Bullying and Dentistry: the effects of malocclusion on school-aged children

This summary is based on the artcile published in the British Dental Journal: Bullying in schoolchildren – its relationship to dental appearance and psychosocial implications: an update for GDPs (May 2011)

J. Seehra,J. T. Newton, and A. T. DiBiase

Context

Bullying in school-aged children is a global phenomenon. The effects of bullying can be both short- and long-term,  resulting in both physiological and psychological symptoms. It is likely that dental care professionals will encounter children who are subjected to bullying.

Clinicians should be aware that children with a malocclusion could be subjected to persistent peer victimization, resulting in a negative impact on both their self-esteem and oral health-related quality of life. Referral for orthodontic assessment and treatment should be considered.

Purpose of the Review

To discuss the incidence of bullying, the types of bullying, the effects of bullying and the interventions aimed at combating bullying in schoolchildren. The role of dentofacial aesthetics and the relationship of bullying and the presence of a malocclusion are also discussed.

Key Messages

• It is generally assumed that an individual with poor dentofacial aesthetics will have low self-esteem (1) and elicit an unfavourable response from society.
• Severe facial disfigurement evokes feelings of sympathy and compassion but milder disfigurements result in ridicule and teasing, creating greater psychological distress in these individuals.(2)
• Particular dental characteristics have been identified that increase the risk of teasing, resulting in disruption of normal psychological development. These include maxillary crowding, an increased overjet and deep overbite.(3) (4) (5) Additional dental features include dentoalveolar trauma,(6) absent teeth (7) and cleft lip with or without cleft palate.55
• A study showed that being bullied due to the presence of a malocclusion resulted in a significant negative impact on both self-esteem and oral health-related quality of life. (8)
  
• Is orthodontic treatment the answer? Historically, orthodontic appliances are reported to attract comments, such as ‘metal mouth’ and ‘scaffolding’, resulting in potential worsening of the teasing. (9)
  
• It is clear that a complex relationship exists between the presence of a malocclusion, bullying, self-esteem and oral health related quality of life. The self-perception of dentofacial aesthetics has been reported to have a greater effect on self-esteem and self-concept. (10) However, evidence
• suggests that a malocclusion can have a negative impact on both an individual’s self-esteem (11) and oral health-related quality of life. (12)
  
• For dental care practitioners clear guidance is lacking; however, any intervention should be focused primarily on the school environment and instigation of anti-bullying policies but may involve other specialties.

References

1. Cunningham S J. The psychology of facial appearance. Dent Update 1999; 26: 438–443.
2. Macgregor F C. Social and psychological implications of dentofacial disfigurement. Angle Orthod 1970; 40: 231–233.
3. Shaw W C, Meek S C, Jones D S. Nicknames, teasing, harassment and the salience of dental features among school children. Br J Orthod 1980;7: 75–80.
4. Helm S, Kreiborg S, Solow B. Psychosocial implications of malocclusion: a 15-year follow-up study in 30-year-old Danes. Am J Orthod 1985;87: 110–118.
5. Gosney M B. An investigation into some of the factors influencing the desire for orthodontic treatment. Br J Orthod 1986; 13: 87–94.
6. Polat Z S, Tacir IH. Restoring of traumatized anterior teeth: a case report. Dent Traumatol 2008; 24: e390–e394.
7. Gill D S, Jones S, Hobkirk J, Bassi S, Hemmings K, Goodman J. Counselling patients with hypodontia. Dent Update 2008; 35: 344–346, 348–350, 352.
8. Seehra J, Newton T, Dibiase A T. Bullying in orthodontic patients and its relationship to malocclusion, self-esteem and oral health related quality of life. London: King’s College London, 2009. MSc Thesis.
9. Prove S A, Freer T J, Taverne A A. Perceptions of orthodontic appliances among grade seven students and their parents. Aust Orthod J 1997; 15: 30–37.
10. Phillips C, Beal K N. Self-concept and the perception of facial appearance in children and adolescents seeking orthodontic treatment. Angle Orthod 2009; 79: 12–16.
11. Kenealy P, Frude N, Shaw W. An evaluation of the psychological and social effects of malocclusion: some implications for dental policy making. Soc Sci Med 1989; 28: 583–591.
12. Boulton M J. Teachers’ views on bullying: definitions, attitudes and ability to cope. Br J Educ Psychol 1997; 67: 223–233.

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