Bullying can affect dental health
Young people who have adverse childhood experiences are at greater risk of poor dental health. This is important knowledge for dental health services, according to new research.
Most teenagers brush their teeth every day, but not all of them. Just over 6 per cent of young people between the ages of 13 and 17 skip brushing their teeth either entirely or partially. Research now shows that bad childhood experiences, including bullying, are associated with bad teeth cleaning habits.
“We cannot say for sure whether one leads to the other, but we do know that there is an association,” says NTNU PhD candidate and psychology specialist Lena Myran at Kompetansesenteret Tannhelse Midt.
She is researching the ways in which adverse childhood and adolescent experiences affect dental health.
Young people who participated in the Young-HUNT Survey 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,” says Myran.
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A vulnerable group
6351 young people participated in the survey. The results indicated 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,” says Myran.
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,” says Myran.
Poor dental health is also associated with shame.
“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.
The more different types of bad experiences you have from your childhood, the stronger the effect on your tooth brushing habits and caries,” says Myran.
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,” says Myran.
Requires 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,” says Myran.
Myran emphasises 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.
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Underlying 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?’”
Myran believes that this is a more holistic approach.
“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,” says Myran.
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,” says Myran.
More time with patients is needed
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 says 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,” says Myran
Source: Lena Myran, et al.: Associations of adverse childhood experiences with caries and toothbrushing in adolescents. BMO Oral Health, published 14 October 2023. The Young-HUNT4 Survey https://doi.org/10.1186/s12903-023-03492-z
