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Abstract

Objective

To have an understanding of the fact how the popularity of “do it yourself” (DIY) videos available on YouTube correlate with authorship, content, quality, reliability, and how they appeal to and influence the customers.

Materials and Methods

A new YouTube account was created, this was followed by a determination of the most commonly used keywords regarding DIY aligners by using “Google Trends.” The keywords were used to search the YouTube website. A total of 112 videos were assessed for various parameters, such as completeness of the content, reliability using a modified version of the DISCERN tool, and quality using a Global Quality Score (GQS). Out of 112 videos, 26 were rejected based on their relevance, duplication, videos without audio, and video language. Pearson’s correlation coefficient was used to study the relationship between the variables, authorship, popularity, and recommendations.

Results

The majority of the videos were uploaded by the laypeople (43%), followed by DIY aligner companies (38%), and dentists and orthodontists (16%). The content for most of the videos was poor (82%), with DISCERN reliability score of zero (65%), and GQS of 1 and 2 (poor to generally poor quality). The view of uploaded videos, view rate, and likes was in proportion to the quality of the videos, their popularity, and reliability. Further authors with a financial interest and poor quality, content, and less reliability of the videos usually recommended the DIY aligners. The reduced cost was one of the important factors for the customers to consider DIY aligner treatment.

Conclusion

YouTube videos on DIY aligners should not be considered a reliable source for the public in general who are looking for orthodontic treatment for correction of their dentofacial irregularities. The dental professional bodies and orthodontists should use social media platforms (YouTube) to increase awareness about the DIY aligners among the public.

Keywords

Aligner DIY do it yourself YouTube

Introduction

Over the past 10 years, aligners have gained popularity among the youths in many countries worldwide because they do not compromise the esthetic during orthodontic treatment as seen with conventional orthodontic treatment.^{1, 2} Due to this massively gained popularity, various brands have introduced “do it yourself” (DIY) aligners, a clear appliance system that can be carried out without direct contact between the patient and the clinician.^{3, 4} Consumer usually receives aligners after scanning upper and lower teeth and adjacent structures done at their doorstep. Therefore, they never have to visit a dental clinic.

One of the reasons for the rise in popularity of DIY aligners could be the Covid pandemic.^{5, 6} Fear of getting infected has increased dental clinic phobia among the general population.⁷ The DIY aligner companies exploit this fear by providing aligner treatment directly at the consumer’s house. Anxious individuals might feel this more appealing due to avoidance of the clinical environment. Anyone with a mailbox and Internet connection can get the aligners at home. Moreover, like many self-marketing companies, DIY aligner companies do paid collaborations with “social media influencers.”⁸ These social media influencers are blindly trusted by the public as they feel more similarities between themselves and these influencers. An influencer can easily share information about aligners to their “followers” through platforms like YouTube and Instagram.^{8, 9} Patient experience and narrative videos on social media are also becoming very popular for sharing healthcare-related information. Research also shows that the experiences of others can strongly influence the decisions related to health care made by the consumers.^{10, 11} However, the major drawback of this information is that it is not peer-reviewed by experts and can be misleading. The video creator might be financially influenced by the sponsored company and can spread misleading information that can compromise the overall oral health of the consumer.^{8, 10, 12}

Traditionally, before starting the treatment, orthodontists discuss the benefits and phases of the orthodontic treatment along with the risks, such as root resorption, bone loss, gingival recession, and so on, with the patient to familiarize them with orthodontic treatment.¹³ When the patient is well informed about their individualized orthodontic treatment plan and its risks and benefits, cooperation with the treatment is always better.¹⁴ However, comprehensive individualized information is hardly shared with the patient by the DIY aligner companies. Harmonious esthetics and functional occlusion are the most important factors orthodontists always aim for and achieve.¹⁵ However, almost all the DIY companies focus majorly on the alignment of the teeth without much focus on esthetic harmony and functional occlusion.¹⁶ Thus, resulting unstable occlusion could result in many stomatognathic complications such as temporomandibular joint problems, improper mastication, relapse, and so on. Furthermore, in many circumstances, an accurate diagnosis of a certain situation is not possible without clinical examination, radiographs, and study models.¹⁷ Aligner treatment usually demands the placement of various attachments and composite buttons on the teeth for effective movements.¹⁸ However, this step is completely skipped in the DIY aligners as it does not require the consumer to visit the dental clinic. Several malocclusions require complex tooth movement, tooth extractions, skeletal base corrections, anchorage management, and interproximal reduction for establishing correct occlusion. However, these things are not possible with the DIY aligner systems.¹⁹ In developing countries like India, the cost of Invisalign is usually ₹1,50,000 to ₹3,00,000, whereas these DIY companies offer the aligner treatment in ₹55,000 to ₹70,000 or even at a lesser cost.^{20, 21} Thus, people further get attracted to DIY companies.

DIY aligners are a relatively new topic, and limited literature is available. Therefore, this study is conducted to determine the popularity, quality, and reliability of DIY aligner videos on YouTube in India. Also, to assess the appeal of DIY aligners to consumers, these results will provide information about consumer preferences and reasons for adapting DIY aligners.

Materials and Methods

The study was approved by the Institutional Ethics Committee of the All India Institute of Medical Sciences, Bhubaneswar, India (T/IM-NF/Dentistry/22/37). The methodology was similar to the study conducted by Collins et al.¹⁷ The authors conducted a study based on 123 videos. The Google Trends website was used to identify commonly used search agreements concerning DIY aligners that were subsequently used for a search of the YouTube site. Videos were evaluated for the fullness of content, dependability (using a DISCERN tool), and quality using Global Quality Score. The “incognito” window of Google Chrome was used to ensure no saved searched preferences.²⁰ A new YouTube account was created for the study. The most common keywords regarding DIY aligners were determined using “Google Trends.” The term “clear aligner” was entered into Google Trends. The search was limited to “India,” and “past 5 years.” The search terms relevant to aligners were “toothsi aligners,” “invisible aligners,” and “clear bee.” These keywords were used to stimulate YouTube search for information on YouTube.

Similar to previous studies, initial 60 videos were assessed against the exclusion criteria for each term.^{17, 21–23} The search filter was set at “sort by relevance,” a default filter in YouTube settings. Irrelevant videos, duplicate videos, videos without audios, and video language other than English and Hindi were excluded. Videos greater than 15 min duration were excluded as duration exceeds 15 min; they are unlikely to hold the viewer’s attention.²⁴ Videos were screened till June 12, 2022. A total of 112 videos were assessed, and 26 were excluded (Table 1). Therefore, 86 videos were included in the study for the assessment. All these videos were downloaded, and video variables such as likes, comments, views, and the number of days since upload were recorded.

Table 1.

Reasons for Excluding YouTube Videos on the DIY Aligners.

Reason for Exclusion	No. of Videos
Duplicate video	2
Video length >15	5
Not related to subject	2
Language not in Hindi/English	17

Data Collection

Authorship

Types of the author were recorded as layperson, DIY company, dental professionals, and news channels (Table 2). Along with the authorship, the financial interest was addressed for the sponsored videos, videos uploaded by DIY companies, and those who had mentioned links with discounts in their video descriptions.

Table 2.

Descriptive Statistics of Assessed the DIY YouTube Videos.

Variable	n Videos (Total 86)	Percentage
Author
Layperson	37	43%
DIY aligner company	33	38%
Dentist and orthodontist	14	16%
News channel	2	2%
Financial Interest
Yes	61	71%
No	23	27%
Unsure	2	2%
Global Quality Score
Score 1	38	44%
Score 2	33	38%
Score 3	8	9%
Score 4	7	8%
Score 5	0	0%
DISCERN Reliability Tool
Score 0	56	65%
Score 1	3	3%
Score 2	3	3%
Score 3	35	40%
Score 4	4	4%
Score 5	0	0%

Global Quality Scale

A Global Quality Scale (GQS) was used to determine the overall quality of the video. The videos were depicted with a score from 1 to 5.¹⁷ Videos with most of the missing information, with poor quality and poor flow, were given a score of 1. Score 2 was given for the videos in which some information was shared, and most of the information was missing. Score 3 was given to the videos which were helpful for patients in which some points were discussed, and some points were missing, with overall moderate quality of the video. Score 4 was given for the videos in which most of the points were discussed with overall good quality. A score of 5 was assigned to the excellent quality videos containing all the information and was very useful for the patients.

DISCERN Reliability Tool

DISCERN consisted of 5 “yes-no” questions to generate a likely score between 0 and 5. Score zero was depicted as unreliable, and 5 were the most reliable videos. Questions were as follow: (a) Is the aim clear and achieved? (b) Are reliable sources of info used? (c) Is the information presented balanced and unbiased? (d) Are additional sources of information listed for patient reference? (e) Are areas of uncertainty mentioned? A maximum score of 5 and a minimum score of 0 were assigned to the video. A score of 5 was considered as most reliable video, whereas a video that scored 0 was considered the most unreliable.

Popularity of Video

It was determined by calculating the number of views, number of likes, number of comments, and viewing rating. The number of dislikes on YouTube are hidden since November 2021. Therefore, not they are not taken into account.

Content Assessment

The content assessment was carried out according to the methodology given by Collins et al.¹⁷ Content assessment was carried out based on the following criteria—definition of DIY aligners, procedure, advantages, disadvantages, biomechanics, usage instructions, pain, oral hygiene, speech, soreness of soft tissues, treatment timing, and comparison of various orthodontic treatments. Videos that scored more than 8 were considered to be content-rich, and videos that scored less than 7 were considered content poor.

Statistical Analysis

Descriptive analyses were performed for each of the parameters. Subsequently, the comparison between the variables was performed using Pearson’s correlation coefficient to ascertain the significance of the relationship. A P value of ≤.05 was set to the level of significance.

Results

Authorship

The majority of the videos were created by laypersons (43%); on the contrary, DIY companies produced 38% of the videos. Dentists or orthodontists created 16% of videos. News channels represented only 2% of the videos (Table 2). The analysis also showed that the number of views (P < .001), likes (P < .001), and viewing rate (P < .001) were directly proportional to the number of subscribers. As the number of subscribers increased, the values of these parameters also increased (Table 3).

Table 3.

P Value of Pearson’s Correlation Coefficient.

Variables	Likes	Views	Subscribers	Viewing Rate	Content Score	Reliability Score	GQS Score
Likes	-	-	-	-	-	-
Views	<0.001***	-	-	-	-	-
Subscribers	<0.001***	<0.001***	-	-	-	-
Viewing rate	<0.001***	<0.001***	<0.001***	-	-	-
Content score	0.451^NS	<0.001***	<0.001***	0.004**	-	-
Reliability score	0.941^NS	0.076^NS	0.365^NS	0.161^NS	0.035*	-
GQS score	0.457^NS	0.133^NS	0.444^NS	0.183^NS	0.08^NS	0.34^NS	-

Note: NS, nonsignificant; *P < .05; **P < .01; ***P < .001.

Financial Interest

Most of the videos (71%) on the DIY aligners are sponsored or have a financial interest (Table 2). Twenty-seven percent of the authors did not have a financial interest. A greater number of sponsored videos have recommended the DIY aligners (93%). Seven percent of the sponsored videos had not directly recommended proceeding with the treatment. On the contrary, the majority (78%) of nonsponsored videos advised proceeding with caution. Twenty-two percent of the nonsponsored videos had suggested proceeding with the aligner treatment (Figure 1).

Figure 1.

Author Recommendation (% of Videos).

Global Quality Score and DISCERN Reliability Tool Score

Most of the videos had GQS scores of 1 (44%) and 2 (38%). DIY aligner companies recommended the majority of these videos. Only 8% of the videos had a score of 4. The videos by dentists and orthodontists scored 3 (9%) and 4 (8%), respectively. None of the videos had a score of 5.

The majority (65%) of the videos scored 0 for reliability using the DISCERN tool. Forty percent of the videos scored 3 (Table 2). These low-scoring videos majorly belong to DIY companies (Figure 2).

Figure 2.

DISCERN Reliability Score and Percentage of the DIY Aligner Videos.

Content Assessment

The most common content in the DIY aligner videos was regarding the procedure and review of the product (87%), therefore they were content-poor. The videos produced by dental professionals widely discussed the aligners, and they were content-rich (13%). There was a significant association between the content score and the reliability of the video (P = .035) (Table 3). The number of views, likes, subscribers, and viewing rate did not have a significant association with the reliability of the video (Table 4).

Table 4.

Descriptive Statistics of Content Assessment.

Content Assessment Variables	n Videos	Percentage
Definition of DIY clear aligners	2	2%
Procedure for DIY clear aligner therapy	76	88%
Usage instructions for DIY clear aligners	12	13%
Comparison of treatment options	25	29%
Biomechanics of aligner therapy	10	11%
Complications	4	4%
Cost of treatment	50	58%
Psychological aspect	1	1%
Treatment success	48	55%
Treatment time	72	83%
Content Assessment
Content poor (0-7)	78	90%
Content rich (8-15)	8	10%
Appeal of DIY Aligners
Reduced cost	27	31%
Ease of use	49	56%
Improved esthetic compared to conventional orthodontic treatment	33	38%
Doctor directed	10	11%
No contact with doctor’s office	32	37%

Discussion

With the increasing fame and popularity of online data-sharing websites, a vast community of Internet users upload and share information related to health care. A video-sharing platform like YouTube and Instagram allows users to explore this content online freely.²⁵ In the past few years, few companies in the United States and United Kingdom started offering aligners at consumers door steps without any involvement of an orthodontist/dentist.⁴ Alike this, some of the companies in India also started offering DIY aligners at the consumer’s doorstep. Usually, it starts with a kit containing impression materials, impression trays, and instruction manuals sent by the DIY company to the consumer. In some cases, companies usually send a technician with a 3D scanner to the consumer’s house to take a digital impression.^{4, 17} Then, after a few days, the consumer receives their DIY aligner at their houses, and that too at a fraction of the cost offered by orthodontics. This solution seems very much tempting to individuals who are anxious to visit the dental clinic and those who are searching for a cheaper alternative to the standard aligner treatment. In routine orthodontic treatment, patients are personally informed regarding the treatment duration, risks, advantages, and retention.¹³ However, companies might not make an adequate effort to deliver such information to their consumers. This can result in the overall compromise of the individual’s oral health. Therefore, the present study was conducted to determine the popularity, quality, and reliability of DIY aligners and appeal of the DIY aligner to consumers in YouTube videos in India.

The reason for an increase in acceptance of DIY aligners is the COVID-19 pandemic, as routine orthodontic care differed for a few months during the multiple waves of the pandemic. The movement of the population was restricted, and they were advised to stay in their homes. Also, the phobia of getting infected further limited the patients’ dental visits. The DIY companies had taken advantage of this and tackled the situation by giving in-home aligner care.^{5, 17}

In considering DIY aligners, most of the videos are uploaded by laypersons (43%) and DIY aligner companies (38%) compared to the videos uploaded by dentists and orthodontists (16%). This is in accordance with the study conducted by Collins et al.¹⁷ Usually, the popularity of a video (likes, comments, viewing rating) usually depends upon the number of subscribers (P < .001). Although the number of videos uploaded by dental professionals was less, the views on the videos gained more overall (17,20,864) than that uploaded by laypersons and DIY companies (12,09,836). This trend is similar to the previously published papers.^{11, 17, 26} In the present study, there was a significant (P = .035) correlation between the content and reliability scores. This shows that the videos which are better in the content have greater reliability. The videos produced by the dentist and orthodontist were of higher quality and considered more reliable. Therefore, informative video on aligners demands more content from professionals to spread awareness.

The popularity of the video creator regardless of the content in the video or whether the uploader is an expert or not. Likewise, laypersons are not professional dentists or orthodontists, still 93% of the authors have recommended the DIY aligners to the viewers. The reason could be a majority of the videos were created by the sponsored uploader or DIY companies.^{17, 27} Among the videos created by dental professionals, a majority (78%) of them are advised to proceed with caution. Also, it was observed that the videos with more GQS and DISCERN reliability tool scores are less likely to recommend the DIY aligners. This result is in agreement with the previous studies.¹⁷ The better knowledgeable the video creator, the less likely they would recommend the DIY aligners. Overall, 74.4% of videos were content poor. The most discussed criteria in the videos were procedure (87%). This is similar to previous work by Collins et al¹⁷ and Ustdal and Guney.²⁶

Many sponsored videos mentioned that the DIY aligner treatment is similar to that of the treatment offered by clinician-directed orthodontic treatment. Most of the videos focused on the alignment of the teeth and improved esthetic during the treatment over the traditional orthodontic treatment. Few videos have claimed that the treatment is completely painless. However, this is not the case. Pain is not uncommon during orthodontic tooth movement.²⁸ None of the videos have discussed the risks during the treatment, contraindications, and retention following the DIY aligner treatment. The treatment duration mentioned in many sponsored videos was 6 to 7 months. In reality, in the traditional orthodontic treatment, 6 to 7 months are invested in the leveling and alignment of the teeth.^{29, 30} This reduced duration of time can be appealing to many viewers.

In summary, consumers usually choose DIY aligner treatment due to the convenience and reduced cost. However, YouTube videos do not always provide valuable information.^{31, 32} Most of the videos shared on YouTube lack information regarding risks and complications. Therefore, YouTube doesn’t seem to be a trustworthy source at this time. Clinicians should be encouraged to post more videos on YouTube regarding DIY aligners to make general consumers well aware. The treatment provided by DIY aligners further needs to be researched by the clinicians.

Conclusion

Usually, DIY aligner companies target viewers who want a cheaper alternative to the standard clear aligner therapy. Most of the videos on DIY aligners are sponsored. The information shared in these sponsored videos lacks most of the critical aspects of orthodontic treatment. This could lead to the compromise of the oral health of the consumer. Therefore, YouTube should not be considered a valuable source of information regarding DIY aligners. On the contrary, the videos produced by clinicians are a more reliable source, and they are further encouraged to create more videos.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research,authorship,and/or publication of this article.

Ethical Approval

The study was approved by the Institutional Ethics Committee of the All India Institute of Medical Sciences,Bhubaneswar,India (T/IM-NF/Dentistry/22/37).

Funding

The authors received no financial support for the research,authorship,and/or publication of this article.

Informed Consent

The participant has consented to the submission of the article to the journal.

ORCID iD

Jitendra Sharan

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Dynamics of Social Media Popularity of “Do It Yourself” Orthodontic Aligners: A YouTube Case Study

Abstract

Objective

Materials and Methods

Results

Conclusion

Keywords

Introduction

Materials and Methods

Reasons for Excluding YouTube Videos on the DIY Aligners.

Data Collection

Authorship

Descriptive Statistics of Assessed the DIY YouTube Videos.

Global Quality Scale

DISCERN Reliability Tool

Popularity of Video

Content Assessment

Statistical Analysis

Results

Authorship

P Value of Pearson’s Correlation Coefficient.

Financial Interest

Author Recommendation (% of Videos).

Global Quality Score and DISCERN Reliability Tool Score

DISCERN Reliability Score and Percentage of the DIY Aligner Videos.

Content Assessment

Descriptive Statistics of Content Assessment.

Discussion

Conclusion

Footnotes

Declaration of Conflicting Interests

Ethical Approval

Funding

Informed Consent

ORCID iD

References