Laypeople's interpretation of, and preference for, orthodontic images

Background: Good communication is fundamental to provision of information and patient engagement in orthodontic treatment. Images can be used to support verbal and written information, but little is known about how laypeople interpret orthodontic images. Objective: To explore laypeople's understanding and preferences for images (clinical photographs and medical illustrations) relating to orthodontic diagnoses and treatments. Design: Cross-sectional survey. Setting: UK. Population: Laypeople aged >= 16 years. Methods: Participants were recruited through social media to complete an online questionnaire containing six pairs of images (clinical photograph and medical illustration) relating to orthodontic diagnoses and treatment. Photographs were selected from a bank with input from laypeople, then a matching medical illustration was created. Images were presented with questions relating to interpretation, preferences and reasons for preferences. Results: A total of 898 people completed the questionnaire. Interpretation of images by laypeople was variable and, in some cases, normal intra-oral features and image orientation caused confusion. A combination of photograph and illustration were preferred for images representing diagnosis (by 41%-50% participants), whereas the illustration alone or both photograph and illustration together was preferred for explaining treatment (43%-48% and 35%-44%, respectively). Photographs were liked for their realism and relatability, while illustrations were often found to be clearer. Arrows aided participants' understanding of the images, but annotations were requested to further improve the value of images. Only 26% of participants reported having previously been shown dental images, but 96% felt they would be helpful to support verbal and written information. Conclusion: Laypeople may not interpret orthodontic images in the way that professionals expect, and unfamiliar intraoral features may distract people from the intended focus of the image. A combination of photographs and illustrations together may improve the usefulness of images, alongside annotation or explanation.