Malocclusion and bullying experience among school-aged children and adolescents: a systematic review

Malocclusion is an oral health problem that causes functional and aesthetic alterations, potentially leading to embarrassment when smiling and speaking, affecting self-esteem, oral health-related quality of life, and contributing to the occurrence of bullying among youth. This study aimed to map the available evidence on the impacts of malocclusion on the experience of bullying in school-aged children and adolescents. A systematic review was conducted with an electronic search in nine databases, including grey literature, and observational studies investigating the association between malocclusion characteristics and bullying were included, without restrictions regarding publication year or language. Study selection, data extraction, and risk of bias assessment were conducted by two reviewers using the Joanna Briggs Institute (JBI) critical appraisal tools for analytical cross-sectional and case-control studies. The electronic search identified 3,412 records, of which 10 met the eligibility criteria and were included in the qualitative synthesis. The studies were published between 2013 and 2024 and presented a risk of bias ranging from moderate to low. Malocclusion characteristics, such as increased overjet, dental crowding, and maxillary misalignment, were associated with the occurrence of bullying. Although some evidence identified this association, other studies did not find a statistically significant correlation. It is concluded that the aesthetic perception of teeth proved to be a relevant factor for vulnerability, being the physical feature most frequently reported as a target of aggression.