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

In this study, we assessed orthodontic patients’ attitudes toward Web-based information as well as the psychometric implications of orthodontic-themed online research. The behavioral effect of social media on orthodontic patients had previously been investigated in the USA by Nelson and Shroff [3], who observed that social media can be used by orthodontists not only as a communications media but also as a marketing tool. It’s noticeable in their work, as well as in ours, that the use of online platforms decreases with age.

Henzell et al. [15] performed a qualitative analysis of orthodontic-related posts on Twitter in New Zealand. They observed that adolescents’ posts concerned experiences and feelings about orthodontic treatment, and only a small number of informational posts were found. These results differ from ours - although such differences may reflect geographical differences, and it may also depend on the very selective choice of online platform made by said Authors. In fact, Twitter may not be the platform of choice for informational content; in our observations, Google resulted to be the most used digital platform by far, and even amongst those who didn’t use it as their principal source it is often chosen as a secondary one (Table 1). YouTube, Instagram and Facebook were used by 15.3% of the respondents, whereas platforms other than the above-mentioned ones barely reached 3.3% (Table 1). Moreover, our results show that the preferred digital platform significantly varies with age (p < 0.001). In fact, YouTube is used as main source of orthodontic information mostly by digital natives, conversely, Facebook is preferred mainly by digital immigrants (Table 2).

It is also noticeable from our investigation that digital natives are more likely to use the Internet to acquire orthodontic information (p < 0.001), and that not only fewer digital immigrants searched the Web, but also their digital scouting was less wide-ranging. Remarkably, secondary platforms were selected by more than a half of the digital natives, whereas only 31.4% digital immigrants declared to have used a secondary platform (Table 2).

To our knowledge, this is the first study to assess the psychometric implications of orthodontic-themed Web-searches on patients’ decisional processes.

In our experience, female patients incorporated information from Web searches in their decisions more than males, who relied more on the orthodontist’s advice (Table 3).

Furthermore, the likelihood to raise concerns about the clinician’s judgement appears to be related to the perceived usefulness of online sources. In fact, patients who were satisfied with the information available online were also more reluctant to cast it aside in case it differed from the orthodontist’s opinion, and 1 in 3 would not rely solely on the dentist’s judgment. On the other hand, more than 80% of the patients who were unsatisfied with their searches preferred to trust the orthodontist (Table 3).

The perceived reliability of digital sources showed an even more significant influence on patients’ behaviour (p < 0.001). Indeed, patients who judged online sources to be reliable were more likely to hold on to the information found on the Web, and 35.6% would propose what they found, consult other dentists or refuse to be treated (Table 3). Furthermore, not only digital immigrants were more likely than digital natives to perceive online sources of information as reliable, but they were also more reluctant to put aside the internet-based information when it differed from the orthodontist’s opinion, as 16.5% would either get an opinion from another orthodontist or completely refuse to be treated (Table 2).

The trends described above should be taken into account during patient’s interview in order to build a more solid doctor-patient relationship. As a matter of fact, it is advisable to ask patients about their searches on the Web, discuss the results together and give them correct and exhaustive explanation of the topic. Eventually, the orthodontist should recommend evidence-based and reliable websites for further researches; this way, patients could acquire valid, evidence-based knowledge on their clinical condition without the risk to fall for inexact, misleading and non-scientific information - which is abundant and easy to run into on the Web [16]. In particular, orthodontists and general dentists should educate their patients to rely on Websites in which sources are clearly stated, and to prefer contents written by professionals or scientific societies over blogs, reports of personal experiences and other types of digital material produced by laypersons. Additionally, patients who wish to dig further into orthodontic topics could be provided with links to the websites of national orthodontic scientific associations, such as British Orthodontic Society (BSO) (UK) [17], Società Italiana di Ortodonzia (SIDO) (Italy) [18, 19] and American Association of Orthodontists (AAO) (USA) [20], which feature informative contents specific for patients.

It is particularly important to build a well-founded doctor-patient relationship not only for ethical reasons and for the patient’s wellbeing, but also because the tendency to trust the orthodontist didn’t show any correlation with the perceived consistency between online information online and dentist’s opinion, whereas the satisfaction with online contents impacted very significantly on the patients’ decisional processes (Table 3). This implies that the likelihood of acceptance of the proposed treatment plan is affected by the patient’s satisfaction with their online searches but not by the found contents per se.

It is important to highlight the limitations of our investigation. First, due to the COVID-19 pandemic, the survey distribution varied among centers participating in the study. While statistical significance was reached, it was not possible to draw conclusions regarding potential differences among Countries. Second, the survey was distributed in both public and private structures, but patients referring to the former and to the latter were not compared; additional studies must be conducted to assess these parameters. Finally, the pediatric patient is not investigated in this study.