How Anterior Crossbite Severity Relates to Appearance-Based Bullying in School-Age Children: Evidence from the ROMA Index

<ns3:p>Introduction This study examined the prevalence of anterior crossbite in school-age children, investigated the frequency of appearance- related bullying, and determined whether crossbite severity correlates with bullying exposure among children aged 8–12 years. Materials and Methods A cross-sectional study involved 2,080 children from public schools in Damascus, using random cluster sampling. Anterior crossbite and other occlusal issues were assessed using the ROMA Index. Dental appearance-related bullying was evaluated using a modified Olweus Bully/Victim Questionnaire; children reporting bullying two or more times monthly were classified as victims. Bullying types—teasing, name-calling, social exclusion, and physical aggression—were documented along with occurrence settings. Severity scores were calculated by summing numerical codes for each bullying type. Relationships between occlusal characteristics and bullying were analyzed using Chi-square tests, Cramer’s V, and logistic regression, adjusting for age and gender. Results Of 2,080 children aged 8 to 12 years, 19.6% had anterior crossbite, and 34.4%reported dental appearance-related bullying. Multivariable binary logistic regression revealed that all forms of malocclusion, particularly those involving an anterior crossbite, were associated with a significantly higher likelihood of experiencing bullying (p &lt; 0.001), and that bullying intensity increased proportionally with crossbite severity. Teasing and mockery emerged as the most common forms of victimization, with rates and locations of such incidents—predominantly in playground settings—demonstrating significant variability across different occlusal characteristics, particularly when compared to the near-zero baseline observed in the normal occlusion group. Conclusion Anterior crossbite severity serves as a meaningful correlate for appearance-based bullying in children, extending beyond simple dental concerns. Incorporating crossbite severity screening into school-based prevention programs offers a practical strategy to address both oral health and psychosocial well-being in childhood.</ns3:p>