Dental appearance may lead young teens to self-harm

By Melissa Busch, DrBicuspid.com associate editor

March 30, 2022 -- Nearly half of teens who self-harm say they engage in self-injurious behavior due to the way their teeth look, according to a survey of more than 600 eighth-grade students. The findings were published March 26 in the American Journal of Orthodontics and Dentofacial Orthopedics.

Tooth color and shape and missing teeth were some of the most common dental features that contributed to self-harm, the authors wrote. In addition, one-fifth of eighth graders who reported engaging in self-harm said bullying about their dental imperfections contributed to their behavior.

"This study demonstrated a relatively high experience of self-harm reported by adolescent school children, with many reporting self-harm as a result of their dentofacial appearance and bullying because of dentofacial features," wrote the authors, led by Dr. Hawazen Sonbol of Kingston Hospital and St. George's Hospital and St. George's Medical School in London.

Throughout the world, self-harm is a growing public health issue. Worldwide, the prevalence of self-harm in teens and young adults is estimated to range between 7.5% and 46.5%.

Self-harming, which includes multiple behaviors like swallowing pills, cutting body parts, and pulling out hair is an expression of distress used to escape stress related to trauma, anxiety, depression, and bullying. Individuals who self-harm are at a greater risk of substance abuse and suicide.

Oral health and dental esthetics factor prominently in a person's perceived body image and self-esteem. Those with malocclusions and other dental imperfections can be targeted for bullying and can lead to low self-esteem and poor body image.

To investigate how dentofacial appearance contributes to the prevalence of self-harm among children, researchers conducted a cross-sectional study of 669 eighth graders from randomly selected schools. The group, which was composed of 339 girls and 360 boys who were 13 or 14, completed questionnaires about their behaviors.

Of the participants, 188 eighth graders (27%) reported engaging in self-harm. Of those who reported self-harming, 90 students (48%) engaged in this behavior due to their dental appearance. Additionally, 41 participants (20%) who reported self-harm did so because of bullying that targeted their dental imperfections, the authors wrote.

The three most common dental features contributing to self-harm and self-injury due to bullying were tooth color and shape, spacing between teeth or missing teeth, and prominent maxillary anterior teeth, according to the study.

The study had some limitations, including the cross-sectional nature of the study. This type of study did not allow longitudinal assessment of the participants in relation to risk factors, they wrote.

In the future, studies should explore clinical dental exams, more detailed information about the type and severity of self-harm being committed, as well as how orthodontic treatment may reduce this behavior, the authors wrote.

"The present study provides baseline data to better understand the relationship between self-harm and dentofacial features," Sonbol and colleagues concluded.


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