We created 2 Facebook accounts. The first account was used to conduct the specific search for this study, and the second account was used for reference, that is, to cross-check the information retrieved by the first account. We performed a cross-sectional study in 3 stages. In the first phase, we conducted a search to determine the number of pages related to oral ulcers on Facebook.

A Facebook page is a collection of posts that are created by a person or an organization with the intention to share innovative ideas about a particular topic on a regular basis. If the person creating the posts has a public account, the posts are normally accessible to everyone; otherwise, they appear only on the timelines of individuals who follow that person's private account. We began our search by collecting posts from pages in Facebook that used the keywords. We then analyzed the information by applying the inclusion and exclusion criteria. To avoid search bias while collecting pages and posts, 2 anonymous accounts were created. Two trained evaluators conducted the searching and selection of websites from March 28 to March 29, 2022; both evaluators were dentists. A systematic search of posts on the Facebook social media platform was undertaken, using the search terms “Stomatitis Aphthous,” “Aphthous Stomatitides,” “Aphthous Stomatitis,” “Stomatitides Aphthous,” “Ulcer Aphthous,” “Aphthous Ulcer,” “Aphthous Ulcers,” “Ulcers Aphthous,” “Aphthae,” “Canker Sore,” “Canker Sores,” “Sore Canker,” “Sores Canker,” “Periadenitis Mucosa Necrotica Recurrens,” “Oral ulcer and mouth ulcer,” and “Oral ulcer or mouth ulcer.” No restriction was placed on the locations of postings, and the origins of the postings were not always evident. After the keywords were used to search Facebook, relevant pages were saved as PDF files within 24 hours to avoid any changes. All of the posts on the pages that were part of this study were gathered.

The initial search retrieved non–dental-related and dental-related pages. We then applied predefined eligibility criteria to include only English-language pages that were posted by individuals affected by oral ulcers or support groups. Pages created by professionals, professional organizations, and academic researchers and pages with information on or images of nonoral and nondental ulcers were excluded (Textbox 1). The selected pages were then screened for page origin and Facebook categories.

The data collected were presented as percentages of the distribution of selected Facebook pages with respect to page origin and Facebook categories.

Ethics approval was not applicable, as no personal identifiable data were accessed or analyzed.

All posts were anonymized to maintain confidentiality and prevent bias during the analysis. Following familiarization with the data set, manual text mining was performed to allow for the selection of pages related to oral ulcers and the exclusion of pages related to oral manifestations of oral precancer, cancer, infectious diseases, and mucocutaneous lesions. A keyword search yielded a total of 517 pages that included 112 pages on oral ulcers. Following the application of the eligibility criteria, 70 posts were excluded, including posts from dental professionals and 9 educational posts. Further, 405 of 512 pages were excluded because the pages were not related to dentistry, with 78% (405/517) of these pages providing information related to widespread ulcers in the body, and the rest of the excluded pages were in languages other than English. After text mining, a total of 32 dental pages on oral ulcers were identified. These 32 dental-related pages were screened, and 2 pages were excluded due to a lack of any posts. Of note, 26 pages included posts on therapies for oral ulcers, and 4 were pages created by dental professionals (Figures 1 and 2).

In Facebook page creation, choosing the right category is considered very important, as the main category appears next to the identity of the page owner (business, organization, or individual), making it easy to connect this information [13]. Out of 30 Facebook dental pages and categories, we found that 30% (9/30) of the sites in our data set were categorized as “health/beauty” pages or as “Dentist & Dental Office Beauty, Cosmetic & Personal Care” pages, 10% (3/30) were categorized as “medical & health” pages, and an approximate of 17% (5/30) were categorized as “community” pages. This suggests that Facebook, in oral ulcer information dissemination, has been primarily used as an adjunct to business enterprises for marketing or for enhancing access to a product (Textbox 2). Although we could not find the sources for 3 of the posts in our data set, it was interesting to note that all pages categorized as “community” pages originated from the United States, while “product” category pages originated from England, Philippines, Australia, and India (3 pages each) as well as from South Africa, France, and Uganda (1 page each).

Oral ulcers are usually painful and uncomfortable and, therefore, make it challenging to eat, drink, and speak. In addition, they can also be unsightly, resulting in embarrassment or self-consciousness [2,3]. A sizable majority of adult internet users report looking for health information on the internet. Facebook has been on the top of the social network sites to be accessed by most people over the past 3 years and is the most accessed social media site for news among American adults [7,14]. Our analysis was restricted to the information available on mouth ulcers (ie, recurrent oral ulcers) in Facebook pages. The level of participation by people with a post indicates how much they are interested in a topic, as well as how much influence the topic has on society. 70% (21/30) pages were found under the keyword “sore, canker,” whereas there were no pages for the keyword “Periadenitis Mucosa Necrotica Recurrens.” Notably, there was little information on the prevention of oral ulcers, long-term treatment, and complications of oral ulcers. Furthermore, the Facebook channel was used most often as an adjunct business tool for products and services, particularly by account holders outside of the United States. Interestingly, in contrast, most pages (24/80, 30%) originating from the United States (not included in this study) were discussion blogs on oral cancer.

Categories in Facebook are used to grow a business, brand, or organization. Hence, it is intriguing to observe that 40% (12/30) of the pages chose the “health/beauty” category or the “product/service” category, suggesting that the primary use of Facebook was mostly for aesthetics and potential remedies. Further, this may indicate that oral ulcers are not perceived as significantly serious enough to search for related information on other professional websites, such as the WebMD website.

Social network channels, including Facebook, are dynamic and change continuously. Our study was restricted to posts created within a specified time and had the following limitations. First, only posts were taken into consideration; we did not consider private messages, the number of likes, and private groups. Second, our study does not provide information about the extent to which people were benefiting from the information presented on Facebook. Although we made efforts to identify and select Facebook pages related to oral ulcers, we did not manually verify the authenticity or accuracy of the pages included in our analysis, potentially limiting the reliability of our findings and resulting in bias toward specific products or services. Finally, it is likely that an in-depth content analysis via text mining could be more useful for assessing the potential of Facebook pages as objective information sources on oral ulcers [15]. Although this work forms something of a pilot project, we hope to expand the project to encompass text mining for content analysis and include multiple social media platforms in the future.

Observations from our qualitative study showed that the Facebook platform has been used partly as a marketing tool for the sharing of information on oral ulcers by unofficial pages and by business or quasi-business entities. Future quantitative and analytic studies are needed to elucidate the complete usefulness of this social network channel.