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Orthodontics are a rite of passage for many adolescents. Once treatment is finished, these young patients often display newfound confidence and pride in their appearance. However, the road to that improved self-esteem can be perilous as other kids can be cruel, using braces as a subject for teasing, bullying, and victimization. Yet these victims are finding self-expression and even solace on social media as they describe their experiences.
Researchers from the University of Otago in New Zealand recently took to Twitter to examine the phenomenon for themselves, searching the website’s database from 2010 to 2014 for keywords relating to bullying, teeth, and orthodontics. Then, they qualitatively analyzed the 321 relevant posts they found to uncover key trends. Joseph Antoun, BDS, DClinDent, of the university’s Faculty of Dentistry shared his insights about their work.
Q: Children with braces have always been bullied. How has social media changed this?
A: Although our research did not look at cyberbullying per se, there is plenty of media around the topic of peer victimization in general. Our study, which focused on personal accounts of bullying victims, does suggest that bullying may not always be physical. Verbal actions and name calling are a few common examples of other forms of bullying. Interestingly, we identified tweets where victims reported being teased about their braces as well as feeling grateful about receiving treatment and having a great smile. I think future studies should certainly focus on cyberbullying as it relates to orthodontic treatment.
Q: How did you analyze these personal accounts?
A: We identified 4 primary categories and several secondary categories that captured the content of the tweets we included in our study. The first primary category, morphological features of teeth or malocclusion, included tweets that contained specific (eg, crooked teeth) and nonspecific (eg horrible and ugly) adjectives to describe an individual’s teeth. The second primary category, psychological and/or psychosocial impact of bullying, included tweets that seemed to have had some effect on an individual’s emotional and/or social well-being (eg, self-hate). The third primary category, coping mechanisms, included a wide range of strategies that victims seemed to have relied on to get through their bullying experiences. Examples included tolerance of bullying, pursuing self-acceptance, reliance on personal or religious beliefs, physical relocation, sharing of personal bullying experiences, and treatment seeking. The last category related to the role of the family. We noted that family members may either offer support to victims of bullying or even be perpetrators of peer victimization!
Q: How could families play both a contributory and mediatory role in bullying?
A: This was a really interesting finding. For instance, we identified 2 posts that highlighted the importance of the role of family members. In one post, the tweeter’s mother was portrayed as a hero, whereas in the other she was described as displaying bullying-related behaviors. Although less common, we have to be aware of this issue when we see young patients reporting bullying experiences.
Q: Could you provide some examples of tweets that you studied?
A: • “front teeth gaps aren’t fun bc throughout my whole childhood I was bullied about it to the point where i stopped smiling & talking”
• “i used to always get teased about my overbite..but I got braces and now I have a beautiful smile so look at me now ^_^”
• “Before I got braces I was teased because of my teeth. I still feel insecure even without braces today.”
• “i was walking at the mall today & some guys started making horse noises at me bc of my teeth. everyone gets bullied. don’t ever feel alone.”
• “I love my smile! Used to get teased bout my teeth then my braces... wonder what their teeth look like these days…”
Q: What were some of the psychological impacts of this bullying?
A: The psychological and/or psychosocial impact of bullying episodes seemed to indicate self-hate or behavioral changes with some describing a state of self-hate with potential long-term psychological sequelae. However, many Twitter users who indicated receiving orthodontic treatment were generally thankful for having braces, with many expressing its positive impact on their psychological well-being, self-esteem, and general life.
Q: What can orthodontists do, in terms of orthodontic treatment, to mitigate bullying?
A: As an orthodontist, I always find the patient’s main reason for seeking treatment one of the most important bits of information that we collect. Victims of bullying, however, may not be forthcoming with this information, so we have to try and build a good rapport with them and their parents in order to tap into this area of their lives. Understanding the motivation for treatment may give us an immense advantage in delivering patient-centered care—the new paradigm of health and dental care nowadays. For instance, a patient who is receiving a great deal of bullying because of something like a midline diastema may benefit from early closure of that space during the early phase of treatment. We may also play an active role in identifying patients who may be suffering from a great deal of distress and could benefit from a referral to a psychologist.
Q: Are there any behavioral approaches that orthodontists and other physicians can take to help mitigate bullying?
A: As I mentioned previously, some patients cope with bullying by sharing their own experiences and seeking treatment. We are in a prime position to help them with both—ie, with our hands, but also our ears. I personally believe that we should never limit our focus to teeth. At the end of the day, we are health professionals who are personally and clinically enriched by making a difference in someone’s life.
The study, “Accounts of Bullying on Twitter in Relation to Dentofacial Features and Orthodontic Treatment,” was published by the Journal of Oral Rehabilitation.