Evaluation of YouTube videos for patients' education on periradicular surgery.

The aim of this study was to evaluate the content of periradicular surgery-related YouTube videos available for patients' education. YouTube search was made for videos related to periradicular surgery using specific terms. After exclusions, 42 videos were selected, viewed and assessed by two independent observers. The videos were assessed in terms of duration, days since upload, country of upload, number of views, likes and dislikes, authorship source, viewing rate and interaction index. To grade the content of videos about periradicular surgery, a usefulness score was created with 10 elements based mainly on the American Association of Endodontists guidelines. Each element was given a score of 0 or 1. SPSS software (SPSS Inc, Chicago, IL, USA) was used to analyze data at a 95% confidence level. An inter-evaluator reliability analysis for the scoring system was performed using the Kappa statistic. The videos received an average of 35103.9 views (range: 9-652378) with an average duration of 338.71 seconds (range: 42-2081), respectively. Most videos were provided by individuals (57%). Half of the videos were posted by authors from the United States. The inter-evaluator reliability for usefulness scoring was 94.5%. No video covered the 10 scoring elements completely, presenting very low usefulness scores (mean: 3.2; range: 1-7). The most discussed elements were supporting media (100%) and steps of the procedure (90.5%) followed by indications and contraindications (45.2%) and symptoms (31%). None of the included videos discussed the procedure's cost or prognosis. In terms of usefulness score, no significant difference was detected between different sources of upload (chi-square test, P > 0.05). Information on periradicular surgery in YouTube videos is not comprehensive and patients should not rely on YouTube as the only source of information. Dental professionals should enrich the content of YouTube with good quality videos by providing full and evidence-based information that will positively affect patients' attitudes and satisfaction.

Introduction

Periradicular surgery is an integral part of endodontic treatment of a tooth with a periradicular lesion which cannot be healed by a traditional root canal treatment or retreatment. This approach is usually perceived as a last resort to retain teeth with persistent periapical lesions despite previous conventional endodontic treatments [1]. The practice of periradicular surgery has increased steadily worldwide; for instance the number of apical surgeries performed in the general dental service in the UK has almost doubled over the past 20 years [2]. The accuracy of this procedure has sharply increased after the adoption of dental operating microscope and other microsurgical tools which enhance the success rate [3], thus making it a more predictable treatment approach and more accepted treatment option [4]. A future increase in the demand for periradicular surgery is anticipated as graduate students and future generation are expected to get sufficient training so as to incorporate it in everyday practice [5].

The need to provide effective and proper patient education regarding periradicular surgery cannot be stressed enough. Providing information to patients in oral health care settings assists them in considering treatment options, increasing knowledge about the procedure and reducing procedure-related distress [6]. It was reported that some patients have difficulties reading endodontic educational materials because of the use of jargons and terminologies that might be confusing to them and those within control of patient education are encouraged to review the readability of their products for their target audience [7]. In clinical practice, information and education about treatment are given verbally or presented in written or audio-visual form. The use of brief informational videos was reported as an efficacious method to provide dental related information and increase knowledge of endodontic patients [6].

The accessibility of smart technologies has had a pronounced influence on the delivery of patient’s education in the medical and dental fields. The number of people turning to the internet to search for health related matters continues to grow; it is estimated that one of three US adults uses the internet to diagnose or learn about a health concern [8]. However, the Web should not be considered a substitute for using more reliable health information sources. This trend has been shown to have an effect on the patient healthcare-provider professional relationship [9]. For health minded patients or anxious individuals, the internet is either used to gather information before the appointment in preparation for the visit or it may have even promoted the visit, meanwhile sicker individuals use the internet after the appointment to assist in processing health information that were provided to them [10]. One of the most commonly visited websites which has emerged as a leading video sharing platform for this purpose is the YouTube which received this weight of popularity due to several factors such as ease and convenience of use where unregistered users can watch unlimited numbers of videos [11]. Moreover, no formal identification is needed and it does not have rigid regulations thus it almost allows anyone to publish contents and classify the content into different categories including education and science [12]. Unfortunately, most of the uploaded materials are not peer-reviewed and can be of a variable quality which prompted healthcare professionals to investigate the nature and quality of information available on this website [13,14]. The risk of depending on YouTube as a source for conventional root canal treatment information was highlighted previously; the authors stated the need for endodontic professionals to get in on that act in enjoining health information seekers towards other trusted sources [15]. Healthcare professionals, academic institutions, and professional organizations should share this responsibility of refining the content of this site directing patients to reliable information sources [13].

Up to our knowledge, there is a paucity of scholarly literature in the content of YouTube videos on periradicular surgery. In this study we aimed to evaluate the content, accuracy and quality of the most viewed periradicular surgery-related videos available on the aforementioned website.

Material and methods

YouTube search strategy

On the fifth of February 2021, YouTube search was made for videos related to periradicular surgery. The following related terms were used: (1) apical curettage; (2) root end resection; (3) root end surgery; (4) root end filling material; (5) periradicular surgery; (6) periapical surgery; (7) apicoectomy; (8) retrograde root canal treatment; (9) retrograde endodontics; (10) retrograde filling material; (11) endodontic surgery; (12) microsurgical endodontics; (13) endodontic microsurgery; (14) surgical endodontics; and (15) non-conventional endodontic therapy.

Past researches proposed that the majority of YouTube users scan the first 30 videos thousand times per day [16]; therefore, we analyzed the first 30 videos for each search term. The search was conducted using an incognito window with a cache clean and unlogged browser to prevent robot learning and under default settings without any filters for sorting by relevance.

Selection of videos

Initial screening was performed to include videos related to periradicular surgery. A video was excluded if it had one the following criteria:

videos lacking audio or visuals

videos about other types of endodontic treatments

videos describing the findings of a research paper/project

videos primarily directed to a specialized audience (i.e., a conference/scientific meeting presentation or a medical/dental school lecture)

non-English language videos

advertisements, stories or songs

drama-based or satirical videos

An account on YouTube was created for the purpose of the study and the included videos were stored following the removal of duplications.

Evaluation of videos

The videos were entirely viewed and analyzed independently by two observers, who are endodontists, to get information about: (1) video’s duration, (2) date of upload, (3) country of upload, (4) numbers of views and (5) number of likes and dislikes. The upload source was identified and categorized based on authorship.

To analyze and grade the value of videos in providing the viewers adequate information about periradicular surgery, a usefulness score was created based mainly on the American association of endodontists (AAE) guidelines. The scores were in the range of 0–10: A score of 10 reflected that the video touched on the following aspects of periradicular surgery: definition, etiology, symptoms, indications and contraindications, steps of the procedure, cost, postoperative care, complications, prognosis and supporting media (images and videos) (Table 1). Each element was given a score of 0 or 1 based on its consistency with the information usefulness about endodontic surgery. Based on this, video content was deemed poor (0–3 points), moderate (4–7 points), or good (8–10 points).

Table 1

A usefulness scoring system and observation rate for videos about "periradicular surgery".

Scoring element	Score	Observation rate
Definition	1	19%
Etiology	1	14.3%
Symptoms	1	31.0%
Indications and contraindications	1	45.2%
Steps of the procedure	1	90.5%
Cost	1	0.0%
Postoperative care	1	4.8%
Complications	1	14.3%
Prognosis	1	0.0%
Supporting media (videos and images)	1	100.0%
TOTAL	10	-

The interactions of users with the included videos were assessed based on the interaction index and the viewing rate by using the formulae: [(number of likes-number of dislikes/ total number of views) * 100%)] and [(number of views/number of days since upload) * 100%)], respectively.

Statistical analysis

An inter-observer reliability analysis for the usefulness scoring was conducted using the Kappa statistic to determine the variability. In the different opinion event, a consensus was obtained after reviewing the related videos.

Statistical tests were run using SPSS software (SPSS Inc, Chicago, IL, USA) to investigate the relationship between content usefulness and video characteristics and demographics. Continuous variables were studied using the Kruskal-Wallis test and Mann-Whitney U test. Categorical variables were studied using the chi-square test. The significance level was set at 5%.

Results

The content usefulness was determined using 10 elements (Table 1). The most covered elements were supporting media (100%) followed by steps of the procedure (90%), indications and contraindications (45.2%) and symptoms (31%). Less than 20% of the videos discussed definition, etiology, complications or postoperative pain. None of the videos discussed the procedure’s cost or prognosis (Table 1).

Video characteristics are provided in Table 2. Half of the videos were from the United States and the rest were from India, the United Kingdom, Canada, Greece, Jordan, Brazil, Italy, South Korea, Spain, and Germany. The source of authorship was identified as individuals (57.1%), companies (31%) or academic institutions (11.9%).

Table 2

Video characteristics.

		N	%
Country	The United States	21	50
	India	7	16.7
	The United Kingdom	4	9.5
	Canada	2	4.8
	Greece	2	4.8
	Jordan	1	2.4
	Brazil	1	2.4
	Italy	1	2.4
	South Korea	1	2.4
	Spain	1	2.4
	Germany	1	2.5
Source of authorship	Individual	24	57.1
	Company	13	31.0
	Academic	5	11.9
Content usefulness score	Good	0	0
	Moderate	16	38.1
	Poor	26	61.9

Descriptive statistics of evaluated videos are provided in Table 3. The included videos have an average of 35103.9 (Range: 9–652378) views with an average duration of 338.7 sec (Range: 42–2081 sec). The mean interaction index score was 1.0 (Range: 0–7.6). The mean number of “likes” was 126.3 (Range: 0–2100). The mean usefulness score was 3.2±1.4 with a range of 1–7. In terms of content usefulness score, 61.9% of the videos were classified as poor, 38.1% as moderate, and 0% as good. The moderate videos were longer in duration with higher number of views, number of likes, interaction index and viewing rate when compared with poor videos (p< 0.05) (Table 4).

Table 3

Descriptive statistics of evaluated videos (n = 42).

Demographics	Mean±SD	Median	Q1-Q3	Min-Max
Video length (in seconds)	338.7±361.3	241.5	136.5–371	42.0–2081.0
Days since upload	2002.5±1243.4	1764	869–3400	133–4242
Numbers of views	35103.9±104231.5	5590.5	645.8–22675	9–652378
Number of likes	126.3±359.2	24	6.3–9.	0.0–2100.0
Number of dislikes	12±34.9	1	0–6	0.0–203.0
Interaction index	1.0±1.6	0.4	0.1–1.0	0.0–7.6
Viewing rate	2073.1±6402.1	329.2	62.7–1099.9	6.8–33335.6
Content usefulness score	3.2±1.4	3	2–4	1–7

Table 4

Comparison of YouTube video demographics based on the usefulness score categories.

Demographics	Poor (n = 26)		Moderate (n = 16)		Good (n = 0)		P- valuea
	Mean±SD	Median	Mean±SD	Median	Mean±SD	Median
Video length (in seconds)	253.5±241.7	185	477.3±475.7	343	0	0	0.017
Days since upload	1764.5±1224.7	1629.5	2389.3±1211.7	2543.5	0	0	0.087
Numbers of views	8102.3±10045.7	2941.5	78981.4±161894.9	18554	0	0	0.01
Number of likes	36.9±54.5	13.5	271.4±558.0	31.5	0	0	0.015
Number of dislikes	2.9±4.6	1	26.7±54.1	1.5	0	0	0.234
Interaction index	457.2±632.2	165.9	4699.1±9974.2	684.2	0	0	0.013
Viewing rate	36.9±54.5	13.5	271.4±558.0	31.5	0	0	0.015

No statistically significant difference was found between video source of authorship and content usefulness score (p>.05). No difference was found between the authors in terms of numbers of views, number of likes, number of dislikes, interaction index, viewing rate or content usefulness (p>0.05). The longest duration was found in videos uploaded by academic institutions (792.2±780.6 sec), followed by individuals (356.5±231.5 sec) and companies (131.5±85.2 sec) (p<0.001). Perfect agreement between the observers in scoring the videos was detected (Kappa = 0.945).

Discussion

Past experiments have studied the YouTube videos contents for various oral-health-related topics [15,17-25]. In the present study, the video content was evaluated based on the AAE guidelines regarding periradicular surgery. Excellent agreement was found between the observers. Patient satisfaction is related to the amount of information received before procedure mainly regarding the steps and complications [18]; in the present study, none of the videos addressed all the elements needed to fully understand the procedure from a patient perspective.

All the evaluated videos were supported with images and audio which could seemingly facilitate knowledge acquisition, thus making them more frequently watched. However, the usefulness score of two-thirds of the tested videos was poor whilst none was qualified to be good. These findings were due to the fact that most of the videos lacked definition, etiology, complications and postoperative pain aspects, and none of them discussed the procedure’s cost or prognosis. None of the videos covered all the elements required to understand the procedure which resulted in an average usefulness score of 3.2±1.4 out of 10. Hence, YouTube is not a suitable single source to obtain comprehensive information about periradicular surgery. Inadequate scores of YouTube videos discussing other dental-related topics were also previously reported [15,18-21,24]. It is known that YouTube videos are not peer-reviewed nor based on scientific evidence [13,14] which adds a question mark over the reliability and quality of the information being presented. In the current study, most of the videos were uploaded by individuals (57.1%), a factor that we believe has contributed to a low usefulness score. In our opinion, this deficiency can be tackled by the involvement of foremost dental academic institutions and organizations in producing high quality YouTube videos. Indeed, YouTube studies have highlighted the importance of professionals’ contribution to high-quality videos as relevant patient-information sources [26,27].

Although low number of the included videos were found in YouTube, it is expected in the near future to have more videos with the increased demand and training sessions for it among postgraduate students [5].

Considering the anticipated increase in demand for periradicular surgery [5], comprehensive patient education materials is highly needed to reduce procedure-related distress [6]. Patients tend to search for health related matters through YouTube platform since it provides health information for free with audiovisual materials. A previous study reported the risk behind patients’ reliance on YouTube as a source of information about non-surgical root canal treatment [15]. Fortunately, the feasibility of periradicular surgery as a treatment option is firstly recognized by the patients after receiving detailed clinical and radiographic examinations and is usually suggested by the dental professional who should discuss these aspects in the clinic and direct patients to high quality sources to obtain verified and up-to-date information, thus minimizing the amount of misleading information and avoiding videos with limited usefulness.

Based on the usefulness scoring, moderate videos showed favorable demographic data. It is noted that moderate videos received higher number of views whilst poor videos received as low as 9 views. Moreover, videos with higher usefulness scores had longer duration with higher number of views, number of likes, interaction index, viewing rate and content usefulness. These findings are inconsistent with some previously published studies [11,13,18,25,28,29]. However, other studies indicated that videos with high usefulness scores were longer [20-23]. In this study, no significant differences were found in video demographics among the different authorship sources except for video duration where academic institutions uploaded longer videos which also gave better usefulness scores. The latter might be ascribed to the ability of covering many aspects of the treatment in a sufficient way with longer videos [25]. The use of videos for oral health education is an enjoyable and preferred method by patients, however, the fun in learning was previously reported to be more with patients who watched the video from 5 to 20 minutes [30]. This calls for the need of studies evaluating the effect of video length on the usefulness of the presented materials and the engagement of the patient.

YouTube’s features such as “like” and “dislike” is a way that indicates the viewers’ feedback and engagement. It can also help dental professionals to measure the video usefulness and patients’ satisfaction. It is noteworthy to mention here, that we found a higher number of likes in the videos that fall in the moderate usefulness category. Another way to measure viewers’ interactions with videos is by assessing the interaction index and viewing rate [13,18,21]. Previous YouTube studies reported varying results about the viewers’ interaction [11,13,26,28,29,31,32]. In our study, the interaction index and viewing rate were better in videos with higher scores. By default, YouTube arranges videos based on number of views, interaction index and viewing rate [15]. Based on this, useful videos will be chosen and watched. Also, videos can be sorted based on number of views, days since upload, viewing rate and video duration.

The health professionals should inform their patients about misleading and unreliable information on YouTube and recommend alternative reliable online sources. Social media, including YouTube, are used by health professionals, mainly for marketing and advertising purposes [33,34]. A previous study showed that that only 4.2% of the dental educators uploaded informative videos on YouTube [35]. Therefore, it is crucial to encourage healthcare professionals to upload videos within the context of healthcare’s good practice and ethical rules.

As with other studies, there are a few limitations in the current study. Our results only reflected information available in English which were collected at the time of the search. It is notable that YouTube accepts videos with a wide range of languages and is being updated continuously by deleting and uploading videos without scientific and quality checks. It was also impossible to figure out the audience nature. Moreover, patients might use other search terms which can eventually show different results. To make this negligible, efforts were made to retrieve a wide range of possible YouTube videos related to periradicular surgery wherein 15 search terms were used in this study. Lastly, the usefulness scoring was made by endodontists wherein different results could have been attained if the scoring had been conducted by other healthcare professionals or patients. Nevertheless, excellent agreement was found between the two observers who come from a specialization background that is directly related to the periradicular surgery treatment modality.

Conclusion

There are a small number of videos on YouTube with adequate information on periradicular surgery. Since the majority of videos received low scores, patients should not rely on YouTube as the only source of information on periradicular surgery. Dental professionals should enrich the content of YouTube with good quality videos by providing comprehensive and evidence based information which can affect patients’ attitudes and satisfaction.

Data collection sheet for YouTube videos about periradicular surgery.

(XLSX)

Click here for additional data file.

16 Nov 2021

PONE-D-21-31439Evaluation of YouTube Videos for Patients' Education on Periradicular SurgeryPLOS ONE

Dear Dr. Ahmed Jamleh,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

Please respond to the comment mentioned in point 5. Review comments to the Author.

==============================

Please submit your revised manuscript by Dec 31 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Tanay Chaubal

Academic Editor

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf.

2. We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match.

When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section.

3. Thank you for stating the following in the Acknowledgments Section of your manuscript:

[Authors of this study deny any conflict of interest. This work was supported by a research grant (NRC21/012/01/R) from King Abdullah International Medical Research Center, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.]

We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form.

Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows:

[No]

Please include your amended statements within your cover letter; we will change the online submission form on your behalf.

4.  Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

Dear Ahmed Jamleh,

Please respond to the comments made by the reviewer.

Thank you.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: how has the appearance video in concern taken into account on social media ? what do u mean by the videos from country of origin? is there any countries upload restricted in your country? can u please let us know the rationale of your study?

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

18 Nov 2021

Tanay Chaubal

Academic Editor

PLOS ONE

Dear Dr. Tanay;

It is an immense pleasure to submit our revised manuscript entitled: “Evaluation of YouTube videos for patients' education on periradicular surgery”. The authors ensured that the manuscript meets PLOS ONE's style requirements and have made changes to the manuscript according to the suggestions from the editor and the reviewers; the changes follow and are made in the revised manuscript using “Track Changes” mode.

The funding information was removed from the “Acknowledgment” section which has to appear in the “Financial Disclosure”.

Reference list was updated and formatted as requested.

We are grateful for the attention and effort spent in reviewing our work, and valuable comments made by the respectful editor and reviewers.

We sincerely hope that the revised manuscript is now suitable for publication in the PLOS ONE Journal.

Sincerely yours,

Reply to reviewer

How has the appearance video in concern taken into account on social media? What do u mean by the videos from country of origin? Is there any countries upload restricted in your country? Can u please let us know the rationale of your study?

Periapical surgery is increasingly becoming a common treatment option in the field of endodontics, and more clinicians including postgraduate students are being trained on this treatment modality. Due to the expected higher demand, the need for good quality educational materials on periapical surgery cannot be stressed enough. With the growing number of patients using social media, it appears that there is a need to evaluate the usefulness of periapical surgery-related videos posted on social media as a source of patient education. One of the most commonly used platforms for this purpose is YouTube due to the several advantages it offers over other platforms, and it is slowly becoming one of the primary sources for patients seeking specific health-related information. We conducted this study to analyze YouTube as a source of patient educational material on periapical surgery. The findings of our study highlight an immediate need for higher quality educational videos on periapical surgery as the existing videos content and quality vary significantly and none of the evaluated videos covered all the essential components related to this type of surgery. This responsibility should be shared among dental organizations, academic and professional clinicians.

The country of origin (country of upload) indicates which countries are talking about this issue. In this study, half of the videos were from the United States.

The search was conducted using an incognito window with a cache clean and unlogged browser to prevent robot learning and under default settings without any filters for sorting by relevance. However, some YouTube videos may not be available in the search as the video owners have chosen to make their content available only to certain countries/regions.

1 Dec 2021

Evaluation of YouTube videos for patients' education on periradicular surgery

PONE-D-21-31439R1

Dear Dr. Ahmed Jamleh,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Tanay Chaubal

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Dear Dr Ahmed Jamleh,

I am pleased to accept your manuscript for publication.

Thank you.

Reviewers' comments:

3 Dec 2021

PONE-D-21-31439R1

Evaluation of YouTube videos for patients' education on periradicular surgery

Dear Dr. Jamleh:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Tanay Chaubal

Academic Editor

PLOS ONE