August 21, 2017

Who provides the best orthodontic information on the internet: Dentists or specialists?

I have based this post on a new study that looked at the quality of orthodontic information on the internet.

We know that a high proportion of our patients spend time on the internet getting orthodontic information from various websites.  While they may find these sources useful, it is important to recognise that there are are no controls over the quality of this information. This means that there is potential for people to provide misinformation and make unsubstantiated claims. Furthermore, our professional ethical codes recommend that any material we post on websites is honest and truthful.  As a result, this study is timely and important.

A team based in East London, the Beautiful South of England, did this study.


Madahar Arun , Qureshi Usman & Ama Johal

Journal of Orthodontics, 44:2, 82-89, DOI: 10.1080/14653125.2017.1313546

They set out to look at the quality, accuracy, usability and readability of orthodontic information on the internet.

What did they do?

They did this study in several main stages.

  1. Firstly, they identified the most popular search terms used by the public in orthodontic searches.
  2. They used these terms to identify 544 websites
  3. Then they excluded discussion groups and scientific articles etc
  4. In this final stage, they analysed the websites using five validated assessment tools.

These were;

  • Discern:  This evaluates the quality of information about clinical choices.
  • LIDA: This looks at the accessibility, usability and reliability of the sites.
  • JAMA: These are benchmarks on the quality of authorship etc
  • HONseal: This focuses on the honesty of healthcare information
  • Flesch Reading score:  This is the readability rating.
What did they find?

They analysed a total of 119 websites and found the following:

  • The keywords “cosmetic braces” and ‘Fixed braces” accounted for 55% of the websites.
  • The most commonly appearing treatment modalities were conventional fixed, removable braces and Invisalign, this accounted for 50% of the “mentions”.
  • Orthodontists and general dentists published 71% of the sites.
  • The specialist orthodontists provided information on the more complicated treatment options. Whereas, general dentists mainly provided short term treatment options, for example, Six Month Smiles, Inman and other alignment methods.
  • Specialist orthodontists produced the highest quality websites in terms of general information, accuracy etc.  General practitioner’s sites were some of the lowest scoring sites.
  • The highest ranked websites did not correlate with the highest quality.
What did I think?

This was a paper that looked at an important question.  I am not an expert in the methods that they used but I thought that they looked reasonable. Importantly, they collected, and analysed the data in a systematic way.  I was a little confused by the use of the validated tools. For example, it was not clear how they measured the accuracy of the information.

Nevertheless, I thought that it was very interesting to find that there was a difference in the quality of the information between the websites of specialists and general practitioners.  When I thought about reasons for this finding, I tended to agree with a suggestion made by the authors. This was that general dentists provided and promoted simple alignment treatments and these methods have a limited evidence base.   Therefore, this reflects their quality and is an important finding. I think that this is particularly true when we consider some of the claims that are made for “speedy treatment” with “new” braces that are claimed to be much better than conventional ones.

When I started reading this paper I thought  I would see information on whether some of the websites made claims that were were misleading.  Unfortunately, I could not find any evidence of this in the paper.  I am aware of several websites that I feel “cross this line”.  I cannot help thinking that this is a big problem and we need to address this issue.

In summary, I think this was an interesting paper that provided an insight into the quality of websites. It was a good first step in identifying an important issue that must be relevant to both our patients and those who support advertising ethics.

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Have your say!

  1. Kevin. A lot of your work and comments are really insightful and useful – and you are to be commended on your dedication to furthering the aims and goals of your profession, but please allow that other people might just be right about many things and that you might just as well be wrong.

    I think that your comment below speaks volumes about your attitude where you pore over everything printed, on a witch-hunt for anything that does not accord with the way you see the world, and are so disappointed when you can’t find anything to criticize.

    “When I started reading this paper, I thought that I would see information on whether some of the websites made claims that were not honest and truthful and were misleading to patients. Unfortunately, I could not find any evidence of this in the paper. ”

    How cynical have you become?

    I personally am very leery of anything and anybody who claims any form of ‘quick fix’. In all the 60 years that I have been involved in human health, nobody has yet been able to persuade me that going against the natural function of the body is the right approach. I will grant that in emergencies and in trauma we have to intervene, but when acute interventions are used as long-term treatment, the few hairs I have left on my head stand up and curl.

    Omission of important side-effects and possible detrimental outcomes of any procedure is unconscionable. Perhaps I have missed the detail but I have not seen any ‘warnings’ by traditional orthodontists that the outcome of much of the ‘level and align’ process is temporary and that permanent retention has to be applied in order to prevent relapse. This is certainly stated after the event, and has become accepted as quite ‘normal’, by unsuspecting consumers.
    I don’t think it would be regarded as ‘normal’ if an orthopedic surgeon told a patient, after having a broken arm reset and splinted, that the cast would have to remain in place forever………….

    I am sure that as a Brit you are familiar with the old Rugby comment that “the spectator sees more of the game”. My 20 years of daily peripheral involvement in ‘orthodontics’ is but a drop in the ocean for you, and many of your readers/subscribers, but it is 100% of my ‘spectator experience’. Whilst I may not be a ‘specialist player’ I regularly see outcomes where perfectly symmetrical upper and lower ‘sixes’ have been ‘forced’ into asymmetrical faces, with an excellent ‘prom smile outcome’ (which relapses when retention is not used) but awful profile and airway outcomes.

    Not everything can be measured by a set standard – and this applies in even greater measure to the human body which is subtly different in every case. Who is to say that the ‘evidence based data’ that you demand is in fact correct? I have been around long enough to see that what I was taught as ‘mainstream and orthodox’ gave way to a ‘new orthodoxy’, which caused my education and learning to be deemed to be ‘alternative’, and now, 50 years later, the flaws are showing up in the ‘new orthodoxy’.

    Please consider that there is no ‘right way’ to do anything when it comes to addressing human health and dysfunction. There is only the most appropriate way for that specific person, and that might not accord with what is deemed to be “best practice” or “evidence based”. There is more than one form of evidence.

  2. And here we go again…yet another homily to the “pyramid of denial” and “alternative facts” fueled by unsubstantiable, ill-informed anecdote coupled with an appalling lack of knowledge on how orthodontic treatment (or science) works. When the evidence does not support one’s fervently-held beliefs, what does one do? Does one question the belief, or question the evidence ? What is fascinating is that the ones who vehemently disparage the science are also the ones who do nothing to provide any support for their perspectives. A legitimate critique is certainly desirable, but the ad hominem diatribes make it amply clear that those peddling “alternative facts” do not like their theories to be scrutinized.

    • Nobody knows anything for certain in orthodontics and dentistry . Most studies conclude further research required.
      If I hear that removing teeth causes no harm because there is no evidence , I feel that the scientific method is flawed. The evidence is the 4 teeth firstly !
      Secondly there is mountains of anecdotal evidence that completely contradicts the no evidence of damage argument. There is often further physiological damage post extraction with posture , airway, neck and back position , IF the mandible has been inadvertently retracted .
      Do you wish to be known as the practitioners who completely ignored this area of the specialty, because it wasn’t double blinded with an rct before they would even countenance it. That is VERY poor scientific method and a head in the sand attitude, given the severity of the suspected consequences.
      Is it not scientific to simply ignore this evidence. All around the world lots of dentists are noticing it. Damon dentists proliferate . It is not just a few loony’s.
      If you want RCT information before we make a decision NO ONE can go to work , because there are so many conflicting treatment planning approaches.
      I have posted on this very web site , And Kevin was kind enough to allow it up of Brendon Stack performing dental miracles .
      Just because no one has as yet double blinded his work with an RCT , it is very a poor scientific approach to ignore this as evidence .
      You cant cherry pick the evidence you like.
      It ALL counts .
      I was nearly crippled with inappropriate orthodontic retraction, un be-known to the well intention-ed practitioners at the time , but let me tell you, the reversal of those retraction mechanics 25 years later, restored my quality of life by removing the debilitating 3-4 splitting migraines a week I was getting.
      The alternative orthodontic camp saved my life, and the traditional retract approach in my case really physiologically hurt me.
      As a 28 yr experienced GDP who has practiced plenty of orthodontics and has performed both treatments AND received both treatments (extract and retract and expand till it pops philosophies) :-
      PLEASE keep an open mind.
      (Well Played Kevin for hosting the debate, and services to orthodontics. )

  3. Denial is not a river in Egypt. This apparent inability to acknowledge existing research is a very convenient and self-serving mechanism to continue to promote pseudo-science and cognitive bias. Despite all these fantastical and absurd claims, there is not a scintilla of credible scientific evidence to support airway, back, knee or heel problems caused by orthodontic treatment. The perspective adopted by proponents of this non-science is quite infantile, and really beggars belief – kind of like saying “There is a Unicorn living in my garage. Now, prove me wrong”.

    What these fringe practitioners fail to understand is that the Plural of Anecdote is not Data. Using questionable, unverifiable personal anecdotes and experiences to draw delusional conclusions about a scientific specialty would only sway the intellectually inept. There is simply no way to measure, evaluate or quantify anything that is being claimed. Keeping an open mind is great…just not so much that your brains fall out. Interestingly, what if someone had the exact opposite anecdote with equally fantastical, magical properties conferred after extractions – like the ability to fly or levitate? Should we believe that as well? After all, nobody knows anything for certain, and double blinded RCTs cannot be trusted….

  4. Dear Prof- I did my masters on the same topic with Martyn Cobourne back in the European Journal 2014 but a few years later websites are looking better and sharper and claims are on the increase – we found a number of problems with claims of curing TMJDS with ortho, advertising systems that had clearly gone into liquidation , a lot of manfacturers advertising with standard imaging and a lack of evidence based information. The usability of a practice website is based on cost, the dental web designer and understanding of marketing.
    General Dental websites are by far clearer and more marketable than specialist Ortho ones.
    DISCERN is the toolkit to look at when evaluating claims and evidence based info –
    There is a lack of communication between web designers and clinicians leading to false advertising ????

  5. Obviously its the specialist who provides accurate information on orthodontic treatment, whereas dentists merely provide much information on this topic since they do not have the same.

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