Title: Clinical Use of Silver Fluoride: Quality Evaluation of YouTube™ Educational Content

Title: Clinical Use of Silver Fluoride: Quality Evaluation of YouTube™ Educational Content | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Title: Clinical Use of Silver Fluoride: Quality Evaluation of YouTube™ Educational Content Sobia Zafar, Kavvner YongHong Low, Wei Yi The, Suen Hong Chan, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6283216/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background: Silver fluoride (SF) is an effective, minimally invasive dental caries treatment, but the quality, reliability, and adherence to manufacturer’s instructions for use (IFU) in YouTube™ videos on SF usage remain uncertain. Aim: Evaluate the reliability and quality of YouTube TM videos on the clinical usage of SF and adherence to their IFU. Design: A cross-sectional analysis of 78 YouTube TM videos was conducted, for reliability (modified DISCERN tool), source quality (Journal of American Medical Association benchmark criteria), production quality (Audio-Visual Quality tool), content usefulness (Total Content Evaluation index) and adherence to manufacturer instructions (IFU Adherence Evaluation tool). Correlations between video characteristics and engagement metrics ere explored. Results: Videos had moderately high reliability (median mDISCERN score: 4 and IQR: 3–4) and usefulness (median TCE score: 5 and IQR: 4–6), but source quality was lower (median JAMA score: 2 and IQR: 2–3). Adherence to IFU varied between SF brands, with videos demonstrating at least 60% of steps. Dental professionals were the most frequent video producers, but no significant quality differences were observed between sources. Conclusion: YouTube TM videos could be a learning resource for SF usage, although stricter guidelines are needed to ensure they convey accurate information. Silver fluoride YouTube™ quality reliability Figures Figure 1 Figure 2 INTRODUCTION Dental caries remains a widespread oral health issue, affecting diverse populations across the lifespan, including paediatric, special needs, and geriatric patients. 1 Managing caries in these vulnerable groups often presents unique challenges. 2 Conventional treatments frequently involve invasive procedures, such as restorations, pulpal therapy, or extractions. These can be traumatic for patients who struggle with cooperation, such as the paediatric and special needs populations. 2 These interventions may also necessitate sedation or general anaesthesia (GA), posing additional risks and complications. 2 Silver fluoride products (SF), such as silver diamine fluoride (SDF), are a minimally invasive, atraumatic and effective means for caries arrest. 3 These topical solutions combine the antimicrobial effects of ionic silver with the remineralizing properties of fluoride. 3 Their application can reduce the need for more invasive procedures. 3 , 4 Despite these clinical advantages, a persisting concern is the permanent black staining SF products cause on arrested carious lesions. This may raise aesthetic concerns, especially on anterior teeth. 2 , 5 In 2021, the World Health Organization (WHO) recognised the importance of SF in global dental care by including it on the WHO list of essential medicines, which emphasises its role in managing caries, particularly in populations that lack access to dental services. 6 In Australia, SF is approved by the Therapeutic Goods Administration (TGA) for treating dentinal hypersensitivity. 7 Its off-label use for caries arrest has been recommended by the Australian Dental Association. 7 , 8 However, the absence of formal clinical guidelines for SF application in caries management reflects a significant gap in its integration into dental practice. 7 At the educational level, there is also a notable deficiency in formal training on the clinical use of SF in both undergraduate and postgraduate dental programs in Australia. 8 Many dental students and practitioners increasingly turn to online platforms such as YouTube™ to supplement their learning. 9 However, the unregulated nature of such content raises concerns about the accuracy and reliability of clinical information that is presented. 10 As SF become used more widely, it becomes crucial to evaluate the quality of these online resources, particularly how they compare to the manufacturer's instructions for use (IFU). This study aimed to assess the reliability and quality of YouTube™ videos on the clinical usage of SF, including how well the information adhered to the manufacturer’s IFU. By evaluating the content against video assessment tools and the manufacturer’s IFU, this research seeks to identify potential gaps in the information available to practitioners. MATERIALS AND METHODS Ethical considerations: The Institutional Human Research Ethics Review Committee granted an exemption for this study (Ethics approval No: 2023/HE001838). Initial Video Selection and Search Strategy: A cross-sectional study was conducted to assess the quality and reliability of YouTube™ videos on the clinical use of SF products. A search was conducted on February 16 2024 using the search terms “silver fluoride” and “silver diamine fluoride” on the YouTube TM platform, with the results sorted by “relevance”. The search was conducted using a browser in incognito mode, to eliminate bias from previous user history. The first 100 videos for each search term were selected for evaluation, following a methodology similar to previous studies. 11 The Uniform Resource Locators (URLs) of the 200 videos were documented in a Microsoft Excel spreadsheet (Microsoft, Redmond, Seattle, WA, USA). Videos were included if they were: (1) related to the clinical use of SF; (2) in the English language; and (3) were available for viewing on the search date. The exclusion criteria were: (1) duplicate videos; (2) irrelevant videos; (3) non-English content; and (4) videos longer than 30 minutes. A flowchart of the video screening and selection process is given in Figure 1. After applying the inclusion and exclusion criteria, 78 videos were selected for assessment. Video characteristics, including upload date, number of subscribers, views, comments and likes, were recorded for each video. The videos were categorised by their upload source as follows: (1) A university or academic source; (2) Dental professionals; (3) Professional dental organisations; (4) Manufacturers and suppliers; and (5) Individual users. Video Evaluation and Assessment Tools: Quality and reliability of the videos was assessed using both validated tools and custom indices, as described below. The files were duplicated to allow independent assessment by two investigators (KL and SC). Any discrepancies in scoring resolved through consensus with the third investigator (WT). Journal of American Medical Association (JAMA) Benchmark Criteria: The JAMA benchmark criteria were originally introduced by Silberg et al. 12 and been used extensively to evaluate the credibility of online information. The criteria assess authorship, attribution, disclosure, and currency of the content, with scores ranging from 0 to 4 (Table 1). Modified DISCERN (mDISCERN) Tool: The DISCERN instrument is a validated tool for assessing the reliability of online health information. 13 It has been modified to assess information presented in the video format. 13,14 The tool uses five questions. Scores ranges from 0 to 5, with one point given for every “Yes” and zero points given for every “No” (Table 1). Audio-Visual Quality (AVQ): The AVQ scale was used in a previous study to evaluate the technical quality of each video. Scores range from 0 to 3. 15 Factors considered include clarity, professionalism in editing, and whether the video was visually and audibly intelligible (Table 1). Total Content Evaluation (TCE): A custom TCE index was developed to specifically assess the depth and completeness of information on the clinical use of SF, using the guidelines on SF usage published by the American Academy of Pediatric Dentistry (AAPD). 16,17 The 7-point index included the definition of SF, patient selection, tooth selection, advantages, disadvantages, clinical application, and follow-up (Table 1). Instruction-For-Use Adherence Evaluation (IAE): For videos demonstrating the steps of SF clinical application, adherence to the manufacturer's IFU was assessed using the IAE tool. Information presented in the videos was compared to the IFU for two prominent SF brands used globally: Advantage Arrest™ (Elevate Oral Care, West Palm Beach, FL, USA) and Riva Star™ (SDI, Bayswater, Victoria, Australia). 18,19 Videos were scored based on how accurately they followed the steps outlined in the respective IFU (Table 2). Videos that did not show the brand used, or featured other brands were excluded from the analysis. Statistical Data Analysis: All statistical analyses were performed with Jamovi version 2.3.24 software (The Jamovi Project, Sydney, NSW, Australia). Based on the Shapiro-Wilk test, non-normal distributions were found for quantitative data (video duration, total views, likes, comments, time since upload, JAMA, mDISCERN, AVQ, TCE and Advantage Arrest TM IAE scores), while Riva Star TM IAE scores displayed a normal distribution. Descriptive statistics were used to summarise data, with the continuous variables presented as median and interquartile range (IQR), or mean and standard deviation (SD). Categorical data were expressed as number (n) and percentage (%). For group comparisons, the Kruskal-Wallis test was used to assess differences between videos by source, while the Spearman’s correlation analysis was used to explore associations between video characteristics and assessment scores. A p-value of < 0.05 was considered statistically significant. The Cohen’s kappa coefficient was calculated to evaluate the degree of inter-rater agreement between the two investigators for video assessment scores, with kappa (κ) values interpreted as follows: 0.80 (almost perfect agreement). RESULTS The search yielded 200 videos, from which 122 were excluded (65 were duplicates, 24 were irrelevant, 23 videos were longer than 30 minutes, and 10 videos were not in the English language). A total of 78 videos were used for analysis, from which 29 videos could be rated using the IAE scoring system, 24 for Advantage Arrest TM and 5 for Riva Star TM . Video characteristics, assessment scores and video sources are summarised in Table 3. Most videos had a short duration and moderate engagement metrics. The majority of videos were produced by dental professionals, followed by professional organisations and commercial brand sources. Video assessment scores indicated moderate content usefulness, low source quality, high reliability, and average production quality. The Kruskal-Wallis test showed a significant difference in video duration by source, with professional organisations producing the longest videos, while dental professionals and individual users produced shorter videos (Table 4). There were no other statistically significant differences in other characteristics or assessment scores across sources (P > 0.05). Spearman's correlation analysis showed significant positive correlations between TCE and mDISCERN scores, and between TCE and AVQ scores, indicating that more comprehensive content was more reliable and was better produced (Table 4). TCE scores and mDISCERN scores were both weakly positively correlated with video duration (r = 0.379, P < 0.001 and r = 0.237, P = 0.037 respectively)), implying that longer videos tended to be more comprehensive and reliable. mDISCERN scores also showed weak positive correlations with engagement metrics such as likes (r = 0.294, P = 0.009) and subscribers (r = 0.418, P < 0.001), suggesting that videos with more reliability attracted more interaction. Similarly, JAMA scores also showed weak positive correlations with engagement metrics such as views (r = 0.330, P = 0.003), likes (r = 0.354, P = 0.001), and subscribers (r = 0.342, P = 0.002), also suggesting that videos with more quality attracted more interaction. Additionally, there was a weak negative correlation between AVQ scores and time since upload (r = -0.231, P = 0.042), indicating that older videos tended to exhibit lower production quality. The median IAE score for Advantage Arrest TM was 100.0% (IQR = 75.0–100.0), while the mean IAE score for Riva Star TM was 69.1% (SD ± 15.2) indicating that videos on Advantage Arrest TM adhered more closely to manufacturer’s IFU than those demonstrating the use of Riva Star TM (Table 3). Adherence to each step of the IFU varied between videos (Figure 2), and between brands, with some steps followed more consistently than others. Cohen’s kappa coefficient values for interrater reliability were substantial to near-perfect: TCE (κ = 0.672), JAMA (κ = 0.801), mDISCERN (κ = 0.672), AVQ (κ = 0.845), IAE for Advantage Arrest™ (κ = 0.619), and IAE for Riva Star™ (κ = 0.870), reflecting strong agreement among the two raters. DISCUSSION This study provides insights into the quality, reliability, and comprehensiveness of YouTube™ videos concerning SF. Considerable variability in video quality and content was evident. Most of the included 78 videos (73.1%) were produced by dental professionals. This reflects the growing use of YouTube as a platform for professional education within dentistry. According to mDISCERN scores, content reliability was generally moderate, with significant correlations to comprehensiveness and credibility. However, the observed variability in quality highlights the need for better quality control and the need to adhere to evidence-based guidelines. According to the JAMA scores, the videos demonstrated overall only low-moderate source quality, with even less compliance in disclosure and attribution. Higher JAMA scores were weakly positively correlated with usefulness and popularity. This highlights the need for more consistent application of these standards for assessing the quality of healthcare videos. Content analysis using the TCE tool revealed that a large portion of the videos was rated as having moderate to high usefulness. However, there were issues with gaps in crucial information which could mislead dental professionals, such as missing information on follow up. A strength of the present study is the use of validated assessment tools such as the mDISCERN, JAMA, and AVQ scoring systems, which allow for structured and comprehensive analysis of video quality. 15,20,21 While the videos on SF had only low-moderate source quality, overall they had moderate to high ratings for reliability, usefulness and production quality. Furthermore, videos that demonstrated the clinical steps of using SF in general had high fidelity in terms of adherence to the IFU. In terms of reliability, the observed moderate correlation between TCE and mDISCERN scores indicates that higher content reliability correlates with video usefulness. Source quality was a less dominant factor for reliability, with only a weak positive correlation between JAMA and mDISCERN scores. There was only a weak positive correlation between production quality and video usefulness. Most videos focused on the use of SF in paediatric cases, with very few addressing its use in geriatric populations or individuals with special health care needs. Given that SF is minimally invasive, cost-effective, and simple to use, its wider application in vulnerable populations of adults should be emphasised more. 8 Almost 90% of videos discussed case selection for caries arrest, which is an off-label application. Few discussed dentinal hypersensitivity, despite studies showing SF can reduce dentinal hypersensitivity by 23-56% after a single application. 7,22 The videos rarely mentioned contraindications, such as teeth with direct pulpal involvement, for which SF is contraindicated. Of note, SF use is safe for reversible pulpitis cases, provided caries is not close to the pulp, 16,23,24 as it causes caries arrest with minimal inflammation in such cases. 23,24 On the other hand, direct application of SF to vital pulp tissue is contraindicated due to concerns of severe inflammation and necrosis. 24 Ideally, SF videos should have addressed such issues. Less than half (40%) of videos discussed the importance of follow-up. The effectiveness of a single application of SF can range from 47% to 90% depending on lesion size and the location of the lesion. 25 Without proper follow-up, lesions that progress will not be detected. 16,25 There were some notable disparities of content in the videos and the manufacturer's IFU, especially for those referring to Riva Star™. For the latter, a common step omitted was the application of potassium iodide (KI). While intended to reduce immediate staining, the use of KI may lower its caries-arresting effects. 26,27 Furthermore, despite immediate benefits of less staining, over longer time periods such as 3 months discolouration is not prevented. 28,29 Another common omitted step was the removal of tooth isolation materials (60% of videos), and proper disposal of materials (100% of videos). These issues drove down the IAE score for Riva Star™ videos compared to Advantage Arrest™. Nevertheless, these last two steps are not critical to clinical success. Overall, the present findings suggest that videos on YouTube TM can be a valuable resource, although users must critically assess their content. 23 As with other studies, only a small proportion of the videos originated from universities. 9,30 In contrast to a past study on dental radiology, our results show that non-university sources can produce worthwhile content on SF clinical applications. This is likely because the use of SF is not a complex topic. 20 Videos should supplement and refer to evidence-based guidelines, rather than replace them. Future studies should explore how these videos impact dental practitioners and whether they improve their knowledge and clinical usage of SF. The present study has several limitations. Video content can quickly become outdated, and hence the results are snapshot in time, during a period where SF use is expanding. This limits the longevity of the findings. The exclusion of non-English videos may affect generalisability of the outcomes. Finally, the limited number of videos from certain sources (e.g., universities) limits the ability to make definitive comments or to detect statistically significant differences in video quality between different types of content producers. More engagement by professional organisations and universities could improve the quality and reliability of educational materials available online. The overall quality of YouTube TM videos on SF is moderate, with some videos providing valuable, accurate information. Gaps remain in terms of completeness of procedural steps and the omission of patient follow-up. Dental professionals should be aware of the limitations of YouTube™ content, and critically evaluate instructional videos for accuracy. Declarations Author Contribution S.Z. and L.W. conceived the ideas; K.L., W.T. and S.C. wrote the methodology; K.L and S.C. collected the data; W.T. analysed the data; K.L., W.T., and S.C. contributed to the writing; S.Z. and L.W. supervised and edited the manuscript Acknowledgement NA References Global Oral Health Status Report : Towards Universal Health Coverage for Oral Health By 2030 . 1st ed. World Health Organization; 2022. Schmoeckel J, Gorseta K, Splieth CH, Juric H. How to Intervene in the Caries Process: Early Childhood Caries - A Systematic Review. Caries Res . 2020;54(2):102-112. doi:10.1159/000504335. Hu S, Meyer B, Duggal M. A silver renaissance in dentistry. Eur Arch Paediatr Dent . 2018;19(4):221-227. doi:10.1007/s40368-018-0363-7. Gao SS, Chen KJ, Duangthip D, Wong MCM, Lo ECM, Chu CH. Arresting early childhood caries using silver and fluoride products – A randomised trial. J Dent . 2020;103:103522-103522. doi:10.1016/j.jdent.2020.103522. Dhar V, Pilcher L, Fontana M, et al. Evidence-based clinical practice guideline on restorative treatments for caries lesions: A report from the American Dental Association. The Journal of the American Dental Association (1939) . 2023;154(7):551-566.e51. doi:10.1016/j.adaj.2023.04.011. Organisation WH. Executive summary: the selection and use of essential medicines 2021: report of the 23rd WHO Expert Committee on the selection and use of essential medicines. 21 June - 2 July 2021 2021. Do LG. Guidelines for use of fluorides in Australia: update 2019. Aust Dent J . 2020;65(1):30-38. doi:10.1111/adj.12742. Gao SS, Amarquaye G, Arrow P, et al. Global Oral Health Policies and Guidelines: Using Silver Diamine Fluoride for Caries Control. Front Oral Health . 2021;2:685557. doi:10.3389/froh.2021.685557. Dias da Silva MA, Pereira AC, Vital S, et al. Online videos: The hidden curriculum. Eur J Dent Educ . 2022;26(4):830-837. doi:10.1111/eje.12766. Li TY, Gao X, Wong K, Tse CSK, Chan YY. Learning clinical procedures through internet digital objects: Experience of undergraduate students across clinical faculties. JMIR Med Educ . 2015;1(1):e1-e1. doi:10.2196/mededu.3866. Huang J, Zhang S, Xiao Q, Cao Y, Li B. YouTube™ as a source of information for Candida auris infection: A systematic review. BMC Public Health . 2020;20(1):832-832. doi:10.1186/s12889-020-08731-4. Silberg WM, Lundberg GD, Musacchio RA. Assessing, Controlling, and Assuring the Quality of Medical Information on the Internet: Caveant Lector et Viewor—Let the Reader and Viewer Beware. JAMA . 1997;277(15):1244-1245. doi:10.1001/jama.1997.03540390074039 Charnock D, Shepperd S, Needham G, Gann R. DISCERN: an instrument for judging the quality of written consumer health information on treatment choices. J Epidemiol Community Health . 1999;53(2):105-111. doi:10.1136/jech.53.2.105 Delli K, Livas C, Vissink A, Spijkervet FKL. Is YouTube useful as a source of information for Sjögren's syndrome? Oral Dis . 2016;22(3):196-201. doi:10.1111/odi.12404. Singh SK, Liu S, Capasso R, Kern RC, Gouveia CJ. YouTube as a source of information for obstructive sleep apnea. Am J Otolaryngol . 2018;39(4):378-382. doi:10.1016/j.amjoto.2018.03.024. Americam Academy of Paediatric Dentistry (AAPD) AAoPD. Chairside Guide: Silver Diamine Fluoride in the Management of Dental Caries Lesions* . 2022:P. 612-613. The Reference Manual of Pediatric Dentistry . Policy on the Use of Silver Diamine Fluoride for Pediatric Dental Patients. Pediatr Dent . 2018;40(6):51-54. Advantage Arrest Silver Diamine Fluoride 38%. Elevate Oral Care ELE489-0318; 2018. Accessed 15/09/2024. RIVA STAR Instructions for use (capsules). 2020. Accessed 15/09/2024. Cesur Aydin K, Gunec HG. Quality of information on YouTube about artificial intelligence in dental radiology. J Dent Educ . 2020;84(10):1166-1172. doi:10.1002/jdd.12362. Er N, Gülfeşan Çanakçı F. Temporomandibular joint arthrocentesis videos on YouTube: Are they a good source of information? J Stomatol Oral Maxillofac Surg . 2022;123(5):E310-E315. doi:10.1016/j.jormas.2022.03.011. Chan AKY, Tsang YC, Yu OY, Lo ECM, Leung KCM, Chu CH. Clinical evidence for silver diamine fluoride to reduce dentine hypersensitivity: A systematic review. J Dent . 2024;142:104868-104868. doi:10.1016/j.jdent.2024.104868. Yan IG, Zheng FM, Gao SS, Duangthip D, Lo ECM, Chu CH. A Review of the Protocol of SDF Therapy for Arresting Caries. Int Dent J . 2022;72(5):579-588. doi:10.1016/j.identj.2022.06.006. Zaeneldin A, Yu OY, Chu C-H. Effect of silver diamine fluoride on vital dental pulp: A systematic review. J Dent . 2022;119:104066-104066. doi:10.1016/j.jdent.2022.104066. Fung MHT, Duangthip D, Wong MCM, Lo ECM, Chu CH. Randomized Clinical Trial of 12% and 38% Silver Diamine Fluoride Treatment. J Dent Res . 2018;97(2):171-178. doi:10.1177/0022034517728496. Sorkhdini P, Gregory RL, Crystal YO, Tang Q, Lippert F. Effectiveness of in vitro primary coronal caries prevention with silver diamine fluoride - Chemical vs biofilm models. J Dent . 2020;99:103418-103418. doi:10.1016/j.jdent.2020.103418. Alvarez-Marín CA, Robles-Bermeo NL, Hassan Moustafa WH, Medina-Solís CE. Antibacterial Effects of Silver Diamine Fluoride with and without Potassium Iodide against Streptococcus mutans. Contemp Clin Dent . 2024;15(1):22-26. doi:10.4103/ccd.ccd_393_23. Aly MM, Yousry YM. Potential discolouration of silver diamine fluoride versus silver diamine fluoride/potassium iodide in primary teeth: a randomised clinical study. Br Dent J . 2022:1-6. doi:10.1038/s41415-022-5272-9. Roberts A, Bradley J, Merkley S, Pachal T, Gopal JV, Sharma D. Does potassium iodide application following silver diamine fluoride reduce staining of tooth? A systematic review. Aust Dent J . 2020;65(2):109-117. doi:10.1111/adj.12743. Dias da Silva MA, Pereira AC, Walmsley AD. Who is providing dental education content via YouTube? Br Dent J . 2019;226(6):437-440. doi:10.1038/s41415-019-0046-8. Tables Table 1 – Assessment criteria of video content, quality, reliability, and production quality using the TCE score, JAMA criteria, mDISCERN tool and AVQ score respectively. Assessment of content: Total Content Evaluation Score 1 | Is the definition of silver fluoride clear and accurate? 1 2 | Does the video mention tooth selection? 1 3 | Does the video mention patient selection? 1 4 | Does the video mention the advantage/s of silver fluoride? 1 5 | Does the video mention the disadvantage/s of silver fluoride? 1 6 | Does the video demonstrate clinical usage of silver fluoride? 1 7 | Does the video mention about follow ups? 1 Assessment of quality: Journal of American Medical Association benchmark criteria Score Authorship: Authors and contributors, their affiliations, and relevant credentials should be provided. 1 Attribution: References and sources for all content should be listed clearly, and all relevant copyright information noted. 1 Disclosure: Website “ownership” should be prominently and fully disclosed, as should any sponsorship, advertising, underwriting, commercial funding arrangements or support, or potential conflicts of interest. 1 Currency: Dates that content was posted and updated should be indicated. 1 Assessment of reliability: Modified DISCERN tool Score 1 | Is the video clear, concise and understandable? 1 2 | Are valid sources cited? 1 3 | Is the information provided balanced and unbiased? 1 4 | Are additional sources of information listed? 1 5 | Does the video address areas of controversy/uncertainty? 1 Assessment of production quality: Audio-Visual Quality (AVQ) Score 3 – Excellent – Clear, professional editing 2 – Average – Non-professional editing 1 – Poor – Blurry, out of focus images, unintelligible speech 0 – Unable to view 0 – 3 Table 2 – IAE scoring system adapted from the respective brands’ IFU. Advantage Arrest TM IFU Steps Score 1 | Isolate the affected area of the tooth with cotton rolls or protect the gingival tissue of the affected tooth with petroleum jelly. Alternatively, a rubber dam can be used to isolate the area. 1 2 | Clean and dry the affected tooth surface. 1 3 | For up to 5 treated sites per patient, dispense 1-2 drops of solution into a disposable dappen dish. Transfer material directly to the tooth surface with an applicator. 1 4 | Allow to air dry, do not rinse. 1 Advantage Arrest TM Total IAE Score Calculation = Score / 4 x 100% 100% Riva Star TM IFU Steps Score 1 | Using a non-fluoride prophylaxis paste in a rubber cup, clean the tooth/teeth to be treated and abutting teeth. 1 2 | Assess condition of teeth. Only teeth with sound dentine and enamel should be treated. 1 3 | Isolate area to be treated with cotton rolls. 1 4 | Dry teeth to be treated and adjoining gingival tissues. 1 5 | Apply a small amount of Gingival Barrier to the tissues, slightly overlapping the tooth (<1 mm) and interproximal spaces. Light cure in a fanning motion. Alternatively, a rubber dam can be used for isolation. 1 6 | Protect any exposed gingival tissues and lips with petroleum jelly/cocoa butter taking care not to contaminate treatment site. 1 7 | Using the silver brush provided, pierce through the foil of the silver capsule and carefully apply solution (SDF) to treatment site only. 1 8 | Immediately after, use green brush provided, pierce through the foil of the green capsule and apply a generous amount of the solution (KI) to the treatment site until the creamy white precipitate turns clear. 1 9 | Blot dry. 1 10 | Remove all protective/isolation materials used in the mouth. 1 11 | Discard used capsules and brushes in accordance with local regulations. 1 Riva Star TM Total IAE Score Calculation = Score / 11 x 100% 100% Table 3 – Video characteristics and assessment scores Video characteristics Videos (n) Mean ± SD Median (IQR) Duration (min) 78 5.36 ± 5.51 2.8 (1.9, 7.8) Number of views (n) 78 15,543 ± 55,304 1863 (422, 10,795) Number of likes (n) 78 78.99 ± 195.67 22 (2, 81) Number of comments (n) 78 8.01 ± 24.33 1 (0, 5) Number of subscriptions (n) 78 62,550 ± 43,3918 1,275 (282, 18,050) Time since upload (day) 78 1607 ± 812 1498 (1144, 2177) TCE score 78 5.01 ± 1.24 5 (4, 6) JAMA score 78 2.31 ± 0.54 2 (2, 3) mDISCERN score 78 3.38 ± 1.15 4 (3, 4) AVQ score 78 2.49 ± 0.50 2 (2, 3) Advantage Arrest IAE score 24 83.3 ± 25.2 100 (75, 100) Riva Star IAE score 5 69.1 ± 15.2 72.7 (63.6, 81.8) Video source n (%) University 1 (1.3) Professional organisations 11 (14.1) Dental professionals 57 (73.1) Commercial brands 4 (5.1) TCE score Yes (n [%]) No (n [%]) Definition of SF 51 (65.4) 27 (34.6) Tooth selection 69 (88.5) 9 (11.5) Patient selection 77 (98.7) 1 (1.3) Advantages of SF 62 (79.5) 16 (20.5) Disadvantages of SF 57 (73.1) 21 (26.9) Clinical application of SF 45 (57.7) 33 (42.3) Follow up 30 (38.5) 48 (61.5) Table 4 – Statistical analysis of videos stratified by source and video characteristics and video assessment tools. Descriptives statistics stratified by source Variable University Professional organisations Dental professionals Commercial brands Individual users p- value Median** Median (IQR) Median (IQR) Median (IQR) Median (IQR) Duration (min) 7.2 11.7 (6.3-13.2) 2.5 (1.4-4.0) 9.4 (4.2-16.5) 2.3 (2.2-3.1) <0.001* View (n) 17273 420 (114- 10576) 2235 (611-10797) 3910 (803-11537) 855 (58-5127) 0.523 Likes (n) 157 2 (1-76) 24 (3-72) 37 (5-86) 4 (0-35) 0.399 Comments (n) 8 0 (0-1) 1 (0-6) 7 (1-19) 0 (0-2) 0.104 Subscriptions (n) 19800 469 (367-1030) 1520 (271-15500) 1292 (893-9368) 26000 (4880-50300) 0.363 Time since upload (day) 1044 1498 (1365-1498) 1563 (1028-2303) 2067 (1429-2517) 1344 (1283-2079) 0.759 TCE 7 5 (4-5) 5 (4-6) 6 (5.5-6.25) 5 (4-6) 0.417 JAMA 2 2 (2-3) 2 (2-3) 2.5 (2-3) 2 (2-2) 0.536 mDISCERN 4 3 (2-4) 4 (3-4) 4 (3.5-4) 3 (2-4) 0.821 AVQ 3 2 (2-2.5) 2 (2-3) 2.5 (2-3) 3 (3-3) 0.082 Spearman’s correlation test for video characteristics and video assessment tools TCE JAMA mDISCERN AVQ Duration r 0.379 0.084 0.237 -0.134 p <0.001* 0.463 0.037* 0.241 View r 0.110 0.330 0.205 0.077 p 0.337 0.003* 0.072 0.500 Likes r 0.222 0.354 0.294 0.115 p 0.051 0.001* 0.009* 0.317 Comments r 0.141 0.114 0.188 -0.070 p 0.218 0.320 0.098 0.544 Subscribers r 0.200 0.342 0.413 0.185 p 0.080 0.002* <0.001* 0.104 Time since upload r -0.103 0.165 -0.184 -0.231 p 0.368 0.150 0.106 0.042* TCE r - - - - p - - - - JAMA r 0.051 - - - p 0.656 - - - mDISCERN r 0.621 0.364 - - p <0.001* 0.001* - - VQ r 0.372 -0.030 0.167 - p <0.001* 0.792 0.143 - Values are presented as median (IQR); a Kruskal-Wallis test was used; *p < 0.05; **University only has 1 video, hence IQR not represented on table. r, Spearman’s rho; * p <0.05 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 22 Apr, 2025 Reviews received at journal 21 Apr, 2025 Reviews received at journal 05 Apr, 2025 Reviewers agreed at journal 04 Apr, 2025 Reviewers agreed at journal 04 Apr, 2025 Reviewers invited by journal 24 Mar, 2025 Editor assigned by journal 24 Mar, 2025 Submission checks completed at journal 24 Mar, 2025 First submitted to journal 22 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6283216","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":434160407,"identity":"cf9d2837-047f-463b-a3d5-9f3d05abcf50","order_by":0,"name":"Sobia Zafar","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAy0lEQVRIiWNgGAWjYLCCCgYGOTCDh2gtZxgYjEnXkthAtBb5BvaHHw7U3EvfcDyB8cHbNgZ5gwMEtAAVJEscOFacu+HMA2bDuW0MhhsIamFgOCD9gS0hd8ONBDZp3jYGRoJa5BsYm38c+JeQbnAjgf03UIs9QS0MB5jZJA62JSQAtbAxA7UkEnbYYTY2i4N9CYYzzzxslpxzTiJ5JkGHtbc/vnHgW4I83/Hkgx/elNnY9hF0GDOcBY4aCULqUUACSapHwSgYBaNgBAEApCtDZPfDJVwAAAAASUVORK5CYII=","orcid":"","institution":"University of Queensland","correspondingAuthor":true,"prefix":"","firstName":"Sobia","middleName":"","lastName":"Zafar","suffix":""},{"id":434160410,"identity":"a4d67701-daa5-4473-9c9c-99f0abc33533","order_by":1,"name":"Kavvner YongHong Low","email":"","orcid":"","institution":"University of Queensland","correspondingAuthor":false,"prefix":"","firstName":"Kavvner","middleName":"YongHong","lastName":"Low","suffix":""},{"id":434160415,"identity":"d3a3fb20-1702-432a-8f25-1412b790e84c","order_by":2,"name":"Wei Yi The","email":"","orcid":"","institution":"University of Queensland","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"Yi","lastName":"The","suffix":""},{"id":434160418,"identity":"c906c5fc-c955-4324-8e22-7499253ea933","order_by":3,"name":"Suen Hong Chan","email":"","orcid":"","institution":"University of Queensland","correspondingAuthor":false,"prefix":"","firstName":"Suen","middleName":"Hong","lastName":"Chan","suffix":""},{"id":434160421,"identity":"abd7d502-53df-4054-87e0-ed15131d8a5e","order_by":4,"name":"Laurence J. Walsh","email":"","orcid":"","institution":"University of Queensland","correspondingAuthor":false,"prefix":"","firstName":"Laurence","middleName":"J.","lastName":"Walsh","suffix":""}],"badges":[],"createdAt":"2025-03-22 11:08:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6283216/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6283216/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":79705088,"identity":"76769383-ac55-4e6c-be96-c0789387f816","added_by":"auto","created_at":"2025-04-01 17:59:56","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":116420,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart demonstrating the video selection process.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6283216/v1/46367674ea45833cabdef9b4.png"},{"id":79705608,"identity":"06e1cf2b-0051-412a-8c1f-82616280d84e","added_by":"auto","created_at":"2025-04-01 18:07:56","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":46193,"visible":true,"origin":"","legend":"\u003cp\u003ePercentage adherence of each step of IFU for Advantage Arrest\u003csup\u003eTM\u003c/sup\u003e and Riva Star\u003csup\u003eTM\u003c/sup\u003e. The steps marked along the horizontal axis are the same as listed in Table 2.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6283216/v1/1f6f1c20326bbca9de722551.png"},{"id":79706319,"identity":"d8439043-0952-4b41-b96e-2111ae1fbd4e","added_by":"auto","created_at":"2025-04-01 18:15:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1250405,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6283216/v1/1e7ac41f-2341-4186-b518-8a9979c1b2a1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Title: Clinical Use of Silver Fluoride: Quality Evaluation of YouTube™ Educational Content","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eDental caries remains a widespread oral health issue, affecting diverse populations across the lifespan, including paediatric, special needs, and geriatric patients.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Managing caries in these vulnerable groups often presents unique challenges.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Conventional treatments frequently involve invasive procedures, such as restorations, pulpal therapy, or extractions. These can be traumatic for patients who struggle with cooperation, such as the paediatric and special needs populations.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e These interventions may also necessitate sedation or general anaesthesia (GA), posing additional risks and complications.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSilver fluoride products (SF), such as silver diamine fluoride (SDF), are a minimally invasive, atraumatic and effective means for caries arrest.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e These topical solutions combine the antimicrobial effects of ionic silver with the remineralizing properties of fluoride.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Their application can reduce the need for more invasive procedures.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Despite these clinical advantages, a persisting concern is the permanent black staining SF products cause on arrested carious lesions. This may raise aesthetic concerns, especially on anterior teeth.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn 2021, the World Health Organization (WHO) recognised the importance of SF in global dental care by including it on the WHO list of essential medicines, which emphasises its role in managing caries, particularly in populations that lack access to dental services.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e In Australia, SF is approved by the Therapeutic Goods Administration (TGA) for treating dentinal hypersensitivity.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Its off-label use for caries arrest has been recommended by the Australian Dental Association.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e However, the absence of formal clinical guidelines for SF application in caries management reflects a significant gap in its integration into dental practice.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAt the educational level, there is also a notable deficiency in formal training on the clinical use of SF in both undergraduate and postgraduate dental programs in Australia.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Many dental students and practitioners increasingly turn to online platforms such as YouTube\u0026trade; to supplement their learning.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e However, the unregulated nature of such content raises concerns about the accuracy and reliability of clinical information that is presented.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e As SF become used more widely, it becomes crucial to evaluate the quality of these online resources, particularly how they compare to the manufacturer's instructions for use (IFU).\u003c/p\u003e \u003cp\u003eThis study aimed to assess the reliability and quality of YouTube\u0026trade; videos on the clinical usage of SF, including how well the information adhered to the manufacturer\u0026rsquo;s IFU. By evaluating the content against video assessment tools and the manufacturer\u0026rsquo;s IFU, this research seeks to identify potential gaps in the information available to practitioners.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthical considerations:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eThe Institutional Human Research Ethics Review Committee granted an exemption for this study (Ethics approval No: 2023/HE001838).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eInitial Video Selection and Search Strategy:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eA cross-sectional study was conducted to assess the quality and reliability of YouTube\u0026trade; videos on the clinical use of SF products. A search was conducted on February 16 2024 using the search terms \u0026ldquo;silver fluoride\u0026rdquo; and \u0026ldquo;silver diamine fluoride\u0026rdquo; on the YouTube\u003csup\u003eTM\u003c/sup\u003e platform, with the results sorted by \u0026ldquo;relevance\u0026rdquo;. The search was conducted using a browser in incognito mode, to eliminate bias from previous user history. The first 100 videos for each search term were selected for evaluation, following a methodology similar to previous studies.\u003csup\u003e11\u003c/sup\u003e The Uniform Resource Locators (URLs) of the 200 videos were documented in a Microsoft Excel spreadsheet (Microsoft, Redmond, Seattle, WA, USA).\u003c/p\u003e\n\u003cp\u003eVideos were included if they were: (1) related to the clinical use of SF; (2) in the English language; and (3) were available for viewing on the search date. The exclusion criteria were: (1) duplicate videos; (2) irrelevant videos; (3) non-English content; and (4) videos longer than 30 minutes. A flowchart of the video screening and selection process is given in Figure 1.\u003c/p\u003e\n\u003cp\u003eAfter applying the inclusion and exclusion criteria, 78 videos were selected for assessment. Video characteristics, including upload date, number of subscribers, views, comments and likes, were recorded for each video. The videos were categorised by their upload source as follows: (1) A university or academic source; (2) Dental professionals; (3) Professional dental organisations; (4) Manufacturers and suppliers; and (5) Individual users.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eVideo Evaluation and Assessment Tools:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eQuality and reliability of the videos was assessed using both validated tools and custom indices, as described below. The files were duplicated to allow independent assessment by two investigators (KL and SC). Any discrepancies in scoring resolved through consensus with the third investigator (WT).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eJournal of American Medical Association (JAMA) Benchmark Criteria:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eThe JAMA benchmark criteria were originally introduced by Silberg et al.\u003csup\u003e12\u003c/sup\u003e and been used extensively to evaluate the credibility of online information. \u0026nbsp;The criteria assess authorship, attribution, disclosure, and currency of the content, with scores ranging from 0 to 4 (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eModified DISCERN (mDISCERN) Tool:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eThe DISCERN instrument is a validated tool for assessing the reliability of online health information.\u003csup\u003e13\u003c/sup\u003e It has been modified to assess information presented in the video format.\u003csup\u003e13,14\u003c/sup\u003e The tool uses five questions. Scores ranges from 0 to 5, with one point given for every \u0026ldquo;Yes\u0026rdquo; and zero points given for every \u0026ldquo;No\u0026rdquo; (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAudio-Visual Quality (AVQ):\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eThe AVQ scale was used in a previous study to evaluate the technical quality of each video. Scores range from 0 to 3.\u003csup\u003e15\u003c/sup\u003e Factors considered include clarity, professionalism in editing, and whether the video was visually and audibly intelligible (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTotal Content Evaluation (TCE):\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eA custom TCE index was developed to specifically assess the depth and completeness of information on the clinical use of SF, using the guidelines on SF usage published by the American Academy of Pediatric Dentistry (AAPD).\u003csup\u003e16,17\u003c/sup\u003e The 7-point index included the definition of SF, patient selection, tooth selection, advantages, disadvantages, clinical application, and follow-up (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eInstruction-For-Use Adherence Evaluation (IAE):\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eFor videos demonstrating the steps of SF clinical application, adherence to the manufacturer\u0026apos;s IFU was assessed using the IAE tool. Information presented in the videos was compared to the IFU for two prominent SF brands used globally: Advantage Arrest\u0026trade; (Elevate Oral Care, West Palm Beach, FL, USA) and Riva Star\u0026trade; (SDI, Bayswater, Victoria, Australia).\u003csup\u003e18,19\u003c/sup\u003e Videos were scored based on how accurately they followed the steps outlined in the respective IFU (Table 2). Videos that did not show the brand used, or featured other brands were excluded from the analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStatistical Data Analysis:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eAll statistical analyses were performed with Jamovi version 2.3.24 software (The Jamovi Project, Sydney, NSW, Australia). Based on the Shapiro-Wilk test, non-normal distributions were found for quantitative data (video duration, total views, likes, comments, time since upload, JAMA, mDISCERN, AVQ, TCE and Advantage Arrest\u003csup\u003eTM\u003c/sup\u003e IAE scores), while Riva Star\u003csup\u003eTM\u0026nbsp;\u003c/sup\u003eIAE scores displayed a normal distribution. Descriptive statistics were used to summarise data, with the continuous variables presented as median and interquartile range (IQR), or mean and standard deviation (SD). Categorical data were expressed as number (n) and percentage (%). For group comparisons, the Kruskal-Wallis test was used to assess differences between videos by source, while the Spearman\u0026rsquo;s correlation analysis was used to explore associations between video characteristics and assessment scores. A p-value of \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003eThe Cohen\u0026rsquo;s kappa coefficient was calculated to evaluate the degree of inter-rater agreement between the two investigators for video assessment scores, with kappa (\u0026kappa;) values interpreted as follows: \u0026lt; 0.20 (slight agreement), 0.21\u0026ndash;0.40 (fair agreement), 0.41\u0026ndash;0.60 (moderate agreement), 0.61\u0026ndash;0.80 (substantial agreement), and \u0026gt; 0.80 (almost perfect agreement).\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe search yielded 200 videos, from which 122 were excluded (65 were duplicates, 24 were irrelevant, 23 videos were longer than 30 minutes, and 10 videos were not in the English language). A total of 78 videos were used for analysis, from which 29 videos could be rated using the IAE scoring system, 24 for Advantage Arrest\u003csup\u003eTM \u0026nbsp;\u003c/sup\u003eand 5 for Riva Star\u003csup\u003eTM\u003c/sup\u003e. Video characteristics, assessment scores and video sources are summarised in Table 3. Most videos had a short duration and moderate engagement metrics.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe majority of videos were produced by dental professionals, followed by professional organisations and commercial brand sources. Video assessment scores indicated moderate content usefulness, low source quality, high reliability, and average production quality.\u003c/p\u003e\n\u003cp\u003eThe Kruskal-Wallis test showed a significant difference in video duration by source, with professional organisations producing the longest videos, while dental professionals and individual users produced shorter videos (Table 4). There were no other statistically significant differences in other characteristics or assessment scores across sources (P \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003eSpearman\u0026apos;s correlation analysis showed significant positive correlations between TCE and mDISCERN scores, and between TCE and AVQ scores, indicating that more comprehensive content was more reliable and was better produced (Table 4).\u003c/p\u003e\n\u003cp\u003eTCE scores and mDISCERN scores were both weakly positively correlated with video duration (r = 0.379, P \u0026lt; 0.001 and r = 0.237, P = 0.037 respectively)), implying that longer videos tended to be more comprehensive and reliable. mDISCERN scores also showed weak positive correlations with engagement metrics such as likes (r = 0.294, P = 0.009) and subscribers (r = 0.418, P \u0026lt; 0.001), suggesting that videos with more reliability attracted more interaction.\u003c/p\u003e\n\u003cp\u003eSimilarly, JAMA scores also showed weak positive correlations with engagement metrics such as views (r = 0.330, P = 0.003), likes (r = 0.354, P = 0.001), and subscribers (r = 0.342, P = 0.002), also suggesting that videos with more quality attracted more interaction. Additionally, there was a weak negative correlation between AVQ scores and time since upload (r = -0.231, P = 0.042), indicating that older videos tended to exhibit lower production quality.\u003c/p\u003e\n\u003cp\u003eThe median IAE score for Advantage Arrest\u003csup\u003eTM\u003c/sup\u003e was 100.0% (IQR = 75.0\u0026ndash;100.0), while the mean IAE score for Riva Star\u003csup\u003eTM\u003c/sup\u003e was 69.1% (SD \u0026plusmn; 15.2) indicating that videos on Advantage Arrest\u003csup\u003eTM\u003c/sup\u003e adhered more closely to manufacturer\u0026rsquo;s IFU than those demonstrating the use of Riva Star\u003csup\u003eTM\u003c/sup\u003e (Table 3). Adherence to each step of the IFU varied between videos (Figure 2), and between brands, with some steps followed more consistently than others.\u003c/p\u003e\n\u003cp\u003eCohen\u0026rsquo;s kappa coefficient values for interrater reliability were substantial to near-perfect: TCE (\u0026kappa; = 0.672), JAMA (\u0026kappa; = 0.801), mDISCERN (\u0026kappa; = 0.672), AVQ (\u0026kappa; = 0.845), IAE for Advantage Arrest\u0026trade; (\u0026kappa; = 0.619), and IAE for Riva Star\u0026trade; (\u0026kappa; = 0.870), reflecting strong agreement among the two raters.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study provides insights into the quality, reliability, and comprehensiveness of YouTube\u0026trade; videos concerning SF. Considerable variability in video quality and content was evident. Most of the included 78 videos (73.1%) were produced by dental professionals. This reflects the growing use of YouTube as a platform for professional education within dentistry.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAccording to mDISCERN scores, content reliability was generally moderate, with significant correlations to comprehensiveness and credibility. However, the observed variability in quality highlights the need for better quality control and the need to adhere to evidence-based guidelines.\u003c/p\u003e\n\u003cp\u003eAccording to the JAMA scores, the videos demonstrated overall only low-moderate source quality, with even less compliance in disclosure and attribution. Higher JAMA scores were weakly positively correlated with usefulness and popularity. This highlights the need for more consistent application of these standards for assessing the quality of healthcare videos.\u003c/p\u003e\n\u003cp\u003eContent analysis using the TCE tool revealed that a large portion of the videos was rated as having moderate to high usefulness. However, there were issues with gaps in crucial information which could mislead dental professionals, such as missing information on follow up.\u003c/p\u003e\n\u003cp\u003eA strength of the present study is the use of validated assessment tools such as the mDISCERN, JAMA, and AVQ scoring systems, which allow for structured and comprehensive analysis of video quality.\u003csup\u003e15,20,21\u003c/sup\u003e While the videos on SF had only low-moderate source quality, overall they had moderate to high ratings for reliability, usefulness and production quality. Furthermore, videos that demonstrated the clinical steps of using SF in general had high fidelity in terms of adherence to the IFU.\u003c/p\u003e\n\u003cp\u003eIn terms of reliability, the observed moderate correlation between TCE and mDISCERN scores indicates that higher content reliability correlates with video usefulness. Source quality was a less dominant factor for reliability, with only a weak positive correlation between JAMA and mDISCERN scores. There was only a weak positive correlation between production quality and \u0026nbsp;video usefulness.\u003c/p\u003e\n\u003cp\u003eMost videos focused on the use of SF in paediatric cases, with very few addressing its use in geriatric populations or individuals with special health care needs. Given that SF is minimally invasive, cost-effective, and simple to use, its wider application in vulnerable populations of adults should be emphasised more.\u003csup\u003e8\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlmost 90% of videos discussed case selection for caries arrest, which is an off-label application. Few discussed dentinal hypersensitivity, despite studies showing SF can reduce dentinal hypersensitivity by 23-56% after a single application.\u003csup\u003e7,22\u003c/sup\u003e The videos rarely mentioned contraindications, such as teeth with direct pulpal involvement, for which SF is contraindicated. Of note, SF use is safe for reversible pulpitis cases, provided caries is not close to the pulp,\u003csup\u003e16,23,24\u003c/sup\u003e as it causes caries arrest with minimal inflammation in such cases.\u003csup\u003e23,24\u003c/sup\u003e On the other hand, direct application of SF to vital pulp tissue is contraindicated due to concerns of severe inflammation and necrosis.\u003csup\u003e24\u003c/sup\u003e Ideally, SF videos should have addressed such issues.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLess than half (40%) of videos discussed the importance of follow-up. The effectiveness of a single application of SF can range from 47% to 90% depending on lesion size and the location of the lesion.\u003csup\u003e25\u003c/sup\u003e Without proper follow-up, lesions that progress will not be detected.\u003csup\u003e16,25\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThere were some notable disparities of content in the videos and the manufacturer\u0026apos;s IFU, especially for those referring to Riva Star\u0026trade;. For the latter, a common step omitted was the application of potassium iodide (KI). While intended to reduce immediate staining, the use of KI may lower its caries-arresting effects.\u003csup\u003e26,27\u003c/sup\u003e Furthermore, despite immediate benefits of less staining, over longer time periods such as 3 months discolouration is not prevented.\u003csup\u003e28,29\u003c/sup\u003e Another common omitted step was the removal of tooth isolation materials (60% of videos), and proper disposal of materials (100% of videos). These issues drove down the IAE score for Riva Star\u0026trade; videos compared to Advantage Arrest\u0026trade;. \u0026nbsp;Nevertheless, these last two steps are not critical to clinical success.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOverall, the present findings suggest that videos on YouTube\u003csup\u003eTM\u003c/sup\u003e can be a valuable resource, although users must critically assess their content.\u003csup\u003e23\u003c/sup\u003e As with other studies, only a small proportion of the videos originated from universities.\u003csup\u003e9,30\u003c/sup\u003e In contrast to a past study on dental radiology, our results show that non-university sources can produce worthwhile content on SF clinical applications. This is likely because the use of SF is not a complex topic.\u003csup\u003e20\u003c/sup\u003e Videos should supplement and refer to evidence-based guidelines, rather than replace them. Future studies should explore how these videos impact dental practitioners and whether they improve their knowledge and clinical usage of SF.\u003c/p\u003e\n\u003cp\u003eThe present study has several limitations. Video content can quickly become outdated, and hence the results are snapshot in time, during a period where SF use is expanding. This limits the longevity of the findings. The exclusion of non-English videos may affect generalisability of the outcomes. Finally, the limited number of videos from certain sources (e.g., universities) limits the ability to make definitive comments or to detect statistically significant differences in video quality between different types of content producers. More engagement by professional organisations and universities could improve the quality and reliability of educational materials available online.\u003c/p\u003e\n\u003cp\u003eThe overall quality of YouTube\u003csup\u003eTM\u003c/sup\u003e videos on SF is moderate, with some videos providing valuable, accurate information. Gaps remain in terms of completeness of procedural steps and the omission of patient follow-up. Dental professionals should be aware of the limitations of YouTube\u0026trade; content, and critically evaluate instructional videos for accuracy.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eS.Z. and L.W. conceived the ideas; K.L., W.T. and S.C. wrote the methodology; K.L and S.C. collected the data; W.T. analysed the data; K.L., W.T., and S.C. contributed to the writing; S.Z. and L.W. supervised and edited the manuscript\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eNA\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e\u003cem\u003eGlobal Oral Health Status Report : Towards Universal Health Coverage for Oral Health By 2030\u003c/em\u003e. 1st ed. World Health Organization; 2022.\u003c/li\u003e\n\u003cli\u003eSchmoeckel J, Gorseta K, Splieth CH, Juric H. 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YouTube\u0026trade; as a source of information for Candida auris infection: A systematic review. \u003cem\u003eBMC Public Health\u003c/em\u003e. 2020;20(1):832-832. doi:10.1186/s12889-020-08731-4.\u003c/li\u003e\n\u003cli\u003eSilberg WM, Lundberg GD, Musacchio RA. Assessing, Controlling, and Assuring the Quality of Medical Information on the Internet: Caveant Lector et Viewor\u0026mdash;Let the Reader and Viewer Beware. \u003cem\u003eJAMA\u003c/em\u003e. 1997;277(15):1244-1245. doi:10.1001/jama.1997.03540390074039\u003c/li\u003e\n\u003cli\u003eCharnock D, Shepperd S, Needham G, Gann R. DISCERN: an instrument for judging the quality of written consumer health information on treatment choices. \u003cem\u003eJ Epidemiol Community Health\u003c/em\u003e. 1999;53(2):105-111. doi:10.1136/jech.53.2.105\u003c/li\u003e\n\u003cli\u003eDelli K, Livas C, Vissink A, Spijkervet FKL. 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Accessed 15/09/2024. \u003c/li\u003e\n\u003cli\u003eRIVA STAR Instructions for use (capsules). 2020. Accessed 15/09/2024. \u003c/li\u003e\n\u003cli\u003eCesur Aydin K, Gunec HG. Quality of information on YouTube about artificial intelligence in dental radiology. \u003cem\u003eJ Dent Educ\u003c/em\u003e. 2020;84(10):1166-1172. doi:10.1002/jdd.12362.\u003c/li\u003e\n\u003cli\u003eEr N, G\u0026uuml;lfeşan \u0026Ccedil;anak\u0026ccedil;ı F. Temporomandibular joint arthrocentesis videos on YouTube: Are they a good source of information? \u003cem\u003eJ Stomatol Oral Maxillofac Surg\u003c/em\u003e. 2022;123(5):E310-E315. doi:10.1016/j.jormas.2022.03.011.\u003c/li\u003e\n\u003cli\u003eChan AKY, Tsang YC, Yu OY, Lo ECM, Leung KCM, Chu CH. Clinical evidence for silver diamine fluoride to reduce dentine hypersensitivity: A systematic review. \u003cem\u003eJ Dent\u003c/em\u003e. 2024;142:104868-104868. doi:10.1016/j.jdent.2024.104868.\u003c/li\u003e\n\u003cli\u003eYan IG, Zheng FM, Gao SS, Duangthip D, Lo ECM, Chu CH. A Review of the Protocol of SDF Therapy for Arresting Caries. \u003cem\u003eInt Dent J\u003c/em\u003e. 2022;72(5):579-588. doi:10.1016/j.identj.2022.06.006.\u003c/li\u003e\n\u003cli\u003eZaeneldin A, Yu OY, Chu C-H. Effect of silver diamine fluoride on vital dental pulp: A systematic review. \u003cem\u003eJ Dent\u003c/em\u003e. 2022;119:104066-104066. doi:10.1016/j.jdent.2022.104066.\u003c/li\u003e\n\u003cli\u003eFung MHT, Duangthip D, Wong MCM, Lo ECM, Chu CH. 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Potential discolouration of silver diamine fluoride versus silver diamine fluoride/potassium iodide in primary teeth: a randomised clinical study. \u003cem\u003eBr Dent J\u003c/em\u003e. 2022:1-6. doi:10.1038/s41415-022-5272-9.\u003c/li\u003e\n\u003cli\u003eRoberts A, Bradley J, Merkley S, Pachal T, Gopal JV, Sharma D. Does potassium iodide application following silver diamine fluoride reduce staining of tooth? A systematic review. \u003cem\u003eAust Dent J\u003c/em\u003e. 2020;65(2):109-117. doi:10.1111/adj.12743.\u003c/li\u003e\n\u003cli\u003eDias da Silva MA, Pereira AC, Walmsley AD. Who is providing dental education content via YouTube? \u003cem\u003eBr Dent J\u003c/em\u003e. 2019;226(6):437-440. doi:10.1038/s41415-019-0046-8.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1 \u0026ndash;\u0026nbsp;\u003c/strong\u003eAssessment criteria of video content, quality, reliability, and production quality using the TCE score, JAMA criteria, mDISCERN tool and AVQ score respectively.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAssessment of content: Total Content Evaluation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScore\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003e1 | Is the definition of silver fluoride clear and accurate?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003e2 | Does the video mention tooth selection?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003e3 | Does the video mention patient selection?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003e4 | Does the video mention the advantage/s of silver fluoride?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003e5 | Does the video mention the disadvantage/s of silver fluoride?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003e6 | Does the video demonstrate clinical usage of silver fluoride?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003e7 | Does the video mention about follow ups?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAssessment of quality: Journal of American Medical Association benchmark criteria\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScore\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAuthorship:\u003c/strong\u003e Authors and contributors, their affiliations, and relevant credentials should be provided.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAttribution:\u003c/strong\u003e References and sources for all content should be listed clearly, and all relevant copyright information noted.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisclosure:\u003c/strong\u003e Website \u0026ldquo;ownership\u0026rdquo; should be prominently and fully disclosed, as should any sponsorship, advertising, underwriting, commercial funding arrangements or support, or potential conflicts of interest.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrency:\u003c/strong\u003e Dates that content was posted and updated should be indicated.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAssessment of reliability: Modified DISCERN tool\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScore\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003e1 | Is the video clear, concise and understandable?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003e2 | Are valid sources cited?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003e3 | Is the information provided balanced and unbiased?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003e4 | Are additional sources of information listed?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003e5 | Does the video address areas of controversy/uncertainty?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAssessment of production quality: Audio-Visual Quality (AVQ)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScore\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003e3 \u0026ndash; Excellent \u0026ndash; Clear, professional editing\u003c/p\u003e\n \u003cp\u003e2 \u0026ndash; Average \u0026ndash; Non-professional editing\u003c/p\u003e\n \u003cp\u003e1 \u0026ndash; Poor \u0026ndash; Blurry, out of focus images, unintelligible speech\u003c/p\u003e\n \u003cp\u003e0 \u0026ndash; Unable to view\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e0 \u0026ndash; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 \u0026ndash;\u0026nbsp;\u003c/strong\u003eIAE scoring system adapted from the respective brands\u0026rsquo; IFU.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 555px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdvantage Arrest\u003csup\u003eTM\u003c/sup\u003e IFU Steps\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScore\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 555px;\"\u003e\n \u003cp\u003e1 | Isolate the affected area of the tooth with cotton rolls or protect the gingival tissue of the affected tooth with petroleum jelly. Alternatively, a rubber dam can be used to isolate the area.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 555px;\"\u003e\n \u003cp\u003e2 | Clean and dry the affected tooth surface.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 555px;\"\u003e\n \u003cp\u003e3 | For up to 5 treated sites per patient, dispense 1-2 drops of solution into a disposable dappen dish. Transfer material directly to the tooth surface with an applicator.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 555px;\"\u003e\n \u003cp\u003e4 | Allow to air dry, do not rinse.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 555px;\"\u003e\n \u003cp\u003e\u003cem\u003eAdvantage Arrest\u003csup\u003eTM\u003c/sup\u003e Total IAE Score Calculation = Score / 4 x 100%\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 555px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eRiva Star\u003csup\u003eTM\u003c/sup\u003e IFU Steps\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScore\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 555px;\"\u003e\n \u003cp\u003e1 | Using a non-fluoride prophylaxis paste in a rubber cup, clean the tooth/teeth to be treated and abutting teeth.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 555px;\"\u003e\n \u003cp\u003e2 | Assess condition of teeth. Only teeth with sound dentine and enamel should be treated.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 555px;\"\u003e\n \u003cp\u003e3 | Isolate area to be treated with cotton rolls.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 555px;\"\u003e\n \u003cp\u003e4 | Dry teeth to be treated and adjoining gingival tissues.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 555px;\"\u003e\n \u003cp\u003e5 | Apply a small amount of Gingival Barrier to the tissues, slightly overlapping the tooth (\u0026lt;1 mm) and interproximal spaces. Light cure in a fanning motion. Alternatively, a rubber dam can be used for isolation.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 555px;\"\u003e\n \u003cp\u003e6 | Protect any exposed gingival tissues and lips with petroleum jelly/cocoa butter taking care not to contaminate treatment site.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 555px;\"\u003e\n \u003cp\u003e7 | Using the silver brush provided, pierce through the foil of the silver capsule and carefully apply solution (SDF) to treatment site only.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 555px;\"\u003e\n \u003cp\u003e8 | Immediately after, use green brush provided, pierce through the foil of the green capsule and apply a generous amount of the solution (KI) to the treatment site until the creamy white precipitate turns clear.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 555px;\"\u003e\n \u003cp\u003e9 | Blot dry.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 555px;\"\u003e\n \u003cp\u003e10 | Remove all protective/isolation materials used in the mouth.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 555px;\"\u003e\n \u003cp\u003e11 | Discard used capsules and brushes in accordance with local regulations.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 555px;\"\u003e\n \u003cp\u003e\u003cem\u003eRiva Star\u003csup\u003eTM\u003c/sup\u003e Total IAE Score Calculation = Score / 11 x 100%\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 \u0026ndash;\u0026nbsp;\u003c/strong\u003eVideo characteristics and assessment scores\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"633\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVideo characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVideos (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eDuration (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5.36 \u0026plusmn; 5.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e2.8 (1.9, 7.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eNumber of views (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e15,543 \u0026plusmn; 55,304\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e1863 (422, 10,795)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eNumber of likes (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e78.99 \u0026plusmn; 195.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e22 (2, 81)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eNumber of comments (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e8.01 \u0026plusmn; 24.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e1 (0, 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eNumber of subscriptions (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e62,550 \u0026plusmn; 43,3918\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e1,275 (282, 18,050)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eTime since upload (day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1607 \u0026plusmn; 812\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e1498 (1144, 2177)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eTCE score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5.01 \u0026plusmn; 1.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e5 (4, 6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eJAMA score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2.31 \u0026plusmn; 0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e2 (2, 3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003emDISCERN score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e3.38 \u0026plusmn; 1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e4 (3, 4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eAVQ score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2.49 \u0026plusmn; 0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e2 (2, 3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eAdvantage Arrest IAE score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e83.3 \u0026plusmn; 25.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e100 (75, 100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eRiva Star IAE score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e69.1 \u0026plusmn; 15.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e72.7 (63.6, 81.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVideo source\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eUniversity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e1 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eProfessional organisations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e11 (14.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eDental professionals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e57 (73.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eCommercial brands\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e4 (5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTCE score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes (n [%])\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo (n [%])\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eDefinition of SF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e51 (65.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e27 (34.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eTooth selection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e69 (88.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e9 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003ePatient selection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e77 (98.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eAdvantages of SF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e62 (79.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e16 (20.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eDisadvantages of SF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e57 (73.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e21 (26.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eClinical application of SF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e45 (57.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e33 (42.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eFollow up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e30 (38.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e48 (61.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 \u0026ndash;\u003c/strong\u003eStatistical analysis of videos stratified by source and video characteristics and video assessment tools.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eDescriptives statistics stratified by source\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eUniversity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eProfessional organisations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003eDental professionals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003eCommercial brands\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003eIndividual users\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cem\u003ep-\u003c/em\u003evalue\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eMedian**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eDuration (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e11.7 (6.3-13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e2.5 (1.4-4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e9.4 (4.2-16.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e2.3 (2.2-3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eView (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e17273\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e420 (114- 10576)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e2235 (611-10797)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e3910 (803-11537)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e855 (58-5127)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.523\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eLikes (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e2 (1-76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e24 (3-72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e37 (5-86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e4 (0-35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.399\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eComments (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0 (0-1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e1 (0-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e7 (1-19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0 (0-2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eSubscriptions (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e19800\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e469 (367-1030)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e1520 (271-15500)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e1292 (893-9368)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e26000 (4880-50300)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.363\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eTime since upload (day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e1498 (1365-1498)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e1563 (1028-2303)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e2067 (1429-2517)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e1344 (1283-2079)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.759\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eTCE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e5 (4-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e5 (4-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e6 (5.5-6.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e5 (4-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.417\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eJAMA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e2 (2-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e2 (2-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e2.5 (2-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e2 (2-2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.536\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003emDISCERN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e3 (2-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e4 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e4 (3.5-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e3 (2-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.821\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eAVQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e2 (2-2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e2 (2-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e2.5 (2-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e3 (3-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpearman\u0026rsquo;s correlation test for video characteristics and video assessment tools\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTCE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eJAMA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003emDISCERN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAVQ\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eDuration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.379\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.084\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.237\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e-0.134\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.463\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.037*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.241\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eView\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.330\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.077\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.072\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.500\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eLikes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.354\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.294\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.009*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.317\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eComments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e-0.070\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.320\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.544\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eSubscribers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.342\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.413\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.185\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.080\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eTime since upload\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e-0.103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e-0.184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.231\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.368\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.042*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eTCE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eJAMA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.656\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003emDISCERN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.621\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.364\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eVQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.372\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e-0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.792\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eValues are presented as median (IQR); \u003csup\u003ea\u003c/sup\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eKruskal-Wallis test was used;\u003cem\u003e*p \u0026lt; 0.05; **University only has 1 video, hence IQR not represented on table.\u003c/em\u003e\u003cem\u003e\u0026nbsp;r,\u0026nbsp;\u003c/em\u003eSpearman\u0026rsquo;s rho; *\u003cem\u003ep \u0026lt;0.05\u003c/em\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-archives-of-paediatric-dentistry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"EAPD","sideBox":"Learn more about [European Archives of Paediatric Dentistry](https://link.springer.com/journal/40368)","snPcode":"40368","submissionUrl":"https://submission.springernature.com/new-submission/40368/3","title":"European Archives of Paediatric Dentistry","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Silver fluoride, YouTube™, quality, reliability","lastPublishedDoi":"10.21203/rs.3.rs-6283216/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6283216/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eSilver fluoride (SF) is an effective, minimally invasive dental caries treatment, but the quality, reliability, and adherence to manufacturer’s instructions for use (IFU) in YouTube™ videos on SF usage remain uncertain.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim:\u003c/strong\u003e Evaluate the reliability and quality of YouTube\u003csup\u003eTM\u003c/sup\u003e videos on the clinical usage of SF and adherence to their IFU.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDesign: \u003c/strong\u003eA cross-sectional analysis of 78 YouTube\u003csup\u003eTM\u003c/sup\u003e videos was conducted, for reliability (modified DISCERN tool), source quality (Journal of American Medical Association benchmark criteria), production quality (Audio-Visual Quality tool), content usefulness (Total Content Evaluation index) and adherence to manufacturer instructions (IFU Adherence Evaluation tool). Correlations between video characteristics and engagement metrics ere explored.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eVideos had moderately high reliability (median mDISCERN score: 4 and IQR: 3–4) and usefulness (median TCE score: 5 and IQR: 4–6), but source quality was lower (median JAMA score: 2 and IQR: 2–3). Adherence to IFU varied between SF brands, with videos demonstrating at least 60% of steps. Dental professionals were the most frequent video producers, but no significant quality differences were observed between sources.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eYouTube\u003csup\u003eTM\u003c/sup\u003e videos could be a learning resource for SF usage, although stricter guidelines are needed to ensure they convey accurate information.\u003c/p\u003e","manuscriptTitle":"Title: Clinical Use of Silver Fluoride: Quality Evaluation of YouTube™ Educational Content","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-01 17:59:52","doi":"10.21203/rs.3.rs-6283216/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-22T06:24:27+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-21T16:21:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-06T02:43:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"81716779357910491643710351268998231279","date":"2025-04-05T00:27:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"181628260895323760840380430410646246019","date":"2025-04-04T12:36:45+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-24T09:30:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-24T07:03:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-24T07:02:57+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Archives of Paediatric Dentistry","date":"2025-03-22T10:58:07+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-archives-of-paediatric-dentistry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"EAPD","sideBox":"Learn more about [European Archives of Paediatric Dentistry](https://link.springer.com/journal/40368)","snPcode":"40368","submissionUrl":"https://submission.springernature.com/new-submission/40368/3","title":"European Archives of Paediatric Dentistry","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"3f6875ad-0918-444d-b846-9dbe6d828f1b","owner":[],"postedDate":"April 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-08-20T07:53:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-01 17:59:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6283216","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6283216","identity":"rs-6283216","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}