The medical and mental health professions are addressing cyberbullying in an effort to aid victims and find offenders. Physicians should ask their patients if they use the Internet, social media, and other electronic forms of communication and if they are the subjects of harassment. Dental professionals might consider a similar approach, especially in pediatric and orthodontic offices, where a large percentage of patients are adolescents, the age at highest risk. All adolescents are at risk of cyberbullying, but anyone who is online frequently can be a victim; thus, cyberbullying can affect people of all ages. Bullying, whether it be traditional bullying or cyberbullying, should be considered when patients or parents of patients disclose, either to dental professionals or to staff, any of the previously listed symptoms. Consider the following scenario: Julia, a bright 13-year-old girl, had been a patient of Dr. Joy’s for most of her life. Dr. Joy had noticed a stark change in Julia’s behavior during her two most recent routine dental visits. The child seemed quieter, and her oral hygiene had become poor. In fact, Julia’s overall personal hygiene seemed to have degenerated. Previously very talkative and animated, Julia barely answered Dr. Joy’s questions regarding her teeth. At first, Dr. Joy attributed her behavior to teenage growing pains. Many adolescents undergo a sullen, sloppy phase at some point. Since Dr. Joy had developed a rapport with Julia over the years, she felt comfortable and compelled to ask her how things were going in her life. What was new? What was the teenage buzz around town? What new technology was taking the teen world by storm? Maybe Dr. Joy could get to the root of what seemed to be bothering Julia. The questions seemed to upset Julia. She snapped back, “There is no buzz or great new technology as far as I’m concerned. I am sick of people on Facebook spreading lies and rumors about me. I might as well never go on the Internet again!” Further questioning revealed that Julia was a victim of cyberbullying. As a result, Dr. Joy spoke with Julia’s mother after the appointment to initiate an intervention. Although annoyed at first, Julia was grateful for the opportunity to finally reveal the truth. She was tired of pretending everything was okay in her life. (HelpGuideOrg International, November 2020) offers several guidelines for stopping this type of bullying. At the top of the list is encouraging the victim to reach out to a trustworthy adult. Adults can do a lot to make a cyberbullying situation better. The dental office scenario above demonstrates that taking the time to ask a few simple questions may make a big difference in a young person’s life. the source of the opinion and decide whether or not to take that person’s comments – good or bad – seriously. Today, word of mouth is still critical to gaining new patients and building a practice. However, the form that “word of mouth” can take has greatly changed. Consumer review websites such as Yelp!, RateMDs.com, DR.Oogle, Angie’s List, healthgrades, and dozens of others allow patients to post online comments about dental providers and practices quickly and easily. Online reviews may be just as powerful as personal word of mouth recommendations or disparagements. As these website reviews become a mainstay of consumer decision making, they cannot be ignored by dental professionals. Even dentists who have resisted the movement to a robust online presence cannot escape the commentary posted on these third-party review sites. Therefore, it is important to have a basic knowledge of how to handle negative commentary and protect a provider’s and practice’s reputation. If all the comments posted on these sites were positive, clearly no one would find them cause for concern. Fortunately, according to one study of 33 physician-rating websites, approximately 88% of all comments posted were positive, only 6% negative, and approximately 6% neutral (Lee, 2013). Most consumer review websites use a grading system of 1 to 5 or 1
It is good for practitioners to be reminded of this ethical obligation mandated by the dental profession. Its strong language and articulate wording leave nothing to the imagination. Cyberbullying may rise to the level of abuse in some cases. The ADA Code (ADA, 2020a), under the principle of nonmaleficence, states that dental professionals also have a duty to refrain from harming the patient. This ethical principle further suggests that dentists should know when to refer to other experts to protect a patient from harm. Although the intent may be to refer patients to a physician or dental specialist as appropriate, it could also be interpreted to mean referring to other appropriate agencies or entities to protect patients from other types of harms. Cyberbullying may require such intervention in some cases. How does bullying cause harm? Bullying itself is repeated, aggressive behavior that involves an imbalance of power or strength. Hitting, shoving, threatening, teasing, intimidating, name-calling, spreading rumors, or stealing and damaging belongings are common behaviors of traditional bullying (stopbullying.gov, n.d.; The Anti-Defamation League (2021). and stopbullying.gov (n.d.), list common signs and symptoms of children who are cyberbullied may exhibit serious symptoms, some of which parallel the symptoms of child abuse. These include: ● Alcohol and drug use. ● Anxiety, depression and sadness. ● Bed-wetting in younger children. ● Sudden disinterest in school with a sudden decrease in grades. ● Poor grades/refuses to go to school. ● Lower self-esteem. ● Health problems and an increase in somatic complaints such as stomachaches and headaches. ● Decreased social activity. ● Withdrawal from family and friends. ● Becoming distraught or angry after online or cell-phone use. As of early September 2017, 49 states had cyberbullying laws (stopbullying.gov, 2017). Information summarizing these state laws is available at https://www.stopbullying.gov/laws/ index.html. States created the laws to provide protections and guidelines for managing cases of cyberbullying. Dental professionals should be familiar with the laws in their jurisdictions. Consumer review websites Consumer reviews are a part of everyday decision making and have existed for as long as choices have been offered in the marketplace. Before there was an Internet, consumers relied on verbal or written communication to provide feedback on all types of consumer products, services, and entertainment opportunities. Individual professional critics published reviews in newspapers and magazines, or on the radio and television, for audiences that were often familiar with their distinctive styles. This type of review can still be found, and consumers may trust certain critics to make reports consistent with their own tastes. Thus, reviews might be completely trusted or “taken with a grain of salt” if the consumer generally tends to disagree with that particular critic. In this scenario, the reader or listener knows that the opinion is that of an individual, possibly an individual in whose opinion he or she has little faith, and the consumer might choose to try a product or service knowing that there is a good possibility that he or she might disagree with this one other person. The review in this case is only a small factor in the choice to purchase an item or partake in a particular new experience. In the pre-Internet world, medical professionals were “reviewed” by word of mouth – positive or negative comments made by existing patients to potential patients concerning their experiences in the office. The potential patient could evaluate
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