Twitter, bullying, dentofacial features and orthodontic treatment.

Twitter, bullying, dentofacial features and orthodontic treatment.

This post is not about “the usual” orthodontic paper. I came across this interesting study on one aspect of social media, bullying and orthodontics and I felt that it was relevant to our patients.

We know that some of our patients are bullied and this has a real effect upon them. This is also important because bullying can be very common. For example,  this happens to between 5 to 55% of children. Importantly, psychological damage from bullying may persist into adulthood.

A team based in New Zealand did this study.

Accounts of bullying on Twitter in relation to dentofacial features and orthodontic treatment

C Austin et al

Journal of Oral Rehabilitation. DOI: 10.1111/joor.12487

The authors did a nice introduction and covered the background to their study very well. I thought that these were the main “highlights” of their introduction.

• Oral health bullying is particularly hurtful
• Traditionally bullying has occurred in face-to-face interactions that occur commonly at school. However, social media provides an additional avenue for this type of behaviour.

As a result, this study is is very relevant to our patients.

They aimed to qualitatively study the psychosocial aspect of dental-related bullying via Twitter.

What did they do?

They did this study in several stages;

• Firstly they searched the Twitter database from 2010 – 2014 using relevant search terms.
• They also prospectively monitored Twitter over a two-week time period
• Then one investigator assessed the Twitter posts concerned with bullying and carried out a thematic analysis to identify the current themes of the tweets. This was checked by another investigator.

What did they find?

They found 321 tweets and identified four main themes. These were;

1. Morphological features of teeth
2. Psychological/psychosocial impact
3. Coping mechanisms that were adopted
4. Role of the family

They looked at the data more closely and found that victims were bullied using adjectives such as “ugly” and “horrible”. When dento-facial features were the target, users included words such as “monster”, “vampire” or “gappy”.

As with most qualitative papers they included descriptions of the tweets. I have included some of the most relevant;

“@ (username) bullied me yesterday and called me fat and ugly and said I have messed up teeth! I got insecure and can’t use selfies any more”.

“Front teeth gaps aren’t fun for because the my whole childhood I was bullied about it to the point where I stopped smiling and talking”

Some were concerned with issues of victimisation;

“Yeah I know. Before I got braces I was teased because of my teeth. I still feel insecure even without braces today”.

There were several quotes that indicated coping;

“to the bully who’s ripping me off for having goofy teeth well I don’t care I’m happy and that’s all that matters keep smiling”.

In their discussion, they pointed out that the use of Twitter as a public surveillance tool has potential. Furthermore, this  sample may not represent the population. There were also unable to collect any information on the young people who tweeted.

Nevertheless, they found consistent and relevant themes.  This was one strength of the study. Overall, they concluded that using social media can provide new and valuable information about both the cause and social effects of bullying. Furthermore, specific coping mechanisms may help, for example, the sharing of bullying experiences via social media.

What did I think?

I am not an expert in qualitative research but I think that this was an interesting and novel study. I thought it was a great change from the usual orthodontic study.  There is clearly a major role for qualitative research in orthodontics.  I did have some concerns about whether the sample size was sufficient to get robust findings.  Also, I was not sure about the “representativeness” of the sample.

Nevertheless, this does illustrate  use of social media in both bullying and coping mechanisms that young people use. For example, young people, who are uncomfortable raising problems face-to-face, can share them on social media as a coping mechanism.

I thought about whether this study has clinical relevance. I feel that it does. This is because it illustrates how the pattern and method of bullying has changed. I also wonder if this results in “no escape” from the bully because exposure to social media is present for 24 hours a day, rather than simply during the school day.

I think that we need to consider these findings when we discuss treatment with our patients.