980964 PRD Primary Dental Journal

Key words Learning Objectives Authors

Instagram, Instagram dentists, social •• To increase awareness of the use of Hui Lynn Ooi BDS (Hons)
media, ethical advertising, education Instagram in dentistry, its benefits and Specialty Dentist, Acute Dental Care, King’s College
the features which make it popular but Hospital Dental Institute, London
also potentially quite dangerous Martin GD. Kelleher M.Sc., FDSRCS,
•• To highlight the precautions needed FDSRCPS, FDSRCS
when using Instagram in dentistry and Consultant in Restorative Dentistry, King’s College
to discuss related guidance on ethical Hospital, London
advertising

Hui Lynn Ooi, Martin G.D. Kelleher

Prim Dent J. 2021;10(1):13-19

Instagram Dentistry
Abstract
Instagram, a photo and video social networking site, is gaining popularity in the
dental world and it is easy to see why this is so. Instagram’s potential to share
information in an engaging way allows dental professionals to share clinical
work and provides a unique way of learning.
Advertising on Instagram has blossomed. Some of this is for self-promotional
reasons, for practice building, or for marketing of new techniques and products by
manufacturers. One ought to be cautious about the implications of some patients’
quest for ‘dental perfection’. That is especially the case when destructive dentistry is
being undertaken by dentists trying to replicate what they have seen on Instagram
in potentially much more challenging patients. Some of those demanding patients
request very ambitious treatments with sometimes hugely unrealistic expectations.
Arguably, Instagram could be the new major trend in dentistry.

Introduction The 101 of Instagram

The rise of social media in dentistry has Instagram is an allegedly ‘free’ photo
paved the way for a new phrase in the and video sharing platform which is
dental world – Instagram Dentistry. popular for its mobile compatibility and
Instagram (IG or Insta) is a photo and ease of use, with its effortless, almost
video sharing networking service, ‘check your brain in at the door’ feel-
launched in October 2010 and now good feeling caused by addictive
owned by Facebook. scrolling.

The total number of active monthly While Instagram can be viewed on your
Instagram users worldwide reached one computer webpage, it was designed
billion in 2020, with over two-thirds primarily for smartphone use with its
of them below the age of 34.1 Instagram easy, palm of your hand access.
is fast increasing in popularity among
12 to 34-year-olds and in that category, An Instagram account can either be private
it has surpassed Facebook’s market share or public. As the name suggests, public
by 66% to 62% in the US population in accounts can be viewed by anybody,
2019.2 whereas private accounts can only be
viewed by approved ‘friends’. This means
Instagram’s methods of engaging users that a dentist posting pictures or videos
with its images make it popular in with dentally related content on a public
dentistry, which is arguably a very visually account can have it viewed by anyone –
demanding field. Instagram has changed be that by existing patients, dental
the way dentistry is advertised, portrayed colleagues or prospective ‘clients’.
to the public, and is being used amongst
a whole new generation of dentists and Instagram’s news feed consists of either
potential patients. Love it or hate it, a photos or short videos that are up to
wave of ‘Insta Dentists’ has arrived. 60 seconds long.

© The Author(s) 2021. Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/2050168420980964

Vol. 1 0 No . 1 M a r c h 2021 journals.sagepub.com/home/PRD 13

 Instagram Dentistry

cases, and demonstrate before and

FIGURE 1 after treatment pictures. It can also be
used in endodontics to show the pre-
treatment problems, images during
Images courtesy of @kreenaspecialistendodontics

endodontic procedures or post-operative

radiographs as effectively shown in
Figure 1.

Also, 60 second videos allow viewers to

watch procedures, with some of the most
popular ones being anterior Class IV
composite restorations. Not only are
dentists able to showcase their skills, but
they can also share the various clinical
tips and techniques used in order to
allow other dentists to experiment with
those methods and hopefully improve
clinical outcomes for patients.
Radix (DL)
2 canals in the main Lateral canal
distal root: DB & DM For example, in creating an interproximal
Master cone Postoperative contour of anterior composite restorations,
someone who has trained with clear
plastic Mylar strips might be interested in
using a posterior metal sectional matrix or
PTFE tape after watching a video
demonstrating that technique.

Dentists with different approaches and

Preoperative training from various parts of the world
are able to share their commonly taught
This allows users to flood their accounts and tried techniques. This a great way
with content, without much fear of for younger dentists to be exposed to
long-term repercussions and it has different approaches while they are
become an instant hit. still trying to establish a protocol for
procedures that work well for them.
Instagram reported 500 million daily It has the potential to bring dental
Radiograph analysis active ‘stories’ users worldwide in communities together from around the
Digital crack January 2019.1 world and possibly help to bridge
various generations of dentists.

So, what exactly has made Instagram’s ‘educational content’

DL Instagram so popular in the offering continues to grow with
dental profession? dedicated dentistry accounts such as
As the expression goes, a picture is ‘dentistry.world’, ‘dentistry forum’ and
worth a thousand words. In dentistry, ‘about_dentistry’, which separately,
DM pictures and videos have the potential boast between 300,000 and 500,000
DL
to share a lot of information and followers. Some of these accounts post
DM knowledge, especially via a user- entertaining, humorous dental content
DB
DB
friendly platform like Instagram. as well as encouraging dentists to
send in work to be shared on the
Dentists can use Instagram to portray page. This incentivises the generation
their work in the form of clinical of new, engaging content from dentists
photographs, radiographs or even around the world, keeping followers
short videos. An Instagram post allows entertained while giving credit to the
viewers to slide quickly between respective dentists, which in turn can
pictures which can make a great help increase online traffic to their
compilation of step-by-step procedures, individual Instagram accounts.
Instagram ‘stories’, a feature that started such as caries removal through to the
in August 2016, allows photos and final restoration. It can quickly illustrate Some dentists are turning to their
15-second videos to be uploaded, which different stages of treatment at various Instagram feeds to discuss topics or
disappear after 24 hours. time intervals, such as in orthodontic deliver clinical pointers. The use of

14 Pr i ma r y De n ta l J ou r n a l
 in to see what friends, colleagues and
relatives are up to, and occasionally,
some interesting dentistry might catch
the eye. So, for the general dentist with
a personal Instagram account, browsing
dental content could be a great way to
see techniques that are not routinely
done in practice, or to get inspiration for
the work ahead, as depicted in the posts
that comprise Figure 3.

Instagram advertising
When posting on Instagram or any
social media, it is all about the image
someone wishes to portray, or the story
they want to tell the world. Be it one’s
own image, a brand, a technique or
a product, one can control what other
people using Instagram will see. There
is a natural tendency to present one’s
best aspects, which fuels the debates
about image and social media.

Dentists who choose to portray their

work, be it in photo or video format,
are able to use Instagram as their online
portfolio. Gone are the days when you
kept your portfolio in a folder tucked
away. Now, the best of your work is
readily visible to your colleagues,
friends, family and the general public.
This is arguably self-promotion at its
best – or at its worst. However, caution
is advised because is it really that
surprising that dentists choose to paint
themselves in the best possible light and
only post their successful and best work
which might not represent their average
result? Many dentists are guilty of a little
‘humble bragging’ and having one’s
work on Instagram definitely gives one
that opportunity.
Instagram ‘live’ which allows watching any dentist and the original uploader of
a procedure in real time, or even just live the content. A person could ask their It is very easy to imply to any potential
‘Question and Answer’ sessions, have followers to reply with their best new patient that very good outcomes are
become increasingly popular. endodontic case and they could then routine when, in fact, they are not. Easy
share the replies of each person’s work cases can look great but more challenging
A plethora of topics can be discussed in their stories. cases will not be so easy or predictable
this way, such as rubber dam placement in much more difficult patients.
tips and tricks as shown in Figure 2 Apart from dental procedures, an
which has become an increasingly increasing number of anatomy related Photos of beautiful clinical work allow
popular topic. Others demonstrate ways Instagram education accounts have one to advertise one’s expertise to
of choosing the right sectional matrix emerged for both medical and dental potential patients, prospective employers
system or give their opinion on the best students.3 This helps to close the gap or even to draw a little envy from one’s
composite polishing protocols. between dry theory and effective clinical colleagues. In many cases, however,
education. the real credit should go to the dental
Instagram stories, which disappear technician rather than to the clinician,
after 24 hours, also allows dentists to Instagram provides a unique and especially when indirect work is involved.
engage in some quick fire questions via arguably exciting way of learning,
the Instagram messaging system which, while many might just enjoy it as a form Some dentists use Instagram primarily to
in theory at least, is private between of entertainment, as a way of checking promote the practice they work at, and

Vol. 1 0 No . 1 M a r c h 2021 15
 Instagram Dentistry

Good work can serve as a source of

inspiration, or even help to set goals
that many young dentists can strive to
achieve. Conversely, the Instagram posts
can have a negative impact on the
mindset of many dentists who might feel
that their own clinical work does not
reach the level of what is seen on
Instagram. That could lead to an
unhealthy amount of mutual professional
comparison and perhaps even an
unrealistic striving for ‘cosmetic
perfection’.

Graphic pictures of the actual destruction

of sound teeth are rarely, if ever,
included in many heavily censored posts.
Consequently, they do not give a full and
frank picture to potential patients of what
is actually going to be done to their
natural teeth to achieve those final
outcomes, which may well be short-lived.
Many outcomes are produced at the
expense of long-term pulpal health and
coronal tooth strength and structure by
damage being done to many mainly
sound teeth to achieve those superficially
attractive outcomes.7

The actual clinical conditions under

thereby hope to generate an increased spied on for someone else’s commercial which the cases were treated often get
patient base. gain. overlooked. A lot of the clinical work
chosen to be posted is often
Instagram is now expanding its A study by Synman and Visser found undertaken electively and privately
online profile by advocating their that a large majority of dentists in with minimal time pressures and using
model for building businesses through South Africa, 83.5%, felt that the use some of the best materials,
advertising with them for a fee. of social media for dentistry marketing instrumentation and skilled dental
Its business appeal rests on having would only increase in the future.5 technicians available.
a large, highly engaged audience. Haas and Park showed in their
This allows enterprises to use Instagram survey of members of the American Other dentists providing care on the
to advertise in order attract ‘customers’ Association of Orthodontists that 55% NHS, who are often pushed for time and
in a cost-effective manner. of them were already using some form with limited resources, cannot offer a
of social media network to market their direct and fair comparison. This unfair
Users can now advertise via stories practice and also that 95% of those comparison can cause many young
and posts and they can customise their surveyed felt social media advertising dentists to become disheartened, with
targeted audience based on location, would be inevitable. Non-users, implications on their clinical confidence.
interests, demographics, behaviours and who were nevertheless eager Furthermore, not every case makes it to
even ‘lookalike audiences’.4 Businesses to use social media for marketing Instagram and inevitably the cases that
can then track the number, as well as the purposes, have cited privacy concerns get chosen to be posted are the ones
demographics, of the people that have and lack of knowledge as potential with better outcomes. Just as in life,
seen the frequent use and interacted with problems.6 people post the more appealing photos
the post that is being promoted. of themselves, or emphasise their best
moments, but quietly hide the bad parts
However, use of Instagram means that Taking everything with a from others.
data is being collected ruthlessly and ‘pinch of salt’
sold on for targeted advertising, Drawbacks are inevitable, and Considerable caution needs to be
sometimes to dubious dental companies the same applies to the boom of exercised in believing what is posted.
or to ‘dental gurus’, some of whom have Instagram in dentistry. Clinical work The amount of editing of photographs
bizarre ideas. Not everyone seems fully posted online might be able to raise with filters and software is an unknown
aware that, in effect, they are being the standard of dentistry. variable because such tools are readily

16 Pr i ma r y De n ta l J ou r n a l
available and easy to use. Arguably, want similar treatments, or among professional’s training and should be
some of the content uploaded other dentists who may well be continued during continued professional
online by less-ethical dentists might be influenced into thinking this is an development (CPD) extending across the
heavily edited or ‘doctored’ and thus, acceptable, or indeed preferable, whole dental team.12
can easily result in unrealistic form of treatment.9
expectations of ‘dental perfection’. Dangers may well arise with advertising
Even worse, some practitioners may on Instagram where manufacturers are
manipulate images to mask Ethical advertising and making ambitious and often
unsatisfactory treatments. pitfalls unsubstantiated claims about products.
Social media has blurred the boundaries One only needs to input ‘teeth whitening’
Hence, an ethical obligation to post between professional and personal life, in the search box to find a plethora of
unedited photos of clinical work is and it is easy for one to negatively products being recommended by ‘brand
needed to maintain trust in the impact the other. It is prudent to keep ambassadors’ promising instantly whiter
profession. Although one would hope these as separate as possible and to teeth which can be easily purchased
that all dentists are honest about their establish a separate professional online. It is important to note that these
work, there is also the possibility for Instagram account from one’s personal ‘brand ambassadors’ – individuals
people to steal images of work seen on account. with a high social media following –
Instagram and pass it off as their own. generally receive income from promoting
An electronic image can be easily The first General Dental Council (GDC) products on their Instagram accounts.
obtained, altered and shared without the advice on using social media was Unsubstantiated, financially driven
author’s knowledge.8 published in 2013 and was updated claims for products or dental techniques
in 2016.10 The guidance focuses on can be dangerous to the general public
maintaining patient confidentiality. due to the potential for dissemination of
Variations in dental Content posted must not be identifiable disinformation and information.13
philosophies in different to patients or others unless the
cultures patient’s explicit consent has been There is very little quality control with
One important point to note is that granted. Certainly, with the increasing content posted online compared to much
there are very different styles of use of social media today, it would be of the information published in journals
dentistry practised around the world. prudent for clinicians to include in the which undergo a strict peer-review
Instagram facilitates the sharing of consent form explicit permission for process.14
these and provides exposure to use of patients’ clinical photographs
techniques, philosophies and ideas on social media. Ethical marketing in healthcare is
from other countries. complex, difficult and dangerous.
That could complement the requirement The complexity lies in the range of
It’s worth noting that some countries
for detailed consent discussions to be problems present in dentistry; difficult,
tend to favour a destructive/invasive
documented carefully in the records to in appeasing patients who hold
style of dentistry, for example, with
include ‘Montgomery consent’ about unrealistic expectations; dangerous,
multiple ceramic veneers being the
‘material risks’ – giving explicit when opinions are plentiful and
common go-to treatment for improving
permission for publications and teaching verifiable facts are rare.15 Things have
smile aesthetics quickly. Some posts
purposes as well as for advertising. been made more complicated by
even show the provision of ceramic
veneers on unrestored virgin teeth to Instagram and other data gathering
The GDC also mentions the professional applications which can then target
improve the colour and shape of the
responsibilities in maintaining susceptible or gullible people in
teeth. This type of unnecessary
appropriate boundaries with patients, persistent and yet subtle ways. Not all
destruction would be criticised quite
and maintaining public trust in the dental dental treatments seen on Instagram
harshly by some more conservative UK
profession. ought to be ‘sold’ to every patient.
dentists.
Serious ethical and consent issues can
Many UK dental institutions teach GDC guidance on online advertising is arise when a patient demands an
dentists to practise minimally somewhat limited to websites and does inappropriately destructive treatment
destructive dentistry and often not really cover social media platforms that they have seen on Instagram.
advocate align/bleach/bond such as Instagram, Facebook or
approaches to preserve sound tooth Twitter.11 Proper marketing should be patient-
structure for the benefit of patients in focussed, ensuring that a particular
the long term. However, the use of In addition, there have been disciplinary treatment is appropriate for that patient
extensive, almost three-quarter crown actions by the GDC related to social at that time and that the other available
style preparations for ‘ceramic media use. This strongly suggests an realistic options are discussed in a
veneers’ can be common practice in urgent need for social media awareness neutral and balanced way.
some other countries. This to can training for all members of the dental
create an unrealistic and dangerous team. This training needs to be part of The potential to ‘over-promise and
expectation among patients who may early education during the dental under-deliver’ is a major source

Vol. 1 0 No . 1 M a r c h 2021 17
 Instagram Dentistry

of litigation if the patient or their

partner/parent is in any way
dissatisfied with the outcome –
regardless of how unrealistic their
expectations might be.

By showcasing only their best work,

dentists, perhaps unintentionally, raise
the expectations of some patients to
unrealistic levels. Consequently,
anything less than an excellent
outcome, as subjectively judged by
them, can result in disappointment or
lead to a complaint. After all, it may
well have been those very images
advertised that convinced a patient to
choose that particular dentist over
another.

Dentists need to be modest in what they the dentist’s Instagram posts, that they An option would also involve referral
promise and remain acutely aware that would automatically end up with the to a specialist dentist and, if this offer
nearly 50% of patients showing up for ‘perfect smile’, then the implied contract is declined by the patient, clear
plastic surgery have a recognisable was to deliver that outcome. If the patient documented evidence of this is
psychiatric disorder, as described in subsequently feels that they did not get prudent.
a classic paper by Napoleon in their subjectively perceived ‘perfect
1993.16 In addition, patients with body smile’, then there could be a tort on that Claims on the longevity of restorations
dysmorphic syndrome seeking cosmetic implied contract. provided should also be quoted
dental treatment are often dissatisfied from a dentist’s own audited figures,
with any procedure provided and Specialist lawyers may well run the and not those from some highly
therefore deem the treatment and that case on a ‘no win no fee’ agreement for experienced specialists. This is needed
dentist a failure.17 If their expectations the patient. Patients frequently allege to provide a clearer and honest picture
are in any way unrealistic, that needs “not understanding that there was a for the protection of patients and for
to be challenged and addressed at an danger of a less than perfect outcome” maintaining the reputation of the
early stage. when they signed the documents, despite dental profession.
extensive discussions.
A visual analogue scale can be used to Dentists need to be self-critical and to
get an insight into the patient’s Patients’ records are vital in such cases, take into consideration the variability of
aspirations or expectations as part of the documenting clear references to a outcomes in clinical dentistry and the
initial assessment before undertaking sensible consent process. A diagnosis of difficulty in reproducing work precisely
any elective cosmetic dental procedure. the cosmetic problem must be present, every single time, particularly in very
Figure 4 depicts an example of a and pre-operative photographs and study challenging patients with very complex
patient’s completed visual analogue models and radiographs are always problems.18
scale (VAS) that clearly highlights serious helpful. Photographs of a direct composite
concerns. As can be seen from this visual mock-up done on the patient’s teeth
analogue scale, the patient is hoping to before undertaking treatment can also Conclusion
achieve a superb appearance, longevity, demonstrate what was actually promised, The ethical and diligent use of Instagram
and preservation of tooth structure with as opposed to a laboratory wax-up, has the potential to contribute greatly
little dental destruction but has virtually which might not be feasible in practice. to the world of dentistry by serving
no real concerns about the risk level of as a source of education and improving
the procedures.15 A detailed record of consent, explaining clinical outcomes for patients. Instagram
any reasonable options, ought to be used for advertising can yield decent
In providing cosmetic dentistry, the risk subjected to a BRAN test–benefits, risks returns but precautions need to be taken
of an implied contract between patient and (doing) nothing, taking into account to always act in a way that is ethical,
and dentist remains high. If a patient the Montgomery ruling on consent, sensible and appropriate and thereby
felt that by receiving extensive dentistry which relates to a patient’s protect patients and reflect well on the
from that particular dentist based on understanding of any material risks. dental profession.

18 Pr i ma r y De n ta l J ou r n a l
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