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

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.