Does Tooth Loss Lead to School Bullying? Evidence from the Longitudinal Study of Australian Children

The impact of tooth loss during adolescence, often a consequence of dental caries or traumatic injuries, extends beyond physical discomfort to significantly affect social interactions and self-esteem. Despite the established associations between poor oral health and various forms of social disadvantage, the potential for tooth loss to be associated with bullying victimization remains inadequately investigated.

This study aims to investigate the causal association between tooth loss and bullying victimization among adolescents, using longitudinal data from Australian children.

We analyzed data from 4,476 children from wave 3 (aged 8 to 9 y) to wave 6 (aged 14 to 15 y) of the Longitudinal Study of Australian Children. Tooth loss was assessed through parent-reported dental extractions due to decay or trauma. Bullying victimization was measured through parent-reported incidents of school bullying. A fixed effects regression model was employed to control for time-invariant confounding and estimate the impact of tooth loss on bullying. Sensitivity analyses, including age restriction, lagged effects, and a negative control, were conducted to validate the findings.

The fixed effects model revealed that adolescents experiencing tooth loss had 42% higher odds of being bullied at school (odds ratio, 1.42; 95% CI, 1.15 to 1.77), after adjusting for household income, disability, and maternal education. Sensitivity analyses supported the robustness of these findings, demonstrating a consistent effect of tooth loss on bullying victimization.

By leveraging longitudinal data, this study quantifies the within-individual association between tooth loss and bullying victimization during adolescence, underscoring the importance of preventing dental caries and trauma impacts. These findings suggest that tooth loss may be a modifiable determinant of bullying risk during adolescence, with potential implications for long-term mental health outcomes.Knowledge Transfer Statement:This study demonstrates a 42% higher risk of school bullying among adolescents who experience tooth loss due to decay or trauma. These findings emphasize the critical need for clinicians to prioritize preventive dental care and early intervention to reduce the social impacts of poor oral health. Policy makers should incorporate oral health interventions alongside antibullying initiatives in schools to mitigate the cascading effects of bullying on mental health and social well-being in adolescents.