The impact of cyberbullying on schoolchildren's dental anxiety in Brazil: A cross-sectional multi-level study.

Objectives: This cross-sectional study assessed the correlation between individual and school-related social environment variables with dental anxiety in Brazilian schoolchildren aged 8-12 years.

Methods: A sample of children from 20 private and public schools (n = 1211) from Pelotas, Brazil, were selected. Socioeconomic data were collected from parents, and data regarding children characteristics were collected using a questionnaire. Dental anxiety (the outcome) was assessed by the following question: 'Are you afraid of going to the dentist?' Dental examinations were performed to assess caries experience (DMFT ≥ 1). The social school environment was assessed by a questionnaire administered to schools' coordinators and considered: type of school, verbal violence between students, presence of gangs at school and cyberbullying episodes. Multilevel Poisson regression was used to investigate the association between school social environment and dental anxiety.

Results: The prevalence of dental anxiety was 9.1% (95%CI 7.5-10.8). For the individual variables, anxiety was more prevalent in girls [1.85 (1.21-2.81)], in children with less-educated mothers [1.50 (1.00-2.27)] and in children who never attended to the dentist [2.48 (1.65-3.72)]. For contextual variables, episodes of cyberbullying in school increased the prevalence of dental anxiety by almost 80% [1.78 (1.14-2.78)].

Conclusions: The school social environment influences dental anxiety. The results suggest that it is important to establish strategies focused on promoting healthier environments and preventing cyberbullying in order to reduce the occurrence of dental anxiety.