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

Abstract

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.

Plain language summary

Study interviewing young people about their experience of having crooked or sticking-out teeth and braces, and how this impacts on friendships and relationships within their peer group

Having a malocclusion in the form of crooked or sticking-out teeth is very common, meaning a lot of children and adolescents wear braces. This is during a period when they are moving away from the control of their parents or guardians and their psychosocial development is more influenced by their peers. Peer relationships are very important for healthy development, with poor relationships or being a victim bullying being linked to loneliness, depression, poor academic achievement and poorer quality of life in the long term. In this study, we interviewed 14 young people aged 14–16 years about their social experiences of having crooked or sticking-out teeth and subsequently braces to treat them. From the interviews, it was found that being very self-conscious and embarrassed socially about their teeth was very common, resulting in trying to avoid smiling and hiding their teeth in photographs. As this study was carried out during the COVID-19 pandemic, a couple of the participants reported that wearing face masks made them feel more confident. They also felt they were being judged by their peers about the appearance of their teeth, even if nothing explicit was said. They in turn were aware they judged other people. All the young people had either experienced being teased or having mean comments made about their teeth or witnessed it happening to someone else. Although most tried to shrug this off, it was apparent that some of the young people found this very hurtful both in the short and long term. Most were having brace treatment or waiting for it to start. This was seen as positive thing and a normal part of growing up. None of them reported being teased for wearing braces and their friends were very supportive and helpful during treatment.