Social Media and Orthodontics

Information source

It is well documented that orthodontic patients use the Internet to access information regarding treatment,² however, regrettably, Internet content for a range of orthodontic topics is of variable quality.^3,4,5 The need to navigate this issue by finding novel ways that patients can access evidence-based information to support their decision-making has led to a number of useful ventures.^6,7 More work is, however, still needed.

As well as the wider Internet, there is some evidence that orthodontic patients also use social media as a means of seeking information about treatment.⁸ In this qualitative study, participants highlighted deficiencies in the information provided by clinicians about retainers, including their social impact and how they would appear to others. As a result, participants sought information from other sources, including social media and people with whom they shared close relationships, as a means of reassurance. This led to some participants searching for other people's experiences of orthodontic treatment using Twitter.

This clearly highlights a need for patients to relate to other people going through a similar experience. It echoes the findings of Bhamrah and colleagues,⁹ who reported that prospective orthognathic patients seek reassurance from those at a more advanced stage of treatment, via online discussion forums. Of course, the effect that this sharing of experiences by peers on social media may have upon patients can only be speculated, until hard evidence emerges.

One potential limitation of using social media as an information source is that posts may not be a true representation of patients' views,¹⁰ and that patients may be more likely to share their negative experiences than their positive ones.¹¹ The latter point could be a reflection of the fact that certain personalities are more likely to use social media to broadcast their views than others.¹² As a result, it may be beneficial to encourage patients to speak to close friends and relatives about their own experiences of orthodontics, in addition to providing professional advice.

Research tool

Patients' use of social media to comment on aspects of their treatment can also be potentially useful for research. Several studies have now investigated patients' experiences of various aspects of orthodontic treatment and appliances, using publicly accessible information from Twitter posts.^11,13

This approach offers a number of potential advantages. Firstly, young people, who represent the main orthodontic patient cohort in the UK, also constitute the highest proportion of Twitter users.¹⁴ It is therefore likely to be a relevant source of information for this group. Furthermore, seeking patients' views using social media posts removes the potential researcher-participant power imbalance associated with qualitative interviews and focus groups. Data are also likely to be contemporaneous, therefore reducing recall bias.

At present, however, this particular method is inappropriate for gaining an in-depth understanding of patients' experiences of treatment. For instance, using Twitter as a data source is limited by the researcher's inherent inability to identify relevant details regarding treatment and demographics, as this is dependent on the detail, and accuracy, of information shared by its users. As a result, it is difficult to analyse social media posts in an accurate context. This method is also likely to be affected by the manner in which individuals choose to portray themselves on social media. Finally, there is also an interesting ethical dilemma regarding consent for those users whose social media posts have later been included in a study. Despite this, it is likely that this vast source of data will prove to be useful for researchers in the future.

Blogs

One clear benefit from social media has been its role in education, both for healthcare professionals and patients. Various blogs have been used to great effect as a means of disseminating new research and highlighting contemporary professional issues.^15,16 Perhaps the biggest advantage of a blog is that the comments section can provide a platform to facilitate discussion amongst professionals about important topics in a timely manner, which cannot be readily achieved by other means outside of social media.

Facebook

Several Facebook groups, for both orthodontics and dentistry in general, have been used as platforms to discuss patient care and various other professional issues. These tend to be private; with entry usually obtained by providing evidence of GDC registration to a moderator. The potential for them to be dominated by more opinionated individuals, perhaps uninhibited by keyboard courage, combined with their largely unregulated nature, means that posts should be viewed with caution to avoid taking potentially false claims at face value.

Although completely against the ethos of such groups, it is important to realize that, even though access is restricted to healthcare professionals, posts could still potentially be screenshotted and shared elsewhere.

Patient education and support

There is some evidence that YouTube videos, in conjunction with standard information provision, leads to improved knowledge about fixed appliance treatment compared to standard information alone.¹⁷ Of course, knowledge alone does not necessarily lead to desired behavioural changes, but this is potentially useful for future developments, including orthodontic smartphone applications. The educational aspect of social media has been particularly useful during the Coronavirus pandemic as a means of demonstrating methods of resolving issues with broken appliances and thus minimizing direct clinical contact with patients.¹⁸

The authors' experiences during this time also suggests that video conferencing can play an important role in distance learning for junior colleagues when more conventional teaching methods are unavailable. Perhaps this can be developed further by university teaching programmes, drawing on lessons learnt during this time.

Closed Facebook groups can also be used to facilitate support amongst certain cohorts of patients, such as those born with a cleft lip and palate.¹⁹ Such groups enable parents to access information regarding key stages of the treatment pathway from trusted and relatable sources, as well as to provide an overall support network. This may be particularly useful in areas where there is a lack of funding for psychological support as part of a multidisciplinary team.

Regulations

Just as companies should avoid making false claims about their products, clinicians should be careful not to make misleading claims about themselves when advertising on social media. The General Dental Council (GDC) have produced guidelines on advertising, which extend to social media and the wider Internet.²⁰

It is good practice for clinicians to declare any conflict of interest when online, just as it would be before submitting a research article. GDC guidance states that, if clinicians endorse specific products, they must only make claims about them that can be verified by evidence. In addition, defamation law can apply to individuals posting content online, whether that is in a personal or a professional capacity. When using social media, it is also crucial to respect copyright issues and add a disclaimer if you have shared information from another source.

Costs

Unlike website development, most social media platforms have no start-up costs; however, if this is used in practice as part of an advertising campaign, consideration should be given as to who will be responsible for maintaining any social media presence, with up-to-date information, and whether that person needs additional training or support to do so. This work may involve responding to patient queries and reviews, as well producing new content.

Pitfalls

These largely centre around issues with the lack of regulation over the posting of online content, as well as who has access to it. Our online presence should reflect the fact that GDC standards extend to these platforms. If posting for advice about the best way of managing a specific patient, then confidentiality must be maintained by ensuring that his/her details remain anonymous. If any identifiable information is posted as part of a case-based discussion, then appropriate consent must be gained beforehand and General Data Protection Regulations followed.²¹

Whilst privacy settings can be amended to be as strict as possible, this is no guarantee that information can be completely protected. All staff should therefore understand the basics of observing professional behaviour online, including avoiding posting inappropriate content and ensuring that no disparaging comments are made about patients, staff or other professionals.²² In order to maintain appropriate professional working boundaries, the GDC also recommends clinicians to think carefully about accepting friend requests from patients.

Finally, given that we potentially have 24/7 access to the relative success stories in other people's professional and personal lives, often out of context with the mundanities of their real lives, the potential for social media to impact negatively upon mental health is perhaps unsurprising. This might be particularly relevant to people already suffering from mental health issues, which is considered to be greater in dentistry compared to other professions.

How to make social media work for you

Practice websites and social media are two of the most common marketing strategies used amongst orthodontic practices.²³ An online presence is therefore potentially significant for attracting new patients, who may search for prospective clinicians online.¹ It is also useful for engaging with existing patients. The following are some general tips for using social media for this purpose: