Bullying in orthodontic patients and its relationship to malocclusion, self-esteem and oral health-related quality of life

Abstract

Objectives: To measure the self-reported frequency and severity of bullying amongst patients referred for orthodontic treatment and to investigate whether there is a relationship between levels of self-reported bullying, malocclusion and need for orthodontic treatment and an individual’s self-esteem and oral health-related quality of life (OHRQoL).

Design and setting: Cross-sectional study of an adolescent group referred for orthodontic assessment at three UK hospitals.

Subjects and methods: Three hundred and thirty-six participants aged between 10 and 14 years were recruited. Validated questionnaires were used to measure the self-reported frequency and severity of bullying, self-esteem and OHRQoL. Orthodontic treatment need was assessed using IOTN.

Results: The prevalence of bullying was 12·8%. Being bullied was significantly associated with Class II Division 1 incisor relationship (P = 0·041), increased overbite (P = 0·023), increased overjet (P = 0·001) and a high need for orthodontic treatment assessed using AC IOTN (P = 0·014). Bullied participants also reported lower levels of social competence (P<0·001), athletic competence (P<0·001), physical appearance related self-esteem (P<0·001) and general self-esteem (P<0·001). Higher levels of oral symptoms (P = 0·032), functional limitations (P<0·001), emotional (P<0·001) and social impact (P<0·001) from their oral condition, resulting in a negative impact on overall OHRQoL (P<0·001), were also reported.

Conclusions: Significant relationships exist between bullying and certain occlusal traits, self-esteem and OHRQoL.

Keywords:

• Bullying
• self-esteem
• oral health-related quality of life
• malocclusion

Acknowledgments

The authors are very grateful to all the patients and parents who took part in the study. In addition, the authors would like to thank the European Orthodontic Society for providing funding for this study.