the over emphasis of dental esthetics is increasing in daily life and concerns about the outward appearance also affect children . anatomy , color and harmony of one 's teeth are especially important to the appearance of the face . people who have well - positioned incisors are considered more attractive , intelligent and adjusted than others who have dental malocclusion and/or anomalies . severe deformities of the face region cause sympathy and compassion in people . paradoxically , more subtle deformities result in taunts and mockery , leading the individual to a situation of low self - esteem . a child 's smile reveals important aspects of their quality - of - life and how the child interacts in his / her environment . a smile denotes a self - esteem , self - confidence and well - being . low et al . showed that children with concerns about their teeth show less smile security . self - perception is a part of children psychological characteristics and it is essential to be aware of how much they like their smile and how happy they are with it . oral disorders may expose an individual , particularly children of school age , to an embarrassing situation . among the various health professions , dentistry commonly experiences situations in which children and adolescents have been subjected to bullying . in everyday clinical practice , the findings suggest that developmental dental anomalies have a deep impact on quality - of - life . olweus describes bullying as an anti - social behavioral phenomenon that violates the rights of another person and reflects intentional and repeated aggression , verbal or physical , against any unable to defend him / herself and can occur in any social context . their victims may have serious psychological consequences , isolation , depression , anxiety and can generate lower performance and learning . bullying in schoolchildren is a global phenomenon and its effects can be short as long - term . the aim of this paper is to present three clinical reports in which children were discriminated in the school environment due to visible tooth anomalies involving anterior teeth . ai is a hereditary disorder that affects the enamel in either quality or quantity , compromising teeth appearance . according to phenotype aspects , ai may be classified as hypoplastic , hypocalcified , hypomaturation or hypomaturation hypoplastic with taurodontism . the teeth esthetic and issues associated with the enamel such as sensitivity , staining and roughness may cause psychological and functional concerns to the patient . a 10-year - old female , sought dental care for extraction of all her teeth and dentures placement . according to her mother 's report , all females and some males of their family had similar dental aspect . at the age of 14 , the mother had all her teeth extracted and replaced by dentures . the patient was discriminated by the classmates at the break time and during group activities . the discriminatory behavior lasted for months and resulted in low learning performance , low self - esteem and introspectiveness . the school psychologist noticed that many embarrassing situations occurred due to the appearance of her teeth . during the clinical evaluation , the patient did not smile and avoided talking , trying to hide her mouth . in addition , it was clear that the family disapproved the child 's appearance . clinically , the child 's presented yellow colored teeth with an irregular rough texture due to mineral deficiency and areas with an enamel loss . the condition was diagnosed as hypomaturation ai and the treatment performed was an intense remineralizing therapy followed by a composite resin veneers [ figure 1a and b ] . ( a ) clinical aspect before esthetic treatment of teeth stricken by hypomaturation amelogenesis imperfecta : rough - looking yellow teeth due to mineral deficiency and areas with loss of structure ; ( b ) early treatment with esthetic veneers on permanent maxillary incisors eh is a developmental defect of enamel caused by a disturbance in the secretion or maturation of an enamel matrix . the severity of the defects depends on the phase of amelogenesis involved and the duration of the stimulus on the ameloblasts . it may be related either to hereditary causes , affecting all the teeth on both dentitions or acquired ones , involving one or more teeth . when eh is related to a hereditary cause a 10-year - old female patient presented a malformation of the permanent maxillary left canine ( hypoplasia ) [ figure 2a ] that affected masticatory function and social life . ( a ) permanent maxillary left canine with dental hypoplasia as a result of disturbance during the apposition of enamel ; ( b ) aspect after the cosmetic restorative treatment during early childhood , the child was outgoing and communicative . however , at age of 9 , your social behavior started changing . according to the family report a similar behavior changing occurred at school , the child stopped talking and did not participate in collective activities . with family consent , the child was evaluated by a psychologist and she reported being constantly called a  vampire  by classmates because of her canine tooth . the child was referred for dental treatment with a direct cosmetic restorative restoration [ figure 2b ] to improve her self - esteem and self - image , associated with counseling to minimize the effects of bullying . the term mih defines a hypomineralization of systemic origin that affects one to four permanent first molars . mih has been linked to environmental changes such as pre - and perinatal problems , respiratory diseases , high fever diseases such as chicken pox and the frequent use of antibiotics in early childhood . recently , studies showed that genetic variation in some enamel formation genes is associated with mih . the prevalence of mih varies considerably throughout the world , ranging from 2.5% to 40% . an 8-year - old girl , after a careful anamnestic and clinical evaluation , was diagnosed with mih [ figure 3a ] . according to her mother , the family was concerned about the permanent incisors opacities . due to partial eruption of the teeth , however , the child still suffered with a verbal mocking by schoolmates , who said that she had not brushed her teeth and had  rotten teeth . family members , including aunts and cousins began to talk about the girl 's appearance . the dental treatment was performed with a glass ionomer cement to remineralize the structure before placing veneers [ figure 3b ] . ( a ) molar - incisor hypomineralization : mineral and structural deficiency in permanent incisors and molars ; ( b ) initial stage of esthetics treatment on maxillary incisors in all three cases , patients had suffered direct or indirect discrimination , exposing them to bullying in school and in their family environments . the children did not feel emotionally supported since they were always subject of comments about how different their teeth were . on physical and clinical examination and according to the reports , it was observed that there were no other factors beyond the tooth , which contributes to bullying . after temporary treatment , they all reported higher self - esteem , greater happiness , freedom and social acceptance . ai is a hereditary disorder that affects the enamel in either quality or quantity , compromising teeth appearance . according to phenotype aspects , ai may be classified as hypoplastic , hypocalcified , hypomaturation or hypomaturation hypoplastic with taurodontism . the teeth esthetic and issues associated with the enamel such as sensitivity , staining and roughness may cause psychological and functional concerns to the patient . a 10-year - old female , sought dental care for extraction of all her teeth and dentures placement . according to her mother 's report , all females and some males of their family had similar dental aspect . at the age of 14 , the mother had all her teeth extracted and replaced by dentures . the patient was discriminated by the classmates at the break time and during group activities . the discriminatory behavior lasted for months and resulted in low learning performance , low self - esteem and introspectiveness . the school psychologist noticed that many embarrassing situations occurred due to the appearance of her teeth . during the clinical evaluation , the patient did not smile and avoided talking , trying to hide her mouth . in addition , it was clear that the family disapproved the child 's appearance . clinically , the child 's presented yellow colored teeth with an irregular rough texture due to mineral deficiency and areas with an enamel loss . the condition was diagnosed as hypomaturation ai and the treatment performed was an intense remineralizing therapy followed by a composite resin veneers [ figure 1a and b ] . ( a ) clinical aspect before esthetic treatment of teeth stricken by hypomaturation amelogenesis imperfecta : rough - looking yellow teeth due to mineral deficiency and areas with loss of structure ; ( b ) early treatment with esthetic veneers on permanent maxillary incisors eh is a developmental defect of enamel caused by a disturbance in the secretion or maturation of an enamel matrix . the severity of the defects depends on the phase of amelogenesis involved and the duration of the stimulus on the ameloblasts . it may be related either to hereditary causes , affecting all the teeth on both dentitions or acquired ones , involving one or more teeth . when eh is related to a hereditary cause a 10-year - old female patient presented a malformation of the permanent maxillary left canine ( hypoplasia ) [ figure 2a ] that affected masticatory function and social life . ( a ) permanent maxillary left canine with dental hypoplasia as a result of disturbance during the apposition of enamel ; ( b ) aspect after the cosmetic restorative treatment during early childhood , the child was outgoing and communicative . however , at age of 9 , your social behavior started changing . according to the family report a similar behavior changing occurred at school , the child stopped talking and did not participate in collective activities . with family consent , the child was evaluated by a psychologist and she reported being constantly called a  vampire  by classmates because of her canine tooth . the child was referred for dental treatment with a direct cosmetic restorative restoration [ figure 2b ] to improve her self - esteem and self - image , associated with counseling to minimize the effects of bullying . the term mih defines a hypomineralization of systemic origin that affects one to four permanent first molars . mih has been linked to environmental changes such as pre - and perinatal problems , respiratory diseases , high fever diseases such as chicken pox and the frequent use of antibiotics in early childhood . recently , studies showed that genetic variation in some enamel formation genes is associated with mih . the prevalence of mih varies considerably throughout the world , ranging from 2.5% to 40% . an 8-year - old girl , after a careful anamnestic and clinical evaluation , was diagnosed with mih [ figure 3a ] . according to her mother , the family was concerned about the permanent incisors opacities . due to partial eruption of the teeth , a preventive treatment was performed . however , the child still suffered with a verbal mocking by schoolmates , who said that she had not brushed her teeth and had  rotten teeth .  unfortunately , the stained surface fractured , what increases the bullying frequency . family members , including aunts and cousins began to talk about the girl 's appearance . the dental treatment was performed with a glass ionomer cement to remineralize the structure before placing veneers [ figure 3b ] . ( a ) molar - incisor hypomineralization : mineral and structural deficiency in permanent incisors and molars ; ( b ) initial stage of esthetics treatment on maxillary incisors in all three cases , patients had suffered direct or indirect discrimination , exposing them to bullying in school and in their family environments . the children did not feel emotionally supported since they were always subject of comments about how different their teeth were . on physical and clinical examination and according to the reports , it was observed that there were no other factors beyond the tooth , which contributes to bullying . after temporary treatment , they all reported higher self - esteem , greater happiness , freedom and social acceptance . in recent decades , bullying has been reported as one of the most prevalent forms of violence in schools and as a precursor to other more serious forms of violence . the negative effects of bullying affect not only the victim but also the family , school and even society , since longitudinal studies have showed that children who are bullied are more likely to develop antisocial behavior such as vandalism , drug abuse and violent attacks in adulthood , as well as low self - esteem and lower sense of empathy toward others . the bullying prevalence in school - aged children varies greatly , under several factors as gender , age and culture of victims and perpetrators . in addition , the study design , cultural differences , bullying understanding , the time frame used to determine the frequency of bullying and the criteria used to differentiate between victims and non - victims are also factors that may explain these variation . in general , the most common form of direct aggression caused by bullying is verbal ( 30.9% ) , followed by spreading rumors against the victim ( 24.8% ) and physical aggression ( 14.7% ) . the prevalence of indirect aggression is possibly underestimated due to the failure of both individuals and teachers to recognize it as a form of bullying . in the cases reported here , fortunately discriminatory act was limited to verbal abuse , there was a clear discriminatory attitude from family members that declared that such changes were not normal and that the teeth were ugly , without being careful not to embarrass the child . although , we know all the consequences of such behavior , we believe that such conduct was a result of the lack of clarification about the causes and possible treatments for enamel defects . the facial pattern appears to be more influential than the individual 's dental appearance . however , in the cases described , the bullying was due to dental problems that influenced the individual 's personality . in this context , it is reasonable that clinicians may encounter children who are experiencing bullying at school . according lyznicki et al . , the clinician 's role involves to identify the children at risk , counsel families , screening for psychiatric co - morbidities and prevention . however , to seehra et al . , a clear guidance to dental care practitioners is lacking , especially because this situation may involve other specialties . the esthetic procedures performed in young children were temporary , since the child is still growing . they are not very expensive at this point and minimally or not invasive , giving the opportunity for a permanent treatment later . after completion of dental treatment and the involvement of family and school psycho - pedagogical monitoring , patients reported they no longer were victims of verbal abuse . significant improvements in self - esteem , self - confidence and socialization of all patients , began within a few days after completion of treatment . in addition , the parental satisfaction regarding the appearance of their children was much improved . in this context , we highlight the importance of dental care and cosmetic dentistry to improve the quality - of - life of patients and to combat this discriminatory behavior that has been growing in recent years , especially in school environments . the cases reported here demonstrate the need for a new teaching approach in dental schools , to sensitize dental professions to the negative social consequences of poor oral hygiene , rampant caries , developmental orofacial defects , including bullying . we believe that prompt dental treatment can corroborate to social integration , well - being and self - esteem of individuals and may reduce even prevent their exposure to bullying . however , psychological distress is not automatically reversed after dental treatment , which may have a negative impact for life . thus , even after dental care , the child must be monitored by a psychologist . by providing a satisfactory esthetic condition to patients and parents , the cosmetic dental treatment was capable of restoring self - esteem and self - confidence , culminating in a greater socialization in school and in their own home environment , reducing the exposure of these individuals to bullying and its consequences .
facial esthetics , including oral esthetics , can severely affect children 's quality - of - life , causing physical , social and psychological impairment . 
 children and adolescents with esthetic - related dental malformations are potential targets for bullies . 
 this study was aimed to present and discuss patients who suffered from bullying at school and family environment due to esthetic - related teeth anomalies . 
 providing an adequate esthetic dental treatment is an important step in their rehabilitation when the lack of esthetic is the main source of bullying . 
 after dental treatment , we noted significant improvement in self - esteem , self - confidence , socialization and academic performance of all patients and improvement in parental satisfaction regarding the appearance of their children . 
 it is imperative that both family and school care providers be constantly alert about bullying in order to prevent or interrupt aggressive and discriminatory practices against children and adolescents . 
 clearly , dental anomalies may be a motive for bullying .