Quality of Information about Accelerated Orthodontics on Instagram

SUMMARY Background/Aim: Social media has become popular in recent years in dentistry. This study aims to evaluate the posts shared on Instagram related to accelerated orthodontic treatment. Material and Methods: The first 100 posts were selected for #acceleratedorthodontics and #speedbraces hashtags and analyzed. The type of posts, posts’ purpose, the source of posts, the number of likes and comments, the number of followers and followings of the users who uploaded the posts were recorded. Four posts in #speedbraces were irrelevant and the remaining 196 posts were evaluated. Results: The sources of the posts include 60 orthodontists, 20 dental pages, 9 dental clinics, 8 periodontologists, 3 surgeons in #acceleratedorthodontics hashtag. Also, 37 posts were preop-postopt, 34 of them were advertising, 14 of them were surgical information, 12 of them were professional information, and 3 of them were personal sharing in #acceleratedorthodontics hashtag. When the aims of the shares were evaluated, it was observed that 56 were for advertisement, 23 were for patient information, 7 were for entertainment, 6 were experience and 4 were preop-postop comparison in #speedbraces hashtag. Conclusions: The posts related to accelerated orthodontics on Instagram are insufficient in terms of the content. The patients should be guided to reach the correct sources of information by orthodontists.


Introduction
Social media platforms are becoming more commonly used in dentistry for multiple purposes, such as marketing, clinical education, and advertisement. Social media has become an indispensable tool for today's people, and 7 out of 10 Americans use social media for communication and entertainment purposes 1,2 . Instagram is strengthening its place in these social media platforms day by day. Instagram has more than 500 million active users and more than 50 billion posts in one day. McMullan stated that the role of patients in the virtual environment has evolved from passive receptor status to the active health information consumer. While the quality, accuracy, and reliability of the information that the patients receive from the virtual environment directly affect the patient, they also affect the health professional indirectly. This information pollution causes healthcare professionals to spend extra effort and time to correct this misinformation or unrealistic expectations they saw on social media and the Internet. The Internet has 3 application areas in the field of health; communication, community, content 3 .
Instagram is a free photo, and video application started in October 2010 4 . In terms of the number of users, the United States ranked first with 120.7 million and followed by India with 88 million, Brazil with 82 million, and Turkey with 39 million. 56.4% of the users are women, while the remaining 43.6% are men. Although the purpose of the use is mostly personal shares, advertising and informative purposes are increasing. It has been reported that Instagram has approximately 1 billion active users a month and 37% of American adults actively use Instagram 5 . information, and 3 of them were personal sharing ( Figure  2). 83 posts were in English, 9 were in Portuguese, 3 were in Arabic, 1 was in Turkish, Russian, Spanish and Greek.
The technology is developing day by day while the speed of production increases with it. This increase creates an expectation in all divisions in technology to achieve the result in a faster way. Patients receiving orthodontic treatment are often included in this group with a desire to shorten the treatment period. Fast and aesthetic methods used in orthodontic treatment attract the attention of patients. People search in the virtual environment in line with their expectations and search the words. They search for the words they determine according to their interests and desires with tags on Instagram.
There is a prior study in the literature evaluating the relationship between accelerated orthodontics and social media (YouTube™) 6 . This study aims to evaluate the posts shared on Instagram related to accelerated orthodontic treatment.

Material and Methods
The most searched keywords by people were determined through Google Trends (https://trends.google. com/) on June 15, 2020. This study was carried out based on mixed-method research methodology. The determined hashtags are: #acceleratedorthodontics and #speedbraces. The hashtags were searched on Instagram (https://www. instagram.com/) on June 20, 2020. The main posts were listed, and the total number of posts was recorded. The URL of the top 100 posts listed in the main list for both hashtags was saved on the Excel worksheet. The posts were examined by the same researcher (T.I.) in one day. The type of the top 100 posts listed (photo, video, text), number of likes, number of comments, date of share, source (orthodontist, periodontologist, patient etc.), purpose (advertisement, information, preop-postop etc.), language, gender and country of registration is registered. Irrelevant posts were excluded from the study. This study does not require ethics committee approval, since the study was performed publicly available data on the Internet.

Results
Determined hashtags; A total of 558 and 878 posts were found for #acceleratedorthodontics and #speedbraces, respectively. A total of 100 posts about #acceleratedorthodontics including 72 photos, 23 videos and 5 text were found. There was no irrelevant post under this hashtag. The sources of the posts include 60 orthodontists, 20 dental pages, 9 dental clinics, 8 periodontologists, 3 surgeons (Figure 1). Amongst the page owners, 56 were male and 15 were female. 37 posts were preop-postopt, 34 of them were advertising, 14 of them were surgical information, 12 of them were professional  When the sources of the shares were assessed it was observed that 59 orthodontists, 30 dental clinics, 7 of them are patients uploaded with #speedbraces hashtag (Figure 3). When the aims of the shares were evaluated, it was observed that 56 were for advertisement, 23 were for patient information, 7 were for entertainment, 6 were experience and 4 were preop-postop comparison in #speedbraces hashtag (Figure 4). Besides, 94 posts were in English, and 2 posts were in German.
Graf et al. 11 examined the relationship between social media and orthodontics in their study. They recorded and evaluated the posts shared by patients on Instagram and Twitter for a specified period. The patients generally shared their treatment plans and experiences as posts, and researchers categorized these posts as positive, negative, or neutral. Positive posts of the patients were related to the removal of brackets, and the negative posts were related to the pain and other problems. Since our study is evaluating Instagram posts about accelerated orthodontics, the study of Graf et al. is related to ours. In terms of orthodontic treatment, the interest of patients shifted to fast, painless, and easy treatment methods.
Meleo-Erwin et al. 12 evaluated 150 posts about #celiacdisease on Instagram. They found that the appreciation rate of 150 posts was 98.56. In addition, most of the posts (74%) are photos, followed by text (23.33%), video (2%) and both text and photos (0.67%).
Yang et al. 13 found that 45.1% of the posts they evaluated were educational, 28% were departmental, 11.7% were academic, and 9.1% were social shares in their study on the current status of Instagram usage in Oral and Maxillofacial Surgery Specialization Programs. They reported that 18.7% of oral and maxillofacial surgeons and 18.1% of orthodontists had Instagram accounts and the number of posts was 9 and 17.5, respectively.
The limitations of our study are the deletion and modification of posts in a highly active and dynamic platform like Instagram. Since Instagram does not support filtering, the first 100 posts were evaluated regardless of whether they are relevant or irrelevant.

Conclusions
Even though the total number of posts in the subject of #acceleratedorthodontics and #speedbraces, which are the keywords we have specified, is lower than expected, the posts should be placed carefully and correctly in order to prevent information pollution for patients. We concluded that posts related to accelerated orthodontics on Instagram are insufficient in terms of the content. We assert that our study will help to increase the benefits of the virtual environment in orthodontics and to evaluate the accuracy and reliability of the information.

Discussion
The time that people spend on the Internet is increasing exponentially every day. An analysis shows the number of Internet users was 4.57 billion last year, and it raised more than 7 percent since then. It can also be asserted that Internet has a significant effect on people's knowledge about health. Patients often tend to make a preliminary diagnosis by searching their symptoms without consulting to a doctor, dentist, or a specialist. They also often read articles about aesthetic treatments that do not require diagnosis and watch patient videos reviewing their experiences about a specific treatment. But it is hard to tell what percent of people pay attention to the quality, reliability and bibliography of the information [7][8][9] .
Social media covers most of the time people spend on the Internet. The average time spent on social media is 135 minutes every day. Social media users have increased by more than 8 percent since April 2019, reaching 3.81 billion today, and this number continues to grow. Instagram, which one of the most popular social media platforms, has more than 500 million daily users thanks to its accessibility. Accordingly, it is used by dental professionals and patients for different purposes. Dental professionals use Instragram mostly for advertising and patient information purposes. Nelson et al. 10 reported that 17.5% of orthodontists use Instagram while 30.3% of patients use Instagram.
Yavuz et al. 6 evaluated 80 videos in total based on their views on 'accelerated orthodontics' on YouTube™, which is another social media platform. They reported that dentists uploaded only 7.5% of the videos. Another criterion they consider is the purpose of the videos. 38 videos were uploaded for education, 16 for product information, 15 for procedure, 7 for patient experience, and 4 for patient information purposes. They concluded that YouTube™ is not a reliable platform in obtaining information for patients with accelerated orthodontics. They indicated that the clinician should recommend the videos that should be watched to their patients.