{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T07:23:46Z","timestamp":1787297026706,"version":"build-2736575974"},"update-to":[{"DOI":"10.12688\/f1000research.179073.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000}},{"DOI":"10.12688\/f1000research.179073.2","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000}}],"reference-count":54,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns5: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\u201312\u00a0years. 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\u2014teasing, name-calling, social exclusion, and physical aggression\u2014were 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\u2019s V, and logistic regression, adjusting for age and gender. Results Of 2,080 children aged 8 to 12\u00a0years, 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. Although specific patterns of bullying exhibited considerable variability across different occlusal traits (p &lt; 0.001), the locations where these incidents occurred\u2014primarily in school playgrounds\u2014did not reveal significant differences among the various groups (p = 0.120). 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.<\/ns5:p>","DOI":"10.12688\/f1000research.179073.3","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T05:44:17Z","timestamp":1782452657000},"page":"590","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["How Anterior Crossbite Severity Relates to Appearance-Based Bullying in School-Age Children: Evidence from the ROMA Index"],"prefix":"10.12688","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5564-5955","authenticated-orcid":false,"given":"Farah","family":"M. Babakurd","sequence":"first","affiliation":[{"name":"Pediatric Dentistry Department Damascus Faculty of Dentistry, Damascus University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2426-2553","authenticated-orcid":false,"given":"Khaled","family":"Omar","sequence":"additional","affiliation":[{"name":"Faculty of Informatics Engineering Damascus Damascus University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9877-3217","authenticated-orcid":false,"given":"Mayssoon","family":"Dashash","sequence":"additional","affiliation":[{"name":"Pediatric Dentistry Department Damascus Faculty of Dentistry, Damascus University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"key":"ref1","first-page":"115-122","article-title":"Worldwide prevalence of malocclusion in the different stages of dentition: A systematic review and meta-analysis.","volume":"21","year":"2020","journal-title":"Eur. 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Your comments on the statistical and methodological aspects provide invaluable insights that will enhance the discussion of our study's findings. We are committed to addressing all the points raised in your report comprehensively. Currently, we are conducting additional statistical analyses and are in the process of preparing a thorough, point-by-point response to clarify our analytical framework. All necessary revisions will be incorporated into Version 4 of the manuscript as promptly as possible to ensure accuracy. Thank you for your time and expertise in reviewing our work.","URL":"https:\/\/f1000research.com\/articles\/15-590\/v3#referee-comment-16967","order":2,"name":"referee-comment-16967","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.204078.r494777, Supriya Nambiar, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, kart, 19 Aug 2026, version 3, indexed","URL":"https:\/\/f1000research.com\/articles\/15-590\/v3#referee-response-494777","order":3,"name":"referee-response-494777","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>farah babakrd<\/b>; \n<i>Posted: 19 Aug 2026<\/i>; We want to extend our sincere appreciation for the time you dedicated to providing feedback on our manuscript. We fully concur with all of your recommendations. We assure you that we will thoroughly incorporate each of your suggestions into the forthcoming Version 4 of our research. ............. Confounders: Adjustment is limited to age and gender. Socioeconomic status, other visible physical traits, self-esteem, and school-level factors are plausible confounders that could substantially affect the appearance-bullying link and are not addressed.  We express our gratitude to the reviewer for this valuable epidemiological insight. We concur that baseline self-esteem, socioeconomic status, and other unmeasured physical attributes may serve as potential confounders or mediators in the relationship between malocclusion and bullying. As recommended, we have explicitly acknowledged this limitation in our revised discussion and have expanded the Limitations section. We emphasize that, while age and gender were rigorously controlled, these socio-psychological factors represent significant areas for future longitudinal research. ........  Selection\/reporting bias: Self-reported bullying via questionnaire in children can be subject to recall and social desirability bias; this isn't acknowledged as a limitation .  We acknowledge the reviewer's observation that self-reported behavioral data from children may be influenced by recall bias and social desirability factors. Consequently, we have explicitly incorporated this consideration as a methodological limitation in the revised Limitations section. .................. &nbsp;Formatting errors present in the text: a stray quotation mark (&quot;t&quot;hose) and missing space (&quot;34.4%reported&quot;) \u2014 these read as transcription\/typesetting errors and should be corrected before submission.  We want to express our gratitude to the reviewer for their thorough proofreading. We will conduct a comprehensive review of the manuscript to ensure that all typographical, quotation, and spacing errors are meticulously addressed and corrected.  ......... &quot;ROMA Index&quot; should be spelled out at first use (Reduced Orthodontic Malocclusion Assessment or equivalent, depending on which index is meant) for readers unfamiliar with the acronym.  In accordance with the reviewer\u2019s request, the abbreviation has been fully articulated upon its initial mention in both the abstract and the main text as the &quot;Risk of Malocclusion Assessment (ROMA) Index.&quot; This adjustment is intended to enhance clarity for readers who may not possess specialized knowledge in the field. \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 Consider specifying whether the 34.4% bullying prevalence is among the full sample or specific to the crossbite subgroup \u2014 as written it's ambiguous.  We would like to clarify that the overall prevalence of bullying among the study sample is 34.4%, representing 715 out of 2,080 children. To eliminate any potential ambiguity, we will revise the phrasing in both the Abstract and Results sections. ....... Near-zero baseline&quot; in the normal occlusion group is a strong claim \u2014 worth stating the actual percentage for transparency.  We appreciate the feedback regarding the importance of maintaining objective scientific language. The term &quot;near-zero baseline&quot; has been removed, and we have clearly stated the exact absolute percentage (0.1%, representing 1 out of 703 children) for the normal occlusion group to enhance transparency and clarity","URL":"https:\/\/f1000research.com\/articles\/15-590\/v3#referee-comment-16966","order":4,"name":"referee-comment-16966","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":5,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}