The quality of information on the Internet on orthodontic retainer wear: a cross-sectional study

Objectives: The objectives of this study were to assess the accessibility, usability, reliability and quality of information on the Internet written for the lay public about orthodontic retainers, and to elucidate the different retention protocols encouraged. Design: A cross-sectional, observational study. Setting: Online, using a computer connected to the Internet in Australia. Methods: Two search terms; ‘orthodontic retainer’ and ‘how long should someone wear a retainer after their braces are removed?’ were entered alternatively into five search engines. Twenty results for each search term per search engine that fulfilled the inclusion criteria were evaluated in terms of accessibility, usability, reliability and quality of information using the LIDA and DISCERN instruments, ensuring there were no internal or cross-search engine duplicates. Any information about frequency and duration of retainer wear was also collected. Results: Two hundred different websites were identified and assessed. The median overall LIDA score was 72%, corresponding to a moderate quality level. The median total DISCERN score was 47%. Twenty-two websites recommended patients adhere to the specific protocol prescribed to them by their practitioner. There were 45 (22.5%) and 28 (14%) websites advising indefinite use of removable and bonded retainers respectively. Conclusions: Information about retainers on the Internet is easily accessible and usable, though the quality of the content is generally of a moderate level. However, the information is not always accurate and reliable. Both full-time and part-time wear of removable retainers was suggested over greatly varying time periods. Indefinite wear of removable and bonded retainers was also advocated.     

Adult orthodontics: a quality assessment of Internet information

Objectives: This study evaluated the quality, reliability and readability of information on the Internet on adult orthodontics. Design: A quality assessment of adult orthodontic websites. Setting: Postgraduate Orthodontic Unit, Cork University Dental School and Hospital, Cork, Ireland. Method: An Internet search using three search engines (Google, Yahoo and Bing) was conducted using the terms (‘adult orthodontics’ and ‘adult braces’). The first 50 websites from each engine and under each search term were screened and exclusion criteria applied. Included websites were then assessed for quality using four methods: the HON seal, JAMA benchmarks, the DISCERN instrument and the LIDA tool. Readability of included websites was assessed using the Flesch Reading Ease Score (FRES). Results: Only 13 websites met the inclusion criteria. Most were of US origin (n?=?8; 61%). The authors of the websites were dentists (n?=?5; 39%), professional organizations (n?=?2; 15%), past patients (n?=?2; 15%) and unspecified (n?=?4; 31%). Only 1 website displayed the HON seal and three websites contained all JAMA benchmarks. The mean overall score for DISCERN was 3.9/5 and the mean total LIDA score was 115/144. The average FRES score was 63.1/100. Conclusions: The number of informative websites on adult orthodontics is low and these are of moderate quality. More accurate, high-quality Internet resources are required on adult orthodontics. Recommendations are made as to how this may be achieved.     

Patient satisfaction after orthodontic treatment combined with orthognathic surgery: A systematic review

Objective:To synthesize available evidence about factors associated with patients’ satisfaction after orthodontic treatment combined with orthognathic surgery.Materials and Methods:Studies that evaluated any factor associated with patients’ satisfaction after the conclusion of an orthodontic treatment combined with an orthognathic surgery were identified. Orthognathic surgical procedures should have been undertaken after completion of craniofacial growth. Any satisfaction psychometric tool was considered. No language limitation was set. A detailed individual search strategy for each of the following bibliographic databases was crafted: MEDLINE, PubMed, EBM Reviews, Web of Science, EMBASE, LILACS, and Scopus. The references cited in the identified articles were also cross-checked, and a partial gray-literature search was undertaken using Google Scholar.Results:Eight articles satisfied the inclusion criteria of this systematic review and accounted for 998 patients. The included studies showed large variation in sample size (range  =  44 to 505 patients), age (range  =  15 to 72 years old), distinct psychological evaluation tools, and time elapsed between the assessment and the completion of surgery and postorthodontic treatment. Most of the studies (five of eight) were classified as having high risk of bias.Conclusion:Factors associated with satisfaction were final esthetic outcome, perceived social benefits from the outcome, type of orthognathic surgery, sex, and changes in patient self-concept during treatment. Factors associated with dissatisfaction were treatment length; sensation of functional impairment and/or dysfunction after surgery, and perceived omitted information about surgical risks.     

YouTube as a source of information about orthodontic clear aligners

ObjectivesTo evaluate the content, reliability, and quality of videos about orthodontic clear aligners on YouTube.Materials and MethodsResearchers 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.ResultsOf 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).ConclusionsVideo 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.     

Interventions for pain during fixed orthodontic appliance therapy: A systematic review

Objective:To compare the different methods of pain control intervention during fixed orthodontic appliance therapy.Materials and Methods:A computerized literature search was performed in MEDLINE (1966–2009), The Cochrane Library (Issue 4, 2009), EMBASE (1984–2009), and CNKI (1994–2009) to collect randomized controlled trials (RCTs) for pain reduction during orthodontic treatment. Data were independently extracted by two reviewers and a quality assessment was carried out. The Cochrane Collaboration''s RevMan5 software was used for data analysis. The Cochrane Oral Health Group''s statistical guidelines were followed.Results:Twenty-six RCTs were identified and six trials including 388 subjects were included. Meta-analysis showed that ibuprofen had a pain control effect at 6 hours and at 24 hours after archwire placement compared with the placebo group. The standard mean difference was −0.47 and −0.48, respectively. There was no difference in pain control between ibuprofen, acetaminophen, and aspirin. Other analgesics such as tenoxicam and valdecoxib had relatively lower visual analog scale (VAS) scores in pain perception. Low-level laser therapy (LLLT) was also an effective approach for pain relief with VAS scores of 3.30 in the LLLT group and 7.25 in the control group.Conclusions:Analgesics are still the main treatment modality to reduce orthodontic pain despite their side effects. Some long-acting nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclo-oxygenase enzyme (COX-2) inhibitors are recommended for their comparatively lesser side effects. Their preemptive use is promising. Other approaches such as LLLT have aroused researchers'' attention.     

The relationship between personality traits,pain perception and attitude toward orthodontic treatment

Objective:To investigate the relationship between personality traits and a person''s attitude toward orthodontic treatment and perception of pain during orthodontic treatment.Materials and Methods:The sample consisted of two groups: group 1 consisted of 200 untreated subjects (100 males, 100 females; average age, 21.50 ± 3.35 years), and group 2 consisted of 200 treated subjects (100 males, 100 females; average age, 20.92 ± 2.48 years). The instrument for data collection was a questionnaire that included assessment of patients'' personality profiles, pain expectation for untreated subjects, pain experience for treated subjects, and attitudes toward orthodontic treatment.Results:Gender, treatment status, and personality traits did not affect subjects'' average attitude toward orthodontic treatment, whereas gender was the only variable that affected subjects'' average pain perception (P < .01). The average attitude score in subjects who experienced pain during orthodontic treatment was 5.06 ± 1.43, compared to 4.32 ± 1.35 for subjects who did not experience pain (P < .001). The average pain perception scores in treated subjects with previous knowledge of orthodontic treatment was 5.29 ± 1.94, compared to 6.07 ± 1.95 in subjects who did not have previous knowledge of orthodontic treatment (P < .01).Conclusions:Personality traits did not affect attitude toward orthodontic treatment and pain perception/experience during orthodontic treatment. A more positive attitude was found in patients who experienced less pain during orthodontic treatment.     

Quantity and quality assessment of randomized controlled trials on orthodontic practice in PubMed

Objective:To find current high-quality evidence for orthodontic practice within a reasonable time, we tested the performance of a PubMed search.Materials and Methods:PubMed was searched using publication type randomized controlled trial and medical subject heading term “orthodontics” for articles published between 2003 and 2007. The PubMed search results were compared with those from a hand search of four orthodontic journals to determine the sensitivity of PubMed search. We evaluated the precision of the PubMed search result and assessed the quality of individual randomized controlled trials using the Jadad scale.Results:Sensitivity and precision were 97.46% and 58.12%, respectively. In PubMed, of the 277 articles retrieved, 161 (58.12%) were randomized controlled trials on orthodontic practice, and 115 of the 161 articles (71.42%) were published in four orthodontic journals: American Journal of Orthodontics and Dentofacial Orthopedics, The Angle Orthodontist, the European Journal of Orthodontics, and the Journal of Orthodontics. Assessment by the Jadad scale revealed 60 high-quality randomized controlled trials on orthodontic practice, of which 45 (75%) were published in these four journals.Conclusion:PubMed is a highly desirable search engine for evidence-based orthodontic practice. To stay current and get high-quality evidence, it is reasonable to look through four orthodontic journals: American Journal of Orthodontics and Dentofacial Orthopedics, The Angle Orthodontist, the European Journal of Orthodontics, and the Journal of Orthodontics.     

Comparison of personality traits,attitude toward orthodontic treatment,and pain perception and experience before and after orthodontic treatment

Objective:To compare personality traits, attitude toward orthodontic treatment, and pain perception and experience before and after orthodontic treatment.Materials and Methods:One hundred subjects (50 male and 50 female) were included in this study. The mean (SD) age was 17.5 (2.05) years at T1 and 19.15 (2.32) years at T2. The instruments for data collection were questionnaires that included assessment of patients'' personality traits, attitudes toward orthodontic treatment, and pain perception/experience. Subjects completed the questionnaires at two different times: before orthodontic treatment (T1) and after fixed orthodontic treatment (T2). Subjects were treated by fixed orthodontic appliances for an average (SD) period of 18.64 (0.35) months. Paired sample t-test and chi-square test were used to detect any differences.Results:Significant changes in personality traits were detected after orthodontic treatment irrespective of gender. Neuroticism, openness, agreeableness, and conscientiousness scores were improved (P < .001). A positive attitude toward orthodontic treatment was reported at T1 (4.31 [±1.26]) and improved at T2 (3.98 [±1.16]) irrespective of gender (P < .05). The average (SD) expected pain score (T1) was 4.73 (1.88) and the average (SD) experienced pain score (T2) was 4.63 (1.58). Significant difference in the expected and experienced pain scores was not detected (P  =  .11).Conclusions:Personality traits and attitude toward orthodontic treatment improved after orthodontic treatment. Reported actual pain experience during orthodontic treatment was similar to that expected before treatment.     

Primary dysmenorrhea is potentially predictive for initial orthodontic pain in female patients

Objective: To investigate the relationship between primary dysmenorrhea (PD) and orthodontic pain in female patients, and to test the hypothesis that the intensity and duration of orthodontic pain could be roughly predicted by severity of PD.Materials and Methods:One hundred twenty college females were enrolled and put into one of three groups—mild (Mi), moderate (Mo), or severe (S)—according to level of menstrual pain. Intensity of the orthodontic pain was measured by visual analog scale (VAS) on days 1, 2, 4, 7, 14, and 28 after archwire placement.Results:As the intensity of orthodontic pain declined with time, the three groups demonstrated different changes during the initial week. Mi had the lowest VAS scores, whereas S possessed the highest scores. In contrast, Mo stayed in between. Significantly positive correlations were found between the severity of PD and the intensity of orthodontic pain at each time point within the first 2 weeks. In addition, though the majority of subjects reported disappearance of pain by the end of the second week in both Mi and Mo, a large proportion of females still perceived pain in S.Conclusion:Females with higher levels of menstrual pain tended to perceive orthodontic pain with higher intensity and more prolonged duration. Thus, PD could potentially serve as a reference to predict orthodontic pain in clinical settings.     

Comparison Between Removable and Fixed Devices for Nonskeletal Anterior Crossbite Correction in Children and Adolescents: A Systematic Review

ObjectiveTo compare removable and fixed orthodontic devices in the correction of non-skeletal anterior crossbite in children and adolescents in the mixed dentition.Materials and methodsElectronic searches were conducted in the following databases: PubMed, Web of Science, Scopus, Medline Ovid, Lilacs, US Clinical Trials, and Proquest. A hand search of the reference lists of the included articles and a Google Scholar search were also conducted. References were evaluated by 2 review authors. Articles that met the eligibility criteria were included. Data extraction, methodological quality assessment (Cochrane tool), and strength of the evidence evaluation (GRADE) were also carried out.ResultsSeven articles were included. The results showed that removable and fixed devices were equally efficacious for overjet correction. Removable and fixed devices can also present inconveniences regarding pain and discomfort levels, the accomplishment of everyday activities (leisure and school), and the performance of functions, such as chewing and speech. However, treatment time and costs were significantly lower in orthodontic therapy with fixed appliances. Sequence generation, allocation concealment, and complete outcome data were not a concern. Blinding of participants or personnel was not reported in any article, and blinding of the assessor was a concern in 2 articles. Selective reporting was a concern in 2 articles. The certainty of the evidence for overjet correction was very low.ConclusionRemovable and fixed orthodontic devices are efficacious for overjet correction in non-skeletal anterior crossbite. However, treatment time and costs are lower for cases treated with fixed devices.     

Quantitative and qualitative analyses of orthodontic-related videos on YouTube

ObjectivesTo investigate content of orthodontic-related videos on YouTube to improve the understanding of orthodontic patients'' perceptions and treatment experiences.Materials and MethodsA systematic search was conducted on YouTube on March 20, 2018, and updated on August 4, 2019, to identify all relevant videos using search terms “orthodontic,” “orthodontics,” “braces,” and “orthodontic braces.” The data set was captured from YouTube Data API (Application Programming Interface) and stored in an Excel database using a query function written in Python. All videos captured were viewed and categorized by three independent dental investigators using thematic analysis. The top 100 videos (by view count) related to patients'' treatment experience were further analyzed using discourse analysis.ResultsA total of 600 orthodontic videos were screened, and 546 were included in the study. Six main themes were identified: (1) individual review of orthodontic treatment (45.8%, n = 250), (2) entertainment (19.8%, n = 108), (3) education (18.3%, n = 100), (4) advertisements (6.6%, n = 36), (5) time lapse of orthodontic treatment (5.3%, n = 29), and (6) do-it-yourself orthodontics (4.2%, n = 23). Of the top 100 videos related to patient''s individual review of treatment, patients'' main focuses were on pain (24%), problems with chewing and swallowing (12%), and adhesive removal (10%).ConclusionsOrthodontic-related YouTube videos are diverse in nature. The most common video category was video providing an individual review of orthodontic treatment experience. Other popular video categories included entertainment, education, and advertisements. A range of do-it-yourself YouTube videos were also identified. YouTube may provide an opportunity for orthodontic professionals to disseminate health information.     

Surfing for mouth guards: assessing quality of online information

Abstract – Introduction: The Internet is an easily accessible and commonly used source of health‐related information, but evaluations of the quality of this information within the dental trauma field are still lacking. Aim: The aims of this study are (i) to present the most current scientific knowledge regarding mouth guards used in sport activities, (ii) to suggest a scoring system to evaluate the quality of information pertaining to mouth guard protection related to World Wide Web sites and (iii) to employ this scoring system when seeking reliable mouth guard–related websites. Materials and methods: First, an Internet search using the keywords ‘athletic injuries/prevention and control’ and ‘mouth protector’ or ‘mouth guards’ in English was performed on PubMed, Cochrane, SvedMed+ and Web of Science to identify scientific knowledge about mouth guards. Second, an Internet search using the keywords ‘consumer health information Internet’, ‘Internet information public health’ and ‘web usage‐seeking behaviour’ was performed on PubMed and Web of Science to obtain scientific articles seeking to evaluate the quality of health information on the Web. Based on the articles found in the second search, two scoring systems were selected. Then, an Internet search using the keywords ‘mouth protector’, ‘mouth guards’ and ‘gum shields’ in English was performed on the search engines Google, MSN and Yahoo. The websites selected were evaluated for reliability and accuracy. Results: Of the 223 websites retrieved, 39 were designated valid and evaluated. Nine sites scored 22 or higher. The mean total score of the 39 websites was 14.2. Fourteen websites scored higher than the mean total score, and 25 websites scored less. The highest total score, presented by a Public Institution Web site (Health Canada), was 31 from a maximum possible score of 34, and the lowest score was 0. Conclusion: This study shows that there is a high amount of information about mouth guards on the Internet but that the quality of this information varies. It should be the responsibility of health care professionals to suggest and provide reliable Internet URL addresses to patients. In addition, an appropriate search terminology and search strategy should be made available to persons who want to search beyond the recommended sites.     

Variation of orthodontic treatment decision-making based on dental model type: A systematic review

Objective:To determine in which clinical scenarios digital models are valid as replacements for plaster models during orthodontic treatment decision-making process and treatment planning.Materials and Methods:An attempt to identify all pertinent published information was made. Retained articles were those where a decision-making process leading to differential orthodontic treatment plans based on either method were compared. The search was tailored for PubMed and adapted for EMBASE, MEDLINE, the Cochrane Library, LILACS, and Web of Science. A partial grey literature search was conducted through Google Scholar. References lists of the included articles were screened for potential relevant studies. The methodology of selected studies was evaluated using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS).Results:Only two studies were finally selected for the qualitative and quantitative synthesis. QUADAS results scores from selected studies ranged from 61% to 83% of 11 items evaluated. In one, the overall treatment plan regarding orthognathic surgery for Class II malocclusion changed in 13% to 22% of the cases. In the other one, 6% of the orthodontic treatment plans changed.Conclusion:Digital models could be used to replace plaster models in Class II malocclusion treatment planning.     

Lingual orthodontic treatment: A YouTube™ video analysis

Objectives:The aim of this study was to examine the quality of information offered for patients seeking information on lingual orthodontic treatment.Materials and Methods:YouTube™ was searched for videos about lingual orthodontic treatment using the key word “lingual braces” from the Google Trends application. One hundred and four videos were selected to be analyzed from the first 120 results. The video content was evaluated using a 10-point score, which was used for classifying low- and high-content video groups. The video information and quality index (VIQI) was applied to determine the quality of the videos. The Mann-Whitney U-test, Chi-square test, and logistic regression analysis were used, and the Pearson correlation coefficient was calculated for statistical evaluations.Results:We classified 32 videos as high-content and 72 as low-content. Most videos were uploaded by laypeople (58.7%, n = 61). Definition of lingual braces and psychological impact were the most commonly discussed topics (51.0%), followed by speech performance (47.1%), pain (44.2%), tongue soreness (37.5%), and biomechanics (14.4%). Compared to the low-content group, the high-content video group had a significantly higher mean number of views (19,867.41 vs 6720.08, P = .002) and more “likes” (135.88 vs 13.01, P < .001), “dislikes” (4.34 vs 0.81, P < .001), and “comments” (26.28 vs 5.31, P = .002). There was no difference in the total VIQI score between the groups (P = .009).Conclusions:The content of YouTube™ videos for lingual orthodontics was generally incomplete. Most videos mentioned psychological effects, but few videos discussed the biomechanics or procedure. Orthodontists should be aware of the information available on YouTube™.     

Pain experience during initial alignment with three types of nickel-titanium archwires: A prospective clinical trial

Objective:To clinically evaluate the pain intensity during the week following initial placement of three different orthodontic aligning archwires.Materials and Methods:A consecutive sample of 75 patients requiring upper and lower fixed orthodontic appliances were alternately allocated into three different archwires (0.014-inch superelastic NiTi, 0.014-inch thermoelastic NiTi or 0.014-inch conventional NiTi). Assessments of pain/discomfort were made on a daily basis over the first 7-day period after bonding by means of visual analog scale and consumption of analgesics. The maximum pain score was recorded. The possible associations between age, gender, degree of crowding, and teeth irregularity and the pain intensity were also examined. Demographic and clinical differences between the three groups were compared with chi-square test or analysis of variance (ANOVA) test.Results:No statistically significant differences were found in the pain intensity when the three aligning NiTi archwires were compared (P  =  .63). No significant differences in pain perception were found in terms of gender, age, lower arch crowding, and incisor irregularity. The intake of analgesics was the least in the superelastic NiTi group.Conclusion:The three forms of NiTi wires were similar in terms of pain intensity during the initial aligning stage of orthodontic fixed appliance therapy. Gender, age, and the degree of crowding have no effect on the perceived discomfort experienced by patients undergoing fixed orthodontic treatment.