Bullying, cyberbullying, self-esteem, psychological distress and relationship with oral health related quality of life: A cross-sectional survey in adolescents

Background: Bullying, including cyberbullying, is a global concern. Few studies have looked at the impact of dentofacial features on bullying and their relationship with psychosocial factors. This study aimed to assess the prevalence of bullying, cyberbullying, low self-esteem, high psychological distress, and investigate the relation with Oral Health-Related Quality of Life (OHRQoL) in adolescents. Methods: This cross-sectional survey used a self-administered questionnaire distributed among middle school students (ages 10-15). The questionnaire assessed bullying/victimization (Florence Bullying and Cyberbullying Scales), self-esteem (Rosenberg scale), psychological distress (Strengths and Difficulties Questionnaire), and OHRQoL (CPQ11-14 ISF:16). Two-level (school and student) logistic regressions with random intercept analyzed relationships between OHRQoL and other variables. Results: Among 437 participants, 18% reported bullying victimization, 14% admitted bullying perpetration, 6% experienced cybervictimization, and 4% perpetrated cyberbullying. Low self-esteem was found in 22%, and 26% reported high psychological distress. CPQ11-14 ISF:16 was associated with victimization (OR = 1.08; 95%CI from 1.05 to 1.10; P < 0.001), bullying perpetration (OR = 1.07; 95%CI from 1.04; 1.11; P < 0.001), cybervictimization (OR = 1.07; 95%CI from 1.03 to 1.10; P < 0.0001), cyberbullying perpetration (OR = 1.09; 95%CI from 1.04; 1.13; P < 0.001), low self-esteem (OR = 1.07; 95%CI from 1.04 to 1.10; P < 0.001), and high psychological distress (OR = 1.10; 95%CI from 1.07 to 1.13; P < 0.001). The four most implicated reasons for teasing related to mouth/teeth/chin were tooth color or shape, orthodontic appliance wear, protruding maxillary incisors, and spacings or missing teeth. Conclusions: The present study found a relationship between perceived oral health and bullying/cyberbullying, low self-esteem, and psychological distress. Furthermore, it highlighted that adolescents can be teased as a result of their dentofacial characteristics.