Statement of problem
Mainly because of poor training, substandard impression disinfection practices have been reported worldwide.
The purpose of this cross-sectional study was to assess the extension, usefulness, and reliability of contents on this topic available on the main video websites for self-training.
Material and methods
An analysis of the YouTube, Vimeo, and Dailymotion websites was undertaken in February 2018. The exclusion criteria were animal procedures, non-English language videos, advertisements, videos exclusively redirecting to websites, soundless videos, duplicated videos, and videos reporting on a research project. Information extension was assessed in 6 nonmutually exclusive dimensions, and usefulness was evaluated by using a 10-item scale. Reliability was assessed on a reliable or nonreliable basis. Statistical analyses were undertaken by using the Mann-Whitney and Fisher exact tests.
Of 386 identified videos, only 22 met the selection criteria, mostly published by health-care professionals (n=8; 36.4%). Most videos had less than 3000 views. Median usefulness score: 3 (IR: 3-3; range: 0-6). No video included all 7 topics considered in the index (median 3; IR: 2.25-3; range: 0-4). Just 5 clips (22.7%) described a procedure according to the American Dental Association and Center for Disease Control (ADA and CDC) guidelines.
Audiovisual online resources on dental impression disinfection includes incomplete information with limited usefulness and reliability. The number of views was not related to quality, and therefore, many viewers may be obtaining knowledge from substandard material.
The widespread use of social media makes inevitable their inclusion in educational experiences. The low value of the audiovisual information available online can result in inadequate impression management with implications for patient safety and treatment quality.
Dental impressions are routinely used to record dental anatomy, alveolar bone, gingival shape, and other oral structures for diagnosis, treatment, or research purposes. Although intraoral scanners have become popular, these systems have limitations, and conventional dental impressions will probably remain a routine dental procedure.
Dental impressions trap potentially infective agents transported out of the oral cavity. These pathogens can be transferred to casts, instruments, and laboratory equipment, starting a chain that may result in infected patients or staff.
To prevent cross-contamination, professional boards and government agencies have issued protocols and recommendations. Unfortunately, these recommendations are not always fulfilled, and a recent systematic review has disclosed a worrying prevalence of substandard practices of cross-contamination control in dental laboratories that highlights the importance of this issue in terms of patient safety.
This lack of compliance has been attributed to a range of causes, the most frequent being the lack of continuous professional courses on this topic. ,
The so-called “connected generation” (Gen C) is specifically defined not by age but by an attitude characterized as expecting instant responses and feedback to their information needs and integrating social media into their daily activities. Health-care students prefer online resources rather than textbooks or scientific journals, and most rely heavily on Google and Wikipedia, with the use of conventional libraries being low.
Social networks and participatory video websites are gaining influence in opinion formation on health issues by members of the general public. Even health-care professionals use social networks for continuous professional development (CPD), , with Twitter and YouTube being the most popular. The main value of participatory video websites in CPD is perceived to be improving knowledge and problem solving. The impact of these channels in professional education is so well recognized that some scientific journals already run their own channels of these platforms. Therefore, when dental staff or dental technicians need information on how to disinfect a dental impression, they turn to one of these resources for a quick answer and a video demonstration. However, the information contained in these videos may be inadequate, outdated, or even dangerous.
The usefulness of online audiovisual contents addressed to the public, students, , , and professionals , has been assessed. However, the authors are unaware of information on the quality and usefulness of audiovisual resources on the disinfection of dental impressions. Therefore, the purpose of this investigation was to assess the extension, usefulness, and reliability of audiovisual contents on this topic available on YouTube, Dailymotion, and Vimeo. The research hypothesis was that existing online audiovisual resources on the disinfection of dental impressions have major flaws in terms of completeness, usefulness, and reliability.
Material and methods
A cross-sectional study was designed and the results of which were reported following the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines.
Audio-visual online information about disinfection of dental impression was identified by searching the sites YouTube ( www.youtube.com ), Dailymotion ( www.dailymotion.com ), and Vimeo ( www.vimeo.com ) by using the following key word: dental impression disinfection. The search was undertaken on February 3, 2018, and the links to the resulting videos were copied into a spreadsheet.
These videos were independently assessed by 3 investigators: a general dental practitioner (I.V.-R.), a prosthodontist (U.A.S.-M.), and an orthodontist. In case of disagreement, the involved videos were viewed again by all 3 reviewers and discussed until a consensus was reached.
The inclusion criteria were dealing with dental impressions and including disinfection procedures. Exclusion criteria included videos related to animal procedures, not in English, advertisements, videos exclusively redirecting to websites, and videos with no sound, duplicated, or showing academic results of a research project. The flow chart of the study is depicted in Figure 1 .
Once the videos were selected for the study, they were assessed, and the following variables entered in a purpose-made form: title, publication date, number of views, and length of the film. Information about the origin of the video was also collected (professional organizations, individual health-care workers, secondary education institutions, laypersons, students of health sciences, universities, or commercial companies), together with the interaction index suggested by Hassona et al (number of likes minus number of do not like, divided by the number of views, and multiplied by 100). A visualization rate was also calculated (number of views, divided by the number of days since upload, and multiplied by 100).
The completeness of the video in terms of aspects of the disinfection process included was assessed in 6 nonmutually exclusive dimensions: importance of the process of cross-contamination control clinic and laboratory; use of personal protective equipment; protocols of impression disinfection; protocols of clinic and laboratory communication; use of mouthwashes before impression making; and perspective of the film (from the clinic or from the dental laboratory).
The usefulness of the contents showed in the videos was evaluated by using a check list of 10 items which assigned a score of zero (absent) or one (present) to each of them. Thus, each film received a score ranging from 0 to 10 to represent its usefulness ( Table 1 ).
|Information about alginate impression disinfection||1|
|Information about silicone impression disinfection||1|
|Information about disinfection dental impressions of polyether or other materials||1|
|Highlights need for efficient communication with dental laboratory||1|
|Includes at least one practical demonstration||1|
|Shows more than one option for disinfection of alginate dental impressions||1|
|Shows more than one option for disinfection of silicone dental impressions||1|
|Reinforces need for disinfection of dental impressions||1|
|Video states disinfections procedures vary according to impression material||1|
|Video shows or states need for use of personal protective equipment||1|
The videos were also analyzed in terms of reliability of the information provided. The standard for this assessment was the protocol issued by the American Dental Association, which permitted discrimination of the films on a reliable or nonreliable basis.
A descriptive statistical analysis was undertaken, and the relationships between variables were assessed by using the Mann-Whitney test for continuous variables and the Fisher exact test for the qualitative ones (α=.05).
A total of 22 videos were included in the study. Most of them were published by health-care professionals (n=8; 36.4%), followed by commercial companies (n=6; 27.3) and health-care students (n=4; 18.2%). Other publishers included secondary education institutions (n=2; 9.1%), individuals (n=1; 4.5%), and professional organizations (n=1; 4.5%).
The length of these videos ranged between 26 and 1331 seconds (22.18 minutes). All videos but 3 had less than 3000 views. One of these videos was published by a secondary education institution (351 336 views) and the other 2 by health-care professionals (461 674 and 1 446 813 views). The visualization rate ranged from 3.8 to 55 880 (median 53.8; interquartile range (IR): 27.5-120), and the interaction index ranged from 0 to 0.79 (median 0.22; IR: 0-0.36). Videos were also classified according to their usefulness, the completeness of their contents, and their reliability by 3 observers with different backgrounds, who reached high average concordance values (Kappa=.75).
No video scored the highest value (0-10) in the usefulness scale designed for this study, with a median value of 3 (IR: 3-3; range: 0-6). The same phenomenon occurred with the completeness of the topics of cross-contamination control of dental impressions contained in the video: none of them presented the 7 topics included in the completeness index (median 3; IR: 2.25-3; range: 0-4). Regarding the reliability of the information displayed, just 5 clips (22.7%) described a procedure in accordance with the American Dental Association and Center for Disease Control (ADA and CDC) guidelines.
A detailed insight on the features of the videos produced by the 2 most important groups of publishers is depicted in Table 2 . No differences were found in the contents of the films by the author, with most of the clips (50% of those produced by commercial companies) not observing the most widely distributed protocol for impression disinfection.
|Variable||Health-Care Professionals||Commercial Company||P|
|Importance of cross-contamination control c||2 (25.0)||0 (0.0)||.472|
|Need of IPEs when handling impressions c||6 (75.0)||5 (83.3)||1|
|Need for disinfection protocol c||4 (50.0)||5 (83.3)||.300|
|Need for protocol of laboratory-clinic communication c||1 (12.5)||0 (0.0)||1|
|Antiseptic mouth rinse before impression making c||0 (0.0)||1 (16.6)||.428|
|Procedures in laboratory c||1 (12.5)||0 (0.0)||1|
|Procedures in clinic c||7 (87.5)||5 (83.3)||1|
|Disinfection of alginate impressions a||5 (62.5)||4 (66.6)||1|
|Disinfection of silicone impressions a||1 (12.5)||2 (33.3)||.338|
|Disinfection of polyether and other impression materials a||1 (12.5)||1 (16.6)||1|
|Explains need for communicating disinfection status a||2 (25.0)||0 (0.0)||.472|
|Includes at least one practical demonstration a||6 (75.0)||5 (83.3)||1|
|Shows more than 1 option for disinfecting alginate impressions a||0 (0.0)||0 (0.0)||—|
|Shows more than 1 option for disinfecting silicone impressions a||0 (0.0)||0 (0.0)||—|
|States importance for disinfecting dental impressions a||3 (37.5)||1 (16.6)||.580|
|States disinfection procedure vary with impression material a||0 (0.0)||0 (0.0)||—|
|Shows or states need for using PPE a||7 (87.5)||5 (83.3)||1|
|Follows ADA and CDC protocol||1 (12.5)||3 (50.0)||.244|
|Visualization rate b||42.9 (25.8-3732)||44.8 (30.3-54.0)||.754|
|Interaction index b||0.22 (0-0.38)||0.17 (0.03-0.22)||.328|
|Duration (s) b||189 (129-569)||121 (90-233)||.413|
|Usefulness score b||3 (2.75-4)||3 (3-3)||.869|
|Completeness index b||3 (2-3)||3 (3-3)||.667|
The investigation of the characteristics of the most viewed videos on dental impression disinfection ( Table 3 ) provides an overview of the information viewers are actually obtained from existing online audiovisual resources on this topic. The most popular film on this issue was a demonstration of disinfecting silicone impressions in a laboratory by a health-care professional who did not follow the most recommended disinfection protocol. Thus, its completeness index was very low, as was its usefulness.
|Number of Views||1 446 813||461 674||351 336|
|Author||Health-care Professional||Health-care Professional||Secondary Education Center|
|Importance of cross-contamination control b||N||N||N|
|Need of IPEs when handling impressions b||N||Y||Y|
|Need for disinfection protocol b||N||Y||Y|
|Need for protocol of laboratory-clinic communication b||N||N||N|
|Antiseptic mouth rinse before impression taking b||N||N||N|
|Procedures in laboratory b||Y||Y||Y|
|Procedures in clinic b||N||N||N|
|Disinfection of alginate impressions a||N||Y||Y|
|Disinfection of silicone impressions a||Y||N||N|
|Disinfection of polyether and/other impression materials a||N||N||N|
|Explains need for communicating disinfection status a||N||Y||N|
|Includes at least one practical demonstration a||Y||Y||Y|
|Shows more than 1 option for disinfecting alginate impressions a||N||N||N|
|Shows more than 1 option for disinfecting silicone impressions a||N||N||N|
|States importance for disinfecting dental impressions a||N||Y||N|
|States disinfection procedure vary with impression material a||N||N||N|
|Shows or states need for using PPE a||Y||Y||Y|
|Follows ADA and CDC protocol||N||N||N|
|Visualization rate||55 883||14 554||13 997|