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Table 2 Data extracted from the included studies

From: Is there a relationship between malocclusion and bullying? A systematic review

Author, year, country Study design Total number of participants Age range (years) Terms used to refer to bullying/Type of bullying Instrument used to assess bullying Instrument used to assess malocclusion Malocclusions evaluated/self-reported Statistical analysis Malocclusion outcomes Association between malocclusion and bullying Conclusions
Shaw et al, 1980 [22], UK Cross-sectional 531 9–13 Nicknames, teasing, harassment/ verbal and physical Interview questionnaire Questionnaire about nicknames, teasing, harassment and physical characteristics Not specified Descriptive analysis and Chi-square Not reported 66% were teased about their physical characteristics. 7% of total sample were teased about their teeth, of which 51% due to incisal prominence, 8% due to crowding. Children teased about teeth were twice likely to suffer harassment (55%) than those were not (26%) (p < 0.001) Malocclusion was significantly related with bullying.
Helm et al, 1985 [23], Denmark Cohort 758 First phase 13–19
Second phase
28–34
Teasing/verbal Fifth question of an own questionnaire: “Did your schoolmates tease you about the appearance of your teeth or jaws?” Instrument used previously by Bjork et al. 1964 Max Ovj > 6 mm, Max Ovj > 9 mm, Mand Ovj, DB > 5 mm, DB > 7 mm, AOB, CrsB, Scissor bite, Crw Max inc, Crw Mand inc, Spacing Max inc. Chi-square and Fisher exacts test 80% (n = 606) presented malocclusion 9% of adults with malocclusion suffered teasing during adolescence, and 1.3% of adults without malocclusion suffered teasing during adolescence (p < 0.001). Extreme maxillary overjet, extreme deep bite, and space anomaly malocclusions were significantly related with teasing.
Rwakatema et al, 2006 [24], Tanzania Cross-sectional 298 12–15 Teased and bullying/ verbal Ng’ang’a et al. questionnaire. Question: “Do your schoolmates tease you about the appearance of your teeth or jaws?” Ng’ang’a et al. questionnaire. Question: “Do you generally observe that your teeth are not appropriately aligned in your mouth?” Self-reported: teeth alignment Chi-square 56% respondents thought their teeth were properly aligned and 69% (n = 205) related that they need orthodontic treatment. Bullying or teasing was not significantly related to teeth alignment (p = 0.093, 0 > 0.05) Malocclusion was not significantly related with teasing or bullying.
Badran et al., 2010 [21], Jordan Cross-sectional 400 14–16 Teasing/ verbal Global negative self-evaluation (GSE) scale IOTN (AC and DHC), self-perceived AC, perceived need for orthodontic treatment Not specified Spearman correlation coefficient 82% (n = 338) presented little, borderline, or definite need for orthodontic treatment. Teasing about teeth was correlated with GSE scale (0.272), with students’ high AC score (0.213) and with perceived treatment need (0.354). Malocclusion was significantly related with teasing.
Seehra et al., 2011, [16] UK Cross-sectional 336 10–14 Bullying/verbal and physical Olweus Bully/Victim questionnaire IOTN (AC and DHC) Incisor relationship, DHC and AC component of IOTN, skeletal pattern, FMPA, LFH, increased Ovj and over bite Chi-square and Fisher exacts test 96% (n = 324) presented little, borderline, or definite need for orthodontic treatment. Bullying was significantly related to Class II division 1 incisor relationship (p = 0.041), increased overbite (p = 0.023), and increased overjet (> 4 mm)(p = 0.001) and high need for OT by AC component of IOTN (p = 0.0014) Malocclusion was significantly related with bullying, principally to the AC component of IOTN.
Al-Bitar et al., 2013 [15], Jordan Cross-sectional 920 11–12 Bullying/verbal Self-questionnaire with component for personal experience of bullying Self-questionnaire with component for general physical characteristics and dentofacial features Self-reported: AOB; spacing between teeth or missing teeth; Crw of teeth; gummy smile; prominent anterior teeth; prominent Mand anterior teeth; retrognathic Mand; incompetent lip coverage; prognathic Mand. Descriptive statements with total frequency Not reported 73% of adolescents reported they were victims of bullying due to dentofacial features. Teeth (50%), lips (14%), and chin (9%). Space between teeth or missing teeth was the most targeted feature. Malocclusion was related with bullying.
Agel et al., 2014, [17], East UK Cross-sectional 728 15–16 Bullying/verbal and physical Six items derived from the revised Olweus Bully/Victim questionnaire WHO oral clinical exam methodology Ovj and lip coverage Chi-square 1.51% of the adolescents presented Ovj > 6 mm and 0.41% presented inadequate lip coverage. Bullying was not significantly related to Ovj > 6 mm or inadequate lip coverage (p > 0.05). Malocclusion addressed by increased overjet was not significantly related with bullying.
Chikaod et al., 2017 [25], Nigeria Cross-sectional 835 12–17 Bullying/verbal Self-administered questionnaire modified from Al-Bitar 2013. Self-administered questionnaire modified from Al-Bitar 2013. Self-reported: space incisor, prominent Ovj, incompetent lip coverage, gummy smile, diastema or missing teeth, AOB, prognathic Mand, retrognatic Mand, prominent Mand anterior teeth, Crw. Descriptive statements with total frequency Not reported 51.9% of adolescents reported they were victims of bullying due to dentofacial features. Teeth (24.3%), chin (15.3%), and lips (12.3%). Space between teeth or missing teeth (12.2%) was the most common dentofacial feature identified as target for bullying. Bullies frequently target to general dentofacial appearance (malocclusion).
Julca-Ching et al. 2019 [26], Peru Cross-sectional 147 12–18 Bullying/verbal Self-administered questionnaire modified from Al-Bitar 2013. DAI Not specified Kruskal-Wallis 87.76% of adolescents presented malocclusion Bullying was not significantly related to malocclusion (p > 0.05). Malocclusion was not significantly related with bullying.
  1. IOTN Index of Orthodontic Treatment Needs, AC esthetic component, DHC dental health component, OT orthodontic treatment, Max Ovj maxillary overjet, Mand ovj mandibular overjet, DB deep bite, CrsB crossbite, AOB anterior open bite, Crw Max Inc crowded maxillary incisor, Crw Mand Inc crowded mandibular incisor, FMPA Frankfort-Mandibular Plane Angle, LFH lower facial height
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