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Year : 2022  |  Volume : 12  |  Issue : 1  |  Page : 43-49

Are YouTube videos on regenerative endodontic procedure reliable source for patient edification?

1 Department of Dentistry, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
2 Private Practitioner, Nagpur, Maharashtra, India
3 Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, Maharashtra, India

Date of Submission30-May-2021
Date of Decision23-Jul-2021
Date of Acceptance26-Jul-2021
Date of Web Publication8-Jan-2022

Correspondence Address:
Ganesh R Jadhav
Department of Dentistry, AIIMS, Nagpur, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sej.sej_111_21

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Introduction: Regenerative endodontic procedure (REP), a biologically based procedure, designed to restore damaged structures such as dentin, root structure, and cells of the pulp-dentine complex. Patients have started using YouTube (YT) as a source of oral information. Hence, this study was planned to appraise the educational worth of REP videos available on YT.
Materials and Methods: YT search was conducted by means of the keyword “REP” which yielded 348 videos. Only 21 videos were complying with the inclusion criteria. REP-data quality score (DQS) was developed for rating the quality of these videos (0–20 points). Four-blinded evaluators reviewed and scored all videos according to REP-DQS. The global quality score (GQS) was used for the score validation. Reviewer's bias was addressed by intra-class correlation coefficient. Internal consistency of REP-DQS score was checked by Cronbach alpha.
Results: Test-retest reliability of both REP-DQS and GQS scores was good which is represented by high degree of conformity between all reviewers. GQS and REP-DQS scores were found to be having a positive linear correlation. REP-DQS was not found to be correlated with any of the video characteristics such as number of views, likes-dislikes, comments, and duration of video.
Conclusion: It is crucial that dental professionals acclimatize to the changing times of contemporary technology. It is the responsibility of dental professional to convey their patients about the shortcomings of YT videos with its judicious use to gain accurate information.

Keywords: Digital social media, global quality score, regenerative endodontic procedure, revascularization, YouTube

How to cite this article:
Jadhav GR, Mittal P, Bajaj NC, Banerjee S. Are YouTube videos on regenerative endodontic procedure reliable source for patient edification?. Saudi Endod J 2022;12:43-9

How to cite this URL:
Jadhav GR, Mittal P, Bajaj NC, Banerjee S. Are YouTube videos on regenerative endodontic procedure reliable source for patient edification?. Saudi Endod J [serial online] 2022 [cited 2022 Aug 11];12:43-9. Available from: https://www.saudiendodj.com/text.asp?2022/12/1/43/335229

  Introduction Top

Social media is a key player in the spreading of oral health-care-related information among the population to help them make learned choices about the dental treatment. YouTube (YT) is the second most popular video-streaming website accessed by patients after Google for health-related information.[1],[2] Initially, YT was created to offer entertainment videos; however, later, it was recognized to be an important educational tool for the population including students as well as professionals. YT is supposed to have around 2 billion logged-in users every month, viewers aged 18 years and above spend 41.9 min daily, and supplies around 1 billion hours of streaming per day to its clients.[3] Traditional method of accessing oral as well as general health-related information by direct consultation with health-care provider (HCP) has largely been replaced by online resources with ubiquitous Internet use and more so during the lockdown period.[4] More than 70% of people use Internet for this information irrespective of age, habit, and location.[5],[6] Such health-related information on YT is not peer-reviewed, and hence, patients might come across wrong and potentially confusing content.[7] Hence, various articles have analyzed the content of YT videos using a range of apposite discipline-specific search terms such as root canal treatment, instrument separation, dental implants, wisdom tooth surgery, and orthodontics.[8],[9],[10],[11],[12] These studies have shown that videos uploaded on YT have variable educational quality.[13]

Regenerative endodontic procedure (REP) is a biologically based procedures designed to replace damaged structures, including dentin and root structure as well as cells of the pulp-dentin complex.[14],[15] REP is a contemporary concept, and hence, it often provokes anxiety among the patients, which can act as a stimulus to search Internet for more information rather than contacting healthcare professionals. Profound YT dependence of patients impacts the patient-dentist rapport and it calls for the assessment of educational value of such content. To the best of our knowledge, no published study has evaluated the educational and informative quality of REP videos on YT. Therefore, the aim of this study was to assess the source and completeness of the content on the videos on REP streaming on the YT website for patients.

  Materials and Methods Top

YT search was performed on March 31, 2021, using the keyword “REP” to categorize all REP videos available since the commencement of YT website after getting institutional ethical approval (29/273/IEC/2021/1). Videos in English language, which lasted ≤15 min with good video quality (≥240 pixels), were included. Videos unrelated to Regenerative Endodontics, repeat videos, or without audio were excluded [Figure 1]. The characteristics and source of REP videos were analyzed. The characteristics of REP videos such as total number of views, dislikes-likes, and comments as well as its time span were analyzed. Moreover, video sources were categorized as HCP (specialist and general dentist), patient and/or patient's parents, company, media (news), and professional society [Figure 1].
Figure 1: Study design

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Various validated scoring systems have been used globally to assess the educational quality of such health-related videos such as usefulness scoring, global quality score (GQS), and Journal of the American Medical Association score.[16],[17],[18] In GQS, a single item with a 5-point Likert scale is used to rate the videos for their effectiveness as a quality assessment tool, as shown in [Table 1]. However, in GQS, all quality content of video is evaluated simultaneously.[19] Hence, a 13-item scoring system “REP-data quality score (DQS)” was created referring to commonly cited articles as well as position statement available on the European Society of Endodontology website.[20] It evaluated the quality of video based on the information provided under three different domains independently, and then, total score was calculated [Table 2]. The domains included informative, procedural, and patient related. Weight age was given to different items considering their relative importance. The final score ranges from 0 to 20 where increasing score indicated greater quality of video. To the best of author's knowledge, there was no such previously published scoring system. Hence, REP-DQS was sent to five senior endodontists with more than 15 years of experience in the field of regenerative endodontics. Face validity of the items and content validity of the domains used in the scale was ascertained by the subject experts using the qualitative technique. Modifications received from these experts were incorporated in the scoring system. Reliability assessment of both the scores was carried out. Interrater reliability as well as internal consistency was calculated using intra-class correlation coefficient (ICC) and Cronbach's alpha, respectively.
Table 1: Global quality score

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Table 2: Regenerative endodontic procedure data quality score

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Four-blinded endodontic reviewers who were not related to the manuscript agreed to score all the included videos according to GQS and REP-DQS. Few online sessions were conducted for reviewers to educate them to score videos accurately. All reviewers were asked to contact first author if any qualms arose during the entire review stage. Reviewers scored all videos independently without knowing scoring and comments of other reviewers. Average of all four reviewers' values for both the scores is taken as a final value. This study was exempted from clinical trial registry as no patient level intervention was done.

Statistical analysis

Microsoft Office Excel Sheet (v 2019, Microsoft Redmond Campus, Redmond, Washington, USA) was used for the data compilation. Statistical Package for the Social Sciences (v 26.0, IBM) software was used for the statistical analysis. Median (interquartile range [IQR]), frequency, and categorical data percentage are depicted. As both the REP-DQS and GQS scales were having a nonnormal distribution; correlation between them was measured using Spearman correlation coefficient. Their association was also displayed using a scatter plot. Association of REP-DQS and GQS scales with video characteristics (total views, dislikes-likes, comments, and video duration) was also assessed using Spearman correlation coefficient and presented in a correlation matrix. Median scores of REP-DQS and GQS were compared between different sources of videos [Table 3]. P < 0.05 was considered statistically significant.
Table 3: Quality of videos assessed through average regenerative endodontic procedure-data quality score and global quality score (n=21)

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  Results Top

“REP” keyword generated 348 videos and 327out of it were eliminated depending upon the inclusion and exclusion criteria. Twenty-one videos were qualified for the final analysis. REP videos showed a median of 1494 views, 39 likes, 0 dislikes, 0 comments, and duration of 4.25 min. The most common source of REP video upload was by specialist (38%). Video characteristics of the selected videos revealed that most of the videos were uploaded from India (28.6%) and USA (23.8%). Median (IQR) duration (in minute) of videos, number of views and likes were 4 (2–11), 1494 (553–12,757) and 39 (12.5–156), respectively. The median age of uploaded videos was 25 months (IQR: 7.5–39.5). Quality of videos as assessed using different items of REP-DQS and GQS scales is described in [Table 3].

Reliability of scales

Four different experts used this scale to assess quality of a set of videos. ICC was used for test-retest reliability and was found to be 0.917 (95% confidence interval [CI]: 0.79–0.97) for REP-DQS and 0.79 (95% CI 0.54–0.91 for GQS, respectively. Internal consistency of REP-DQS was also found to be acceptable (Cronbach's alpha = 0.71). As GQS was a single-item questionnaire, internal consistency was not applicable.

Association between regenerative endodontic procedure-data quality score and global quality score scales and video characteristics

GQS and REP-DQS scores were found to be having a strong positive correlation with each other (Spearman Correlation Coefficient-0.879 [P < 0.0001]) which is also reflected in their linear relationship [Figure 2]. Correlation between GQS and duration of video was found to be significant (correlation coefficient: 0.59 [P < 0.05]), although it was not found to be significantly correlated with other video characteristics (View, Like, Dislike, or Comment) [Table 4]. REP-DQS was not found to be correlated with any of the video characteristics. Among video characteristics, “Like” and “Dislikes” were found to be significantly correlated with “view” and “month since upload” but not correlated with “duration” and “comment.”
Figure 2: Scatter plot showing association between regenerative endodontic procedure-data quality score and global quality score

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Table 4: Correlation matrix showing association between quality of video (global quality score, regenerative endodontic procedure-data quality score), and video characteristics (view, like, and comment) (n=21)

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Association of regenerative endodontic procedure-data quality score and global quality score score with source of video

REP videos by HCP (Specialist and General Dentist) and Professional Society are having higher median REP-DQS scores (14 and 10, respectively) compared to those uploaded by company and media (5.5 and 0, respectively). Median GQS score was also higher in those uploaded by HCP compared to that of media (3.5 vs. 1.0). For other categories, difference in median GQS score differed marginally [Table 5].
Table 5: Distribution of the videos based on median global quality score and regenerative endodontic procedure-data quality score and source of video (n=21)

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  Discussion Top

The present study highlights the educational quality of REP uploaded on YT. The use of general search terms would highlight the broad range of information related to REP, whilst specific terms such as stem cells; revascularization would cover simply the fraction of procedure that might result in a poorer completeness score. Therefore, broad terminology-REP was chosen as a search terms because it would match with the terms that patient may use during an Internet exploration. There was a broad range of unrelated videos available on YT with this search term (n = 327), which were eliminated during the analysis. Surprisingly, YT videos are not reviewed and may not be scientific. Moreover, it is not subjected to any quality control method other than the viewer's likes-dislikes and comments-shares. Regardless of these limitations, more than 30% of people consider these websites as an accurate source of health information.[21] Such a lack of authenticate information and the contributions by the general population to online videos pose serious concerns for its authenticity. It is imperative to assess the educational content of these videos and make population aware of its authenticity. Hence, this study was planned and conducted.

In this study, YT audience gave more “likes” than “dislikes” for all videos which signifies its usefulness from the viewers' perspective. Despite nonscientific and subjective nature of these video, it is catching the attention of new viewers. This rating was directly dependent upon the number of views of the videos and length of time after upload. Hence, the number of “likes-dislikes” did not depend upon its content. Similarly, comments-share is done by lay audience and is not associated with peer review. YT has several search options to segregate the videos. Bearing in mind the possibility of so many arrangements of search options, it was unlikely to foresee precisely which search options the viewers would use. This led the authors to use “relevance” option as it were assumed to be commonly sought filter by a layperson although it might not represent the precise or entire information.

The median age of the uploaded REP videos was 25 months; however, certain videos were older than 110 months. It shows that REP videos are uploaded in the recent times only. Two previous YT video studies on root canal treatment and instrument separation concluded that the quality of these videos was variable and sub-standard for the general population. This REP YT video study showed that the uploaded videos were lacking information regarding REP's contraindications, instructing patients before the procedure about its successful long-term follow-up and obtaining informed consent after explaining risk, benefits, and alternatives. HCP (specialist and general dentist) uploaded the maximum number of REP videos on YT with the highest REP-DQS and GQS in comparison to other sources. It showed that good quality of accurate information is spread by HCP and it could have positive impact on public opinion. However, these videos showed wide range in its scores suggesting variability in its educational quality. So, HCP should be vigilant in preparing such informative videos for the general population. Although company is the next common REP video source on YT; it could not on include fundamental aspects of REP. The primary goal of these videos was to attract the clinicians and researchers. So, it may not be helpful in spreading the correct, selfless information of the procedure as seen from its lower scores. Hence, videos uploaded from the company do not guarantee quality information. Use of dental slang was seen in these videos that disinterested the lay audience. Therefore, dental professionals working in such companies should ensure the use of simple language in these videos.

Professional society and media did not upload the sufficient number of videos. Despite this, both sources got highest number of reviews due to its wide popularity and usefulness in public opinion. Professional societies need to step up and take responsibility to spread awareness about this relatively new treatment modality among general population. In the medical field, media uploaded contentious and ambiguous information to attract more audience. This is also true for REP video. If the video is older on YT, it will get more views which will ultimately attract new viewers. This may be the reason for constant availability of poor-quality information. E.g.,–video uploaded by company had lowest REP-DQS and GQS but highest number of views (80 and 186 respectively). Few videos were focusing more on advertisements for different materials used in the REP rather than the operative procedure per se A few videos were intended for attracting dental professionals to various products that are used in REP. Lower rank videos had overall sub-standard educational quality and dental professionals should guide patients about such videos.

It is noteworthy that overall quality of the videos can be improved by including patient's experience about this treatment modality briefly. Moreover, videos uploaded by patients and/or patient's parents can guide others about the procedure and likely expectation during intra-operative and postoperative stages. However, there were no REP videos uploaded from patients on YT. This may be due to contemporary nature of the procedure and limited application of REP in academic institutions.

Social media is a curate's egg for the healthcare field based on its use and user. Although HCP and professional societies review their videos before uploading, the remaining sources are still miles away from such a review process. Such misinformed videos can cause harm to patients. This must coerce the dental professionals to form a panel of experts to scrutinize all type of dental information uploaded on the social media. However, it is impossible to moderate such a gigantic source of internet information. So, there is a growing consensus to train dental health care workers to assess major sources like YT, Tweeter, and Facebook periodically and report such misinformation. Oral healthcare workers should channelize patients to scientific, sky-scraping educational quality videos. YT can be an easy and efficient means to perceive and convey oral health related information to the population provided its limitations are understood.

This REP YT video interpretation has some limitations. Not many REP videos were included in the study for the final analysis. It was unclear whether the consent of the patient was obtained for online publication of the videos.[22] It is impossible for audience to confirm the legitimacy of uploaded videos. Such retrospective study design has its inherent bias. Literature lacks any validated assessment tool for the evaluation of REP videos uploaded on YT. Hence a new scoring system was proposed after validating from five senior endodontists. However, this study results cannot be applied for YT videos with duration more than 15 min, in languages other than English or poor streaming quality. Dental specialists evaluated these videos which may not be scored similarly by a general nondental population. Such scoring of dental videos would heavily rely on dental health literacy. ICC values obtained in the current study showed dependable reliability among reviewers in terms of scoring. YT is a dynamic website with numerous videos uploaded every other day; it is the earliest attempt at evaluating the educational quality of REP videos uploaded on YT.

  Conclusion Top

Patients will keep on using YT as a suitable source for online information irrespective of the questionable quality of such information. Hence oral health care professional should be alert about the precise and contemporary social media information about their field to direct patients rightly. Social media can be an effective means to defy people's misconceptions about REP. This study revealed that the REP videos uploaded by health care professionals, especially specialist, can be relied upon.


The authors deny any conflict of interest.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Figure 1], [Figure 2]

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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