The association between bullying and toothache in Brazilian students: An analysis of the Brazilian National Student Health Survey.

This study analyzed the association between self-perceived bullying and self-reported toothache among Brazilian students and evaluated the moderating role of school-based health actions, including participation in the School Health Program, oral health promotion, and bullying prevention. A cross-sectional study was conducted using data from the 2019 National School-based Health Survey, including 53,711 students aged 13-17 years. The outcome was self-reported toothache and the main exposure was self-perceived bullying. Moderating variables included school participation in the School Health Program, oral health promotion actions, and bullying prevention actions. Poisson regression models with robust variance were fitted, with standard errors adjusted for clustering by school. Overall, 23.6% of students reported toothache and 13.7% reported bullying. Moderation analyses showed no evidence that school health actions influenced the association between bullying and toothache. For bullying once or ≥2 times, prevalence ratios were: School Health Program participation (PR_once = 0.92, 95%CI 0.77-1.09; PR_ ≥ 2 = 1.07, 95%CI 0.81-1.41), bullying prevention (PR_once = 0.98, 95%CI 0.76-1.25; PR_ ≥ 2 = 0.82, 95%CI 0.72-1.09), and oral health promotion (PR_once = 1.13, 95%CI 0.96-1.33; PR_ ≥ 2 = 1.19, 95%CI 0.94-1.52). These findings indicate that school-based health actions alone may be insufficient to mitigate the impact of bullying on adolescents' oral health.