Traumatic dental injuries in children with attention deficit/hyperactivity disorder

Abstract –  The aim of this study was to assess the frequency and distribution of traumatic injuries in 247 children with attention deficit/hyperactivity disorder (ADHD) who were 7–16 years old and attended the Ondokuz Mayıs University Medical Faculty (Department of Child Psychiatry, Samsun, Turkey). Each psychiatric diagnosis was based on criteria from the Diagnostic and Statistical Manual of Mental Disorders (4th edn, Washington, DC: American Psychiatric Association, 1994). Traumatic dental injuries were recorded using the classification of the World Health Organization, which was slightly modified by Andreasen and Andreasen (Textbook and color atlas of traumatic injuries, 3rd edn. Copenhagen, Denmark: Munksgaard; 1994. p. 151). Thirty-two percent (78/247) of the ADHD children presented 103 traumatized teeth. The frequency of dental injuries peaked in children who were 10–12 years of age, and showed no significant difference between subtypes of ADHD or gender. The maxillary central incisors were the most vulnerable to injury, and there were no differences between the right and the left sides in terms of susceptibility. Uncomplicated crown fracture (52.4%) and complicated crown fracture (16.6%) were the most commonly encountered types of injury. The main causes of dental injury were falls, collisions with objects, violence, and traffic accidents, and there was no difference in the frequencies of these causes between subtypes of ADHD, age, or gender. Only 5.1% (4/78) of the ADHD children sought treatment within the first 24 h of the injury. In conclusion, children with ADHD experience dental injuries more frequently than was previously described.     

Oral health, dental anxiety, and behavior management problems in children with attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is a common developmental disorder. The aim of this study was to investigate whether children with ADHD have a higher caries prevalence, a higher degree of dental anxiety, or more dental behavior management problems (BMP) than children of a control group. Twenty-five children with ADHD and a control group of 58 children, all aged 11 yr, were included in the study. The children underwent a clinical dental examination, and bitewing radiographs were taken. The parents completed the Dental Subscale of Children's Fear Survey Schedule (CFSS-DS). Dental records from the subjects were obtained, and data regarding notes on behavior management problems (BMP) of the children when between 3 and 10 yr of age were compiled. Compared with controls, children with ADHD had significantly higher decayed, missing or filled surfaces (DMFS) (2.0 ± 3.0 vs. 1.0 ± 1.5) and significantly higher decayed surfaces (DS) (1.7 ± 3.6 vs. 0.5 ± 0.9). Differences between the groups regarding CFSS-DS scores were non-significant. In the ADHD group, the prevalence of BMP increased when the children were between 7 and 9 yr of age. In conclusion, children with ADHD exhibited a higher caries prevalence, did not exhibit a higher degree of dental anxiety, and had more BMP than children of a control group.     

Salivary cortisol levels and dental anxiety in children with attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is a common developmental disorder. The present study tested the hypotheses that children with ADHD, particularly those exhibiting severe hyperactivity and impulsivity, have a different stress reaction (measured by salivary cortisol) during a dental recall visit and are more dentally anxious than children in a control group. Eighteen children with ADHD and a control group of 71 children, all 13 yr of age, underwent a clinical dental examination and completed the Corah Dental Anxiety Scale (CDAS). Four saliva samples were gathered for analysis of cortisol: one prior to dental examination, one after, and two the following morning. The subgroup ADHD with hyperactivity/impulsivity had statistically significantly lower cortisol levels than the control group 30 min after awakening. When cortisol values were plotted on a timeline, this subgroup always had lower cortisol concentrations than children in the control group. There was a significant correlation between CDAS scores and cortisol concentrations prior to the dental examination in both the ADHD and the control group. Behavioral expressions of anxiety in children with ADHD may be different from those in other children, not only due to the characteristics of their disorder, but also because of lower stress reactivity.     

Tips for managing children with attention deficit hyperactivity disorder in the dental setting

It has been estimated that between 3% and 7% of children suffer from attention deficit hyperactivity disorder (ADHD). It is probable, therefore, that these children will present in any dental office. ADHD is characterized by inattention, overactivity and impulsivity. Such symptoms can be quite severe and often present challenges in the dental setting. ADHD symptoms are often managed by medication; and it is important for the clinician to be familiar with these medications to determine when to schedule dental appointments. In dealing with ADHD children, adjunctive behavioral strategies are often useful. Several basic techniques are discussed here.     

Dental caries and oral health behavior in children with attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is a common developmental disorder. This study tested the hypothesis that children with ADHD exhibit a higher caries prevalence and poorer oral health behavior than children in a control group. Twenty-one children with ADHD and a control group of 79 children, all aged 13 yr, underwent a clinical dental examination and completed two questionnaires on dietary habits and dental hygiene habits. Differences between the groups regarding decayed, missed, or filled surfaces, decayed surfaces, initial caries lesions, and gingival inflammation were non-significant. Forty-eight percent in the ADHD group brushed their teeth every evening compared with 82% in the control group. The corresponding frequencies for brushing the teeth every morning were 48% and 75%. Children with ADHD were 1.74 times more likely to eat or drink more than five times a day than children in the control group. In conclusion, at age 13, children with ADHD do not exhibit a statistically significantly higher caries prevalence but do have poorer oral health behavior than children in a control group. The intervals between dental examinations of children with ADHD should be shorter than for other children to prevent a higher caries incidence in adolescence because of their oral health behavior.     

Oral health of children with attention deficit hyperactivity disorder

This study assessed and compared oral health and oral‐health behaviours among children with and without attention deficit hyperactivity disorder (ADHD). The study included 31 children, 12–18 yr of age, with ADHD and 31 age‐ and gender‐matched children without ADHD. Clinical data were recorded by a trained and calibrated examiner for caries, traumatic dental injuries, periodontal health, tooth wear, and salivary function. A questionnaire was also given to parents or caregivers about the oral health habits and behaviours of these children. Data were compared using Mann–Whitney U‐tests and chi‐square tests. No significant differences were found between children, with or without ADHD, in caries extent or prevalence, dental trauma prevalence, prevalence of periodontal disease or plaque, tooth wear, or unstimulated salivary flow. Children with ADHD had a significantly higher percentage of sites with gingival bleeding, as well as a higher frequency of parent‐reported dislike of dentists, bruxism, history of assisted toothbrushing, and toothbrushing duration <1 min. They also had higher attendance at government dental clinics. The findings indicate that children with ADHD have poorer oral hygiene and more adverse oral‐health attitudes and behaviours than do children without ADHD.     

Behaviors of children with and without attention deficit hyperactivity disorder during a dental recall visit

Many children are diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), but the impact of this on behavior at a dental visit has not been examined. This study compared the behaviors of children with and without ADHD during a dental recall visit. Forty-two children with and forty-two without ADHD (fifty-six boys and twenty-eight girls, ages 6.0 through 10.6 years of age) were selected from a chart review at a hospital dental clinic. Every child was observed in the dental chair before and during the dental visit. Tell-show-do was utilized with every patient. Each child was evaluated for compliance or resistance and was rated using the Frankl behavior rating scale. Behavior ratings of children with and without ADHD were not statistically different. This could indicate that children with and without ADHD behave similarly in the dental setting. Use of Tell-show-do and presence of a pediatric dentist trained in child psychology could have contributed to this similarity.     

Dental caries in adolescents with attention deficit hyperactivity disorder: a population-based follow-up study

This study tested the hypothesis that adolescents with attention deficit hyperactivity disorder (ADHD) exhibit a higher prevalence of caries than adolescents in a control group. Thirty-two adolescents with ADHD and a control group of 55 adolescents from a population-based sample, all 17 yr of age, underwent a clinical and radiographic dental examination. The mean ± SD number of decayed surfaces (DS) was 2.0 ± 2.2 in adolescents with ADHD and 0.9 ± 1.4 in adolescents of the control group. Thirty-one per cent of the adolescents in the ADHD group had no new caries lesions (DS = 0) compared with 62% in the control group. Six per cent of the adolescents in the ADHD group were caries free [decayed, missing or filled surfaces (DMFS) = 0] compared with 29% in the control group. Adolescents with ADHD also had a higher percentage of gingival sites that exhibited bleeding on probing compared with the control group: 35 ± 39% vs. 16 ± 24% (mean ± SD), respectively. At 17 yr of age, adolescents with ADHD exhibited a statistically significantly higher prevalence of caries compared with an age-matched control group. Adolescents with ADHD need more support regarding oral hygiene and dietary habits. They should be followed up with shorter intervals between dental examinations to prevent caries progression during adulthood.     

Attention deficit hyperactivity disorder. Literature review for the pediatric dentist

The purpose of this review was to give a complete summary of the ADHD (Attention Deficit Hyperactivity Disorder) for dentists, especially for those who deal with dental traumatology. Children with ADH disorder show symptoms of restlessness, hyperactivity, impulsive behaviour and inattention often resulting in serious dental accidents. The article summarizes the literary data concerning ADH-Syndrome, presents a typical case and also deals with the dental considerations.     

The pathophysiology, medical management and dental implications of adult attention-deficit/hyperactivity disorder

BACKGROUND: Few published reports in the dental literature have focused on adult attention-deficit/hyperactivity disorder (ADHD) and its dental implications. TYPES OF STUDIES REVIEWED: The authors conducted a MEDLINE search for the period 2000 through 2005 using the terms "adult" and "attention-deficit" to define ADHD's pathology, medical treatment and dental implications. RESULTS: ADHD is a developmental condition that affects slightly more than 4 percent of the adult U.S. population. Its symptoms include inattention, hyperactivity and impulsivity that can cause personal, social, occupational and leisure-time dysfunction. Medications used to treat the disorder include stimulants, selective noradrenergic uptake inhibitors and tricyclic antidepressants. CLINICAL IMPLICATIONS: The oral health of people with ADHD may be compromised by inattention and impulsivity that impair home care regimens and can lead to cigarette addiction, which may cause oral cancer and damage the periodontium, and excessive ingestion of caffeinated sugar-laden soft drinks that promote dental caries. To safely care for this patient population, dentists must be familiar with the stimulant and nonstimulant medications used to treat adult ADHD, because these drugs can cause adverse orofacial and systemic reactions and interact adversely with dental therapeutic agents.     

The dental management of patients with bipolar disorder

Bipolar disorder (manic depressive disease) affects 1% of the United States population. These persons suffer from prolonged episodes of extreme elation and depression. There is a significant incidence of dental pathosis and a need for dental care among these patients. The medications used for the treatment of this disease, their physiologic effects, and their interactions with the drugs used in dentistry are reviewed.     

Traumatic dental injuries and attention‐deficit/hyperactivity disorder: is there a link?

Abstract –  Traumatic dental injuries (TDIs) constitute a major cause of morbidity among children worldwide. Both TDIs and attention-deficit/hyperactivity disorder (ADHD) are prevalent conditions with similar male-to-female predominance and similar age of presentation. While the commonest causes of TDIs have been identified as playground or sports accidents, a well-known feature of ADHD is accident proneness. Violence, another significant risk factor for TDIs, is more likely to be observed in conduct disorder, a common comorbidity of ADHD. Also, both TDIs and ADHD have been found to be associated with left-handedness. The presence of multiple dental trauma episodes (MDTE), as well as increased risk for non-dental injuries in children with TDIs indicates an underlying persistent condition, which resembles ADHD. Higher point prevalence of mental distress at age 30, found to be associated with increased lifetime prevalence of TDIs, may also be taken as an evidence of a background developmental disorder persisting into adulthood with various comorbidities. In conclusion, this review combines the results of several studies and explains the significance of ADHD as an underlying and predisposing factor for TDIs. Increased awareness and close collaboration between different disciplines involved are essential.     

Prevalence of bruxism in children receiving treatment for attention deficit hyperactivity disorder: a pilot study

The objective of this study was to evaluate reported bruxism among children affected by attention deficit hyperactivity disorder (ADHD). Thirty children diagnosed with ADHD and 30 healthy age and gender matched controls participated in the study. All subjects were examined for dental attrition, and the parents were asked for signs and symptoms of bruxism in their children using a questionnaire. Prevalence of oral parafunction was evaluated comparing ADHD children taking medications, ADHD children not taking medications, and controls. Subjects affected by ADHD and pharmacologically treated showed higher occurrence of bruxism compared to subjects affected by ADHD not taking medicines and controls; and within the ADHD group taking medications, CNS-stimulants have been associated with such side effect more frequently than the other drugs.     

You may be treating children with mental retardation and attention deficit hyperactive disorder in your dental practice

Providing dental services for children with mental retardation is complicated further for those youngsters with the comorbidity of attention deficit hyperactivity disorder. A general introduction into these conditions is presented in an effort to extend practitioner awareness and ability to provide needed care.     

Dental injuries and attention‐deficit/hyperactivity disorder in children

The purpose of this study was to determine the relationship between attention‐deficit/hyperactivity disorder (ADHD) and traumatic dental injuries in children. A total of 194 children aged 7–15 years participated in this study. Fifty‐seven traumatic injuries to permanent teeth were observed in 33 children. Although a statistically significant difference was not found (p= .848), the rate of incidence was higher in the group with ADHD (17.5%) than in the control group (16.5%). The maxillary right central incisors accounted for nearly half of all injured teeth, while the maxillary central incisors represented the most frequently injured teeth. Enamel fracture was the most common type of dental injury observed. The incidence of enamel fracture was higher in the control group (66.7%) than in the subjects with ADHD (43.3%). There was a significant association between the occurrence of traumatic dental injury and the presence of an overjet greater than 3 mm (p= .020).