الفهرس 
Oral Findings in Children with Attention Deficit Hyperactivity Disorder versus Normal Children: A Cross-Sectional Study
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Abstract
Attention deficit hyperactivity disorder is a complex, multifactorial disorder which has a
substantial impact on many aspects in the child’s daily life. Short attention span and impaired
cognitive and executive functions of children with ADHD can lead to significant behavioral problems
that may affect oral health and make oral hygiene and dental treatment of such individuals
challenging.
The current cross-sectional study was conducted to assess the different oral health problems of
children and adolescents with ADHD compared to a control group.
A sample size of 78 children, aged 4-12 years, were included in this study. Thirty-nine children
fulfilled the criteria for ADHD and underwent oral and dental examination at the dental clinic located
in the Center of Social and Preventive Medicine, Abo El-Resh children Hospital. A matched 39
Healthy non-ADHD children attending the diagnosis clinic of Pediatric Dentistry and Dental Public
Health Department, Faculty of Dentistry, Cairo University, constituted a control group.
The parents/caregivers received detailed explanation for the study aim and design and were
asked to sign an informed consent for their approval to participate in the study.
The patients were only clinically examined (no radiographs were taken) for any oral and/or
dental problem and/or abnormality and asked about their oral hygiene habits. Patients were assessed
for dental caries, dental trauma, dental wear, malocclusion, parafunctional habits and gingivitis.
The results of the current study were as follows:
§ The ADHD group showed higher percentage of males (53.8%) than females (46.2%).
§ The mean caries indices scores were lower in the ADHD group than the control one in the
mixed dentition stage with mean (DMFT) score of 0.45پ}0.98 and 1.03پ}1.43 respectively. The
mean (deft) score was 2.87پ}2.64 and 4.4پ}2.5 in ADHD and non-ADHD groups respectively.
§ The ADHD group showed higher percentage of TDIs (15.4%) than control group (7.7%).
§ The prevalence of patients found to have dental wear were higher in the ADHD group (30.8%)
than the control one (2.6%).
§ There was no difference in the prevalence of malocclusion between the two groups. Both
groups showed (28.2%) of children with malocclusion.
§ The number of hypocalcified teeth were (8) and (7) in the ADHD and control group
§ In general, the prevalence of parafunctional oral habits was greatly higher in the ADHD group.
The most prevalent oral habits were bruxism, nail biting and other uncommon habits (Pen
biting, Plastic Biting, Clothes Biting, Paper Biting, Toes Nail Biting & Wedging wood
between teeth) with a percentage of (41.02%) in the ADHD group and (17.9%), (17.9%) and
(5.1%) respectively in the control group. The percentages of lip biting, digit sucking, mouth
breathing and tongue thrusting were (17.9%), (15.4%), (17.9%) and (15.4%) in the ADHD
group and (2.6%), (5.1%), (15.4%) and (2.6%) in the control group respectively.
§ The prevalence of gingivitis was (17.9 %) and (12.8%) in the ADHD and the control groups
respectively.
§ Children with ADHD showed a higher percentage of patients who never brushed their teeth
(43.6%) versus (17.9%) in the control group. On the other hand, non-ADHD children showed
higher percentage of children who brush their teeth once and twice daily with percentages of
(12.8%) and (20.2%) respectively versus (10.3%) and (2.6%) in the ADHD group.
from the results of the current study the following could be concluded:
§ Children with ADHD have lower prevalence of dental caries when compared to the control
group, but they may constitute a risk group for dental caries.
§ Children with ADHD at of higher risk of oral and dental trauma.
§ Parafunctional oral habits especially bruxism, nail biting, tongue thrusting and some other
unusual oral habits (Pen biting, Plastic Biting, Clothes Biting, Paper Biting, Toes Nail Biting
& Wedging wood between teeth) are more frequent in children with ADHD which may lead
to different oral and dental implications such as dental wear, muscle fatigue, localized
gingivitis or periodontitis and increase the risk of malocclusions.
§ Children with ADHD have poorer oral health behavior in the terms of frequency of tooth
brushing.
Limitations of the study:
§ Only simplified examinations were conducted on site and no dental radiographs were taken;
thus, it was not possible to reliably identify non-cavitated lesions in hidden areas such as the
proximal surfaces of posterior teeth.
§ Moreover, the cross-sectional design of the study also resulted in limitations in the
interpretation of data and therefore, the results cannot be used to confirm any causal
relationships. Longitudinal studies would be preferable for explaining the potential
association between ADHD and oral health.
Based on results and limitations of the present study, the following is recommended:
§ Early caries preventive measures such as fluoride treatments, fissure sealants, oral hygiene
and dietary advice and regular dental check-ups are recommended for both children with and
without ADHD. Children with ADHD should be followed up at shorter intervals between
dental examinations to prevent caries progression.
§ As ADHD children are of higher risk of dental trauma, instruction of parents/caregivers on
appropriate protocol following dental trauma (locate/preserve missing tooth and put in cold
milk; seek immediate professional care) is mandatory, as well as, reviewing safety issues
suitable to the age of the child, such as mouth guards to prevent oral-facial trauma. Moreover,
more epidemiological studies from representative populations using standardized trauma
classification systems are required.
§ Regular check-up for children with parafunctional oral habits for early detection of
malocclusion and consequently, early orthodontic intervention if needed. Night guard is
recommended in cases of bruxism to reduce the incidence of dental wear, temporomandibular
joint disorders (TMD) and muscle fatigue.
§ Tooth brushing charts for ADHD children to take home and mark off daily are more
recommended than verbal instruction in order to overcome their forgetfulness and low
concentration.
§ Parents/caregivers of children with ADHD must receive good oral and dental educational
programs to be aware of the condition of their children’s oral health, as well as, early seeking
for dental treatments to avoid any possible complications. They also need better instructions
for a more sufficient supervision of oral hygiene practices of their children.
§ Future studies are needed to examine the effect of different ADHD medications on oral and
dental health. The presence/absence of an association between ADHD/ADHD medications
and EH is also recommended to be studied in the future research.
§ Gap of knowledge between child psychiatrists and pediatric dentists should be filled so that
collaboration can serve to the improvement of children with developmental disorders.