Original Article

Does YouTube provide adequate information about orthodontic pain?

Ieva Tamošiūnaitėa; Arūnas Vasiliauskasb; Furkan Dindaroğluc

ABSTRACT
Objectives: To evaluate the content and quality of information about orthodontic pain on YouTube.

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Materials and Methods: YouTube was searched using the keywords ‘‘orthodontic pain’’ and
‘‘brace pain.’’ A total of 65 videos were chosen for the final analysis. Videos were classified into
high- and low-content groups using an eight-point scoring system and reviewed according to
selected orthodontic pain–related topics. Video quality was rated by the Video Information and
Quality Index (VIQI) and Global Quality Scale (GQS). Statistical data analysis was performed using
SPSS 28.0 software, Mann-Whitney U-tests, v2 tests, and Spearman correlation coefficients.
Results: Most YouTube videos related to orthodontic pain were low content (86.2%), and a few
were high content (13.8%). Pharmacological pain relief was the most prevalent topic (50.8%),
followed by duration of pain (32.3%) and influence of pain on patient quality of life (29.2%). The
least-mentioned topic was possible location of pain (7.7%). Most of the videos were uploaded by
laypeople (64.6%). Videos uploaded by dental professionals had significantly higher means of GQS
scores (P ¼ .035), flow of information (P , .001), information quality (P ¼ .008), and total VIQI (P ,
.001). Compared with low-content, high-content videos had a higher mean of flow of information (P
¼ .037). There was a weak correlation between total content and GQS scores and a strong
correlation between GQS and VIQI scores (r ¼ 0.740; P , .01).
Conclusions: Overall, YouTube was found to be an inadequate source of information on
orthodontic pain. (Angle Orthod. 2023;93:403–408.)
KEY WORDS: Orthodontic pain; Brace pain; YouTube; Social media; Internet

INTRODUCTION It is known that orthodontic tooth movements

produce tension and compression zones in periodontal
Orthodontic pain is one of the most common adverse
ligament space, which appears to be the main reason
effects of orthodontic treatment that, according to for pain.4 Initial orthodontic pain begins 2–12 hours
research, affects 90% of orthodontic patients. It can after the start of orthodontic treatment, peaks at 24
even be a reason for discontinuing treatment, with an hours, and starts to decrease after 3–7 days, returning
estimated 30% of patients considering stopping treat- to baseline levels in 1 month.3,5
ment prematurely as a result of the pain experienced.1 To relieve pain, the first thing a dentist may suggest
In addition, orthodontic pain is known to decrease is a pharmaceutical, such as acetaminophen or
patient health-related quality of life by impairing daily nonsteroidal anti-inflammatory drugs (NSAIDs); a small
life activities such as mastication and speech.2,3 number of studies also investigated the effect of local
anesthetics and opioids (tramadol).6 However, there is
a
Private Practice, Kaunas, Lithuania. a widely discussed controversy relating to NSAIDs and
b
Professor, Department of Orthodontics, Faculty of Odontol- their effect on tooth movement. It has been suggested
ogy, Medical Academy, Lithuanian University of Health Scienc-
that NSAIDs impair tooth movement by blocking
es, Kaunas, Lithuania.
c
Associate Professor, Department of Orthodontics, Faculty of prostaglandin synthesis.7 Nevertheless, more research
Dentistry, Ege University, Izmir, Turkey. on this topic is needed.8
Corresponding author: Ieva Tamošiūnaitė, Faculty of Odon- A range of nonpharmacological methods have also
tology, Medical Academy, Lithuanian University of Health been proposed recently. These include low-level laser
Sciences, A. Mickevičiaus g. 9, Kaunas 44307, Lithuania
(e-mail: ievatamosiunaite01@gmail.com) therapy, vibratory devices, chewing gum or bite wafers,
brain wave music, cognitive behavioral therapy, and
Accepted: December 2022. Submitted: July 2022.
Published Online: February 23, 2023 posttreatment communication in the form of a text
Ó 2023 by The EH Angle Education and Research Foundation, message. However, these methods lack high-quality
Inc. evidence to support their use for alleviating pain.9

DOI: 10.2319/072822-527.1 403 Angle Orthodontist, Vol 93, No 4, 2023

404 TAMOŠIŪNAITĖ, VASILIAUSKAS, DINDAROĞLU

Regarding the location of pain during orthodontic terms were used to broaden the search results: (1)
treatment, most of the studies suggest that most orthodontic pain and (2) bracket pain.
significant pain occurs in the incisor area, particularly For the YouTube (https://www.youtube.com/; Goo-
the lower incisors, both during the initial alignment and gle) video search, no filters or features were applied;
debond.10 It is known that the perceived level of pain videos were only sorted by relevance. ‘‘Incognito
can vary and is influenced by a variety of factors, such mode’’ was set to prevent previous search influence
as clinical, demographic, psychological, and genetic on new results. Search results were limited to the first
factors. However, there are still mixed opinions on 200 videos. Videos titles were reviewed manually, and
which factors have the greatest impact.11 those that were related to orthodontic pain were
By reviewing various studies, it was concluded that included in the further selection.

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elevated anxiety and fear levels, low motivation for During the video screening, the following exclusion
treatment, and low activity temperament are associat- criteria were applied: (1) not related to orthodontic pain,
ed with an increased level of pain.12 It was also (2) language not English, (3) advertisement, (4) longer
suggested that giving a patient a sense of control of a than 15 minutes, (5) no audio, and (6) duplicate. After
situation can make a positive influence on the sense of application of the exclusion criteria, 65 videos were
pain. It can be achieved not only by direct control of included in the final qualitative and content analysis.
dentist’s actions but also by providing information on The video playlist was created to be stored for later
treatment. analysis.
Social media is used widely among dental stu- The following data were extracted from videos: days
dents,13 practicing clinicians, and orthodontic pa- since upload, duration (in minutes), number of likes,
tients.14 In one survey, nearly 90% of students from and number of views. The viewing rate was calculated
health-related academic backgrounds stated that info- according to the study by Hassona et al.19
graphics on social media have a greater appeal The source of videos was categorized into the
compared with written articles because it is easier to following two groups: dental professionals (dentists,
navigate through complex science in a visual way.15 specialists, hospitals, universities, and private offices
YouTube, the second most used social media platform were included in this group) and laypeople (bloggers
worldwide16 with 122 million active daily users,17 also and social media influencers). Video content was
allows access to a great variety of medical information, evaluated for the following topics: (1) duration of pain,
including orthodontics. However, because YouTube is (2) start and end of pain, (3) pharmacological pain relief
a publicly open source and everyone can upload (medication), (4) instructions for medications and
content, information can often be misleading or adverse effects, (5) possible location of pain, (6) pain
incorrect.18 Therefore, it is wise to take a deeper look intensity, (7) possible factors influencing level of pain,
into what kind of information is being disseminated. In and (8) quality of life. Coverage of each separate topic
the literature, there is an increasing number of studies was scored as one point for a total of eight points.
analyzing social media; however, no studies were High-content videos were those that scored four or
found relating to the information about orthodontic pain more points, and low-content videos were those that
on YouTube. scored fewer than four points.
Audiovisual quality of videos was assessed using
MATERIALS AND METHODS the Video Information and Quality Index (VIQI), a five-
point Likert scale that uses the following four topics to
This study was a cross-sectional evaluation of
examine videos and gives a score from one (poor
Internet-based video media and was exempted from
quality) to five (high quality): (1) flow of information, (2)
the approval of the ethics committee as it used only
accuracy of information, (3) quality (one point each for
public Internet data.
use of still images, animation, interview with individuals
On the Google (Mountain View, Calif) Trends
in the community, video captions, and a report
website (https://trends.google.com), a search was
summary), and (4) precision (level of coherence
conducted on November 15, 2021, to find the most
between video title and content).
frequently used search term for ‘‘orthodontic pain’’ with
The Global Quality Scale (GQS) was used to assess
the parameters ‘‘worldwide’’ and ‘‘past 5 years.’’ Before
the educational quality of videos (Table 1).20
searching, computer history and cookies were deleted
to prevent any restrictions relating to user history.
Statistical Data Analysis
Keyword ideas were defined by using a related-queries
table. It was determined that the most used search Statistical evaluations were performed with SPSS
term for orthodontic pain was ‘‘orthodontic pain,’’ version 28.0.1.1 (IBM Corp., Armonk, N.Y.). To
followed by ‘‘bracket pain.’’ The following two search determine the normality of data distribution, the

Angle Orthodontist, Vol 93, No 4, 2023

ORTHODONTIC PAIN IN YOUTUBE 405

Table 1. Global Quality Scale

Score Description
1 Poor quality, poor flow of the video, most information
missing, not helpful for patients
2 Generally poor quality and poor flow, some information
listed but many important topics with limited use to
patients
3 Moderate quality, suboptimal flow, some important
information is adequately discussed, but other
information is poorly discussed, so somewhat useful
for patients
4 Good quality, generally good flow, most relevant

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information is covered, is useful for patients
5 Excellent quality and flow, very useful for patients

Shapiro-Wilk test was used. For the number of views,

days since upload, video duration, number of likes, and
viewing rate, descriptive statistics were acquired. To Figure 1. Flowchart. Initially, 4540 videos were obtained using the
analyze the differences between high- and low-content keywords ‘‘orthodontic pain’’ and ‘‘bracket pain.’’ The first 200 video
videos and different video uploader groups, Mann- titles were reviewed and, after the application of certain exclusion
Whitney U-tests were performed. Frequencies of criteria, 65 videos were chosen for final analysis.
ownership and contents were compared using v2 tests.
Possible correlations of total content were estimated demographics, including ownership and content, are
between GQS and VIQI scores and YouTube demo- reported in Table 3. The majority of videos were
graphics, and Spearman correlation coefficients were uploaded by laypeople (64.6%, n ¼ 42), and the
calculated. The statistical significance level was set at remaining videos were uploaded by dental profession-
P  .05. als (35.4%, n ¼ 23).
Comparing the number of mentioned topics, of 65
RESULTS videos, only 9 (13.8%) were in the high-content
The initial search using the terms ‘‘orthodontic pain’’ group, and 56 (86.2%) were in the low-content group.
and ‘‘bracket pain’’ returned a total of 4540 videos. The most covered topic was pharmacological pain
Titles of the first 200 videos were screened and, after relief (50.8%, n ¼ 33), followed by duration of pain
implementing the specific exclusion criteria, 135 videos (32.3%, n ¼ 21), quality of life (29.2%, n ¼ 19), start
were removed (Figure 1). A total of 65 videos were and end of the pain (27.7%, n ¼ 18), pain intensity
analyzed in this study. (26.2%; n ¼ 17), instructions for medications and
Descriptive statistics, containing the number of adverse effects (15.4%, n ¼ 10), and possible factors
views, likes, duration, and days since upload, are influencing the level of pain (9.2%, n ¼ 6). The least
displayed in Table 2. The most viewed and most liked covered topic was possible location of pain (7.7%, n
video was derived from a patient source. Other video ¼ 5).

Table 2. Descriptive Analysis of the YouTube Videosa

Variable Minimum Maximum Mean (SD) Median Total
Video characteristics
No. of views 74.00 6,384,716.00 232,312.11 (816,373.62) 19,871.00 15,100,287
No. of likes 0.00 37,000.00 2647.45 (6048.88) 227.00 172,084
Duration, min 0.39 14.54 6.38 (3.52) 5.39 428.11
D since upload 186.00 4726.00 1372.65 (1097.60) 1139.00 95,397
Viewing rate 9.39 243,598.47 15,358.98 (36,528.36) 1914.86 955,979
Total content score 0.00 5.00 2.09 (1.36) 2.00 129
GQS 1.00 5.00 2.88 (0.80) 3.00 183
VIQI content assessment
Flow 1.0 5.0 2.95 (1.05) 3.00 192
Information accuracy 2.0 5.0 4.11 (0.92) 4.00 267
Quality 0.0 4.0 1.74 (0.79) 2.00 113
Precision (coherence between title and content) 2.0 5.0 4.14 (0.92) 4.00 269
Total score 6.0 17.0 12.94 (2.26) 13.00 841
a
GQS indicates Global Quality Scale; SD, standard deviation; and VIQI, Video Information and Quality Index.

Angle Orthodontist, Vol 93, No 4, 2023

406 TAMOŠIŪNAITĖ, VASILIAUSKAS, DINDAROĞLU

Table 3. Distribution of YouTube Video Uploaders and Contents in High-Content and Low-Content Video Groups
High-Content Videos, n (%) Low-Content Videos, n (%) Total, N (%)
Ownership
Dental professionals 3 (13.0) 20 (87.0) 23 (35.4)
Laypeople 6 (14.3) 36 (85.7) 42 (64.6)
Total 9 (13.8) 56 (86.2) 65 (100.0)
Content
Duration of pain 5 (55.6) 16 (28.6) 21 (32.3)
Start and end of pain 6 (66.7) 12 (21.4) 18 (27.7)
Pharmacological pain relief 7 (77.8) 26 (46.4) 33 (50.8)
Instructions for medications, adverse effects 3 (33.3) 7 (12.5) 10 (15.4)
Possible location of pain 2 (22.2) 3 (5.4) 5 (7.7)

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Quality of life 7 (77.8) 12 (21.4) 19 (29.2)
Possible factors influencing level of pain 2 (22.2) 4 (7.1) 6 (9.2)
Pain intensity 7 (77.8) 10 (17.9) 17 (26.2)

Comparing video uploader groups, the laypeople Correlations between the total content score, GQS,
group had a significantly higher mean of video duration VIQI score, and video demographics are shown in
(8.23 minutes), whereas the dental professional group Table 5. Spearman correlation analysis showed a
videos were shorter (3.25 minutes) (P , .001) (Table weak correlation between total content and GQS score
4). In addition, there were differences in the GQS, flow (r ¼ 0.284; P ¼ .022). In addition, the Spearman
of information, information quality, and total VIQI score correlation indicated a strong correlation between GQS
and VIQI scores (r ¼ 0.740; P , .01).
(P ¼ .035, P , .001, P ¼ .008, and P , .001,
respectively) between the groups. The dental profes-
DISCUSSION
sional group had the highest means, whereas the
laypeople group scored the lowest. Comparing GQS, More patients are relying on social media for
the mean score for the dental professional group was information because of its easy accessibility. Dentists
3.13 (standard deviation [SD], 0.63), whereas the could direct patients to get additional guidance from
laypeople group scored 2.74 (SD, 0.86). The mean social media, but, before that, it is important to
research whether the information given online is
score of the flow of information in the dental profes-
accurate. All 65 videos included in the study were
sional group was 3.61 (SD, 0.78), whereas it was 2.59
viewed by a total of 15.1 million Internet users, which
(SD, 1.01) for the laypeople group. The mean of indicated that orthodontic pain is a topic of high
information quality in the dental professional group was interest.
2.13 (SD, 0.92) and 1.52 (SD, 0.63) in the laypeople The results of this study showed that YouTube is
group. The mean total VIQI score in the dental currently not an adequate source of information for
professional group was 14.26 (SD, 1.68), whereas orthodontic pain. This was consistent with other studies
the laypeople group scored 12.21 (SD, 2.23). that found that videos on YouTube were not sufficient

Table 4. Comparison of Variables Between Different Video Uploader Groupsa

Dental Professionals Laypeople
Variables Minimum Maximum Mean (SD) Median Minimum Maximum Mean (SD) Median P Value
Video characteristics
No. of views 121 1,459,444 157,355.4 (330,585.8) 5941 74 6,384,716 273,359.9 (988,340.7) 31,846.5 .115
Likes 0 6900 1410.30 (2225.81) 78 1 37,000 3324.93 (7288.86) 375.5 .073
Duration, min 0.39 8.21 3.25 (2.10) 2.3 2.36 14.54 8.23 (3.27) 7.52 ,.001*
D since upload 295 4726 1576.87 (1379.66) 984 186 4578 1260.81 (907.17) 1140.5 .826
Viewing rate 9.39 114,993 11,945.32 (24,857.97) 446.36 19.32 243,598.50 17,228.37 (41,727.21) 2004.66 .092
GQS 2 5 3.13 (0.63) 3 1 5 2.74 (0.86) 3 .035
Flow of information 2 5 3.61 (0.78) 4 1 5 2.59 (1.01) 2 ,.001*
Information accuracy 2 5 4.09 (0.90) 4 2 5 4.12 (0.94) 4 .815
Information quality 1 4 2.13 (0.92) 2 0 3 1.52 (0.63) 1.5 .008*
Precision (level of 3 5 4.44 (0.73) 5 2 5 3.98 (0.98) 4 .065
coherence between
video title and
content)
Total VIQI 12 17 14.26 (1.68) 14 6 17 12.21 (2.23) 12 ,.001*
a
GQS indicates Global Quality Scale; SD, standard deviation; and VIQI, Video Information and Quality Index.
* P value statistically significant if .05.

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ORTHODONTIC PAIN IN YOUTUBE 407

Table 5. Spearman Correlation Coefficient Scores Between Total Content Score, GQS, VIQI, and YouTube Demographicsa
Total Content GQS Total VIQI
Variable Correlation Coefficient P Value Correlation Coefficient P Value Correlation Coefficient P Value
Total content 1.000 – 0.284 .022* 0.239 .056
GQS 0.284 .022* 1.000 – 0.740 ,.001*
Total VIQI 0.239 .056 0.740 ,.001* 1.000 –
a
GQS indicates Global Quality Scale; and VIQI, Video Information and Quality Index.
* P value statistically significant if .05.

information sources for various dental topics.21–25 On mentioned this topic. Similar reasoning applies to

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the contrary, Wong et al.26 found that there was high- possible factors influencing the level of pain due to
quality content on YouTube regarding the topic of the mixed opinions regarding this topic in the literature.
botulinum toxin A for wrinkles. In addition, the fact that NSAIDs can slow the rate of
More videos (n ¼ 42) were produced by laypeople, orthodontic movement is still a controversial topic;
and fewer (n ¼ 23) were produced by dental therefore, adverse effects were less often discussed in
professionals. This could be explained by the fact that the videos. Currently, analgesics are widely used over-
orthodontic pain is an experience by patients. That is the-counter medications and are easily accessible for
why there may be more videos in which patients share purchase, usually without a prescription from a health
their knowledge rather than dentists explaining the professional. Because it is a commonly used product
subject. However, some studies suggested that videos and most of the patients have a general idea about its
containing information about patient experiences can dosage, it may validate the fact that there is no need for
be misleading and less educational.27,28 On the other explanation on how to use it. One survey showed that
hand, one study by Gas et al. showed that the video young adults are usually conscious about the instruc-
source did not affect the quality of video content.29 The tions of pain relievers, although there is still a small
current study found that dental professionals produced proportion who report taking medication inappropriate-
higher quality videos (had higher means of GQS [P ¼ ly.31
.035], flow of information [P , .001], information quality A weak correlation was found between total content
[P ¼ .008], and total VIQI [P , .001]).
and GQS score (r ¼ 0.284; P ¼ .022) as well as a strong
Regarding the duration, videos uploaded by indi-
correlation between GQS and VIQI scores (r ¼ 0.740; P
vidual users were significantly (P , .001) longer
, .001). This can be explained by the fact that videos
(mean, 8.23 minutes; median, 7.52 minutes) than
that contain higher amounts of accurate content and
those uploaded by dental professionals (mean, 3.25
auditory and visual components have a higher educa-
minutes; median, 2.3 minutes). Other studies also
tional value. Similar results were reported in the study
reported similar results.29 In addition, Lena et al. noted
by Sezici et al.23
that longer videos may have higher content.30 How-
ever, the current study did not find a significant This study investigated and compared metrics,
relationship between high-content scores and video trends, and quality of information about orthodontic
duration (P ¼ .842). A previous study added that pain on YouTube videos. These findings helped
viewers might lose interest in videos that are evaluate what kind of information reaches patients.
excessively long; therefore, it is important to keep However, analyzed videos were only in English,
video length appropriate.30 meaning that they reached only English-speaking
None of the extracted videos covered all the people. Another limitation inherent to this study is that
predetermined topics. The most prevalent contents YouTube is an extremely dynamic search engine, and
were pharmacological relief of pain, duration of pain, extracted data from videos may change quickly.
and possible effects on quality of life. The predomi- Variables such as days since upload, likes, or viewing
nance of these topics may be explained by the high rates shift quickly, and the results can be ever-
rate of laypeople as video uploaders because these changing. Also, data were analyzed only by the GQS
topics are highly related to patient experiences. and VIQI, and including other assessment tools could
The least mentioned topics were possible location of give more insight into other aspects of the results and a
pain, possible factors influencing the level of pain, and more comprehensive analysis. It is also worth noting
instructions for medications and adverse effects. that no information about the audience was collected,
Because the location of orthodontic pain can differ and it is not known what kind of patients these videos
from patient to patient and sometimes it is hard to reach. Thus, this could also be a potential area of
localize the exact place of it, a lower number of videos investigation in future studies.

Angle Orthodontist, Vol 93, No 4, 2023

408 TAMOŠIŪNAITĖ, VASILIAUSKAS, DINDAROĞLU

CONCLUSIONS 13. Uma E, Nieminen P, Mani SA, et al. Social media usage
among dental undergraduate students—a comparative
 The pharmacological treatment of pain was the most study. Healthcare (Basel). 2021;9(11):1408.
common topic of YouTube videos regarding ortho- 14. Siddiqui N, Chia M, Sharif MO. Social media and orthodontics:
dontic pain, whereas the possible location of pain are our patients scrolling? J Orthod. 2022;49(2):179–184.
was a relatively rarely mentioned topic. 15. Lee SH, Pandya RK, Hussain JS, et al. Perceptions of using
infographics for scientific communication on social media for
 The content of YouTube videos related to orthodontic
COVID-19 topics: a survey study. J Vis Commun Med. 2022;
pain was insufficient. Most of the videos lacked 45:(2)105–113.
information about orthodontic pain characteristics. 16. Kepios Pte Ltd. DataReportal. Global social media statistics.
 Dental professionals’ videos concerning orthodontic Available at: https://datareportal.com/social-media-users.
pain had higher educational and audiovisual quality Accessed February 8, 2022.

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17. Global Media Insight. YouTube user statistics 2022. https://
compared with those uploaded by laypeople.
www.globalmediainsight.com/blog/youtube-users-statistics/.
Available at: Accessed February 8, 2022.
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opadhye AK. Healthcare information on YouTube: a
This research received no specific grant from any funding systematic review. Health Informatics J. 2015;21:173–194.
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