the study. Each site was categorised and analysed for quality using the DISCERN and the LIDA instruments. The Flesch-Kinkaid Reading Grade Level (FKRGL) and the Flesh Reading Ease Score (FRES) were used to assess legibility.ResultsAfter applying the inclusion and exclusion criteria, 32 single websites entered the study. The median score for the DISCERN instrument (3 [2–3]) indicated serious or potentially important shortcoming in the quality of the information obtained. LIDA scores showed modest percentages for accessibility (79.36 [74.60–85.31]) and intermediate for usability (59.20 (50.46-68.51)) and reliability (55.55 [45.37–66.66]). Legibility indices reached scores within the range of difficult to read (FRES = 51.72 [38.70–55.27]); FKRGL = 12.76 [10.07–14.87]).Conclusions
Available e-health information on dental implants in English language is difficult to read for the average patient and poor in terms of quality.
Objective:
To evaluate orthodontic practice websites for the reliability of information presented, accessibility, usability for patients and compliance to General Dental Council (GDC) regulations on ethical advertising.
Setting:
World Wide Web.
Materials and methods:
The term 'orthodontic practice' was entered into three separate search engines. The 30 websites from the UK were selected and graded according to the LIDA tool (a validated method of evaluating healthcare websites) for accessibility, usability of the website and reliability of information on orthodontic treatment. The websites were then evaluated against the GDC's Principles for ethical advertising in nine different criteria.
Results:
On average, each website fulfilled six out of nine points of the GDC's criteria, with inclusion of a complaints policy being the most poorly fulfilled criteria. The mean LIDA score (a combination of usability, reliability and accessibility) was 102/144 (standard deviation 8.38). The websites scored most poorly on reliability (average 43% SD 11.7), with no single website reporting a clear, reliable method of content production. Average accessibility was 81% and usability 73%.
Conclusions:
In general, websites did not comply with GDC guidelines on ethical advertising. Furthermore, practitioners should consider reporting their method of information production, particularly when making claims about efficiency and speed of treatment in order to improve reliability.
Accessibility is one of six quality criteria articulated by the European Commission in its code of conduct for health websites. Readability plays an integral part in determining a website's accessibility. Health information that is hard to read may remain inaccessible to people with low health literacy. This study aimed to calculate the readability of websites on various causes of disease. The names of 22 health conditions were entered into five search engines, and the readability of the first 10 results for each search were evaluated using Gunning FOG, SMOG, Flesch-Kincaid and Flesch Reading Ease tests (n=352). Readability was stratified and assessed by search term, search term complexity, top-level domain and paragraph position. The mean reading grade was 12.30, and the mean FRE was 46.08, scores considered 'difficult'. Websites on certain topics were found to be even harder to read than average. Where conditions had multiple names, searching for the simplest one led to the most readable results. Websites with .gov and .nhs TLDs were the most readable while .edu sites were the least. Within texts, a trend of increasing difficulty was found with concluding paragraphs being the hardest to read. It was also found that some of the most frequent search results (such as Wikipedia pages) were amongst the hardest to read. Health professionals, with the help of public and specialised libraries, need to create and direct patients towards high-quality, plain language health information in multiple languages.
The aim of this study was to evaluate the quality of information available on the Internet for a person interested in orthodontic extractions.
The term "orthodontic extractions" was entered into the search engines of both Google and Yahoo, and the first 50 Web links for each were pooled and examined. Exclusion criteria consisted of repetitions, sites requiring registration or login, and those accessing scientific articles. Sites fulfilling the criteria for inclusion were examined by using the LIDA instrument, a validated method of evaluating health care Web sites, based on accessibility, usability, and reliability. The readability of each site was further assessed by using the Flesch reading ease score.
Of the 100 Web sites identified, 21 were suitable for inclusion and scoring. Overall, the mean total LIDA score was 93 of a possible 144 (65%) (range, 71-116 or 49%-81%). No Web site scored above an arbitrary gold standard of 90%; however, most (20 of 21) scored above 50%. With the LIDA instrument, average accessibility was 70%, average usability was 72%, and average reliability was 41%. The average Flesch reading ease score was 58.3.
Overall, the quality of information available on the Internet with regard to orthodontic extractions is variable. Although readability is generally good, reliability is a cause for concern, and patients should interpret many of these sites with caution. The top-rated Web sites in a search engine are not necessarily those of the highest quality.
Patients increasingly use the internet to access health information. Inadequate health literacy is common and frequently limits patient comprehension of healthcare literature. We aimed to assess the readability of online consumer-orientated Parkinson's disease (PD) information using two validated measures.
We identified the 100 highest ranked consumer-orientated PD webpages and determined webpage readability using the Flesch-Kincaid and Simple Measure Of Gobbledygook (SMOG) formulae.
None of the webpages analysed complied with current readability guidelines. Commercial websites were significantly easier to read (p = 0.035). The Flesch-Kincaid formula significantly underestimated reading difficulty (p < 0.0001). Ease of reading correlated weakly with search engine ranking (r = 0.35, p = 0.0004).
Only 1% of the top 100 PD information webpages are fully comprehensible to the average adult. Simple Measure Of Gobbledygook should be the preferred measure of webpage readability. Parkinson's disease information websites require major text revision to comply with readability guidelines and to be comprehensible to the average patient.
To develop a short instrument, called DISCERN, which will enable patients and information providers to judge the quality of written information about treatment choices. DISCERN will also facilitate the production of new, high quality, evidence-based consumer health information.
An expert panel, representing a range of expertise in consumer health information, generated criteria from a random sample of information for three medical conditions with varying degrees of evidence: myocardial infarction, endometriosis, and chronic fatigue syndrome. A graft instrument, based on this analysis, was tested by the panel on a random sample of new material for the same three conditions. The panel re-drafted the instrument to take account of the results of the test. The DISCERN instrument was finally tested by a national sample of 15 information providers and 13 self help group members on a random sample of leaflets from 19 major national self help organisations. Participants also completed an 8 item questionnaire concerning the face and content validity of the instrument.
Chance corrected agreement (weighted kappa) for the overall quality rating was kappa = 0.53 (95% CI kappa = 0.48 to kappa = 0.59) among the expert panel, kappa = 0.40 (95% CI kappa = 0.36 to kappa = 0.43) among information providers, and kappa = 0.23 (95% CI kappa = 0.19 to kappa = 0.27) among self help group members. Higher agreement levels were associated with experience of using the instrument and with professional knowledge of consumer health information. Levels of agreement varied across individual items on the instrument, reflecting the need for subjectivity in rating certain criteria. The trends in levels of agreement were similar among all groups. The final instrument consisted of 15 questions plus an overall quality rating. Responses to the questionnaire after the final testing revealed the instrument to have good face and content validity and to be generally applicable.
DISCERN is a reliable and valid instrument for judging the quality of written consumer health information. While some subjectivity is required for rating certain criteria, the findings demonstrate that the instrument can be applied by experienced users and providers of health information to discriminate between publications of high and low quality. The instrument will also be of benefit to patients, though its use will be improved by training.
Patients require good quality, evidence based information so that they can participate actively in the decision making process. The DISCERN instrument has been developed to help patients rate the quality of written information materials about treatment choices. This study evaluated the reliability of DISCERN using 31 information leaflets discussing treatment options for prostate cancer. The index of agreement between two independent raters was substantial for the overall quality rating (kappa=0.65, 95% confidence interval 0.49, 0.82), indicating that the instrument could be used to discriminate reliably between low and high quality prostate cancer publications. Healthcare professionals should inform patients of the availability of the instrument and encourage its use by patients who regularly attend to written sources of information on treatment choices. Early indications show that DISCERN could enable both patients and healthcare professionals to discriminate between the plethora of variable quality information currently available.
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About the authors
Dreyer is the former PR Begg Chair in Orthodontics at the University of Adelaide in Australia. He is currently involved in the teaching of postgraduate orthodontic students and the supervision of several research projects
- W Craig
Craig W. Dreyer is the former PR Begg Chair in Orthodontics at the University of
Adelaide in Australia. He is currently involved in the teaching of postgraduate orthodontic
students and the supervision of several research projects.