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Abstract

Adolescents between 12 and 13 years of age suffer social discrimination and low self-esteem because of their physical appearance. The objective of this study was to evaluate the presence of oral manifestations such as dental malposition, gummy smile, halitosis, and bone malformations of the maxillary and jaw, and determine their social impact on adolescents. A descriptive study was performed in secondary school adolescents between 12 and 13 years of age. First, an interview was carried out to identify the impact of oral manifestations as a cause of social discrimination and then clinical examination was performed. It was found that in adolescents, oral manifestations cause social discrimination. Dental malposition was the main cause (81 %), followed by gummy smile (29 %), maxillary and jaw bone malformations (16 %) and halitosis (11 %). Of those interviewed, 90 % expressed having received negative comments about their oral cavity and 81 % referred the need for dental care; 72 % felt discriminated by their classmates and 65 % did not like to speak in public (p
7
Int. J. Odontostomat.,
10(1):7-10, 2016.
Oral Manifestations in Adolescents and
Their Impact on Social Discrimination
Manifestaciones Orales en Adolescentes,
Su Impacto con la Discriminación Social
Ameyalli Jocelyn Martínez Delgado*; Gustavo Israel Martínez González*;
Sonia Martha López Villarreal* & Osvelia Esmeralda Rodríguez Luis*
MARTÍNEZ, D. A. J.; MARTÍNEZ, G. G. I.; LÓPEZ, V. S. M. & RODRÍGUEZ, L. O. E. Oral manifestations in adolescents
and their impact on social discrimination. Int. J. Odontostomat., 10(1):7-10, 2016.
ABSTRACT: Adolescents between 12 and 13 years of age suffer social discrimination and low self-esteem because
of their physical appearance. The objective of this study was to evaluate the presence of oral manifestations such as dental
malposition, gummy smile, halitosis, and bone malformations of the maxillary and jaw, and determine their social impact on
adolescents. A descriptive study was performed in secondary school adolescents between 12 and 13 years of age. First, an
interview was carried out to identify the impact of oral manifestations as a cause of social discrimination and then clinical
examination was performed. It was found that in adolescents, oral manifestations cause social discrimination. Dental
malposition was the main cause (81 %), followed by gummy smile (29 %), maxillary and jaw bone malformations (16 %) and
halitosis (11 %). Of those interviewed, 90 % expressed having received negative comments about their oral cavity and 81 %
referred the need for dental care; 72 % felt discriminated by their classmates and 65 % did not like to speak in public (p
<0.005). It was concluded that a relationship exists between oral manifestations and social discrimination in adolescents.
KEY WORDS: odontology, public health, malposition, adolescent, bullying, discrimination.
INTRODUCTION
Adolescents feel that their rights have been
violated because of their physical appearance, a matter
that was identified in 24.5 % of adolescents in the
National Survey on Discrimination in Mexico (Consejo
Nacional para Prevenir la Discriminación, 2011a).
Therefore, facial harmony is an important factor in the
health and quality of life of these individuals. Facial and
occlusal disharmony cause negative effects in
adolescents at a time in life when adolescents overreact
to problems of personal appearance (Gutiérrez Reina
et al., 2008). Puberty begins at this stage, and for many,
it is a period of turbulence that is accompanied by shame,
a feeling that is magnified by the fear that others will
discover that they are insecure. One of the main
concerns of adolescents is the need to find a new identity
and this includes several elements, such as physical
appearance and social acceptance (Blum et al., 2012).
Among the oral manifestations that can cause
social problems is halitosis, defined as an unpleasant
breath odor that is frequently related to bad oral hygiene.
This condition causes insecurity and shame and affects
personal relationships (Hechavarria Martínez et al.,
2014). Another is dental malposition, defined as any
alteration or occlusal disorder caused by esthetic, ethnic
and cultural factors (Aguilar & Taboada, 2013). The
gummy smile has also been described as a condition in
which more than 2 mm of gingival tissue is exposed when
a person smiles. Etiologically, it is caused by dental,
skeletal and soft tissue factors, producing a disagreeable
effect that causes individuals to cover their mouths or to
avoid smiling. This has a negative effect on the person,
altering their facial expression and sometimes triggering
behavioral problems (Chacón Martínez et al., 2011).
Lastly, bone malformations of the maxillary and jaw are
alterations that occur during organogenesis and can be
caused by environmental and genetic factors (Sadler,
2010). Prognathism is characterized by protrusion of the
middle third of the face in relation to the maxillary bone
(Palomeque Blacutt et al., 2014).
Hypoplasia of the su-
* Facultad de Odontología, Universidad Autónoma de Nuevo León, Nuevo León, México.
8
perior maxillary is characterized by a sagittal, vertical
and transverse deficiency of the maxillary bone
(Meneses & Botero, 2012).
Discrimination denies people equal liberties, rights,
and opportunities. It excludes individuals and hinders
them from reaching their full potential, placing them in a
situation of high vulnerability. This systematic, unjust and
undeserved disadvantage causes adolescents who suffer
oral problems to be more and more susceptible to having
their rights violated in the future (Consejo Nacional para
Prevenir la Discriminación, 2011b). On the other hand,
bullying is an aggressive, deliberate and repetitive
harassment of one student by another due to race,
religion, social position, physical structure or age (United
Nations Organization, 2006).
Social problems in adolescents of the state of
Nuevo Leon have increased. This is due to the parent´s
lack of information of the manifestations of dental
diseases such as halitosis, gummy smile, dental
malposition, and bone malformations, among others,
in adolescents. This, combined with the poor care
provided to adolescents, causes a high incidence,
which is an important cause of discrimination. The
objective of this study is to evaluate adolescents´
physical appearance and the presence of oral
manifestations and their social impact with the purpose
of collecting data on dental problems that trigger so-
cial discrimination to propose solutions and alternatives
to achieve equality and respect.
MATERIAL AND METHOD
This was a descriptive cross-sectional study
previously authorized by the Bioethics Committee
(SPSI-010613, no. 0064) that was performed in a
secondary school in Monterrey, Nuevo Leon with
adolescents that met inclusion criteria with an age
range of 12 to 13 years that attended the first year of
school and who presented oral manifestations.
Informed consent for participation was obtained from
the parents or tutors. Adolescents with systemic
disorders, under dental or psychological treatment, and
those who refused to participate in the study and had
incomplete surveys were excluded. The final sample
was composed of 62 adolescents.
A Likert-scale survey of 40 questions, distributed
into 6 sections, was constructed and validated, identifying
the clarity and pertinence indexes for validity of the
construct of interest. Questions started with general data
of the adolescent, followed by a section that identified
the presence of social discrimination with relation to
aspects of the face, teeth, gummy smile, and bad breath
(36 questions); finally, the adolescents´ perception of their
physical appearance was identified. Clinical examination
of the adolescents was performed using the clinical re-
cord to corroborate the existence of the previously
described oral manifestations. For examination, a
number five mouth mirror, a 6 mm Williams-periodontal
probe, and dental floss without wax were used.
RESULTS AND DISCUSSION
The group consisted of adolescents between the
ages of 12 and 13 years; of these, 56 % were girls and
44 % boys (Table I). Regarding the different oral
manifestations, 81 % had dental malposition (Table II),
mainly Class I Angle´s malocclusion. Based on this, 60
% perceived social discrimination and 74 % received
negative comments about their oral cavity due to dental
malposition. We deduced that dental malposition
negatively influenced the adolescent´s physical
appearance (p <0.05) (Table III). Previous research
supports these results mentioning that adolescents with
mild malocclusion have an inferiority complex; in addition,
the appearance of their teeth caused taunting that made
them withdraw from activities. It was also established
that a small orthognathic deformity can cause
psychological alterations and social discomfort in the
individual (Gutiérrez Reina et al.). Choi et al. (2014)
pointed out that malocclusion is a key factor associated
with poor quality of life caused by limited oral function,
pain and social disability. Taghavi Bayat et al. (2013)
mentioned that low self-esteem seemed to be related to
concerns about the presence of malocclusion in
adolescents and they looked for different strategies to
face this concern such as hiding their teeth and trying to
receive orthodontic treatment. Malocclusion problems
found in this study probably developed because of
inadequate maxillary growth, since 16 % of the
adolescents examined had bone malformations of the
maxillary and jaw; of these 8 % had mandibular
prognathism and 5 % hypoplasia of the upper maxillary
(Table II). The literature has reported that maxillary
malformations are associated with dentofacial
disproportions that affect the facial appearance of the
individual, and correct dental occlusion, mastication,
swallowing, phonation and facial symmetry. The main
concern in these patients is their effect on social
interrelations which cause psychological problems, since
MARTÍNEZ, D. A. J.; MARTÍNEZ, G. G. I.; LÓPEZ, V. S. M. & RODRÍGUEZ, L. O. E. Oral manifestations in adolescents and their impact on social discrimination.
Int. J. Odontostomat., 10(1):7-10, 2016.
9
the patient is dissatisfied with his/her appearance
(Palomeque Blacutt et al.).
On the other hand, halitosis predominated in 11 % of
our respondents (Table II). Suzuki et al. (2008) corroborates
that halitosis is a common problem in humans and that it is
associated with the status of the oral cavity and the poor
psychological condition of the person who suffers it.
With regard to gummy smile, this was found in 29 %
of the evaluated adolescents (Table II). Chacón Martínez
et al. describe that gummy smile produces an anti-esthetic
appearance that makes people cover their mouths or avoid
smiling to hide the problem. This negatively affects the indi-
vidual altering spontaneous facial expression and, on
occasion, complex behavior. They also reported that
when individuals are subjected to correction, their
appearance and self-esteem improves.
The validation process of the questionnaire
produced a Cronbach's alpha of 0.84. This implies
that the questionnaire used is a reliable instrument
since Soler Cárdenas & Soler Pons (2012) evidenced
that a value close to 1 demonstrates greater reliability
of the instrument.
Aguilar & Taboada mention that alterations
of form and physical appearance reduce quality of
life and can be a negative factor in the emotional
balance of the adolescent since it threatens harmony
and esthetics. In this study, 65 % of adolescents
did not want to speak in public, 90 % mentioned
negative comments regarding their oral appearance,
81 % expressed the need for dental care due to
their oral condition, and 72 % felt they were rejected
by their peers. At the same time, a relationship
between the identified oral manifestations and the
need to change their oral condition was found (p
=0.00000001) (Table IV).
CONCLUSION
In this study, dental malposition was identified
as the main oral alteration in adolescents, with this
causing a negative impact on their physical
appearance and triggering social discrimination. It is
suggested to design awareness campaigns for the
previously mentioned oral manifestations for the
family to obtain opportune and preventive care for
adolescents to reduce the rate of social discrimination.
ACKNOWLEDGEMENTS. We thank the Ministry
of Education for their support granted through
PRODEP 2014.
Oral manifestations
Physical appearance Present Not present
F* % F* %
Teeth 35 56 6 10
Table I. Age and sex of adolescents (n= 62).
Table II. Presence of oral manifestations based on sex (n= 62).
X2= 20.512, p<0.05, F*= Frequency.
Oral Manifestations
Oral breath Teeth Smile Form of the face TotalNeed for change
F* % F* % F* % F* % F* %
Oral breath 3 5 2 3 0 0 3 5 8 13
Teeth 0 0 32 52 1 2 2 3 35 57
Smile 0046350 0711
Form of the face 2 3 3 5 0 0 7 11 12 19
Total 5 8 41 66 4 7 12 19 62 100
Table III. Impact of dental malposition on the physical
appearance of adolescents (n= 62).
Table IV. Presence of oral manifestations in adolescents that they do not like and its relationship
with changing their oral condition (n= 62).
X2= 53.54, p= (0.00000001), F*= Frequency.
Sex
Age Female Male Total
F* % F* % F* %
12 11 18 13 21 24 39
13 24 39 14 23 38 61
Total 35 562744 62100
Sex
Oral manifestations Male Female Total
F* % F* % F* %
Dental malposition 24 39 26 42 50 81
Gummy smile 8 13 10 16 18 29
Halitosis 5 823711
Malformation 4 6 6 10 10 16
Hypoplasia of the upper
maxillary 1 2 2 3 3 5
Mandibular prognathism 3 5 4 6 7 11
MARTÍNEZ, D. A. J.; MARTÍNEZ, G. G. I.; LÓPEZ, V. S. M. & RODRÍGUEZ, L. O. E. Oral manifestations in adolescents and their impact on social discrimination.
Int. J. Odontostomat., 10(1):7-10, 2016.
F*= Frequency.
10
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Aguilar, M. N. A. & Taboada, A. O. Frequency of malocclusions in
association with body posture problems in a school-age
population from the State of Mexico. Bol. Med. Hosp. Infant.
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profesional. Monterrey, Universidad Autónoma de Nuevo León,
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psicosociales. Arch. Méd. Camagüey, 12(5):1-10, 2008.
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Correspondence to:
Dra. Osvelia E. Rodríguez Luis
Jefa del Departamento de Escolar
Profesora Investigadora
Facultad de Odontología
Universidad Autónoma de Nuevo León
Calle Dr. Eduardo Aguirre Pequeño s/n
Colonia Mitras Centro
Nuevo León, C.P. 64460.
MÉXICO
Email: osveliardzl@yahoo.com.mx
MARTÍNEZ, D. A. J.; MARTÍNEZ, G. G. I.; LÓPEZ, V. S. M. & RODRÍGUEZ, L. O. E. Manifestaciones orales en adolescentes,
su impacto con la discriminación social. Int. J. Odontostomat., 10(1):7-10, 2016.
RESUMEN: Actualmente los adolescentes entre 12 y 13 años sufren discriminación social y por ende baja autoestima,
debido al bullying provocado por el aspecto físico. Evaluar la presencia de manifestaciones orales como, malposición dental,
sonrisa gingival, halitosis, malformaciones óseas del maxilar y mandíbula y su impacto en la discriminación social de los adoles-
centes. Se realizó un estudio descriptivo en adolescentes entre 12 y 13 años que cursaban nivel básico, primeramente se aplicó
una entrevista para identificar el impacto de las manifestaciones orales como desencadenantes de discriminación social segui-
do de un examen clínico. Se identificó que existe discriminación social en los adolescentes debido a las manifestaciones orales.
La malposición dental fue la principal desencadenante (80,65 %), seguido de sonrisa gingival (29,03 %), malformaciones óseas
del maxilar y la mandíbula (16,13 %) y halitosis (11,29 %). El 90,33 % de los encuestados expresó haber recibido comentarios
negativos acerca de su cavidad oral y el 80,65 % refirió la necesidad de atención odontológica. Se han sentido discriminados
por sus compañeros 72,20 % y no les gusta hablar en público 64,52 % (p <0,005). Es posible concluir que existe relación entre
las manifestaciones orales que presentaron los adolescentes y que impactan en su discriminación social, ya que expresaron
sentir discriminación por sus compañeros, por lo que les gustaría cambiar su aspecto físico.
PALABRAS CLAVE: odontología, salud pública, malposición, adolescente, bullying, discriminación.
Received: 06-08-2015
Accepted: 03-02-2016
MARTÍNEZ, D. A. J.; MARTÍNEZ, G. G. I.; LÓPEZ, V. S. M. & RODRÍGUEZ, L. O. E. Oral manifestations in adolescents and their impact on social discrimination.
Int. J. Odontostomat., 10(1):7-10, 2016.
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