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Users voted on the posts related to the “treatment process” category and moved the posts to the list of top posts on the platform.
•
In the “question” thread, 47.79% of the posts asked for advice, 21.11% of them were related to failures and complications, and 11.85% of them were about retention appliances and relapse.
•
Overall, 69% of the replies were categorized as “useful.”
ABSTRACT
Backround
This study aimed to analyze the semantic network and content analyses of the posts published in a subreddit related to orthodontic treatment on Reddit (Advance Publications, Inc., San Francisco, California).
Methods
The eight threads in the r/Braces subreddit were divided into two categories: 1) “treatment process” (Braces are off!!!, Braces progress, Before and after!, and Day 1!) and 2) “question/problem” (Question, Discussion!, Need advice! and Rant!). For both categories, a semantic network analysis was performed using the Leximancer software (Leximancer Pty Ltd., Brisbane, Australia). In addition, the quality of the posts published in the “question” thread and the usefulness of the replies provided to these questions (useful, misleading, or neutral) were analyzed.
Results
Seven themes (braces, teeth, months, day, worth, started, and result) that mostly emphasized orthodontic treatment and treatment duration were elicited from the “treatment process” category, and seven themes (teeth, orthodontist, braces, week, bands, brush, and extractions) that mostly emphasized orthodontic treatment, orthodontists, and time were elicited from the “question/problem” category. It was also revealed that users voted on the posts related to the “treatment process” category and moved the posts to the list of top posts on the platform. In the “question” thread, 47.79% of the posts asked for advice and 21.11% of them were related to failures. In addition, 69% of the replies were categorized as “useful.”
Conclusions
Reddit is a successful data mining platform, and the users provide highly useful replies to the questions posted on Reddit regarding orthodontic treatment.
]. On written and visual social media platforms, patients can share their opinions about their treatment needs, processes, and experiences and can also ask for support regarding the problems they encounter [
Sharing experiences regarding orthodontic treatment on social media platforms can play a significant role in advancing other individuals’ understanding of the expectations, motivational factors, and problems of patients receiving or planning for such treatments [
]. Considering that these posts are shared by both patients and other individuals without feeling under pressure, the evaluation of these posts by other patients/individuals provides valuable information regarding the experiences of other patients [
]. Among these, Leximancer (Leximancer Pty Ltd, Brisbane, Australia) is a text mining program used for analyzing conceptual facts and employing word-like associations to extract themes from the text. Leximancer performs a text analysis that is particularly useful for large data sets, allowing visual representation of the data and determination of contextual relevance of words through word co-occurrences along with their location and frequency across the text [
]. Reddit diverges from other social media applications, as it is a discussion platform where users can express their thoughts on various topics of interest within the framework of certain rules with no word limit [
]. On the Reddit platform, which has a wide range of subject content, users follow the subtitles (subreddits) of the topics they are interested in and share or interact with the topics in these subreddits. Each subreddit is denoted by “r/…” (e.g., r/science) and is moderated by a moderator, and posts that are not allowed in the subreddit or that have deceptive information are moderated by the moderator. In addition age and sex of the authors were mostly anonymous on Reddit [
] in the literature, to the best of our knowledge, there has been no study examining the Reddit posts in the field of orthodontics. To that end, this study aimed to perform a qualitative and quantitative analysis of the posts shared in the /r/braces subreddit community on Reddit using Leximancer.
2. Methods and materials
The data analyzed in the mixed-methods study were retrieved from the posts of the /r/braces subreddit community on Reddit (Advance Publications, Inc., San Francisco, CA). No ethical approval was required, as the data were obtained from a publicly accessible platform.
2.1 Data collection
The r/braces subreddit community was created on May 8, 2010, and has approximately 27,000 followers, portraying itself as a group providing support for questions and discussions regarding orthodontic treatment. Owing to the wide scope of orthodontic treatment, eight main threads (Braces are off!!!, Before and after, Braces progress!, Day 1!, Discussion!, Need advice!, Rant!, and Question) have been created by the subreddit administrators in this subreddit, so that users can share their views in various threads.
To attain the data to be used in the study, a total of 1559 posts that were shared on Reddit regarding orthodontic treatment between January 2020 and January 2022 were retrieved, saved in MS Word files, and analyzed. These posts had been categorized into eight threads by the subreddit administrators: 1) Braces are off!!! (n = 226), 2) Before and after (n = 204), 3) Braces progress! (n = 176), 4) Day 1! (n = 156), 5) Discussion! (n = 180), 6) Need advice! (n = 248), 7) Rant! (n = 97), and 8) Question (n = 270). Subsequently, these threads were gathered under two categories based on their content:
1.
Treatment Process (posts related to the process of the orthodontic treatment): Braces are off!!!, Braces progress, Before and after! and Day 1!
2.
Question/Problem (posts in which users asked for help and also exchanged and/or discussed ideas, and shared their problems): Question, Discussion!, Need advice! and Rant!
Based on the votes cast by the users, the threads of the all-time top (One of the three tabs of the feed) 250 posts along with the numbers of their votes and the replies were also recorded.
2.2 Semantic network analysis
Semantic network analysis of the data was performed using the Leximancer software. Leximancer, which is used for visualizing the data, particularly in large data sets, can determine the relevance between/among words based on their positions, co-occurrences, and frequencies [
]. Leximancer performs both semantic and relational inference to interpret and visualize the data. In the semantic inference phase, data are scanned to identify concepts that are “collections of words that often travel together throughout the text.” For relational inference, the data are re-examined based on the concepts identified in the semantic inference phase. Statistics including the numbers of concepts, co-occurrences, and relative concepts are calculated, and a visualization or “concept map” is developed to visualize the concepts that have a high degree of association [
]. Concept maps were created to visualize the themes elicited from the posts (“treatment process” and “question/problem”) as well as the concepts underlying them and the relationships between/among the concepts.
2.3 Content analysis
Qualitative content analysis of the posts was performed only on the “question” thread to ensure standardization. Of these posts, the ones that were reached on January 20, 2022, and had been shared within the last 2 months were included in the analysis. In the initial examination, these posts were gathered under six main groups according to the topic they were most related to:
1.
Seeking advice and opinion: Posts asking for ideas or advice on any topic before or during orthodontic treatment (e.g., Is it too late to get braces at age 18? Will it change my face shape if I do?)
2.
Failures and complications: Posts asking for information and advice about failures related to intra-oral appliances or complications during orthodontic treatment (e.g., Metal end of braces has come loose!! Will my teeth start to move?)
3.
Retention-relapse: Posts asking for information/experience about retention-relapse after treatment (e.g., Do my retainers fit well?)
4.
Dissatisfaction with the treatment process: Posts asking for information/experience about other users’ satisfaction level regarding their orthodontic treatment (e.g., Braces-why is the front gap getting bigger?)
5.
Dissatisfaction with the outcome: Posts expressing dissatisfaction regarding clinical outcome based on the images attached to the post (e.g., My ortho says my braces should be done in a month… I don't though… I still have an occlusal cant)
6.
Other: Posts related to topics other than orthodontic treatment (e.g., Does anyone know what these black lumps [after tooth extraction] are? They don't hurt. The extraction site was stitched yesterday)
Of these groups, “seeking advice and opinion,” “failures and complications,” and “retention-relapse” were further divided into subgroups.
2.4 Seeking advice and opinion
1.
Limits of orthodontics (e.g., Does getting braces at the age of 20 affect facial growth?)
2.
Elastics (e.g., I got elastics for my over bite 3 days ago but now I'm confused as to why I have this pattern...why is it triangular?)
3.
Techniques (e.g., I am getting braces next year, my orthodontist told me to choose between self-ligating and traditional braces, she told me that both of them will take me to the same results, and the only difference will be the time, still don't know what to choose, any suggestions?),
4.
Eating-Drinking (e.g., Can I eat Oreo crumbles with braces?),
5.
Tooth extraction (e.g., Could lower jaw teeth extraction leave less room for the tongue and cause tongue bites?)
6.
Oral hygiene (e.g., Best Waterpik model for braces?)
7.
Cost (e.g., How much did your inbrace cost? What state?)
8.
Bite block (e.g., How to eat with bite blocks?? When is it going to stop being uncomfortable?)
9.
Palate expander (e.g., e.g. If you had a quad helix expander (palate expander without a key) how long did you have to wear it?)
10.
Other appliances (e.g., Temporary Anchorage Devices [TADs], Anyone got these, and what was your experience?)
11.
Treatment progress (e.g., 4 months in and no bottom braces yet?)
12.
Adult orthodontics (e.g., Do braces affect your dating life as an adult?),
13.
Self-intervention (e.g., Can I pull these off myself?)
2.5 Failures and complications
1.
Bracket failure (e.g., Broke my first bracket today. My next appointment is in 10 days. Should I call and let my orthodontist know? What can I do for now?)
2.
Staining (e.g., Will blueberries stain clear braces?)
3.
Pain (e.g., About to get braces any advice? How bad is the pain? Is it tolerable?)
4.
Intraoral injury (e.g., Got a little blood boil and it popped yesterday. Should I be worried? I have an appointment on Thursday for tightening, just wanna know what to expect.)
5.
Other appliances (e.g., Is it okay to leave archwire that came out of last bracket?)
6.
Other complications (e.g., Why are my gums puffy? My dentists also don't say anything about it could something fishy be going on? I asked and they said it's what happens when you don't floss.)
2.6 Retention-relapse
1.
Retention (e.g., How do I keep my retainers in after months of not wearing?)
2.
Relapse (e.g., Has anyone had teeth move post braces with a permanent retainer?)
The replies provided to the posts were evaluated as 1) useful (i.e., replies that contained useful information regarding orthodontic treatment or were in the best interest of the patients), 2) misleading (i.e., replies that contained inappropriate information regarding orthodontic treatment or involved risks for the progression of orthodontic treatment and/or the patients’ health), and 3) neutral (i.e., replies that did not contain any useful or misleading information regarding orthodontic treatment).
Qualitative content analysis of the posts was performed by a properly calibrated single orthodontic specialist (D.E.E). A total of 100 randomly selected posts were re-evaluated separately by two orthodontists (D.E.E. and M.A.Y.) 15 days after the initial evaluation.
2.7 Statistical analysis
Data were analyzed using SPSS for Windows version 22.0 (IBM Corp, Armonk, NY). Descriptives were expressed as mean, SD, and frequencies (n). Normal distribution of data was assessed using the Shapiro-Wilk test. Group means were compared using the Kruskal–Wallis test. Intra- and inter-rater reliability of the variables were calculated using the Cohen's kappa coefficient (κ). A P < 0.05 was considered significant.
3. Results
Intra- and interrater reliability values were 0.98 and 0.95, respectively. Figure 1 presents the concept map of the “treatment process” category and Table 1 presents the semantic network analysis results of this category, including the frequencies (i.e., hits) of the themes and their connectivity and representative examples. In this category, seven themes were elicited, including braces, teeth, months, day, worth, started, and result.
Figure 1Thematic cluster of the ‘treatment process’ category.
Figure 2 presents the concept map of the “question/problem” category and Table 2 presents the semantic network analysis results of this category. In this category as well, seven themes were elicited, including teeth, orthodontist, braces, week, bands, brush, and extractions.
Figure 2Thematic cluster of the ‘question/problem’ category.
Table 2Leximancer themes regarding “question/problem” and representative examples.
Theme
Connectivity
Hits
Example
Teeth
7005
970
After all its better not getting any teeth extracted. None, I just have some gap between my teeth that needed to be filled and my front tooth was slightly crooked so they didn't extract any tooth.
Orthodontist
4877
836
I wore my retainer pretty much at all times the first few months until my orthodontist told me to only wear it at night since October, and I wear it every night while I sleep. Is this normal, or do I need to talk with my orthodontist?
Braces
4832
1018
After putting braces for one month, my lips became very very dry and the skin keeps peeling off. And my throat feels dry too, like not enough saliva all the time.
Week
3165
477
Am getting RPE and headgear next week. Advice?
Bands
2433
339
The only time elastics hurt me was when I had to do double bands. I didn't really feel them the rest of the time, and I didn't really feel power bands either.
Brush
358
45
I've been living off of oatmeal and protein shakes. Does it eventually heal so you can sorta brush the appliance?
Extractions
158
52
After all its better not getting any teeth extracted. None, I just have some gap between my teeth that needed to be filled and my front tooth was slightly crooked so they didn't extract any tooth.
Table 3 presents the number of votes and replies for the top 250 posts. These posts mostly fell under the “Braces are off!!!” thread (n = 80) and the posts with the highest numbers of replies fell under the “Braces progress!” thread (mean 35.39 ± 38.89). All the 250 posts belonged to the “treatment process” category, and no significant difference was found among them with regard to the number of votes and replies (P < 0.05).
Table 4 presents the findings of the content analysis. Most of the posts (47.79%) fell under the group of “seeking advice and opinion,” followed by “failures and complications” (21.11%) and “retention-relapse” (11.85%). Moreover, 69.43% of the replies were categorized as “useful.” Most of the replies provided to the questions regarding “Limits of orthodontics” were “useful” (91.25%).
Table 4Content analysis of the posts in the “question” thread.
This study investigated the posts created by the users regarding orthodontic treatment in the r/braces subreddit community on Reddit, which is the 22nd most visited Web site worldwide and the seventh in the United States according to February 2022 statistics [
]. The results of the semantic network analysis showed that for the “treatment process” category, a triangular thematic cluster was created to summarize the effects of “braces” on “teeth” over “time” (Figure 1). Considered together, the posts in our study described a “journey” that focused on orthodontic treatment involving treatment initiation, duration and progress, smile, change in jaw closure, and finally removal of brackets. The connection between “happy” and “outcome” and the creation of a theme by the word “worth” showed that the users were highly satisfied with the treatment outcomes and expressed their satisfaction with positive feelings and statements on social media. Similarly, Graf et al. [
] analyzed orthodontic-related posts on Twitter and Instagram and reported that the initiation and completion of orthodontic treatment are frequently shared by users. Considering that social media is one of the most important factors for individuals to decide on orthodontic treatment, these posts were likely to encourage individuals reading these posts to apply for orthodontic treatment [
]. In line with our findings, there are studies showing that the sharing of experience among patients motivates patients, as they mention the achievement of excellent aesthetic outcomes and better occlusion at the end of the treatment [
Effect of social media in improving knowledge among patients having fixed appliance orthodontic treatment: a single-center randomized controlled trial.
For the question/problem category, the thematic cluster expectedly generated the themes including “teeth,” “orthodontist,” “braces,” and “week” and also visualized the problems arising during the orthodontic treatment (Figure 2). In addition, frequent co-occurrence of the word “orthodontist” with other words including “told,” “need,” “retainer,” and “wear” indicates that users frequently mentioned the retainers or other appliances recommended to patients by orthodontists. In addition, it was revealed that the concept formed by the word “teeth” was expressed by sharing the image of the front teeth or the experiences of biting along with the use of the words “smile” and “look.” However, the co-occurrence of the concept of “extraction” alongside the concept of “teeth” suggests that the users asked for opinions from other users regarding tooth extraction. However, it should be recognized that the recommendations provided by nonprofessionals regarding orthodontic treatment may mislead the treatment process or the candidates. Interestingly, it was revealed that the use of orthodontic elastics created a concept as large as that of other themes, which was consistent with the literature [
]. In addition, it was also revealed that users frequently raised questions or problems regarding elastics in their posts and also mentioned the possible difficulties of this experience, particularly as it was closely related to the words “bad” and “feel.” [
] Therefore, such posts may lead to bias in candidates of elastics. In line with our findings, the quality and reliability of the YouTube and TikTok videos about orthodontic treatment mechanics are mostly poor and can be misleading for patients [
]. The frequency of such posts could be reduced by encouraging orthodontists to instruct their patients on how to use elastics and on the possible difficulties they may experience.
Studies have shown that the increase in individuals’ knowledge about orthodontic treatment through posts published on social media has a positive effect on their motivation during their treatment [
Effect of social media in improving knowledge among patients having fixed appliance orthodontic treatment: a single-center randomized controlled trial.
]. In our study, all of the top 250 posts pertained to the “treatment process” main category, which suggests that the posts regarding the initiation, progress, and outcomes of the treatment received positive votes. Registered users of Reddit shared content including text posts, images, and videos, and other registered users replied to these posts, and their positive and negative votes determined the ranks of the posts [
]. Similarly, numerous studies reported that the emotions expressed by the patients on social media were more positive than negative, such as enthusiasm, self-confidence, pleasure, excitement about the aesthetic result, and excitement after braces removal [
] concluded that patients may take into account the opinions and experiences of other patients besides professional and evidence-based information. It was also revealed that a significant portion of the posts in this group was aimed to ask for other users’ opinions about the limits of orthodontics, elastics, techniques, and eating and drinking. In line with our findings, Graf et al. [
] showed that “Seeking Information” about orthodontics was one of the main themes in users’ posts on Twitter and Instagram. Sharing patients’ treatment experiences with a wider audience on social media may result in other patients attaining information about the basics, advantages, and risks of orthodontic treatment, and thus, their treatment processes are positively affected [
The second most common topic was related to the appliance failures and complications experienced during the treatment, with the most commonly mentioned complaints including bracket fractures, staining, pain, and soft tissue injuries. Meriç and Kılıç [
] also indicated that dietary recommendations and braces failures are two of the top five frequent categories on orthodontics-related TikTok Videos. Similarly, a Twitter study conducted by Noll et al. [
] reported that the most common complaints were related to pain, and another study indicated that the users frequently complained about eating, cleaning brackets and archwires, soft tissue wounds, and the use of elastics [
The third most common topic in our study was about retention appliances and relapse. Studies have shown that the posts related to retainers often mention pain, speech problems, aesthetic anxiety, odor and discoloration problems in removable retention appliances, difficulties in wearing these appliances during meals and the risk of losing them, and the difficulties in maintaining oral hygiene, particularly in fixed retainers [
]. In our study, the contributors of approximately 15% of the posts that probed questions were not satisfied with the treatment process or outcome and consulted about what to do. Similarly, it has been reported that in addition to positive articles about orthodontics on social media, there are expressions of antipathy, annoying things, reduced self-esteem, and impatience for the end of the treatment [
]. It is commonly known that patients’ satisfaction levels may be affected by the severity of the malocclusion at the beginning of the treatment or by the final outcome of the treatment [
]. It is also known that the relationship between the treatment outcome and the level of satisfaction depends primarily on the final appearance of the teeth after orthodontic treatment and secondly on the good communication among the orthodontist, staff, and patient [
]. Accordingly, it is recommendable that informing the patients about the process of orthodontic treatment in detail will also improve their satisfaction level during and after the treatment, as it will allow them to predict the possible outcomes of the treatment.
The use of social media for health-related reasons may not only provide benefits for the users but also have adverse effects on their treatment because of the spread of misinformation [
]. Therefore, there has been an increase in the number of studies evaluating the content in the field of health care on different social media platforms in recent years [
]. Our findings indicated that an average of four replies were provided to the posts published under the question thread, and interestingly, 70% of these replies were categorized as useful. In line with our findings, some other studies showed that patients prefer to share their experiences with individuals receiving orthodontic treatment on social media platforms such as forums and blogs, and it has been reported that it is easier for them to share their feelings on such platforms rather than to communicate with their orthodontists [
Effect of social media in improving knowledge among patients having fixed appliance orthodontic treatment: a single-center randomized controlled trial.
]. In addition, patients are in active communication with other internet users to exchange information and support with each other, and the helpful answers that patients can obtain in this way, particularly at times when they cannot reach their orthodontists, can be beneficial for orthodontists as well [
]. As consistent with the literature, the posts analyzed in our study indicated that the individuals with treatment experience were highly motivated and were willing to provide useful posts and replies.
] showed that patients often prefer clinicians who use social media actively. Meaningfully, it is commonly known that the information shared by clinicians on social media platforms regarding the problems commonly experienced by patients can contribute to the prevention of the problems to be experienced by other patients and/or candidates.
Our study was limited in several ways. First and foremost, as Reddit is an actively used platform, new posts are constantly published or the existing posts can be deleted; therefore, it is possible to obtain different results in studies to be conducted in different time periods. Second, the demographic profiles of the users could not be retrieved because the users did not disclose their age and sex on Reddit.
5. Conclusions
Our findings confirmed that Reddit is a data mining platform with a wide range of content, where users search for the processes, progress, and outcomes of orthodontic treatment as well as solutions to the problems encountered during the treatment. In addition, the following were also revealed:
1.
A substantial portion of the posts in the “question” thread was aimed to ask for other users’ opinions about the limits of orthodontics, elastics, techniques, and eating and drinking.
2.
Users provide highly useful replies to the questions posted on Reddit regarding orthodontic treatment.
3.
Informing the patients about the benefits and risks of the treatment throughout the treatment process may strengthen communication between the orthodontist and the patients.
References
Wang X
Shi J
Kong H.
Online health information seeking: a review and meta-analysis.
Effect of social media in improving knowledge among patients having fixed appliance orthodontic treatment: a single-center randomized controlled trial.
Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.
Competing interests: Authors have completed and submitted the ICMJE Form for Disclosure of potential conflicts of interest. None declared.
Provenance and peer review: Non-commissioned and externally peer reviewed.
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