Using Twitter for Teaching and Learning in

an Oral and Maxillofacial Radiology Course

Shawneen M. Gonzalez, DDS, MS; Cynthia C. Gadbury-Amyot, MS, EdD
Abstract: The aim of this study was to describe the implementation of one form of social media (Twitter) in an oral radiology
course and evaluate dental students’ use and perceptions of this technology for teaching and learning. An author-developed
questionnaire was used to solicit second-year students’ knowledge, use, and perceptions of Twitter for teaching and learning in an
oral radiology course at one U.S. dental school. A combination of Likert scales, multiple allowable answers, and an open-ended
comment question was employed. The questionnaire was piloted in spring 2010 followed by data collection in spring 2011. Out
of 45 students, 40 (88.9%) completed the questionnaire. Of the respondents, 95% reported having not used Twitter prior to their
second year of dental school; 55% of them created an account for the course. The top two reasons they gave for creating an ac-
count were viewing radiographic examples and staying informed about questions and answers that were posted. The top two rea-
sons they gave for not creating an account were that the content was viewable online without an account and not wanting another
online account. The students perceived the Twitter sessions as helpful and reported it improved accessibility to the instructor. The
results of this study challenged the assumption that dental students are well versed in all forms of social media, but overall, these
students agreed that the use of Twitter had enhanced the learning environment in the radiology course.
Dr. Gonzalez is Director of Oral and Maxillofacial Radiology Clinic and Assistant Professor, Department of Pathology and
Radiology, School of Dentistry, Oregon Health & Science University and a Diplomate, American Board of Oral and Maxillofa-
cial Radiology; Dr. Gadbury-Amyot is Associate Dean and Professor, School of Dentistry, University of Missouri-Kansas City.
Direct correspondence to Dr. Shawneen M. Gonzalez, OHSU School of Dentistry, 2730 SW Moody Ave., Mail Code SD-RAD,
Portland, OR 97201; 503-494-8790; gonzalsh@ohsu.edu.
Keywords: dental education, radiology, oral and maxillofacial radiology, educational technology, social media, Twitter
Submitted for publication 4/24/15; accepted 7/13/15

S
ocial media has been defined as “a group of
Internet-based applications that build on the
ideological and technological foundations of
Web 2.0 that allow the creation and exchange of
user-generated content.”1 The use of social media
in educational settings appears to be escalating as
evidenced by a rise in the literature with authors
documenting increased learning.2,3 A study pub-
lished in 2013 examined dental educators’ use of
social media, preferred social media applications,
and perceived barriers.4 While the majority of these
faculty members at five North American dental
schools reported using social media, by far the most
frequent reason was for communication with friends
and family and not for educational purposes. Not
surprising was the finding that the most frequently
used social media application was Facebook. When
asked about YouTube, only 21% reported using it
in their lectures. Among the reported barriers to us-
ing social media were time and privacy issues, with
others reporting uncertainty about the usefulness of
social media application and a lack of expertise in
how to implement social media. It was interesting to
note that age was not a barrier, with faculty members
in that study from all five age categories reporting
no barriers to using social media.
Research has found that active learning, in-
teraction, and greater engagement among students
including collaborative work and problem-solving
lead to deeper levels of learning.5-9 Active learning
can be defined as an instructional approach that
requires students to engage in the learning process
by participating in meaningful learning activities
that require them to think about what they are do-
ing.6 The positive impact of interaction and social
learning has been well established through the work
of theorists like John Dewey (1859-1952) and Lev
Vygotsky (1896-1934). Dewey argued that learners
do best by actively engaging in the learning process.10
Vygotsky’s social constructivism theory posits that
knowledge is built mutually with the teacher acting
as facilitator and with opportunities for students to
learn from their more knowledgeable peers.11 More
recently, Chickering and Gamson’s “seven principles
of good practice” in education expand on the impor-
tance of factors such as contact between students and
faculty and use of active learning in contributing to
high-quality outcomes.5 These theories have formed
the basis for research into the use of technology for
teaching and learning in dental education.12-15
Considering the value of active learning, we
can envision the potential for promoting this type

February 2016  ■  Journal of Dental Education 149

 of learning through the use of social media applica-
tions. While dental faculty members have reported
uncertainty about the usefulness of social media and
a lack of expertise in how to implement applica-
tions,4 educational research provides the rationale
for their use. One popular social media platform,
Twitter, is a form of microblogging in which users
are limited to 140 characters and/or words per post
(tweet).16 Twitter’s popularity is largely due to the
immediate response users can receive from other
users. Twitter’s limited character count allows users
to gain information in a concise manner. Junco et al.
found that both students and faculty had increased
engagement during communication using Twitter in
an undergraduate course.17 Due to the limited amount
of research in dental education on the topic of social
media, there has been a call for more study regarding
its potential in that environment.18
Therefore, the aims of this study were to
describe the implementation of Twitter in a second-
year dental radiology course and evaluate students’
use and perceptions of this type of technology for
teaching and learning. The research questions for
Figure 1. Example of Twitter feed of Dr. Gonzalez (@DrGstoothpix)
150
the study were as follows: 1) What was the reported
use of Twitter both prior to and during the radiology
course? and 2) Did students perceive that using Twit-
ter had a positive impact on the course’s teaching and
learning environment?
Materials and Methods
This descriptive study was approved by the
University of Nebraska Medical Center Institutional
Review Board (#414-09EX). A Twitter account (@
DrGstoothpix) was created for the Introduction to
Oral Radiology (OB 561) and Radiographic Interpre-
tation (OB 562) courses at the University of Nebraska
Medical Center College of Dentistry (Figure 1). Both
are one-semester courses taught during students’
second year in the program (Introduction to Oral
Radiology in the fall and Radiographic Interpretation
in the spring) and were taught by the same instructor
(the principal investigator [PI], SMG) at the time of
the study. The introductory course covers such top-
ics as radiation biology, radiation physics, intraoral
and extraoral radiographic technique, radiographic
Journal of Dental Education  ■  Volume 80, Number 2
image quality control, image formation (digital and
analog), and anatomy on radiographs. The inter-
pretation course covers radiographic lesions, caries
interpretation, and identification of tooth anomalies,
dysplastic diseases, benign neoplasms, and malignant
neoplasms.
The students were informed of the Twitter
account at the start of each semester, given the ac-
count name and URL (twitter.com/drgstoothpix), and
instructed how to ask a question, ensuring the course
director would see the question asked by adding “@
DrGstoothpix” into the tweet. A one-hour question
and answer (Q&A) session was offered via Twitter
the night before each exam and the final examina-
tion. During the Q&A session, students could post a
question and receive a near-immediate response. The
course instructor retweeted the initial question from
her account without the student’s name so it would
remain anonymous and then posted the answer for all
viewing to see. Radiographic examples of contents
covered in the course were posted with a sample
question such as “identify the abnormality or identify
the anatomy.” The answers for the radiographs were
posted at the end of the hour to ensure students had
adequate time to review the radiograph and come
Figure 2. Opening page of website created by Dr. Gonzalez (www.DrGstoothpix.com)
February 2016  ■  Journal of Dental Education
up with an answer. All radiographs posted were de-
identified to ensure HIPPA compliance.
The creation of a Twitter account and partici-
pation in the Q&A sessions were voluntary and not
a requirement of the course. In addition to Twitter,
a Pinterest page was created to compile a visual
database of links to radiographic entities and topics.
As the course instructor came across other websites
with accurate examples of entities (www.pinterest.
com/pin/150378075032784541/), she posted them
to the Pinterest page in what is called a “pin.” The
Pinterest page was connected with the @DrGstooth-
pix Twitter account so that anytime a new pin was
posted in Pinterest, it was automatically posted to the
Twitter account for students to view. Finally, an oral
radiology website was created on which radiographic
examples were added, and blog posts on a variety of
topics were created weekly in conjunction with top-
ics covered in the courses (Figure 2). The blog posts
allowed for greater explanation when needed since
Twitter posts are limited to 140 characters.
The PI developed a questionnaire with the
aid of other scholars in a Technology in Education
Scholarship (TiES) program at the University of
Nebraska Medical Center. It employed a combi-
151
 nation of response formats: forced choice from a
menu of Likert scales, multiple allowable answers,
and an open-ended question at the end. The 17-item
questionnaire solicited students’ knowledge and use
of Twitter prior to and during the course of their ra-
diology instruction. Six questions solicited students’
perceptions of Twitter’s impact on the teaching and
learning environment, and the open-ended question
solicited additional feedback from the participants
about using Twitter in the classroom.
The initial questionnaire was pilot tested in
spring 2010; feedback from the pilot was incor-
porated into the final version of the questionnaire.
The survey was scheduled for the conclusion of the
Radiographic Interpretation course in spring 2011.
The questionnaire was administered to the students
during their oral and maxillofacial pathology course
after completion of the Radiographic Interpretation
final examination. The PI explained to the students
the purpose of the questionnaire about the use of
Twitter in the oral and maxillofacial radiology course
and emphasized that it was voluntary. After distrib-
uting the questionnaire, the PI left so that students
would not be pressured to complete it. The oral and
maxillofacial pathology instructor collected the
questionnaires and returned them to the PI.
Results
Out of a class of 45 students, 40 (88.9%)
completed the questionnaire (Table 1). Addressing
research question one (What was the reported use
of Twitter both prior to and during the radiology
course?), the results showed that 38 (95%) of the
students had not used Twitter prior to their second
year of dental school. Of the 38 students without an
account prior to taking the courses, 21 (55%) cre-
Table 1. Demographics and reported Twitter accounts
of study participants (n=40)
Variable Number (%)
Gender
Females 18 (45%)
Males 22 (55%)
Age: mean (standard deviation) 24 (1.71)
Reported Twitter account environment.
Prior to study 2 (5%)
During and following study 21 (52.5%)
Chose not to create account during study 17 (42.5%)
152
ated an account, and 17 (45%) chose not to create an
account. Of those students who created an account,
the top two reasons cited were to view radiographic
examples posted and to stay informed of other ques-
tions and answers being posted (Figure 3). Of the
students not creating an account, the top two reasons
were that content could be viewed online without an
account and they did not want another online account
(Figure 4).
Addressing research question two (Did students
perceive that using Twitter had a positive impact on
the course’s teaching and learning environment?), the
students generally scored the question and answer
sessions as helpful and perceived that they improved
accessibility to the instructor (Table 2). In response
to whether the students would enjoy using Twitter in
other courses, 49% agreed or strongly agreed, while
31% were neutral. Regarding whether they would
enjoy using Twitter in the classroom for asking ques-
tions during a lecture, the largest percentage (46%)
disagreed or strongly disagreed.
At the end of the questionnaire, students were
encouraged to provide any additional feedback/
comments about the use of Twitter in the classroom,
and 20 (51%) did so. Analysis was conducted to de-
termine whether the comments were of a positive or
negative nature. The majority (16/20) were positive
with some consistent themes including the advantage
of further exposure to radiology beyond the class-
room. For those who indicated that the experience
had been positive, there was a theme of wanting
greater instruction on the use of the technology as
students believed they lacked the necessary skills to
fully engage with it. On the negative side, there was
concern about privacy and an unwillingness to sign
up for additional online accounts.
Discussion
The major findings of this study were that the
students viewed the use of Twitter positively, found
it helpful in their oral and maxillofacial radiology
courses, and were open to the using Twitter in other
courses in the future. Previous studies have found
increased student engagement with the use of Twitter
in undergraduate and medical education,2,17,19 and our
study supports those findings in a dental education
In this study, only a handful of students had
a Twitter account prior to the start of the courses
with only slightly more having any knowledge of
Journal of Dental Education  ■  Volume 80, Number 2
Figure 3. Students’ reasons for creating a Twitter account (n=21)

A=Personal reasons including staying in touch with C=Stay informed of other questions and answers (n=18)
classmates and friends (n=2) D=View radiographic examples posted (n=21)
B=Ask questions and receive a quick response (n=11)
Note: Instructions were “select all that apply.”

Figure 4. Students’ reasons for not creating a Twitter account (n=17)

A=Did not use information posted (n=0) G=Not interested (n=3)

B=No Internet access at home (n=0) H=Prefer personal interactions with instructor (n=3)
C=Unsure how to create an account (n=1) I=Used another classmate’s account (n=4)
D=Prefer email interaction with instructor (n=2) J=Didn’t want another online account (n=11)
E=Unavailable during sessions with instructor online (n=2) K=Viewed content online without an account (n=13)
F=Do not like Twitter platform (n=3)
Note: Instructions were “select all that apply.”

Twitter as a social media platform. These findings
mirror the sentiments expressed in a 2011 article in
The Chronicle of Higher Education titled “Digital
Natives Aren’t Necessarily Digital Learners.”20 We
started out thinking that all students would easily
navigate their way through Twitter, but that was
not the case. Some students struggled to figure out
how to create accounts or how to post questions and
were not able to fully use the application. Going
forward, a more comprehensive orientation to the
technology will be delivered at the start of the class.
While it is true that the technology is merely a de-
livery modality for instruction and the principles of
good teaching apply regardless of the modality, we

February 2016  ■  Journal of Dental Education 153

 Table 2. Students’ perceptions of whether Twitter had a positive impact on the teaching and learning environment, by
number and percentage of total respondents (n=39)
Strongly Strongly
Agree Agree Neutral Disagree Disagree

The question and answer sessions on Twitter were very helpful. 5 (13%) 30 (77%) 2 (5%) 2 (5%) 0
The use of Twitter for question and answer sessions had a positive 4 (10%) 17 (44%) 14 (36%) 3 (8%) 1 (3%)
impact on my overall grade.
I feel using Twitter for question and answer improved my overall 2 (5%) 15 (38%) 17 (44%) 4 (10%) 1 (3%)
grade.
The Twitter question and answer sessions improved accessibility 5 (13%) 30 (77%) 4 (10%) 0 0
to the instructor.
In the future, I would enjoy using Twitter in other courses. 1 (3%) 18 (46%) 12 (31%) 6 (15%) 2 (5%)
In the future, I would enjoy using Twitter in the classroom for 1 (3%) 9 (23%) 11 (28%) 9 (23%) 9 (23%)
asking questions during lecture.

believe that the use of Twitter provides an environ-
ment for learning that is easily accessible to students
and allows instructors to tap into resources beyond
the classroom, e.g., Internet sites, which ultimately
result in a more dynamic learning environment. Ad-
ditionally, the students reported that participating on
Twitter by reviewing questions, answers, comments,
and radiographs increased communication with and
access to the instructor, supporting one of the seven
principles of good teaching advanced by Chickering
and Gamson.5 The students were open to the use of
Twitter in the future but, interestingly, commented
that only if the course instructor was knowledgeable
about using this platform.
The PI chose Twitter for teaching and learn-
ing for several reasons including its near-immediate
interaction, condensed posts, open interaction, and
no requirement to join to view posts. The near-im-
mediate interaction component allowed students to
ask a question and receive an answer within minutes,
ensuring they spent less wasted time on studying
incorrect material or pursuing an incorrect thought
process on material. The limit of 140 characters (in-
cluding punctuation and spaces) forced both students
and the instructor to post a question, answer, or com-
ment in a direct, concise way, making it easier for
others viewing to know exactly what was being asked
and getting a direct answer. The open interaction of
this platform allowed students to respond to others’
questions, creating an open learning environment
in which the instructor would then guide all those
interacting to the correct answers. Another valuable
aspect of Twitter is that anyone with an Internet con-
nection could view the instructor’s feedback and see
all the questions, comments, and radiographs that
were posted.
Student feedback was instrumental to the PI in
incorporating an additional technology learning tool,
an online oral radiology website (www.DrGstoothpix.
com). The students indicated a desire for a platform
that would allow them to view additional radiographs
beyond what was posted during the Q&A sessions on
Twitter. Twitter is limited in providing easily search-
able radiographic entities. The development of the
website provided an additional venue for learning;
and beyond addressing student feedback, the website
has been well received by numerous dental profes-
sionals around the world. A serendipitous outcome
of using an open access Twitter account for teaching
and learning at a dental school is that it has led to a
following of dental professionals from around the
world. The current total number of followers is 1,864
with the top five locations of followers being 46.1%
in the United States, 19.4% in the United Kingdom,
11.2% in Saudi Arabia, 3.4% in Canada, and 2.9% in
India. These professionals interact with the Twitter
account on the #Radiographoftheday posts as well as
sometimes participating in the Q&A sessions for the
students. The Twitter account provides a means for
others to see current posts from the website as well.
There were limitations to this study including
that it was carried out in only one dental school,
with a small sample size. The ability to generalize
the results is therefore limited. Another limitation to
interpreting the results is that the data were collected
in spring 2011, before Twitter reached its current
prominence across the culture. We can speculate
that a similar study conducted today would discover
greater student familiarity with Twitter, which could
also support greater potential for its use in education.
Future studies should examine student behaviors
when provided a more in-depth orientation to Twitter

154 Journal of Dental Education  ■  Volume 80, Number 2

as a teaching tool. It will also be important to study
this tool over time and preferably across multiple
institutions.
Conclusion
The results of this study showed that the use of
Twitter for question and answer sessions in an oral
and maxillofacial radiology course was perceived
positively among second-year dental students.
Dental faculty members have indicated uncertainty
about the usefulness of social media in teaching and
learning. This study provides one example of how the
use of social media resulted in increased interaction
between students and instructor, facilitated prompt
feedback from the instructor, and encouraged active
learning, all considered best practices for teaching
and learning.
Acknowledgments
The authors would like to acknowledge Mu-
hammed Yaseen, PhD, for his assistance in data
compilation.
REFERENCES
1. Kaplan AM, Haenlein M. Users of the world, unite! The
challenges and opportunities of social media. Bus Hori-
zons 2010;53:59-68.
2. George DR, Dellasega C. Use of social media in
graduate-level medical humanities education: two pilot
studies from Penn State College of Medicine. Med Teach
2011;33(8):e429-34.
3. Mondahl M, Razmerita L. Social media, collaboration, and
social learning: a case study of foreign language learning.
Electr J e-Learn 2014;12(4):339-52.
4. Arnett MR, Loewen JM, Romito LM. Use of social media
by dental educators. J Dent Educ 2013;77(11):1402-12.
5. Chickering AW, Gamson ZF. Seven principles for good
practice in undergraduate education. Am Assoc Higher
Educ Bull 1987;3-7.
February 2016  ■  Journal of Dental Education
6. Prince M. Does active learning work? A review of the
research. J Eng Educ 2004;93(3):223-31.
7. Wiggins GP, McTighe J. Understanding by design. 2nd
ed. Alexandria, VA: Association for Supervision and
Curriculum Development, 2005.
8. Hake RR. Interactive-engagement vs traditional methods:
a six-thousand-student survey of mechanics test data for
introductory physics courses. Am J Phys 1998;66(1):
64-74.
9. Michael J. Where’s the evidence that active learning
works? Adv Physiol Educ 2006;30(4):159-67.
10. Dewey J. The child and the curriculum. Chicago: Univer-
sity of Chicago Press, 1906.
11. Vygotsky LS. The development of higher psychological
processes. Cambridge: Harvard University Press, 1978.
12. Corum KA, Gadbury-Amyot CC, Johnson K, Strait
TM. U.S. dental hygiene faculty perceptions of learner
outcomes in distance education courses. J Dent Educ
2014;78(4):530-40.
13. Sateesh KM, Saylor-Boles CD, Rapley JW, et al. Stu-
dent evaluation of clickers in a combined dental and
dental hygiene periodontology course. J Dent Educ
2013;77(10):1321-9.
14. Gadbury-Amyot CC, Singh AH, Overman PR. Teaching
with technology: learning outcomes for a combined dental
and dental hygiene online hybrid oral histology course. J
Dent Educ 2013;77(6):732-43.
15. Gadbury-Amyot CC, Brockman WG. Transition of a
traditional pharmacology course for dental students to
an online delivery format: a pilot project. J Dent Educ
2011;75(5):633-45.
16. NewsBlaze LLC. What is Twitter and why does it keep
following me around? At: tweeternet.com/. Accessed 22
Apr. 2015.
17. Junco R, Heibergert G, Loken E. The effect of Twitter on
college student engagement and grades. J Comput Assist
Learn 2011;27:119-32.
18. McAndrew M, Johnston AE. The role of social media in
dental education. J Dent Educ 2012;76(11):1474-81.
19. Kassens-Noor E. Twitter as a teaching practice to enhance
active and informal learninng in higher education: the
case of sustainable tweets. Active Learn Higher Educ
2012;13(1):9-21.
20. Cowan B. Digital natives aren’t necessarily digital learn-
ers. Chronicle of Higher Education, November 6, 2011.
155