It it important that patients exploring dental topics are not being led astray by questionable information on websites. An interesting article titled “The reliability of online information regarding orthognathic surgery available to the public” written by Cobb and Scotton appears in the 2013 edition of Oral Surgery (vol. 6, pp. 56-60). The article discusses how the internet is increasingly being used to access health information and explores the reliability of information on websites regarding orthognathic surgery also known as corrective jaw surgery. The reliability of online information regarding wisdom teeth removal has been explored by this site before in the past, see the post Some New Wisdom Teeth and Dental Information Websites. The post discussed two websites that used to be accessible but have since been deleted that provided some questionable information on wisdom teeth. In addition a PhD Thesis titled “The Impact of Providing Patients with Internet Guidance on Clinical Decision-Making and Health Care Outcomes” written by Kamal Hanna in 2017, for the University of Adelaide in Australia, explored the quality and readability of online health information related to wisdom teeth.
The article by Cobb and Scotton discusses the health website accreditation organizations including the Health on the Net Foundation (HON) and the Utilization Review Accreditation Committee (URAC) which allow websites to display their logo if they meet their standards. Such accreditation of a website can allow for both physicians and patients to better quickly determine the possible accuracy of the information presented. Cobb and Scotton devised a study using 5 major search engines and entered in the keywords orthognathic surgery, jaw osteotomy, and surgical orthodontics. They then assessed the first 30 websites that came up for each keyword for each search engine and excluded some websites such as if they were duplicates or the links did not work to make up their final website study list of 138 websites. The authors collected basic information about each website including accessibility, target audience, accreditation, affiliation, owner, references, and author. They also rated each website on indications, surgical procedure, complications, postoperative healing, and long-term outcome using a rating scale of either 0, 1 or 2. A rating of 0 was given if the category for the website was not addressed and not in accordance with accepted U.K. practice patterns, a rating of 1 was given if the category for the website was address but was not in accordance with accepted U.K. practice patterns, and a rating of 2 was given if the category for the website was addressed and was in accordance with accepted U.K. practice patterns.
Cobb and Scotton found that only 2 of the 138 websites (1.4%) included in their study had any health website accreditation. They found that the owners of the websites were primarily surgeons/surgeon groups, with 34 of the 138 websites (23.8%), and dentists/dental groups were next with 26 of the 138 websites (18.2%). The authors of the websites were primarily oral and maxillofacial surgeons with 45 of the 138 websites (31.5%) and orthodontists with 34 of the 138 websites (23.8%). References were only provided on 38 of the 138 websites (26.6%) indicating a lack of transparency. The authors found that the two categories with the highest mean scores were indications (1.1) and surgical procedure (0.9). The two categories with the lowest mean scores were long-term outcomes (0.6) and complications (0.5). The authors performed multivariate analysis with logistic regression and found that target audience had the highest association with overall website quality followed by ownership. In addition, they found websites owned by surgical groups had the strongest association with overall website quality. When addressing why long-term outcomes and complications scored the lowest, the authors say this is because these topics were frequently unaddressed, and further state:
“This observation may be explained by the fact that almost half of the websites were run by commercially motivated surgical (24%) or dental (18%) groups.”
Cobb and Scotton go on to say that the overall quality of information on the websites they reviewed was poor. They feel that accreditation of websites could help but don’t have any firm ideas as to why about 99% of the websites related to orthognathic surgery they reviewed were not accredited. The authors state:
“The findings from this study suggest that information accessed by the public regarding orthognathic surgery is generally of poor quality and many critical aspects of the surgical process are often overlooked.”
The results from Cobb and Scotton are not surprising. In the past it has been discussed how a large amount of oral and maxillofacial surgeons have similar content on their websites since they are all being designed by the same company PBHS Inc., see http://www.teethremoval.com/oral_surgery_websites_similar_content_similar_sites.html. On the current website from the American Association of Oral and Maxillofacial Surgeons (AAOMS) discussing wisdom teeth management over at https://myoms.org/procedures/wisdom-teeth-management, there is a discussion of dry socket that can occur after wisdom teeth removal along with pain; however, other than that, no real mention of complications and long-term outcomes of wisdom teeth removal seems to be made.
Hanna conducted a study using 3 major search engines and entered in the keywords wisdom tooth removal, wisdom tooth extraction, and impacted wisdom tooth problems. They looked at the first fifty results in each search engine and after removing duplicates and low and medium relevancy sites, they ended up with 50 websites for their study. Hanna found that some of these websites recommended prophylactic removal of disease-free asymptomatic impacted wisdom teeth to prevent future problems even though there is a lack of current scientific evidence to support this. Hanna also found that some websites did not provide evidence-based information and as an example said that continuously applying ice packs after wisdom teeth surgery has not been shown in randomized controlled trials to have a significant difference on swelling, pain, and trismus (mouth opening). Hanna states:
“Clinicians have a responsibility to apply the current best evidence in the shared decision-making process to reach a decision that is ethical, and in the best interest of the patient.”
Hanna found that information varies significantly across websites and patients might not be able to identify high quality resources. Further a shortlist of websites with high quality information on wisdom teeth was identified. This shortlist appears to be
- Bupa.co.uk at https://www.bupa.co.uk/health-information/dental-oral-health/wisdom-teeth-removal
- Animated-teeth.com at https://www.animated-teeth.com/wisdom_teeth/t1_wisdom_tooth.htm
- Mayoclinic.org at https://www.mayoclinic.org/diseases-conditions/wisdom-teeth/diagnosis-treatment/drc-20373813
- NHS at https://www.nhs.uk/conditions/wisdom-tooth-removal/
- WebMD.com at https://www.webmd.com/oral-health/wisdom-teeth
Hanna seems to suggest that patients should be provided a shortlist of websites with information on wisdom teeth removal because they have trouble determining for themselves which websites have high quality information after performing search queries in search engines. In a study looking at 165 patients in Australia he found that internet use was not associated with having a better understanding of wisdom teeth.