TikTok talks teeth: a quantitative and qualitative analysis of fixed appliance related TikTok videos

Malocclusion, one of the three major oral health problems, has a prevalence ranging from 39% to 95% and affects individuals across a wide range of age groups.¹ Its impact on individuals extends beyond oral health and function as it also significantly affects mental health, social well-being, oral health-related quality of life, and dentofacial aesthetics. Orthodontic fixed appliances were introduced over a hundred years ago as a treatment modality for correcting malocclusions and have since gained significant publicity.

The rise of social media and the internet has seen an increase in videos containing orthodontic content. Social media platforms such as TikTok, Facebook, and Instagram are information dissemination and communication powerhouses, with millions of users engaging daily. These have become indispensable tools in modern-day society and TikTok, in particular, stands out as one of the fastest-growing ‘apps’, surpassing previous social media platforms related to user numbers and usage intensity. TikTok’s content is strictly in video form, with an average length of just 32.4 sec.² Information is conveniently shareable, packaged as entertainment, and consumable within minutes.

The healthcare sector, including patients, caregivers, and healthcare professionals, has widely adopted the use of social media. Studies have reported its benefits for patient empowerment, health promotion activities, health surveillance, and the improvement of healthcare quality.³ However, others shed light on the dangers of misinformation displayed on social media.⁴

To date, few studies have addressed the impact of social media and the information available to orthodontic patients. Several studies have focused on evaluating the reliability, quality, or content of social media information^3,4. These evaluations often involved either a single measure or a combination of two measures, while other information related to uploader status (professional or layperson) has been noted. However, most previous research has concentrated on assessing other social media platforms such as YouTube, Twitter, and Instagram. Additionally, topics related to orthodontics, identified as pain, orthodontic retention, appliances, and clear aligners have been similarly studied.^3,5–9 Furthermore, earlier studies have revealed that orthodontic-related information found on various social media platforms lacks quality, reliability, and content. The reliability of videos previously assessed was found to be low-grade or generally poor. The overall quality of the content ranged from average to moderate, while the content itself was described as low and often insufficient.^3,5,7–9

The aim of the present study was to analyse the content, reliability, and quality of TikTok videos related to orthodontic fixed appliances (braces).

The data collection process involved accessing TikTok via the website http://www.tiktok.com/ in January 2021. In order to ensure the absence of pre-existing data bias in the algorithmic feed, a new TikTok account was created.¹⁰ The research strategy involved employing TikTok’s search function to identify hashtags associated with fixed appliances. Three prominent hashtags, namely #braces, #bracestips, and #braceface, were identified because they were found to be searched frequently on the topic of orthodontics by using the Google Trends application. For each of the selected hashtags, a total of 50 videos featured in the ‘Top’ tab were systematically extracted. This sample size was selected based on prior studies.^5,11

The research team systematically reviewed the videos to ensure relevance and adherence to inclusion criteria. Videos duplicated, not in the English language, lacking substantial content, and containing advertisements were excluded. Ethical approval was not deemed necessary, as the study exclusively analysed publicly available data.

All pertinent information pertaining to the selected videos was filtered by a sole researcher (L.Z.) on January 17, 2023. This dataset encompassed details regarding the identity of the uploaders (professional or layperson, verified or not verified), the quantitative characteristics (likes, views, comments, days since upload and lengths), the video content attributes, and the assessment of video quality and reliability. To facilitate systematic data management, a Microsoft Excel worksheet was employed.

To evaluate the quality, reliability, and content of the videos, three established tools were applied, which included a Modified DISCERN tool, the Global Quality Scale (GQS), and a content score. The modified DISCERN, originally designed to assess the reliability of healthcare-related information, was adapted for video content evaluation and has been widely used for examining the quality of healthcare-related videos.^12–14 It consists of five “yes/ no” questions, with each “yes” response scoring one point. The maximum score attainable is five, indicating excellent reliability, while the minimum score is zero, indicating poor reliability.

GQS is a five-point Likert scale used to measure the overall quality, flow, and ease of use of videos.¹⁵ Videos were rated on a scale from 1 (poor) to 5 (excellent). A 9-point content scoring system was developed to assess the depth and breadth of the information conveyed within the video content. The original idea was adapted from previous similar studies.^9,16,17 It contained nine domains associated with fixed appliances: (1) The process of putting on/ removing braces; (2) Before and after treatment; (3) Components of braces—arch wire, ligatures, rings; (4) Tips for others; (5) Negative impacts of braces; (6) Eating with braces; (7) Changing wires/ligatures; (8) How to clean teeth with braces on; and (9) Broken braces.

Each point was allocated to videos containing specific domains. The maximum score achievable in this case was nine, while the minimum score was zero. Based on the score, videos were categorised into low (0 to 2 points), medium (3 to 6 points), and high (7 to 9 points) content.

Discourse analysis was employed to assess the key messages in all of the videos which were represented in the form of a word cloud by transcribing the spoken language as well as the words that appeared on the screen.

The TikTok videos were classified according to the criteria shown in Figure 1. Of a total of 150 videos (available from the corresponding authors upon request, Appendix 1), 14 were excluded while the remaining 136 videos were included for the qualitative and quantitative analyses. Of these 136 videos, 73 (53.7%) were posted by laypersons, and the remaining 63 videos were posted by dental professionals (46.3%).

Figure 1.

The videos were categorised into three groups (educational, experiential, and humorous) based on their contents. The majority (87.3%) of the videos posted by dental professionals were about education and helpful tips on braces, information about the components of braces, and the negative aspects of orthodontic treatment. In contrast, videos posted by laypersons mostly shared their personal experiences (69.9%). The most popular content involved comparing appearances before and after treatment, followed by personal negative experiences.

As of the data collection date (17 January 2023), the videos had been viewed a total of 455,403,698 times by TikTok users. A summary of video characteristics (available from the corresponding authors upon request, Appendix 1), the content scores, DISCERN scores, and the GQS are summarised in Table I.

The mean DISCERN score was 2.18 (out of 3, 95% CI: 2.03 - 2.33), and the mean GQS score was 2.36 (out of 5, 95% CI: 2.14 - 2.58). According to the GQS scale, 37 (27.21%) of the total number of videos were of high quality, 16 (11.76%) were of moderate quality, and 83 (61.03%) were of poor quality. For content, the mean score was 1.31 (out of 4, 95% CI: 1.16 - 1.46).

The differences in the popularity (followers, views, likes, comments), video length, and days since uploads (Table II), as well as the content score, DISCERN, and GQS scores (Table III) for videos posted by laypersons and dental professionals are summarised in Tables II and III. Videos uploaded by professionals had higher DISCERN, GQS, and content scores than those posted by laypersons. The mean DISCERN score for videos uploaded by professionals was 2.71 (95% CI: 2.57–2.86), while the corresponding DISCERN score for videos uploaded by laypersons was 1.73 (95% CI: 1.53–1.93). The association between the three scoring methods is indicated in Figure 2. A strong correlation between the GQS and DISCERN scores is indicated through an analysis of the Spearman coefficient which was 0.77.

Figure 2.

A WordCloud (Figure 3) was generated to visualise the high-frequency words that appeared in the video content. The most frequently appeared words were “braces,” “teeth,” “wire,” “colour,” and “food.”

Figure 3.

The rise and evolution of social media in the last decade has changed the way people interact and learn¹⁸. This can be beneficial for healthcare practitioners, students and patients. The rapid sharing of information made possible by social media allows for more efficient communication between healthcare students and their lecturers.¹⁸ Within the profession, healthcare providers benefit from using social media as a means of professional development, allowing networking, the exchange of knowledge and problem solving with peers online.^18,19 Most relevant to the present study may be the impact on patients viewing orthodontic information on social media. The current findings suggest that the quality of orthodontic videos on TikTok is generally poor; professional videos had relatively better content (with room for improvement) than those from lay persons; and it is recommended that users seek professional advice for reference. A guideline should be considered to ensure the dissemination of accurate orthodontic information.

TikTok is a fast-growing social media platform, with over 2 billion downloads globally and an extensive user base. Therefore, the platform has the ability to achieve widespread dissemination of orthodontic information. The benefits of social media becoming so accessible is that patients have more autonomy and can become more involved with their care.²⁰ This may be accomplished through the sharing of experiences with others who may be undergoing or, have a particular interest in treatment. As they are able to actively discuss with others, patients become more engaged in their care²⁰ and, in addition, are able to supplement knowledge provided by the orthodontist.²¹ Due to TikTok’s ability to reach many, it could be an important instrument for the distribution of healthcare material. However, it is easy for unreliable information to be disseminated due to the nature of social media as anyone with an account can share explanations and advice regarding health conditions and treatments.

As of the study completion date (January 17, 2023), no published studies have focused on evaluating the informational value and bias of videos related to braces on TikTok. Previous studies have predominately explored the quality of orthodontic-related videos on various social platforms including YouTube and Instagram.^22–24 The remaining studies on TikTok have primarily focused on analysing information related to orthodontics as a whole, as well as the informational analysis of Invisalign and oral health education videos for orthodontic patients.^9,25 Few papers have analysed Tik Tok content qualitatively. The present study adds new information to the current evidence; however, limitations exist in which TikTok content cannot be amended by professionals and therefore users have unconditional power to select the more appealing videos in which information is possibly biased and based on personal experience.

The DISCERN tool has been widely utilised to determine the reliability of healthcare information, with a modified version used for information distributed in video form.^13,17,26 The overall mean modified DISCERN score found from the present study was 2.18 of the maximum score of 5, indicating poor reliability. This score was higher for videos made by dental professionals with a mean score of 2.71 compared to 1.73 for laypersons.

The quality of videos was assessed using the Global Quality Scale (GQS), which utilises a 5-point scale to evaluate a video’s usefulness and its flow to the audience.¹⁴ The mean GQS score for the present study was 2.36, indicating poor video quality. Notably, videos created by dental professionals demonstrated a higher mean GQS score of 3.24 compared with 1.60 for laypersons, suggesting improved quality. The current study also revealed strong positive correlations between the GQS scores and DISCERN scores. It is worth noting that almost all of the aforementioned studies recorded that the quality of orthodontic-related videos on TikTok was poor, which aligns with the present findings. Only one overall orthodontic-related study considered that the quality of videos was moderate.^3,5,27 Furthermore, the positive correlations observed between GQS and DISCERN scores, as well as the higher GQS scores associated with videos uploaded by dental professionals compared to those by laypersons, are consistent with the findings of other studies.^6,9 Videos found on the TikTok platform are generally of limited use to patients and may be an inadequate source of quality orthodontic information.

In the present study, a 9-point content scoring system was used to comprehensively assess the depth and breadth of information related to orthodontic fixed appliances in TikTok videos. This content scoring system was adapted from previous studies analysing healthcare information and enabled the classification of videos according to three different levels: low-content, medium-content, and high-content.^17,28 The average score of the content rating system was 1.30, meaning that the video quality was, on average, of low-content. This is similar to the results of previous studies conducted across multiple platforms, all of which were all of low-content.^9,17,28,29 It is worth noting that 63.53% of the low-content videos were provided by laypersons, with the content consisting mainly of ‘Before and after treatment’, ‘Components of braces’, ‘Negative impacts of braces’, and ‘Tips for others’. This suggests that these videos are of limited use to viewers seeking reliable information. This side-steps the importance of identifying the source and reliability of orthodontic information on TikTok and the need to improve the quality of the content.

The quality and reliability of content regarding fixed appliances on TikTok vary, and a large percentage of videos are produced by laypersons with no formal education in orthodontics. Therefore, although a sense of community can be created on social media through ‘experience’ videos, educational videos should require regulation. Furthermore, orthodontic treatment is a complex process that requires careful and long-term planning to tailor to an individual’s unique dental needs. The short video format (15–180 sec) of TikTok videos may hinder content creators from presenting detailed explanations, leading to over-simplification or misinformation. This could misguide viewers, affect their attitude towards orthodontic treatment and could even lead to uninformed decisions and discouragement from necessary procedures. Therefore, it is imperative that educational videos on TikTok strike a balance between concise but informative and accurate content. This is especially important as the age demographic of most orthodontic patients corresponds with the main user demographic on TikTok (10–29 years).¹⁷ A study conducted by Siddiqui et al. found that 73% of orthodontic patients would be willing to engage with social media in the future to support their treatment.³⁰

This study provides a baseline idea of the type of information shared about fixed appliances on TikTok, including the accuracy, educational value and overall impact. Further research could be done on how these videos have influenced the viewer’s opinion on orthodontics and, if they are in the age bracket, whether there has been a positive or negative effect on an individual’s desire to get braces. The present research could also delve deeper into the specific misinformation and gaps of knowledge of the orthodontic content on TikTok, and strategies to improve public education can be explored. The present study and those similar, can help in the development of guidelines to ensure the dissemination of accurate orthodontic and, more widely, oral health information and advice.

There were limitations in the study. Videos in languages other than English were not included, thus the findings may not be generalised to non-English speaking countries. The data collection was undertaken in a cross-sectional fashion, in which all videos were collected at a single point in time. This may not recognise the dynamic nature of social media in which published videos are often deleted after being uploaded.⁹ However, this percentage was considered low in the present study, and only 10 of the included 136 videos (7.35%) were unavailable 8 months after video collection. The cross-sectional data did not allow for a follow-up and so the present study is unable to explore how viewers may be influenced by the watched videos. It is therefore unknown whether this results in positive or negative concepts towards fixed appliances and, further, if it has influenced a patient’s decision to accept appliance treatment. A long-term analysis of orthodontic videos may be required to determine a consistent review.³¹ In the present study, three hashtags #braces, #bracetips and #braceface were analysed, resulting in a broad and representative set of videos. The use of a mixed methods approach resulted in a quantitative measure of the reliability, content and quality of data. In addition, there is a qualitative measure exploring language usage and general themes in the collected videos, and the lack of the inter- and intra- examiner reliability tests may affect the validity of the results of the present study.

The overall content, reliability, and quality of TikTok videos regarding orthodontic fixed appliances was poor. However, the three scores for videos uploaded by professionals were higher than those posted by laypersons. There was a strong correlation between the GQS and the DISCERN score noted in the present study.