Can bullying affect dental health?

Most teenagers brush their teeth every day, but a new study suggests around 6% of young people between the ages of 13 and 17 skip brushing their teeth either entirely or partially. Research shows that bad childhood experiences, including bullying, are associated with bad teeth cleaning habits.

As a part of the Young-HUNT Study*, young people in the Norwegian county of Trøndelag were asked if they had experienced anything bad in their childhood such as bullying, abuse, violence or parents with serious alcohol problems. They were also asked about their teeth cleaning habits. The answers have been collated with data from the public dental health service.

“We have conducted a study in which we combine self-reported answers with clinical dental health data. This makes the study unique, and we were a little surprised at what we found,” said PhD candidate and psychology specialist at the Norwegian University of Science and Technology (NTNU), Lena Myran at Kompetansesenteret Tannhelse Midt.

“We cannot say for sure whether one leads to the other, but we do know that there is an association,” said Myran, who is researching the ways in which adverse childhood and adolescent experiences affect dental health.

A vulnerable group

The survey had 6351 young participants, with results indicating that young individuals with a background of adverse childhood experiences were more likely to report not brushing their teeth daily. Among other things, young people aged 16 to 17 who experience bullying were more likely to report bad teeth cleaning habits.

Poor dental health is also associated with shame. “It doesn’t mean that everyone who is bullied doesn’t clean their teeth every day. Most people brush their teeth every day.

The vast majority are doing a good job, they look after their teeth and have little tooth decay. However, there is a group that is a little more vulnerable that we need to be aware of,” Myran said.

Bad dental hygiene habits can lead to decay — ‘caries’ in medical terms — which in turn increases the risk of cavities and can cause pain.

“Toothache can lead to avoiding dental treatment, which in turn can make people afraid of going to the dentist,” Myran said.

Abuse, bullying and decay

“The correlations we find provide us with important knowledge about young people. Experiences of violence, abuse and bullying are harmful in many areas of life, and we now see that this is also the case when it comes to dental health,” Myran said.

The more different types of bad experiences you have from your childhood, the stronger the effect on your tooth brushing habits and caries.

Dentine caries, more commonly known as decay, causes cavities and is treated with fillings. The researchers found that most of the survey participants who had had caries were among the oldest young people, aged 16 to 17 years old.

“On average, our figures indicate more dentine caries in this age group among those who experience bullying, violence and abuse, compared with those who had not experienced them,” Myran said.

Need for a holistic approach

The researchers also found a correlation between dose and response. “The more different types of bad experiences you have from your childhood, the stronger the effect on your tooth brushing habits and caries. For example, many people have experienced both abuse and parents with alcohol-related problems. These young people are more likely to have poor dental health than those who have experienced only one of the two,” Myran said.

Myran emphasised that a large proportion of young people who have had adverse childhood experiences have good dental health. However, there are some young people who do not clean their teeth well enough, a habit that it is important to establish early in life.

“These findings show that dental health clinics need to take a holistic approach. When a young person comes in with a lot of caries, clinics can be more curious about whether the person has had any difficulties in their life that may have contributed to a poor diet or poor dental hygiene habits.

Identifying causes

Myran would like dental health professionals to ask themselves what the cause of poor dental health might be. Asking patients about adverse experiences is important when trying to identify vulnerable individuals and the underlying reasons why dental treatment is required.

“Instead of saying, ‘You need to be better at brushing your teeth and flossing’, you might ask: ‘Why has it become difficult for you to clean your teeth?’ We can also ask ourselves the question ‘What has the patient experienced that has caused their dental health to deteriorate?’

“There can be many reasons why a person has cavities or struggles with their dental hygiene. There is no one out there who actively sets out to neglect their teeth, but good advice and instructions about the importance of brushing teeth are not always taken fully on board by some people,” Myran said.

A holistic approach, by contrast, can lead to earlier and more targeted preventive measures.

“It might include measures such as providing additional support to teach people about dental hygiene or referring them to other relevant support services,” Myran said.

More time with patients

Myran’s background as a psychologist means she is aware of the importance of focusing on communication and building trust when interacting with young patients. She would like dental health professionals to focus even more on building positive and supportive relationships with young people.

“Creating an environment where young people feel safe enough to be honest about their habits and share their experiences is a prerequisite for helping certain vulnerable patients.”

Myran said that many dentists and dental hygienists are already doing a great job of establishing good relationships with their patients.

“By continuously prioritising and further developing an alliance of confidence, we can contribute to better adapted treatment plans. But these are tasks that steal precious time from dental practitioners.”

Therefore, it is important that decision-makers for the public dental health service facilitate this.

“Good collaboration not only leads to an improvement in young people’s dental health, it also contributes positively to their general quality of life,” Myran said.

*Young-HUNT is the adolescent part of the Trøndelag Health Study (The HUNT Study) — a cohort health study conducted by Norwegian county of Trøndelag. The Hunt Research Centre, part of the Faculty of Medicine and Health Sciences at the Norwegian University of Science and Technology (NTNU), collects and provides access to the data and samples from the study.

Image credit: iStock.com/Thai Liang Lim