ADHD and Oral Health

Author: Advanced Hygienist Naz

What is ADHD?

ADHD is a disorder that is defined through analysis of behaviour (according to www.adhduk.co.uk). People with ADHD show a persistent pattern of inattention and/or hyperactivity–impulsivity that interferes with day-to-day functioning and/or development

What causes ADHD?

There is no one cause of ADHD. It is considered to be a result of an often complex interplay between genetic and environmental factors – with genetic factors being responsible for 70%-80% of the probability [Journal of Learning Disabilities].

History

As was the sentiment towards the then un-named condition since the 1700s, in 1902 paediatrician Dr George Still published an article in the Lancet on a ‘Disorder of Moral Control’.
The later 20th century saw increased research, but also highlighted conflicting theories defining this misunderstood condition. Approaching the 1990s, the UK and the US finally diagnosed ‘ADHD’. It wasn’t until 2008 that DSM-V proved that this childhood disorder, if undiagnosed, never goes away. The impact of this can be terrifying, but also fascinating. During the 1990s, only severe cases were diagnosed – historically the ‘naughty boys’.

It is important for dental hygienists and dental therapists to understand conditions like ADHD as they can significantly impact a patient’s oral health and the way they should receive treatment and advice.

ADHD often makes it difficult for a patient to pay attention and control impulsive behaviors. When it comes to going to the dentist, patients with ADHD may tend to feel anxious or stressed, which can make it hard for them to focus and sit still during a dental appointment. We can help them by using a positive, patient approach. Coordinated efforts between parents and providers create support that is essential for patients with ADHD.

Cavities are the most common dental issue that dentists see in children with ADHD​. It can sometimes be difficult for these children to perform routine activities like brushing their teeth or flossing, and their poor oral hygiene practices put them at greater risk for cavities. In a study published by the National Center for Biotechnology Information, only 48% of children with ADHD brushed their teeth every morning and only 48% brushed their teeth every evening. This low percentage proves why it’s important to instill a dental care routine from a very young age. Another study showed that children with ADHD had nearly 12 times the odds of having a high number of diseased, missing, and filled teeth.

In light of these oral health challenges, it’s paramount that professionals are able to give individuals with ADHD tailored, helpful advice and care. This means that it may be worth scheduling appointments more regularly, especially to ensure that they are keeping on top of oral hygiene routines at home.

We should also be making sure that we give advice to these patients in easy-to-understand terms and even explore different ways to communicate, such as using more visual means. This way, you can help prevent advice becoming too difficult to understand or too long-winded, as well as engaging with patients in a way that is likely to keep their attention. We can also suggest measures such as tooth-brushing charts for use at home for younger patients – these are a good way to help everyone keep track of their oral health and to add a sense of accomplishment. If there are signs of bruxism, it’s also a good idea to talk about the options of mouth guards and other preventive measures that can help tackle this problem.

References

Monuteaux MC, Faraone SV, Herzig K, Navsaria N, Biedermann J (2005) ADHD and Dyscalulia: Evidence for Independent Familial Transmission. Journal of Learning Disabilities 38:86-93

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition

McVey C (2021) Becoming a doctor with ADHD. British Medical Association

Orwig R (2021) What You Need To Know About ADHD in Medical School. STATMedLearning