Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 14 nº 4 - Oct/Dec - 2017

Original Article Imprimir 

Páginas 85 a 96


Bullying at school and factors associated with oral health

Bullying en la escuela y factores asociados a la salud oral

Bullying na escola e fatores associados a saúde oral

Autores: Marina Flamia Haas1; Alessandro Bellato2; Gehysa Guimarães Alves3; Guilherme Arossi4

1. Graduated in Dentistry from the Lutheran University of Brazil (ULBRA). Torres, RS, Brazil
2. Bachelor's Degree in Dentistry from the Pontifical Catholic University of Rio Grande do Sul (PUCRS). Porto Alegre, RS, Brazil. Professor of Dentistry at the Lutheran University of Brazil (ULBRA). Torres, RS, Brazil
3. Doctor in Education from the Pontifical Catholic University of Rio Grande do Sul (PUCRS). Porto Alegre, RS, Brazil. Coordinator of the Postgraduate Program in Health Promotion of the Lutheran University of Brazil (ULBRA). Canoas, RS, Brazil
4. PhD in Genetics and Toxicology Applied by the Lutheran University of Brazil (ULBRA). Canoas, RS, Brazil. Professor of the Postgraduate Program in Health Promotion at the Lutheran University of Brazil (ULBRA). Canoas, RS, Brazil

Correspondência:
Guilherme Anziliero Arossi
Universidade Luterana do Brasil
Avenida Farroupilha, 8001, São José
Canoas, RS, Brasil. CEP: 92425-900
guilhermeclinica@gmail.com

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Keywords: Bullying, oral health, school health, self concept.
Palabra Clave: Bullying, salud bucal, salud escolar, autoimagen.
Descritores: Bullying, saúde bucal, saúde escolar, autoimagem.

Abstract:
OBJECTIVE: This study aims to identify bullying in schools and associated factors related to oral health.
METHODS: The population studied consisted of 183 elementary school students selected within the 6th to 9th grade of public and private schools that answered to the self-administered questionnaire.
RESULTS: Of the 183 students surveyed, 41.4% said they had experienced bullying, 24.6% revealed they already practiced and 38.1% were victims, and the majority of the offenders were male. There was a significant correlation between teeth dissatisfaction and frequency of being bullied; as well as being a victim and have already practiced bullying, which shows that bullying becomes a vicious cycle.
CONCLUSION: It can be concluded that there is a significant relationship between lower teeth self-satisfaction and being a victim of bullying in school.

Resumen:
OBJETIVO: Este trabajo tiene por objetivo identificar al bullying en las escuelas y factores asociados relacionados a la salud oral.
MÉTODOS: La población de este estudio fue compuesta por 183 alumnos seleccionados en grupos del 6º al 9º año do enseñanza fundamental de escuelas públicas y privadas de municipios del sur del país, que respondieron al cuestionario auto-aplicable.
RESULTADOS: De los 183 alumnos investigados, 41,4% respondieron que vivieron bullying, 24,6% revelaron que ya lo practicaron y 38,1% que fueron víctimas, siendo la mayoría de los agresores del sexo masculino. Fue identificada correlación significativa entre la insatisfacción con los dientes y la frecuencia del bullying sufrido; así como entre ya haber sido víctima y ya haber practicado bullying, lo que revela que esta práctica se torna un ciclo vicioso.
CONCLUSIÓN: Se puede concluir que hay una relación significativa entre una menor autosatisfacción con los dientes y ser víctima de bullying en la escuela.

Resumo:
OBJETIVO: Este trabalho objetiva identificar o bullying nas escolas e fatores associados relacionados à saúde oral.
MÉTODOS: A população deste estudo foi composta por 183 alunos selecionados em turmas do 6º ao 9º ano do ensino fundamental de escolas públicas e privadas de municípios do sul do país, que responderam ao questionário autoaplicável.
RESULTADOS: Dos 183 alunos investigados, 41,4% responderam que vivenciaram bullying, 24,6% revelaram que já o praticaram e 38,1% que foram vítimas, sendo a maioria dos agressores do sexo masculino. Foi identificada correlação significativa entre a insatisfação com os dentes e a frequência do bullying sofrido; assim como entre já ter sido vítima e já ter praticado bullying, o que revela que esta prática se torna um ciclo vicioso.
CONCLUSÃO: Pode-se concluir que há uma relação significativa entre uma menor autossatisfação com os dentes e ser vítima de bullying na escola.

INTRODUCTION

Violent situations in schools are increasingly common events. Schoolchildren have been ridiculed by their equals, being mistreated in an environment that should be protective. Aggressiveness in school is a universal problem and the term bullyingis adopted to characterize this type of abuse1,2. It comprises all conduct of aggression and victimization occurring between intentional and repeated pairs without obvious motivation, where there is the abuse of someone stronger towards a weaker one, being executed within an unequal relationship of power causing pain and anguish2, 3. Presents, usually in the form of physical aggression, verbal, or includes other behaviors such as grimacing, keep the young out of the group, kidding disparagingly or threaten him2.3.

Although the studies are recent, the phenomenon is old and worrying, mainly due to its harmful effects. Incidents such as the massacre in Erfurt in Germany in which 18 people died and the suicides of adolescents in Scotland due to bullying have increased public awareness of these issues1. Economic, social and cultural factors, innate aspects of temperament and influences of family, friends, school and the community constitute risks for the manifestation of bullying, which can have an impact on the development of children and young people1.

There are three elements that characterize bullying: repetition, prejudice and inequality of power3. The aggressor feels satisfaction in hurting his target, showing power over the other, believing that the target is physically, mentally and / or emotionally weak3,4. Victims tend to be anxious and insecure, with low self-esteem, depressive tendencies and therefore an easy target for aggressors. The characteristics of the victims usually persist even if the aggressions have already stopped.This can lead to their failure in school, the internalization of behavior and psychosomatic symptoms4. Usually, the perpetrator perpetuates this behavior and eventually becomes a victim again in other environments. The aggressor is one who perpetuates the aggressions and acts in a way to intimidate. It is characterized by being popular, having impulsive characteristics and understands its own aggressiveness as quality. It is generally stronger than its target and feels pleasure in dominating, controlling, causing damage and suffering to others 2, 3. Witnesses are not directly involved in bullying, but they are spectators and conniving with this type of attitude. They can not help the victim by not knowing what to do and fearing to become the next victim. The presence of the public, which responds to the aggressors' appeals and venerates their exploits, often encourages attacks5.

The school is the place where young people are concentrated and, therefore, a propitious territory for bullying. However, this practice is not restricted to the school, and may emerge in other spaces, such as the route to school, holiday camps, sports clubs or in cyberspace2,3. As a result, bullying victims often feel frightened, lonely and sad, turning the school into a place of fear and violence. Negative effects affect not only the victim, but also the family and school, as ill-treated young people are more likely to develop antisocial behavior, as well as low self-esteem and less empathy with others4. Considering that most of the acts of bullying occur outside the eyes of adults and that most of the victims do not respond or speak about the aggression suffered, one can understand why teachers and parents have little perception of bullying , underestimate their prevalence and act insufficient form for the reduction and interruption of such situations2.

Physical appearance, which includes facial and dental features, appears to be one of the main reasons why a young person is bullied, with a particularly harmful dental appearance6. In this phase of life, in which a series of transformations are occurring, the school must develop mechanisms of resilience to the environment in which it is inserted, resulting in the establishment of its behavioral profile. Lifestyle will influence your oral health through habits of dental interest (brushing, flossing, diet, going to the dentist, tooth and gum pain), and self-perception on the teeth.

The smile reveals important aspects of the quality of life of a young person and defines how this one interacts in their daily environment7. The conditions of anatomy, color and harmony of the teeth are extremely important8 as people are judged by others based on appearance, including facial dento appearance and aesthetics. When a dental change draws attention to its aesthetic negative aspect, it starts to cover the social aspects and self-esteem of the young, causing problems for the whole life. Therefore, aesthetic dental treatment not only has consequences in the short term, but also for human development itself, reducing the impact of bullying and improving the quality of life9. Thus, the objective of this work was to identify the prevalence of school violence (bullying) and their associated oral health factors.


METHODOLOGY

This is a cross-sectional analytical study. The study population consisted of all students from the sixth to ninth grade classes of nine public and private schools; covering the municipalities of Torres-RS, Canoas-RS, Candelária-RS, Cachoeira do Sul-RS and Goiatuba-GO, with a total of 205 students.

The participating schools signed an authorization to conduct the research (TACD) after receiving the information about the study. After obtaining these opinions, the project was evaluated and approved by the Human Research Ethics Committee of ULBRA (CEP / ULBRA), under the opinion 891.311. The researchers commit to maintaining the confidentiality of the data collected through the Data Use Commitment Term (TCUD).

Following the approval of the CEP / ULBRA, the participants of the study were informed about their objectives and signed the Informed Consent Form (TCLE) and written authorization of those responsible for participating in the research. We included in the study all the students who were present in the classroom on the day of data collection and who had signed an agreement with those responsible, totaling 183 participants.

To collect the data, self-administered questionnaires were used to characterize behavior variables, self - perception of oral health, oral hygiene habits, age and grade. In addition, the Kidscape questionnaire has been applied with objective questions related to bullying (www.kidscape.org.uk), and how much it interferes in their lives. The outcome variable of this study was 'bullying'.

Data collection instruments were scanned using Epidata 3.1 software. Double typing was performed to identify inconsistencies. After this quality control, tables were generated and the quantitative data were analyzed through the statistical analysis software SPSS 17.0. The analysis was performed by descriptive statistics and possible correlations between the variables and the outcome (bullying) were performed using the Spearman Correlation test, considering the significant correlation when p ≤ 0.05.


RESULTS

Of the 183 students investigated, the variable ' in the last month, in which situation you felt discriminated, intimidated or mistreated' was answered by the entire population of the study and the variable ' feel happy' was the least answered, totaling 84.7% of adequately fulfilled answers. Regarding the schooling of the interviewees, 28% were in the sixth year, 19.6% in the seventh, 40.5% in the eighth year and 11.9% in the ninth year, where the mean age was 13 years, ranging from 11 and 17. Regarding oral health, 49.5% performed on average three toothbrushes a day, with 5.5% brushing their teeth only once a day and 3.3% brushing their teeth at times. 40.1% used dental floss at times, while 27.5% never used floss (Table 1).




Most of the interviewees (76%) consulted the dentist in the last year, however, 9.5% never went to the dentist. As to why they sought this professional, 34.3% for revision or control, 17.1% for toothache, 16.6% for tooth decay, 5% for redoing treatments and 3.3% when their gums bleed. Regarding the students' satisfaction with their teeth, 38.3% were satisfied, 24.4% were very satisfied, 15.6% neither satisfied nor dissatisfied, 13.3% said they did not know, 7.2% were dissatisfied and 1.1% very dissatisfied with their teeth.

Regarding the presence of bullying in school, 61.9% reported that they were never victims and 38.1% had already been victims. Those who have already experienced bulliyng reported believing that this event occurred because they were excluded or discriminated against because of their face or body, race or color, religion or sexual orientation. Of the 183 students, 24.6% answered that they had bullying against a colleague, and the majority of the aggressors were male, three times more than female aggressors.

The variables of this study were characterized by being ordinal, with a non-normal distribution of the data around the mean, which justifies the chosen statistical test. We investigated the correlation between the outcome "having been bullied" and the variables of oral health, behavior and sociodemographic variables. This was done using the Spearman Correlation method, in a bivariate analysis, considering a significant relation when p ≤ 0.05.

The variables that presented a significant correlation with the outcome were: personal satisfaction with teeth (p= 0,035; Rö= -,160), unable to overcome difficulties (p = 0.014, Rö = -0.1888), feeling under pressure (p = 0.004, R0 = -0.220); lose sleep (p = 0.044; OR = -0.153), feeling unhappy (p = 0.003; OR = -0.225) and have already been author of bullying (p = 0.002; OR = 0.232), age at which it occurs bullying (p =, 000; Rö = -, 589) and sex that intimidated (p =, 000; Rö = -, 522). The other variables studied did not show any correlation with the outcome (Table 2).




The results presented in Tables 1 and 2 should be interpreted considering that no questionnaire was answered in full and there was a partial loss of responses, which determined different total values in each question.


DISCUSSION

The present research had similar results to other studies that analyzed bullying, such as Maia and Leme (2014)10, in which 77 primary school students who were 12 to 18 years old participated; that of Alves (2011)11, with 95 participants from the 8th year between 13 and 16 years; and that of Fulgêncio (2013)12, with 736 young people aged 13 to 15 years.

The Kidscape instrument has been used in research on Bullying13 in the same way as in this study, being able to characterize this type of violence, and still has content agreement with the literature, where questionnaires with similar questions to this research were used, with questions of multiple choice that made it possible to identify young people as victims, aggressors, victims / aggressors and witnesses12, 14.

Regarding the position of bullying victim , the outcome of this study, 38.1% of the respondents reported that they had already suffered this violence. In the study by Frick (2011)5, 30.77% of the students were victims, and in Almeida, Silva and Campos (2008)15, 22% of the students were victimized, which was very close to this study. In the work done by Tognetta and Rosario (2013)16, 15.9% of the students were victims.

The results of this study showed that 36.6% of the participants in the research had already witnessed bullying , lower than the investigations of Bandeira and Hutz (2012)7, which reported a total of 83.9%; as well as Tognetta and Rosario (2013)16, in which number was 62.8%. Most schoolchildren reported that the school environment is the place where bullying has occurred, which coincides with the work of Frick (2011)5, with the courtyard and classroom being the most frequently referred to respectively.

As for the position of aggressor, 24.6% have already done bullying against a colleague, a percentage lower than that found by Bandeira and Hutz (2012)3, which was 54.7%. A study carried out in São Paulo-SP showed that 15% of the students were already aggressors15; while a study in Rio de Janeiro-RJ, the percentage of aggressors was 12.7%. Similar data were published by Alves (2011)11, with 10.2% of students having bullying. In the work of Tognetta and Rosario (2013)16, this number was 19.5%, which more closely approached our results. Regarding the sex of the aggressors, 75% reported that the aggressor was male and 25% female. This result coincided with the work of Bandeira and Hutz (2012)3. There was a relationship between bullying and personal satisfaction with the teeth, so that the more times the student suffered bullying, the less satisfaction was with his teeth. This result corroborates the findings of the study that pointed out that young people with permanent tooth fractures had a greater negative impact on their daily lives than young people without any traumatic injury8. Young people with untreated traumatic teeth had difficulty chewing, avoided smiling and had their social interactions affected compared to young people without dental trauma. This demonstrates a significant association between dental trauma and emotional well-being9. In the study by Soares (2011)9, we evaluated the perception of aesthetic components of oral health in children in different stages of psychological development, where it was concluded that young people were aware of their dental aesthetics and the appearance of other youngsters.

The relationship between the student who was bullied and who had already been an aggressor proved to be significant, and it is possible to note that the more the student is bullied, the more he practices it, and it becomes a vicious cycle. The quality of life of young people can be severely affected, making them increasingly dissatisfied and frustrated with themselves and relying less on their potential, thus having their emotional health negatively affected. This can be observed in the association between the outcome and the inability of the young person to overcome the difficulties (Table 2). The quality of life of the students is related to the age and the capacity to face problems. This protective effect may contribute to the development of other personal skills that help in facing adversities17.

Young people presented a negative social perception with the dental aesthetic alteration of another young person, as well as an association in which youngsters with esthetic alterations felt more sad than young people without dental alterations9. Another study with students from Goiânia showed that 98.3% of the individuals had at least one dental malformation that impacted the quality of life18. The evaluation of biopsychosocial impact and self-perception of malocclusion were studied in schoolchildren aged 14 to 18 years. Negative repercussions were found in the lives of young people with malocclusions that affect dental aesthetics9.

The need for orthodontic treatment has been associated with social and emotional domains in 11 and 12 year old schoolchildren19. In this age group, the social coexistence is intense, the appearance is important and all this is intimately connected with the emotions. This result points to the importance of a healthy smile that satisfies the youngster so that he becomes capable of being resistant to the bullying to which he is subjected. At the same time, the youngster dissatisfied with his own smile may have as a cause of this dissatisfaction issues greater than oral problems, contraindicating interventional dental treatments. No epidemiological research has been carried out on the social impact caused by changes in teeth and the possible sociopsychological and emotional consequences on their behavior9.

Bullying prevention should be carried out in all social settings: at school, at home, at work, in public service institutions, in sport and leisure institutions4. Bullying prevention actions should include knowledge by the entire school community about this event, discussing and addressing the issue, becoming aware of its consequences, both in the life of the victim and the aggressor. In addition, it is a subject that deserves the attention of researchers, teachers and other professionals to plan actions that can positively impact the life of the school community3.

Most young offenders report that their parents and teachers did not warn them about their behavior5. Results such as these underscore the importance of regular communication among youth, parents, teachers, and health professionals about bullying incidents so that they learn to deal with everyday frustrations and difficulties and not use them as an excuse for violence.

In relation to the role of the school, it is important that it becomes aware that it is necessary to be attentive to the signs of violence, seeking to neutralize the aggressors and helping the victims to face these aggressions more proactively. There is a need to develop actions to promote a culture of peace within the school, increasing supervision at break times, not allowing situations of scorn, nicknames or rejection in the classroom, and promoting debate about the various forms of violence and the construction of more ethical and supportive human relations.

The characteristics of the study design do not make it possible to establish if dissatisfaction with the teeth has been the cause of the bullying or if it has been the cause of the dissatisfaction with the teeth. Our result shows only that there is a significant relationship between these two variables. Studies that evaluate the relationship between oral health conditions and bullying in larger samples and containing other age groups are also useful and recommendable. In addition to this limitation, there is a scarcity of literature on the subject, with very few studies linking oral health variables and bullying, emphasizing the importance of the present study.


CONCLUSION

It was possible to identify the prevalence of 38.1% of bullying in the schools involved in the research, having as factors associated with violence personal satisfaction with teeth, not being able to overcome difficulties, feeling under pressure, losing sleep, feeling unfortunate, the age at which bullying occurs , the sex that intimidated and has already been the author of bullying .


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