INTRODUCTION

The Internet has, in some instances, made access to information, products, and services instantaneous. The Internet has also provided an immediate and efficient way of transferring information, the boundaries of which are only limited by accessibility to an Internet connection. Wide accessibility should allow for implementation of e-health in orthodontic practice. In general terms, e-health refers to health care delivery using electronic media over the Internet and can encompass a variety of services including informational, educational, administrative, clinical, and commercial.1 Because the characteristics and current habits of Internet use are determined, strategies can be developed for implementation of current and future technology.

There is currently no information available specific to Internet use by orthodontists. This study assesses Internet usage by Canadian orthodontists in 2004. The findings of this study can be compared with baseline data for Internet usage by the general population and by dentists more specifically. Statistics Canada and US Census Bureau indicate that in 2000, almost half of the households in North America had access to the Internet at home.23 Surveys of American dentists show that in 2000, 92.4% had access at home and 85.6% had access at work.4

The Internet has become the source of a wealth of information. Understanding who the users are can help increase the service it can provide. Descriptive research has shown that Internet users have certain characteristics. That is, factors such as education, household income, age, and location are used to establish profiles of Internet users and nonusers.

Age has become a common identifier of Internet use. The general trend is that Internet use is lower among older age groups. As is commonly seen, younger generations are more willing to accept, implement, and apply new technology. Surveys of the North American population have revealed that Internet use is highest among persons in their late twenties to early forties.23 Because of the length of time it takes to obtain an education as a certified specialist in orthodontics, one would expect that those who have recently graduated would fall in the age range of 30 to 40 years. Therefore, orthodontists in this age range would be more likely to have Internet access than those at the end of their careers. This is seen among dentists who reported that 85.7% of dentists under the age of 39 had Internet access at work, whereas 67.1% of dentists over the age of 60 had Internet access at work.4

As previously mentioned, an orthodontic education takes numerous years of postsecondary university education. With the typical 2–4 years of general studies, four years of dental school, and 2–3 years of orthodontic specialty training, the minimum amount of postsecondary education for a certified specialist in orthodontics would be 8–10 years. Educational attainment is a factor that has been linked to Internet use. It would be expected that orthodontists would be more likely to have access to the Internet.23 US and Canada census information reports that 66.0% and 83.1% of individuals with a bachelor's degree or a university degree had access to the Internet at home.23 Dentists in the US reflect the correlation between greater amount of postsecondary education and Internet access because 92.4% reported having Internet access at home and 85.6% reported having Internet access at work.4

About 8 in 10 family households in the US with annual incomes of $75,000 US or more had at least one individual who accessed the Internet from home. In contrast, only about 2 in 10 US families with household incomes below $25,000 had Internet access.3 In Canada, 80.5% of family households with a household income of $80,000 CAN or more had at least one Internet user. Only 32.8% of family households with a household income of less than $30,000 had at least one Internet user.2 An American Dental Association (ADA) survey of American orthodontists and dentofacial orthopedists revealed that the average net income from primary private practice in 1998 was $223,730.5

The objectives of this study were as follows.

1. To obtain information regarding office characteristics relative to Internet use among orthodontists.

2. To compare the socioeconomic characteristics of orthodontists to the North American public regarding Internet use.

3. To develop profiles of Internet users and nonusers in the orthodontic profession.

MATERIALS AND METHODS

RESULTS

From the population of 667, a total of 304 surveys were received for data collection, which produced a response rate of 45.58%. Nine respondents were in “full-time academic” positions, 17 reported as “not practicing”, and 278 orthodontists were currently practicing. The 17 persons who were not practicing were excluded from the analysis. Key demographic data are shown in Table 1.

TABLE 1.  Key Demographic Data of Survey Respondents^a

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A total of 76.6% of orthodontists reported having Internet access at work. In addition to this, another 12.4% reported accessing the Internet from a different location. Therefore, 89.0% of orthodontists in Canada have access to the Internet.

Key descriptive data and cross tabulations by Modem/Internet access are shown in Table 2.

TABLE 2.  Key Descriptive Data and Cross Tabulations by Modem/ Internet Connection

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The overall regression identified only number of staffs as significant (P < .001), with R² = 0.12. In the final model, years of practice was significant (P = .046, odds ratio = 0.97), and the number of staffs was significant (P < .001, odds ratio = 1.25) (Table 3).

TABLE 3.  Result of Stepwise Logistic Regression for Practice Var iables Associated With Internet Access

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Office size vs Internet

Offices with more staffs use the Internet more than those with fewer staffs. Offices with nine or more staffs had Internet access at work 94.4% of the time, whereas only 54.9% of offices with less than five staff members had Internet access at work. The association between number of staffs and Internet access was statistically significant to P < .001. The odds ratio for having Internet access was 1.25, which indicates that there is a 1.25 times greater chance of having Internet access, with addition of another staff member.

In offices where the orthodontist starts 300 cases or more, 88.2% had Internet access. This steadily decreased to 60.0% in offices that started less than 100 cases per year. Practice production, based on the number of case starts per year, was significantly correlated with number of staffs (P < .001, r = 0.498). Because of this correlation, a separate regression for number of case starts by category was completed (Table 4). The odds ratio for having Internet access on the basis of number of case starts, suggests that the likelihood of having Internet access increased by 5.6 times between the categories less than one hundred and the category of 300–399 case starts.

TABLE 4.  Result of Stepwise Logistic Regression For Number of Case Starts by Category Associated With Internet Access

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Although not statistically significant, descriptively, the more hours an orthodontist works, the more likely he or she is to have an Internet connection. Only 66.7% of orthodontists working three days or less per week had the Internet compared with 81.0% with orthodontists who worked more than four days per week.

DISCUSSION

On the basis of the findings of this research, a profile of an Internet user in the orthodontic profession can be developed. Although some of the characteristics did not reach statistical significance, descriptively, they mirror many of the socioeconomic factors of Internet users seen in the general public. Because these characteristics are identified, efforts can be made to target and assist those who desire and are in need of assistance in incorporating telecommunication technology into their offices.

Descriptively, age and years of orthodontic practice seem to be factors related to Internet usage. The trend observed in the slow but steady decrease in Internet access, as it relates to age, is consistent with other findings. For example, the ADA research shows a gradual but steady decline in Internet access at work in the age categories from under 40 to 60 and older.4 The North American public has also reported that increase in age has a negative relationship to Internet use.23 As with any new technology, the younger generations seem to be quicker to accept and apply them. It might be expected that as time goes on, age will become a less important indicator of Internet usage because the technology would have filtered through all the generations.

Over three-fourths of orthodontists had Internet access at work, and an additional 12.4% had access at a different location. In other words, the total for Internet access among Canadian orthodontists is 89.0%. This is reflective of a highly educated population, which would be expected to have a relatively high level of Internet usage. In 2000, the comparative dental group reported that 56.4% had the Internet at work, 90.6% had access at home, and another 1.7% had specified access from another location or from a wireless connection.4 Similarly in 2000, North Americans with a minimum of a university or bachelors degree reported having Internet access in 79.3% of Canadian homes and 66.0% of US homes.23

Individuals in the general population located in urban or metropolitan areas have tended to be higher Internet users than those in rural or nonmetropolitan areas.23 Because orthodontic offices are for the most part located in urban or metropolitan centers, data comparison was not expected to show differences between offices located in differently populated centers. This was in fact the case. There was no descriptive or statistical significance in the relationship between the population of the center in which the office is located and computer use. Obviously, part of the issue relates to Internet availability in remote or rural locations. In some more remote locations, Internet access may not yet be available. Because orthodontic offices are typically located in more densely populated areas, Internet availability should not be a factor. In fact, none of the orthodontists who reported that they did not have access to the Internet stated that it was because they were located in a remote location and the service was unavailable.

Similarly, even though Statistics Canada information has shown differences in Internet usage from one province to another, this did not seem to be a significant factor when applied to orthodontist's Internet use. Because of the small number of orthodontists in some of the provinces, it was difficult to obtain statistically significant information, but descriptively, there was no apparent relationship between provincial location and Internet use. In fact, some of the data were opposite of what is seen in the general population, in that orthodontists from Alberta, British Columbia, and Ontario reported less Internet access than their colleagues from other provinces.2

Economic factors are also correlated with Internet usage. Statistics Canada and the US Census Bureau use $80,000 CAN and $75,000 US, respectively, as their upper limit for their household income groupings. On the basis of ADA Survey Center research, the average net income for orthodontists from their primary private practice in 1998 was $223,730 US. This would indicate that in all probability the majority of practicing orthodontists would fall into the highest end of the household income categories. Orthodontists' Internet use was comparable with or slightly higher than that of the high income general public.235

Because net income may not relate directly to practice size, total number of staffs, hours of work per week, and orthodontic case starts were the practice factors used to assess practice size. On the basis of number of staffs and number of case starts, it appears that there is a major increase in Internet usage from the very small (less than 100 case starts) and the moderately large sized (300–399 case starts) practice. Larger orthodontic practices use the Internet more than smaller orthodontic practices.

CONCLUSIONS

• A total of 76.6% of orthodontists in Canada have Internet access at work, and 89.0% report Internet access either at work or elsewhere.

• There is no statistical significance between an orthodontist's age of practice and Internet use; however, younger cohorts appear to be more likely to use the Internet.

• Orthodontists' Internet access is similar to or slightly higher than the university educated general population.

• Most orthodontic offices are located in urban locations, and no relationship was found between population size and office Internet access.

• There is no apparent interprovincial difference in Internet access.

• Larger orthodontic offices, which have more staffs and treat more cases, have a greater frequency of Internet access.