The digital and social media (DSM) are defined in this study as internet-based applications that allow the creation and exchange of user-generated content and the associated digital technologies used in this creation and exchange [1
]. Prominent examples of DSM include a range of communication modes across social media platforms (e.g., Twitter, Facebook, and Instagram), instant messaging apps (e.g., WhatsApp, WeChat), and video conferencing platforms (e.g., Zoom, MS Teams) through users’ smartphone or computer devices. The current 3.8 billion global DSM users suggest there is an increasing impact of DSM in the private and working lives of the general population [2
]. This has extended to dental students and dental professionals, with up to 98% of dental students and 75% of dental professionals reporting that they used DSM for professional and personal use [3
], for example, for communication (with friends and family), professional education (teaching and learning dentistry), or dental practice advertisement (promoting oral health care and marketing dental services) [5
]. The literature suggests that both user groups have highlighted perceived risks associated with the use of DSM [8
]. Perceived risks can be defined as a possible loss, harm, or uncertainty of using DSM services [10
]. Previous studies in the general online services context have applied this definition to understand and address the risk associated with the use of information technology and social media to advance the uptake of its services in the general population [10
]. In this paper, these are referred to risks associated with the use of DSM in the general context.
Dental professionals in academic and practice settings have a professional reputation as well as regulatory requirements to uphold and be sensitive to since they have a professional standing that elicits society’s trust [12
]. Concerns about breaching patients’ confidentiality and compliance with regulations and professional standards could also hinder the uptake of DSM in the professional context [13
]. In this paper, these are referred to risks associated with the use of DSM in the professional and education context.
Despite the ongoing debate of the usefulness of DSM in dentistry [13
], there have been few attempts to identify the risks of using DSM between the contexts in terms of general usage and how usage specific to dental education and profession affects the uptake of using DSM. Additionally, although this body of knowledge about dental students and professionals’ compliance is crucial [14
], there are several other general and professional risks that need to be explored and discussed. Moreover, without a doubt, the COVID-19 pandemic has brought immense challenges to dental education worldwide, which has caused a sudden transition to implement online technologies, including DSM [16
]. Therefore, identifying risk perceptions associated with the implementation of such technologies seems to be justified and rational. This study aimed to identify the risk factors of using DSM to provide an insight into the inherent implications this has on dental professionals in practice and the education of trainee professionals. Dental students and professionals’ risk perceptions appeared to differ from the public risk perceptions of using DSM. The research questions were:
RQ1: What are the perceived risks that can be identified associated with dental students and professionals using DSM in dental education and practice?
RQ2: Do the identified risks associate specifically with dental education and professional context and/or general usage context?
This study attempted to identify the risk perceptions specific to dental students and dental professionals’ usage of DSM and discuss how their perceptions are different from the public users. Interestingly, some perceived risks were consistent with the use of DSM in the general context identified in previous studies [10
], including psychological, privacy, and time risks, and others were associated with the use of DSM in the professional and education context, such as non-compliance with guidelines, breaching patient’s confidentiality, and using invalid information [8
The identified risk themes indicated that DSM impacted both the professional and personal life of dental students and professionals. When they used DSM in their personal life, they perceived similar risks as users perceived in a general e-services context [10
]. However, the significant theme was privacy risks because the nature of DSM usage is to connect and interact with colleagues or friends by revealing information, such as sharing thoughts, photos, movements, facial expressions, and interests with others. This type of activity is neither guarded against strangers nor effectively able to be protected. Such concern has been found to be an essential factor affecting the unwillingness and dissatisfaction to use DSM [11
]. A comparable outcome was reached previously among a sample of dental students and dental educators, when 60% of them stated that privacy concerns were the major reason for not using DSM [4
]. Nevertheless, in this study, dental students and professionals extended their perceptions to include other aspects of privacy issues, such as a high incidence of hacking and personal data breaches, making them speculate the security of their personal information on DSM.
Interestingly, psychological issues emerged from the interviews, which is in line with a growing number of studies that suggest a possible association between using DSM and a potential negative influence on self-esteem, depression, and emotions [24
]. In this study, this could be explained by the fact that most DSM interactions were unprotected from negative remarks that may affect dental students and professionals’ self-esteem, causing feelings of distress. Similarly, Davila et al. observed that depressive symptoms, including sadness and feelings of worthlessness, were associated with the quality of online communications and interactions they received while using DSM [26
]. Another explanation could be due to the excessive time that dental students and professionals spend on DSM. According to a study by Iwamoto and Chun, significant positive correlations were found between the hours spent on DSM and stress, anxiety, and depression in a sample of undergraduate students [25
Approximately half of the interviewees admitted that they were spending up to two hours per day on DSM, which could negatively impact students’ academic progress and professionals’ daily work. This theme indicated that DSM platforms provide various means that genuinely encourage users to allocate considerable time, ranging from connecting with friends to browsing the latest news and exploring other posts, making it time-consuming. These findings are supported by a previous study among dental students who believed that using DSM was time-consuming and distracted them from their studies [27
With regards to risks associated with the use of DSM in professional and education context, the interviewees shed light on a crucial risk, that is, invalid information. They noted that DSM has become an open-learning resource, providing educational materials through a user-generated content feature; however, much information shared is neither checked for its validity nor based on a reliable source. This important finding has been discussed in the literature and could have serious implications for dental education [8
]; hence, dental students and professionals need additional training and education to search for evidence-based information effectively. In a recent study, Khatoon et al. demonstrated that dental students might not be competent in the skills and experience required to scrutinise the information shared online [28
]. With the current dramatic move to online education and the imminent surge in the adoption of digital technologies to disseminate educational contents due to the COVID-19 pandemic, such crucial training has become a necessity [29
]. Furthermore, nearly half of the dental students and professionals stated that they could be in breach of patient confidentiality if they shared their work, including clinical cases, on DSM. Additionally, some of them reported that posting patients’ photos was entirely unacceptable, even if consent was obtained. The governing dental body, such as the General Dental Council (GDC) in the UK, declared that posting unidentifiable patients’ photos on social media was prohibited without explicit consent from patients [30
]. Patients should manifest an understanding of this reality before consenting. Several studies showed differences in the perceptions of dental students relating to this argument, suggesting the importance of introducing e-professionalism education to the curriculum of undergraduate and postgraduate students to help them avoid these pitfalls when using DSM [3
]. Furthermore, a point worth consideration is that dental students and professionals must be familiar with the dental school and hospital guidelines governing DSM use and strictly comply to them as the laws in different countries about posting patient images on DSM could differ.
Even though this study aimed to understand the risk perceptions that concern dental students and professionals themselves as health care providers, they reported a risk that affects public users, including their patients. DSM creates uncontrolled online spaces, housing communication and dental advertising that might contain a potential threat of misinformation, which could affect the delivery of treatment care or management of patient expectations of dental practice. Some dental professionals warned of such information [31
], especially for patients among young groups who are very sensitive to the perception of their dental, facial, and body appearance [32
]. Shuttleworth and Smith stated that the rising incidence of cases that are influenced by the misinformation posted on DSM could open up new challenges for stakeholders in the dental health system, with the increased sharing of commercially-directed advertisements on such uncontrolled platforms [33
It is noteworthy to mention that the impact of the ample challenges brought by COVID-19 on the perceptions of dental students and professionals have not been investigated in this study [16
]. Future studies to analyse the impact of COVID-19 on the use of DSM in the professional development and training of dental students are required.
Furthermore, it is imperative to utilise quantitative methodology, e.g., a questionnaire instrument with a larger number of participants, to generalise the identified risks and assess differences between groups and their magnitude on the uptake of DSM in dental education.