Can a malocclusion cause bullying?

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Malocclusion, peer relations and bullying among school children Andrew Dibiase

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Can a malocclusion cause bullying?



Join me for a summary exploring bullying and its relationship with malocclusion, with a contemporary review of evidence showing the psychological effects various malocclusions can cause young people. This podcast is a summary of Andrew DiBiase’s lecture last year at the British Orthodontic Conference. Andrew’s research explores what factors moderate bullying, and what factors can be protective against bullying.





  • Nearly 1 in 3 patients report teasing or fear of teasing as a motivating factor for orthodontic treatment Bauss 2023 AJODO
  • 1 in 7 patients attending our clinics are bullied Seehra et al., 2011
  • Most upsetting feature of bullying teeth 60.7% Shaw
  • 13, 387 teenagers 25% report bullying
    • Around 7% related to teeth


Definition of bullying: Olweus 1984

  • Unprovoked and sustained campaign of aggression, towards someone in order to hurt them
  • Student exposed repeatedly to negative action on the part of one or more students
    • Harm, imbalance of power, organised, repetitive, harm experienced


Who gets bullied and how?

  • Younger more – 10 year olds 22%, 15 year olds 7%
  • Girls are greater than boys by 5%
  • Boys low athletic competence
    • Judged on homour as well Langlois 2000
  • Girls appearance
    • We do judge girls on physical appearance Langlois 2000
    • 80% verbal – Cyber bullying – doest stop at the school gate


Consequences of bullying

  • Short term and long term effects
    • Poorer academic performance
    • Crime
    • Self harm
      • 26% within young population and teeth occupying the reason in 1 in 5 young people Bitor 2022 AJODO
    • Low self esteem
    • Structural changes, medulla – related to fear (peer victimisation and its impact on adolescent brain)


What features are more likely to result in bullying Dibiase,   Jad Seehra 2014

  • Greater rate of bullying
  • 2 div 1: 18%
  • Increased overjet 16% Tristão SR 2020
  • Deep overbite
  • Missing teeth, anterior spacing
  • IOTN AC 9 and 10
  • Regression – younger worse
  • Low athletic competence p 0.019





  • Relationship between bullying and severe malocclusion
  • Schoolchildren who report being bothered by their teeth report being lonelier at school and lower self-esteem
  • Malocclusion has a greater impact on females than males
  • Malocclusion and peer relations is moderated by self-esteem in girls, but not boys
  • Good peer relations protect against the negative impact of malocclusion in girls with low or average self-esteem







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