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

Objective: To explore how having a malocclusion and orthodontic treatment impacts on peer relationships in adolescents.

Design: A cross-sectional qualitative study.

Setting: Three schools in the South-East of the U.K.

Participants: Fourteen schoolchildren aged 14 – 16 years (mean age xxxx, SD = xxx).

Methods: In-depth one-to-one semi-structured interviews carried out online. All interviews were transcribed verbatim and analysed thematically by five researchers according to Braun & Clarke ‘s model of thematic analysis (2006).

Results: The central finding of this research was that adolescents are socially conscious of their dental appearance, and it impacts on social interactions. Four main themes were identified: 1) Teeth, appearance and judgement 2) Bullying and teasing related to dental appearance 3) Behavioural modifications due to dental appearance 4) Social experiences and expectations of orthodontic treatment. Participants reported being self-consciousness of their teeth prior to treatment which 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. This appeared to been exacerbated by the online teaching that had occurred during the COVID-19 pandemic with participants routinely using filters and lighting to enhance their own appearance. 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 following starting orthodontic treatment. Orthodontic treatment was seen as desirable and normal with an expectation it would improve self-confidence particularly in social settings. Friends and peers were a source of support and information during treatment.

Conclusion and Implications: The adolescents interviewed reported being self-conscious of their dental appearance, either experienced or witnessed teasing due to dentofacial features, were accepting orthodontic treatment which was considered a normal part of adolescent life and believed it would improve their self-confidence, finding friends a source of information and support during treatment.