The Hidden Impact of Cyberbullying on Teens' Orthodontic Decisions: A Mixed-Methods Study

Cyberbullying, particularly appearance-related harassment, is a growing psychosocial concern among adolescents. Dentofacial features, often targeted in online ridicule, may influence adolescents' health behaviors, including acceptance of orthodontic treatment. Objective: This study examined the association between cyberbullying victimization and orthodontic treatment acceptance among adolescents using a mixed-methods approach.

A convergent parallel mixed-methods design was employed among 200 adolescents aged 12-18 years from schools and orthodontic clinics. Cyberbullying exposure was assessed using the Cyberbullying Victimization Scale, and orthodontic treatment acceptance was measured using a modified 8-item scale. Quantitative analysis included Pearson's correlation and multivariate regression. In-depth interviews with 20 participants were thematically analyzed to explore underlying motivations.

A total of 38.5% of adolescents reported moderate to high cyberbullying exposure, with 23% experiencing appearance-related insults. Adolescents exposed to cyberbullying demonstrated significantly higher orthodontic treatment acceptance scores (31.2 ± 4.3) compared with non-victimized peers (27.6 ± 4.8; p < 0.001). Cyberbullying remained an independent predictor of treatment acceptance ( = 0.39, p < 0.001), explaining 31% of the variance. Qualitative themes revealed that adolescents perceived orthodontics as a strategy to counteract ridicule ("Seeking Change to Escape Bullying") and that online commentary strongly shaped self-perception ("Social Media Mirrors Self-Perception").

Appearance-based cyberbullying significantly influences adolescents' motivation to pursue orthodontic treatment. These findings highlight the need for orthodontists to address psychosocial factors in clinical decision-making and to integrate supportive counseling within treatment planning.

• Adolescents exposed to appearance-related cyberbullying are more likely to seek orthodontic care, emphasizing the role of psychosocial influences in treatment demand. • Orthodontists should consider screening for cyberbullying experiences during consultations to better understand patient motivations. • Integrating psychological support alongside orthodontic treatment may improve overall well-being and treatment satisfaction.