Malocclusion, orthodontic treatment and peer relationships in adolescents: A qualitative study

OBJECTIVE: To explore the relationship between malocclusion, orthodontic treatment and peer relationships in adolescents. DESIGN: A cross-sectional qualitative study. SETTING: Three secondary schools in the South-East of the U.K. PARTICIPANTS: A total of 14 schoolchildren aged 14-16 years (mean age = 15.7 years; age range = 14.4-16.5 years). METHODS: In-depth one-to-one semi-structured interviews carried out online. All interviews were transcribed verbatim and analysed thematically according to Braun and Clarke's model of thematic analysis. RESULTS: The central finding of this research was that adolescents are self-conscious of their dental appearance, it impacts on social interactions, and peers and friends are both a source of pressure and support regarding dental appearance and treatment. Two main themes were identified: (1) malocclusion and peer relationships; and (2) social expectations and experience of orthodontic treatment. Participants reported being self-consciousness of their teeth before treatment, and this increased with age. They feared being judged based on their dental appearance, undertaking behaviour to hide their teeth in social situations, in photographs or online. All participants reported either being teased personally about their teeth or witnessing this happening to someone else although they mostly did not see this as bullying. This had a negative impact on self-confidence. No one reported being teased after starting orthodontic treatment. Orthodontic treatment was seen as desirable and normal within this age group, with an expectation it would improve self-confidence, particularly in social settings. Friends and peers were a source of support during treatment. CONCLUSION: Young people are self-conscious of their dental appearance, which impacts their peer relationships and can make them a target for teasing and bullying. Orthodontic treatment is considered normal, with peers and friends providing support.