Association between bullying at school and tooth loss among 15–19-year-olds from southern Brazil

KLEIN, Giovanna Leal; COMIM, Letícia Donato; DALLA NORA, Ângela; RACKI, Débora Nunes de Oliveira; ZENKNER, Julio Eduardo do Amaral; ALVES, Luana Severo

doi:10.1590/1807-3107bor-2024.vol38.0083

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Original research/Behavioral Sciences • Braz. oral. res. 38 • 2024 • https://doi.org/10.1590/1807-3107bor-2024.vol38.0083 copy

Association between bullying at school and tooth loss among 15–19-year-olds from southern Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study aimed to investigate the association between bullying at school and tooth loss in southern Brazilian adolescents. This population-based cross-sectional study included a representative sample of 15–19-year-old students attending high schools in Santa Maria, southern Brazil. Data on sociodemographic and behavioral variables were collected through questionnaires. Contextual data on bullying at school was provided by educational institutions (bullying episodes in the previous year: ‘no,’ ‘sometimes,’ or ‘often’). Tooth loss was clinically assessed by the M component of the DMFT index, modeled as a discrete variable. Multilevel Poisson regression was used, and rate ratios (RR) and 95% confidence intervals (CI) were estimated. The prevalence of tooth loss was 9.2% (95%CI = 7.5–10.8). Adolescents who attended the schools where bullying events often occurred had 0.39 (95%CI = 0.33–0.45) missing teeth, on average, in contrast to an average of 0.14 (95%CI = 0.08–0.19) among those whose schools did not experience bullying in the previous year. After adjusting for important cofactors, the contextual variable of bullying at school remained significantly associated with the study outcome. Adolescents who attended schools where bullying frequently occurred were 2.49-fold more likely to have an additional missing tooth than those whose school did not experience bullying in the previous year (RR = 2.49, 95%CI = 1.37–4.51, p = 0.003). In conclusion, the frequent bullying episodes at school were associated with more permanent teeth lost due to caries in this population. Hence, improving the school environment may improve the oral health of adolescents.

Tooth Loss; Bullying; Adolescent; Cross-Sectional Studies; Multilevel Analysis

Variable	n (%)	Mean (95% CI)
Contextual variable
Bullying at school*
No	612 (51.8)	0.14 (0.08–0.19)^a
Sometimes	512 (43.3)	0.13 (0.09–0.17)^a
Often	58 (4.9)	0.39 (0.33–0.45)^b
Individual variable
Demographic and socioeconomic variable
Sex
Boys	513 (42.9)	0.14 (0.10–0.17)^a
Girls	684 (57.1)	0.15 (0.10–0.21)^a
Age (years)
< 17	655 (54.7)	0.08 (0.43–0.11)^a
≥ 17	542 (45.3)	0.23 (0.16–0.30)^b
Skin color*
White	779 (67.0)	0.11 (0.07–0.15)^a
Non-white	384 (33.0)	0.22 (0.17–0.27)^b
Mother’s education*
University	192 (16.7)	0.03 (0.01–0.06)^a
High school	380 (33.1)	0.13 (0.08–0.18)^b
≤ Primary school	577 (50.2)	0.19 (0.13–0.25)^b
Socioeconomic status*
High	335 (28.9)	0.05 (0.02–0.09)^a
Mid-high	302 (26.1)	0.14 (0.06–0.23)^ab
Mid-low	320 (27.6)	0.20 (0.14–0.26)^b
Low	201 (17.4)	0.25 (0.12–0.39)^b
Behavioral variable
Sugar-sweetened drink consumption*
≤ twice a day	664 (55.6)	0.11 (0.07–0.14)^a
≥ 3 times a day	531 (44.4)	0.19 (0.14–0.25)^b
Tooth brushing frequency*
≥ 3 times a day	566 (47.4)	0.11 (0.08–0.15)^a
≤ Twice a day	628 (52.6)	0.17 (0.12–0.23)^b
Dental care service*
Private	642 (57.8)	0.13 (0.08–0.18)^a
Public	289 (26.0)	0.24 (0.16–0.32)^b
Other	180 (16.2)	0.09 (0.02–0.15)^a
Oral health variable
Gingivitis
Absent (< 10% bleeding sites)	1,031 (86.1)	0.14 (0.10–0.18)^a
Present (≥10% bleeding sites)	166 (13.9)	0.16 (0.09–0.24)^a
Untreated caries (teeth)
0	908 (75.9)	0.08 (0.05–0.11)^a
1–2	247 (20.6)	0.28 (0.19–0.37)^b
≥ 3	42 (3.5)	0.79 (0.50–1.07)^c
Total	1,197 (100)	0.15 (0.11–0.18)

Variable	Unadjusted		Adjusted
Variable	RR (95%CI)	p-value	RR (95%CI)	p-value
Contextual variable
Bullying at school
No	1.00		1.00
Sometimes	0.99 (0.47–.2.07)	0.98	0.81 (0.54–1.21)	0.31
Often	3.49 (0.98–12.35)	0.05	2.49 (1.37–4.51)	0.003
Individual variable
Demographic and socioeconomic variable
Sex
Boys	1.00		1.00
Girls	1.14 (0.85–1.53)	0.39	1.03 (0.74–1.43)	0.85
Age (years)
< 17	1.00		1.00
≥ 17	2.55 (1.85–3.51)	< 0.001	2.15 (1.51–3.05)	<0.001
Skin color
White	1.00		1.00
Non–white	1.65 (1.22–2.22)	0.001	1.58 (1.14–2.19)	0.006
Mother’s education
University	1.00		1.00
High school	3.26 (1.46–7.30)	0.004	4.72 (1.44–15.4)	0.01
≤ Primary school	3.99 (1.80–8.84)	0.001	3.59 (1.08–11.9)	0.04
Socioeconomic status
High	1.00		1.00
Mid–high	2.59 (1.50–4.48)	0.001	2.28 (1.25–4.13)	0.007
Mid–low	2.99 (1.75–5.11)	< 0.001	2.66 (1.46–4.84)	0.001
Low	3.52 (2.00–6.18)	< 0.001	2.96 (1.55–5.65)	0.001
Behavioral variable
Sugar–sweetened drink consumption
≤ twice a day	1.00		1.00
≥ 3 times a day	1.67 (1.24–2.25)	0.001	1.55 (1.12–2.15)	0.009
Tooth brushing frequency
≥ 3 times a day	1.00		1.00
≤ Twice a day	1.35 (1.00–1.83)	0.05	1.63 (1.16–2.28)	0.005
Dental care
Private	1.00		1.00
Public	1.46 (1.06–2.02)	0.02	1.13 (0.79–1.61)	0.49
Other	0.58 (0.34–0.98)	0.04	0.64 (0.37–1.09)	0.10
Oral health variable
Gingivitis
Absent (< 10% bleeding sites)	1.00		1.00
Present (≥10% bleeding sites)	1.12 (0.75–1.68)	0.58	0.94 (0.60–1.48)	0.80
Untreated Caries
0	1.00		1.00
1–2 teeth	3.35 (2.42–4.62)	< 0.001	2.51 (1.76–3.56)	< 0.001
≥ 3 teeth	7.64 (4.99–11.7)	< 0.001	4.71 (2.87–7.73)	< 0.001

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[1] Corresponding Author
:Luana Severo Alves E-mail: luanaseal@gmail.com