Uncovering a pseudoscience: an analysis of 'biological dentistry' Instagram posts.

OBJECTIVE: This infodemiology study aimed to analyze characteristics of English-language Instagram posts on 'Biological Dentistry'. MATERIALS AND METHODS: Using CrowdTangle, we analyzed 500 'Biological Dentistry' posts published on Instagram from May 2017 to May 2022. Two researchers assessed each post for facticity, motivation, author's profile, sentiment, and interaction metrics. Statistical analysis was employed to compare interaction metrics between dichotomized categories of posts' characteristics and determine predictors of misinformation and user engagement. RESULTS: Over half of the posts (58.4%) were from health-related authors, and a considerable number contained misinformation (68.2%) or were financially motivated (52%). Sentiment was mostly negative or neutral (59.8%). Misinformation was associated with financial motivation (OR = 2.12) and health-related authors (OR = 5.56), while non-health-related authors' posts associated with higher engagement (OR = 1.98). Reliable content, non-health-related authorship, and positive sentiment were associated with increased user interaction. CONCLUSION: Misinformation about 'Biological Dentistry' on Instagram is mainly spread by financially incentivized health-related authors. Yet, non-health-related authors' posts resonate more with audiences, highlighting a nuanced relationship between content facticity, authorship, and engagement.

Unveiling deception: Characterizing false amber necklace messages on Facebook.

BACKGROUND: Messages promoting the benefits of amber necklaces for children are common on social media, despite their health risks. AIM: This study characterized Facebook posts with false content about the efficacy of amber necklaces in teething. DESIGN: A sample of 500 English-language Facebook posts was analyzed by two investigators to determine the motivations, author's profile, and sentiments of posts. Latent Dirichlet Allocation topic modeling was used to identify salient terms and topics. An intertopic distance map was created to calculate the topic similarity. These data were analyzed using descriptive analysis, the Mann-Whitney U test, Cramer's V test, and multiple logistic regression models, regarding the time since initial posting and interaction metrics. RESULTS: Most posts were made by business profiles and expressed positive sentiments, with social, psychological, and financial motivations. The posts were categorized into the topics "giveaway," "healing features," and "sales." Overperforming scores and total interaction increased with time since the initial posting. Posts with links had higher overperforming scores. CONCLUSION: The findings suggest that Facebook posts about the efficacy of amber necklaces in teething are motivated by financial interests, using psychological and social mechanisms to achieve greater interaction with their target audience.

Digital surveillance: The interest in mouthwash-related information.

BACKGROUND: The comprehension of the interests of Internet users regarding their health-related searches may reveal the community's demands about oral health. The study aimed to characterize the interests of Google users related to mouthwash in Australia, Brazil, Chile, Japan, Mexico, Russia, the United Kingdom, the United States, Saudi Arabia and South Africa applying the Google Trends. METHODS: This longitudinal retrospective study analysed the mouthwash-related interest of Google users from January 2004 to December 2020. The monthly variation of relative search volume (RSV) and the main queries related were determined using Google Trends. Autoregressive integrated moving average (ARIMA) forecasting models were built to establish the predictive RSV values for mouthwash for additional 12 months. Auto-correlation plots and a general additive model (GAM) were used to diagnose trends and seasonality in RSV curves. In addition, the influence of social isolation related to the outbreak of COVID-19 were analysed. RESULTS: The RSVs curves showed a considerable increase in searches related to mouthwash to AUS, BRA, JAP, MEX, GBR and USA (RSV > 25), while the growth was slight to CHI, KSA, RSA and RUS (RSV < 25) over the years, without influence of monthly seasonality. All countries showed a significant increase in mouthwash interest after the outbreak of COVID-19, except for KSA and RUS. The mouthwash-related searches were associated to specific brands or chemical compositions, treatments, whitening agents, homemade mouthwash and indications for the 'best mouthwash'. CONCLUSIONS: In general, there was an increasing interest of Google users in mouthwash-related topics between 2004 and 2020. In addition, in most countries, there was an expansion in searches during the social isolation of the COVID-19 pandemics.

Reacting, Sharing, and Commenting: How Many Facebook Users Are Engaging with Posts Related to Dental Caries That Contain Misinformation?

Recent studies have been concerned about the vast amount of misinformation detected on social media that directly hampers the prevention and control of chronic diseases. Based on these facts, the aim of this study was to identify and characterize misinformation about dental caries-related content found on Facebook, regarding the predictive factors of user interaction with posts. Then, CrowdTangle retrieved 2,436 posts published in English, ordered by the total interaction of the highest users. A total of 1,936 posts were selected for inclusion and exclusion criteria to select a sample of 500 posts. Subsequently, two independent investigators characterized the posts by their time of publication, author's profile, motivation, the aim of content, content facticity, and sentiment. The statistical analysis was performed using Mann-Whitney U and χ2 tests and multiple logistic regression models to determine differences and associations between dichotomized characteristics. p values <0.05 were considered significant. In general, posts were predominantly originated from the USA (74.8%), related to business profiles (89%), presented preventive content (58.6%), and noncommercial motivation (91.6%). Furthermore, misinformation was detected in 40.8% of the posts and was positively associated with positive sentiment (OR = 3.43), business profile (OR = 2.22), and treatment of dental caries (OR = 1.60). While the total interaction was only positively associated with misinformation (OR = 1.44), the overperforming score was associated with posts from the business profile (OR = 5.67), older publications (OR = 1.57), and positive sentiment (OR = 0.66). In conclusion, misinformation was the unique predictive factor of increased user interaction with dental caries-related posts on Facebook. However, it did not predict the performance of the diffusion of posts such as business profiles, older publications, and negative/neutral sentiment. Therefore, it is essential to promote the development of specific policies toward good quality information on social media, which includes the production of adequate materials, the increase of the critical sense of consuming health content, and information filtering mediated by digital solutions.

Tweeting for Health Using Real-time Mining and Artificial Intelligence-Based Analytics: Design and Development of a Big Data Ecosystem for Detecting and Analyzing Misinformation on Twitter.

BACKGROUND: Digital misinformation, primarily on social media, has led to harmful and costly beliefs in the general population. Notably, these beliefs have resulted in public health crises to the detriment of governments worldwide and their citizens. However, public health officials need access to a comprehensive system capable of mining and analyzing large volumes of social media data in real time. OBJECTIVE: This study aimed to design and develop a big data pipeline and ecosystem (UbiLab Misinformation Analysis System [U-MAS]) to identify and analyze false or misleading information disseminated via social media on a certain topic or set of related topics. METHODS: U-MAS is a platform-independent ecosystem developed in Python that leverages the Twitter V2 application programming interface and the Elastic Stack. The U-MAS expert system has 5 major components: data extraction framework, latent Dirichlet allocation (LDA) topic model, sentiment analyzer, misinformation classification model, and Elastic Cloud deployment (indexing of data and visualizations). The data extraction framework queries the data through the Twitter V2 application programming interface, with queries identified by public health experts. The LDA topic model, sentiment analyzer, and misinformation classification model are independently trained using a small, expert-validated subset of the extracted data. These models are then incorporated into U-MAS to analyze and classify the remaining data. Finally, the analyzed data are loaded into an index in the Elastic Cloud deployment and can then be presented on dashboards with advanced visualizations and analytics pertinent to infodemiology and infoveillance analysis. RESULTS: U-MAS performed efficiently and accurately. Independent investigators have successfully used the system to extract significant insights into a fluoride-related health misinformation use case (2016 to 2021). The system is currently used for a vaccine hesitancy use case (2007 to 2022) and a heat wave-related illnesses use case (2011 to 2022). Each component in the system for the fluoride misinformation use case performed as expected. The data extraction framework handles large amounts of data within short periods. The LDA topic models achieved relatively high coherence values (0.54), and the predicted topics were accurate and befitting to the data. The sentiment analyzer performed at a correlation coefficient of 0.72 but could be improved in further iterations. The misinformation classifier attained a satisfactory correlation coefficient of 0.82 against expert-validated data. Moreover, the output dashboard and analytics hosted on the Elastic Cloud deployment are intuitive for researchers without a technical background and comprehensive in their visualization and analytics capabilities. In fact, the investigators of the fluoride misinformation use case have successfully used the system to extract interesting and important insights into public health, which have been published separately. CONCLUSIONS: The novel U-MAS pipeline has the potential to detect and analyze misleading information related to a particular topic or set of related topics.

Analysis of Fluoride-Free Content on Twitter: Topic Modeling Study.

BACKGROUND: Although social media has the potential to spread misinformation, it can also be a valuable tool for elucidating the social factors that contribute to the onset of negative beliefs. As a result, data mining has become a widely used technique in infodemiology and infoveillance research to combat misinformation effects. On the other hand, there is a lack of studies that specifically aim to investigate misinformation about fluoride on Twitter. Web-based individual concerns on the side effects of fluoridated oral care products and tap water stimulate the emergence and propagation of convictions that boost antifluoridation activism. In this sense, a previous content analysis-driven study demonstrated that the term fluoride-free was frequently associated with antifluoridation interests. OBJECTIVE: This study aimed to analyze "fluoride-free" tweets regarding their topics and frequency of publication over time. METHODS: A total of 21,169 tweets published in English between May 2016 and May 2022 that included the keyword "fluoride-free" were retrieved by the Twitter application programming interface. Latent Dirichlet allocation (LDA) topic modeling was applied to identify the salient terms and topics. The similarity between topics was calculated through an intertopic distance map. Moreover, an investigator manually assessed a sample of tweets depicting each of the most representative word groups that determined specific issues. Lastly, additional data visualization was performed regarding the total count of each topic of fluoride-free record and its relevance over time, using Elastic Stack software. RESULTS: We identified 3 issues by applying the LDA topic modeling: "healthy lifestyle" (topic 1), "consumption of natural/organic oral care products" (topic 2), and "recommendations for using fluoride-free products/measures" (topic 3). Topic 1 was related to users' concerns about leading a healthier lifestyle and the potential impacts of fluoride consumption, including its hypothetical toxicity. Complementarily, topic 2 was associated with users' personal interests and perceptions of consuming natural and organic fluoride-free oral care products, whereas topic 3 was linked to users' recommendations for using fluoride-free products (eg, switching from fluoridated toothpaste to fluoride-free alternatives) and measures (eg, consuming unfluoridated bottled water instead of fluoridated tap water), comprising the propaganda of dental products. Additionally, the count of tweets on fluoride-free content decreased between 2016 and 2019 but increased again from 2020 onward. CONCLUSIONS: Public concerns toward a healthy lifestyle, including the adoption of natural and organic cosmetics, seem to be the main motivation of the recent increase of "fluoride-free" tweets, which can be boosted by the propagation of fluoride falsehoods on the web. Therefore, public health authorities, health professionals, and legislators should be aware of the spread of fluoride-free content on social media to create and implement strategies against their potential health damage for the population.

eHEALS as a predictive factor of digital health information seeking behavior among Brazilian undergraduate students.

This study aimed to perform the cross-cultural adaptation and validation of the eHealth Literacy Scale (eHEALS) for Brazilian Portuguese. The cross-cultural adaptation was conducted through conceptual equivalence, verbatim translation, semantic, item and operational equivalence, and back-translation. Subsequently, 521 undergraduate students answered the adapted version of the eHEALS, the General Perceived Self-Efficacy Scale (GSES), the Oral Health Impact Profile-14 (OHIP-14) and sociodemographic and health-related questions. Statistical analysis was performed to determine the dimensionality, internal consistency, stability and concurrent/convergent/discriminant/predictive validities of the eHEALS (p < 0.05). The adequacy of sample size was confirmed by a non-identity correlation matrix (Bartlett's test of sphericity, p < 0.001), without influence of multicollinearity (determinant = 0.026). The confirmatory factor analysis identified four factors in agreement to the constructs namely as online searching self-efficacy, awareness of available sources, information usage ability, and critical analysis of useful information. The eHEALS displayed an excellent internal consistency (Cronbach's alpha = 0.88), a good stability (ICC = 0.71, 95% CI: 0.49-0.84), and it was significantly correlated with GSES (concurrent validity). Higher eHEALS scores were identified among (i) white and (ii) younger students, (iii) from health sciences courses, (iv) with more years of graduation, (v) who their fathers were working in specialized functions (discriminant validity), and (vi) among those who were frequently interested in digital health information (convergent validity). The students with higher eHealth literacy levels were more likely to seek health information in the last 24 h (predictive validity). In conclusion, the eHEALS demonstrated adequate psychometric properties to be applied for the Brazilian population.

The eHealth Literacy Scale (eHEALS) is a self-fulfilling tool designed to determine individuals' levels of electronic health literacy. It helps to determine how people deal with electronic health-related information, being useful to identify potential difficulties of accessing, evaluating and using online health information, with potential to support the planning of educational interventions. This study aimed to adapt and validate the eHealth Literacy Scale (eHEALS) for being applied to Brazilian Portuguese native speakers. Five hundred twenty-one undergraduate students answered the adapted version of the eHEALS, the General Perceived Self-Efficacy Scale (GSES), the Oral Health Impact Profile-14 (OHIP-14), and sociodemographic and health-related questions. The tool showed sufficient consistency and stability, with the detection of higher eHEALS scores among white and younger people who reported a frequent interest for seeking digital health information, students from health sciences courses, those with more years of graduation, and who their fathers were working in specialized functions. Also, the students with higher eHealth literacy scores were more likely to seek health information in the last 24 h. In conclusion, the eHEALS demonstrated being adequate to be applied for the Brazilian population.

Digital surveillance: The interests in toothache-related information after the outbreak of COVID-19.

OBJECTIVES: The aim of this ecological study was to analyze the relationship of social restriction measures and people's interest in searching toothache-related information on the Internet. MATERIALS AND METHODS: The following indicators Stringency Index (SI), Years Lived with Disability (YLDs) for untreated caries in permanent teeth, Google market share, Internet penetration, and relative search volume (RSV) for the Topic "Toothache" in Google Trends were determined for 21 countries with available data, from April 2018 to May 2020. Statistical analysis was performed using Mann-Whitney U test, t-Student test, Pearson's Chi-square test, and Spearman and Pearson's cross-correlation tests (α = 0.05). RESULTS: Relative search volume values increased significantly after restriction measures in all countries, except for Japan. Higher RSV values were found among 11 countries that presented a cross-correlation between RSV and SI with r≥│0.6│. The most common queries were linked to the treatment and self-resolution of toothache, with a sudden increase of searches that combined the symptom with COVID-19. CONCLUSIONS: The interests in toothache-related digital information were associated with social restriction measures. These results allow the identification of dental demands of distinct populations, contributing to the planning of specific public health policies during and after the pandemic period.

Characterization of False or Misleading Fluoride Content on Instagram: Infodemiology Study.

BACKGROUND: Online false or misleading oral health-related content has been propagated on social media to deceive people against fluoride's economic and health benefits to prevent dental caries. OBJECTIVE: The aim of this study was to characterize the false or misleading fluoride-related content on Instagram. METHODS: A total of 3863 posts ranked by users' total interaction and published between August 2016 and August 2021 were retrieved by CrowdTangle, of which 641 were screened to obtain 500 final posts. Subsequently, two independent investigators analyzed posts qualitatively to define their authors' interests, profile characteristics, content type, and sentiment. Latent Dirichlet allocation analysis topic modeling was then applied to find salient terms and topics related to false or misleading content, and their similarity was calculated through an intertopic distance map. Data were evaluated by descriptive analysis, the Mann-Whitney U test, the Cramer V test, and multiple logistic regression models. RESULTS: Most of the posts were categorized as misinformation and political misinformation. The overperforming score was positively associated with older messages (odds ratio [OR]=3.293, P<.001) and professional/political misinformation (OR=1.944, P=.05). In this context, time from publication, negative/neutral sentiment, author's profile linked to business/dental office/news agency, and social and political interests were related to the increment of performance of messages. Although political misinformation with negative/neutral sentiments was typically published by regular users, misinformation was linked to positive commercial posts. Overall messages focused on improving oral health habits, side effects, dentifrice containing natural ingredients, and fluoride-free products propaganda. CONCLUSIONS: False or misleading fluoride-related content found on Instagram was predominantly produced by regular users motivated by social, psychological, and/or financial interests. However, higher engagement and spreading metrics were associated with political misinformation. Most of the posts were related to the toxicity of fluoridated water and products frequently motivated by financial interests.

Parental perspectives on early childhood caries: A qualitative study.

BACKGROUND: Early childhood caries (ECC) affects about 621 million children worldwide, causing chronic pain, infections, sleeping disorders, and tooth extraction. AIM: To determine perspectives of parents and caregivers of preschoolers regarding ECC. DESIGN: Three focus groups were conducted with attendees of the Clinics of Paediatric Dentistry from the Bauru School of Dentistry. The meetings were video- and audio-recorded, and the contents were transcribed verbatim. Then, textual passages were examined and coded using the software NVivo 12 Plus. RESULTS: The participants associated the presence of dental caries lesions with negative consequences for children, such as problems for permanent dentition, discrimination, and psychological damages. Although regular oral hygiene and healthy diet were recognized as important factors for the prevention of ECC, specific doubts about feeding, toothpaste usage, oral hygiene, and dental eruption were detected among parents. Additionally, they declared that their children brush teeth alone, intake fermentable carbohydrates frequently, and sleep during breastfeeding without dental plaque removal, because uncooperativeness, permissiveness, and convenience. CONCLUSIONS: Based on these results, parents and caregivers understand the unfavourable effects of ECC on children's quality of life; however, their attitudes against the disease seemed to be inaccurate, influenced by their daily routines, doubts, and beliefs.

Are the Internet users concerned about molar incisor hypomineralization? An infoveillance study.

BACKGROUND: Molar incisor hypomineralization (MIH) is a developmental enamel defect characterized by well-demarcated discolorations frequently detected in molars, causing pain and esthetic alterations. AIM: To assess the interests of Google users on MIH-related information. DESIGN: Digital data were collected in Google Trends through two search strategies, 'molar incisor hypomineralization' (topic) and 'MIH' (search term), between January 2004 and November 2018. ARIMA models were applied to analyze trends of curves and to predict the activity of Google users during 12 months. Autocorrelation and partial autocorrelation (ACF/PACF) plots were used to detect trends in the variation of relative search volume (RSV) related to search strategies over time. The most popular queries were analyzed qualitatively, whereas geographical heat maps were retrieved to determine search volumes according to countries (P < .05). RESULTS: Gradual increasing trends were detected, with forecasts indicating similar levels of RSVs to the period between December 2017 and November 2018. Most popular queries and topics were associated with MIH diagnosis, being retrieved predominantly in European countries. CONCLUSIONS: The activity of Google users related to this condition is maintained low, with a reduced intensification over time, suggesting that the awareness on MIH is probably confined to dentists and affected people worldwide.

Digital behavior surveillance: Monitoring dental caries and toothache interests of Google users from developing countries.

OBJECTIVE: To determine the differences between the levels of interest of South American Google users on information related to dental caries and toothache over time. MATERIALS AND METHODS: The monthly variation of Relative Search Volume (RSV) for both queries was obtained in Google Trends between 2004 and 2017. The association between RSVs, Internet penetration, and disability-adjusted life-years (DALYs) for dental caries in permanent teeth were tested by distinct regression models. Forecasting ARIMA models were developed to analyze trends and predict the interests until December 2018. RESULTS: In general, toothache-related searches presented an uptrend associated positively with Internet penetration and negatively with DALYs, whereas dental caries-related searches presented a downtrend associated negatively with Internet penetration and positively with DALYs. The seasonality affected only dental caries curves, with the highest rates observed in the first trimester and the lowest rates in June, July, and December. CONCLUSION: The levels of interests of South American Google users in seeking dental caries and toothache information appear to have a direct connection with the burden of untreated dental caries lesions and Internet penetration. The no association between dental caries- and toothache-related interests reinforces the unfamiliarity of most people about the relationship of dental pain with the final stages of chronic oral diseases.

Digital behavior surveillance for monitoring the interests of Google users in amber necklace in different countries.

AIM: To determine the interests of Google users in information about amber necklace in distinct countries over time. DESIGN: This longitudinal retrospective study analyzed the amber necklace-related computational data generated from the activity of Google users from17 countries, by the application of Google Trends. Four search strategies were defined in English, Spanish, Portuguese, and Italian, for retrieving the monthly variation of relative search volume (RSV) between January 2004 and September 2018, including all categories and sources of search. Trends and 12-month predictive interests of users were analyzed by forecasting autoregressive integrated moving average models, while the influences of seasonality were evaluated by generalized additive models. The most popular queries employed for Google users were determined to qualitative analysis. P values < 0.05 were considered significant. RESULTS: In general, RSV curves were characterized by uptrends in most studied countries over the years, without the influence of monthly or quarterly seasonality. The queries were frequently associated with a desire for additional information, with respect to the definition, usability, and teething symptoms relief promoted by amber jewelries. CONCLUSIONS: These findings indicate an increasing interest of Google users in amber necklace-related topics in different countries.

The Brazilian validation of a health literacy instrument: the newest vital sign.

OBJECTIVE: This study aimed to perform the cross-cultural adaptation and validation of the NVS for Brazilian Portuguese. MATERIAL AND METHODS: Two hundred and fifty adults responded to the adapted version of the NVS, the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30), ten questions of the National Functional Literacy Index (NFLI), and a questionnaire about demographic and oral health-related aspects. Statistical analysis determined the internal consistency, stability, difficulty of items, and convergent/discriminant/predictive validities of the NVS. p < .05 was considered significant. RESULTS: The NVS displayed a good internal consistency (Cronbach's alpha = 0.79) and a fair stability (ICC = 0.57; 0.39-0.70 95% CI). Seventy-two percent of participants answered the easier question (#5) correctly, whereas only 28.4% were successful in responding the most difficult question (#1). The convergent validity of the NVS was demonstrated by its significant correlation with the BREALD-30 (Rs = 0.601, p < .001) and NFLI (Rs = 0.544, p < .001). The observation of higher NVS scores among health professionals, white and more educated people confirmed the discriminant validity of the instrument. Moreover, health literacy was a significant predictor of self-reported oral health and reason for dental utilization. CONCLUSION: The NVS demonstrated adequate psychometric properties to be applied in Brazilian oral health epidemiological surveys.

What is the impact of artificial intelligence-based chatbots on infodemic management?

Artificial intelligence (AI) chatbots have the potential to revolutionize online health information-seeking behavior by delivering up-to-date information on a wide range of health topics. They generate personalized responses to user queries through their ability to process extensive amounts of text, analyze trends, and generate natural language responses. Chatbots can manage infodemic by debunking online health misinformation on a large scale. Nevertheless, system accuracy remains technically challenging. Chatbots require training on diverse and representative datasets, security to protect against malicious actors, and updates to keep up-to-date on scientific progress. Therefore, although AI chatbots hold significant potential in assisting infodemic management, it is essential to approach their outputs with caution due to their current limitations.

Can heart rate variability data from the Apple Watch electrocardiogram quantify stress?

Chronic stress has become an epidemic with negative health risks including cardiovascular disease, hypertension, and diabetes. Traditional methods of stress measurement and monitoring typically relies on self-reporting. However, wearable smart technologies offer a novel strategy to continuously and non-invasively collect objective health data in the real-world. A novel electrocardiogram (ECG) feature has recently been introduced to the Apple Watch device. Interestingly, ECG data can be used to derive Heart Rate Variability (HRV) features commonly used in the identification of stress, suggesting that the Apple Watch ECG app could potentially be utilized as a simple, cost-effective, and minimally invasive tool to monitor individual stress levels. Here we collected ECG data using the Apple Watch from 36 health participants during their daily routines. Heart rate variability (HRV) features from the ECG were extracted and analyzed against self-reported stress questionnaires based on the DASS-21 questionnaire and a single-item LIKERT-type scale. Repeated measures ANOVA tests did not find any statistical significance. Spearman correlation found very weak correlations (p < 0.05) between several HRV features and each questionnaire. The results indicate that the Apple Watch ECG cannot be used for quantifying stress with traditional statistical methods, although future directions of research (e.g., use of additional parameters and Machine Learning) could potentially improve stress quantification with the device.

Exploring online oral health misinformation: a content analysis.

Considering the unfavorable implications of health falsehoods and the lack of dental research into information disorder, this study aimed to identify and characterize online oral health misinformation. A total of 410 websites published in English were retrieved using Google Advanced Search and screened by two independent investigators to compile falsehoods through thematic content analysis. Afterward, 318 pieces of misinformation were consensually divided into four groups concerning their informational interest (G1), financial, psychological, and social interests produced/disseminated by non-dental professionals (G2) or by dental professionals (G3), and political interests (G4). Social media (Facebook and Instagram) and fact-checking tool (Snopes) were also screened to determine the spread of falsehoods by identifying corresponding posts and warnings. As a result, misinformation was mainly associated with gum diseases (12.0%), root canal treatment (11.6%), toothache (10.4%), fluoride (10.4%), and dental caries (9.8%), with a special highlight on recommendations for the usage of natural products, toxicity concerns, and anti-fluoridation propaganda. Additionally, most misinformation was allocated in G3 (41.9%), which presented a statistically higher frequency of financial interests than G4. Finally, falsehoods were considerably identified on Facebook (62.9%) and Instagram (49.4%), especially G3 and G4. Nevertheless, Snopes has debunked only 5.9% of these content items. Therefore, misinformation was predominantly produced or disseminated by dental professionals mainly motivated by financial interests and usually linked to alternative/natural treatments. Although these items were shared on social media, fact-checking agencies seemed to have limited knowledge about their dissemination.

Ethical principles for infodemiology and infoveillance studies concerning infodemic management on social media.

Big data originating from user interactions on social media play an essential role in infodemiology and infoveillance outcomes, supporting the planning and implementation of public health actions. Notably, the extrapolation of these data requires an awareness of different ethical elements. Previous studies have investigated and discussed the adoption of conventional ethical approaches in the contemporary public health digital surveillance space. However, there is a lack of specific ethical guidelines to orient infodemiology and infoveillance studies concerning infodemic on social media, making it challenging to design digital strategies to combat this phenomenon. Hence, it is necessary to explore if traditional ethical pillars can support digital purposes or whether new ones must be proposed since we are confronted with a complex online misinformation scenario. Therefore, this perspective provides an overview of the current scenario of ethics-related issues of infodemiology and infoveillance on social media for infodemic studies.

Toothpaste-related interests of Google users from different countries.

The Internet is a growing source of knowledge and can provide information about oral health. This ecological study aimed to characterize the interests in toothpaste among Google users from different countries. Our hypothesis was that there would be an increase in Google users' interest in information about toothpaste. This retrospective longitudinal ecological study analyzed the toothpaste-related interest of Google users from 10 countries between January 2004 and December 2020. The monthly variation in relative search volume (RSV) and the main related queries were determined using Google Trends. Autoregressive integrated moving average (ARIMA) forecasting models were built to establish the predictive RSV values for toothpaste for an additional 12 months. Autocorrelation plots and the generalized additive model (GAM) were used to diagnose trends and seasonality in RSV curves. Additionally, the influence of social isolation related to the outbreak of COVID-19 was analyzed. Although not detected by autocorrelation function (ACF) and partial autocorrelation function (PACF) analyses, the heuristic analysis showed an increase in the interest in toothpaste-related information in all countries, with a stable trend observed in the 12-month forecasts, except for the increases in the United Kingdom and South Africa. Also, GAM analyses demonstrated a non-significant monthly or quarterly seasonal influence on data. In addition, social isolation during the COVID-19 pandemic did not influence the online information-seeking behavior of Google Search users linked to this topic. We confirmed the hypothesis that the interest of Google Search users in information about toothpaste increased in all of the 10 assessed countries.

Digital surveillance: Monitoring the activity of Internet users searching for information related to early childhood caries.

This study evaluated the behavior of Internet users from seven countries through the analysis of the monthly variation of the Relative Search Volume (RSV) for queries related to early childhood caries (ECC), retrieved by Google Trends application programming interface between January 2004 to December 2020. The association of RSV with years lived with disability (YLDs) for untreated dental caries in deciduous teeth and Internet penetration were tested by regression models. Forecasting models were developed to predict the interests until December 2021. Relevant topics linked to searches were assessed qualitatively. Increasing levels of interests were observed in most countries, regarding the comparison of periods 2004-2012 and 2013-2021, without influence of seasonality. These results were associated with YLDs only in France and with the Internet penetration in Mexico and France. Searches were mostly related to the definition, risk factors, and preventive care of ECC. The interests of Internet users in ECC-related information increased in the last years in all seven countries, although it was maintained low over time. It might indicate a lack of awareness about the negative consequences of the disease in the early stages of life. Specific policies should be developed toward the dissemination of oral health information and the prevention of the disease.